This wonderful little bubble of safety they we have felt on Kaua‘i is over for now. We are all dealing again with the heightened awareness of the real risk of becoming infected and bringing the virus home to our families. This column is not about how we should have opened with at least two tests and a shorter quarantine. It is about how do we make the best of the situation we are facing.
This column is about masks. Face masks differ quite a bit. When all of this started there were not enough masks for our healthcare workers and the general public. Our wonderful volunteers on Kaua‘i made 1,000s of masks and distributed them widely and they worked.
Those homemade masks helped keep us safe on Kaua‘i and as we all know that the beauty of those masks is that the masks protected the people around us from our droplets (and their tropical prints were attractive).
Now with school starting and visitors arriving, the airport workers, teachers, and frontline workers in most workplaces are at real risk of being exposed to the virus. We need to consider each of our risks and what type of mask might work the best for each of our daily routines.
The better the mask, the more it protects the person that wears it as well as the people around them. There is also an intriguing paper written by researchers from UC San Francisco that suggests that there is evidence that if you catch the virus while wearing a mask, you might have a much milder illness as much less virus actually gets by the mask to infect you.
The best masks available to the public are N95s. The 95 means they filter out 95% of particles of a certain size. Hospital workers in high risk situations will wear fitted N95s and some type of face shield. The face shield is added protection. A face shield by itself does not provide enough viral particle blockage but it is a good addition in a high risk situation.
The KN95s that are available online and in places like the ABC stores are Chinese versions of the N95. They are not considered as good as the N95s but they do provide protection (unfortunately they apparently are variable in quality). One note about N95s, some have valves on them. The valve lets your breath out without filtering it. That means masks with valves may protect you, but they do not protect the people around you.
The next level down are the multi-layer disposable surgical masks. They are similar to the standard masks used in lower risk hospital settings. They don’t work as well as the N95s but they certainly do provide a level of protection for the wearer and for those around them. They are labeled as medical grade and non-medical grade. The Costco disposable masks look like surgical masks but say they are “general purpose” (at least the ones I have seen) and I am not sure how well they work. My understanding is soon masks will have some type of grade in them but for now we have to figure this out for ourselves.
The next level is probably the cloth masks. If they are three or more layers and have filters in the middle and fit well, they also provide some level of protection for the wearer but frequently they do not fit well around the nose or under the chin. They do a fairly good job of protecting those around you but often do not do as good a job of protecting the one wearing them. Among the least effective masks are the single layer cloth coverings like bandanas.
So, the question is, how does one apply this information? There is good advice about what types of masks medical and dental personnel should wear depending on their risk. There is much less advice for the general public. This next section is just my opinion as there does not seem to be enough research yet by the scientists.
I think frontline workers such as police, firemen, and others at higher risk should consider wearing a face shield and a N95 mask or at least a KN95. If I was a teacher, particularly an older teacher, I would also consider wearing a N95 or a KN95. Teachers are real front line workers and most children are not going to know when they are infected. I might also consider wearing one of the better masks if I was an airport worker or anyone else with exposure to large numbers of visitors. If I was sitting at those little desks checking IDs all day, I would certainly wear a higher quality mask. For myself, since I am not on the frontlines but still want to be safe, I have replaced my homemade mask with the disposable hospital grade paper masks and wear it anytime I am in a public place.
Another important question is, how strict should we be about masking in public places? There is plenty of science about this. The answer from virtually all the experts is that we should be very strict.
I believe all persons working in stores or establishments that serve the public should properly wear good masks. Workers in restaurants who are serving the public are at particular risk because they are serving people who are not wearing masks. And the policies for those working in restaurants should be very strict.
I believe the high volume stores like Costco and the big food stores should have particularly strict policies. If a customer does not properly wear a mask while in the store, they should be asked to wear the mask properly (which means not below the nose) and to leave if they do not comply. The policy should be clearly stated by the store that there will be no service if you do not wear a mask and wear it properly.
The science could not be clearer, the best way for the island to stay safe is a fourteen day quarantine or a shortened quarantine with a second test for all arrivals from elsewhere. The next most powerful line of defense is wearing masks and wearing really good masks if you are at extra risk.
Be safe Kaua‘i, someday this will be over but we must stay very aware that it most certainly is not over now and in fact our risk may be greater than any other point since this coronavirus hit America. Covid-19 is surging in much of the mainland, Canada, and Europe. Now that borders are open, we are vulnerable and masking really can make us safer.
This column represents a sharing of information. No content on this column should ever be used as a substitute for direct medical advice from your doctor or other qualified clinicians.
Lee A Evslin, MD is a Board Certified Pediatrician and Fellow of The American Academy of Pediatrics. He was a former healthcare administrator on Kauai and periodically writes a column for the Garden Island.