Having worked during the recent pandemic as an APRN, I agree that masking is difficult and creates challenges to many- however, I wore a mask throughout as a courtesy to my patients and their families, as well as my own family members at risk. Do we always know if we are walking into a room with someone with a co-morbidity such as suppre…
Having worked during the recent pandemic as an APRN, I agree that masking is difficult and creates challenges to many- however, I wore a mask throughout as a courtesy to my patients and their families, as well as my own family members at risk. Do we always know if we are walking into a room with someone with a co-morbidity such as suppressed immunity, or perhaps they had a family member at home with this and were at greater risk from potential airborne infection? Washing hands before, during and after patient contact, and being mindful of staff practices as well I am sure reduced the potential for spread of infection. Patient's are not always honest when asked about recent or concurrent URI symptoms. When a patient is politely advised of the reasons to wear a mask, they usually submit. There is no reason to politicize this catastrophic infection or any other and sometimes, well constructed studies to prove something are just too slow and too difficult to conduct in real time.... I support the use of masks and honestly, if I were undergoing a surgical procedure, I would expect my surgeon and technicians to have the courtesy to protect me from their runny noses, their sneezes and their coughs....somehow this just makes sense.
Surgical masks are less meant to protect the patient from the surgeon but to protect the surgeon and others from splash contamination, which is very common in a surgical theater.
Julie, I think there's actually very little evidence that mask wearing does much in surgery - definitely not for anyone else but the surgeon, and I'm not sure that we have any hard evidence that it makes much difference if they're wearing one either! So if that's the crux of your point, it's a very weak one. We mask in surgery because it's a convention, not because we have any convincing peer reviewed evidence that it actually does anything. Sucked in by biological plausibility yet again...
You are certainly entitled to an opinion on the use of masks in a health care setting. Let us not confuse opinion with fact here. Perhaps you would like to comment further and be specific about what you believe to be a "lie" as it relates to the importance of masks in reducing the transmission of certain infectious diseases. I can certainly cite recent studies and reviews about the effectiveness of respirators/surgical masks. Let me know if you would like to see the data. Civil exchange is welcome.
Just one brief question: Do you realize that surgery, where an incision is made creating a potential transmission route that *does not exist in nature*, is a very different case from a simple office visit? That’s why surgical teams have worn masks for decades, maybe even centuries, even at times when masking in other contexts was unheard-of. (Ditto for dentistry and other procedures requiring you to work inside the patient’s open mouth). It disturbs me that a degreed health professional can lose sight of such elementary distinctions.
A simple office visit is a rare event these days. And yes, working in the outpatient setting is very different than a surgical suite and oncology unit or ICU. If you are given a choice of walking into an exam room to see a patient who has respiratory symptoms, mild or severe, acute or chronic, would you yourself choose to err on the side of caution and wear a mask in that setting? Or would you roll the dice and hope the patient does not have TB or RSV? And your next patient is a mom with her baby who was recently discharged from the NICU due to prematurity....Think about that. The variables on any given day in any given setting are vast. That is my distinction for you to ponder.
Julie, it seems you see this as a simple, dramatic moral question: “Do we care enough to protect our patients and ourselves from harm?”
This would make sense if it were supported by the facts. You assume that if Patient #1 has a respiratory virus and you don’t mask, you WILL catch it – and transmit it to the baby (seroconversion within 15 minutes I guess!). If you do mask, you WILL NOT catch it and will keep everyone safe.
If wearing a disposable N95 were really that kind of magic talisman, I think we would have known it long, long before 2020. But it’s not, and to believe this requires something much closer to religious faith than scientific confidence.
The closest we have to solid evidence, I think, is that Cochrane Review meta-analysis from 2022 – which failed to find a significant benefit. That matches my own “anecdotal” experience. Particularly since the dawn of the Omicron Era three years ago, which forced me to face facts: the Covid virus was definitely aerosolized (not droplets), and masking was clearly pretty feeble to prevent its spread. Luckily, it had also become much less lethal.
So what can we say? As you put it, “the variables on any given day in any given setting are vast.” Are you sitting across a desk from me; briefly putting a stethoscope to my back; leaning in for a long hard look at my tonsils; or opening up my abdominal cavity with a scalpel? Am I sniffing slightly every five minutes, or sneezing and coughing uncontrollably? How old or young, how healthy or fragile are each of us? And what is circulating in the community: Tuberculosis, or RSV? There’s a difference, you know.
It may be that wearing an N95 makes transmission of “a respiratory virus” at least 8% less likely. Maybe even 12%. Depending on the circumstances. So, if I am bending low over a newborn, premature baby, perhaps it makes sense to invoke every protection possible: masks, latex gloves, alcohol wipes, maybe even grandma’s rosary.
But if I am sitting in my PCP’s office trying my best to hear and speak clearly, breathe freely and produce an accurate blood-pressure reading so he can figure out what's ailing me? In that case I think it makes sense to let my PCP use his clinical judgment (and let us do some shared decision-making) rather than impose a mandate on either of us.
Having worked during the recent pandemic as an APRN, I agree that masking is difficult and creates challenges to many- however, I wore a mask throughout as a courtesy to my patients and their families, as well as my own family members at risk. Do we always know if we are walking into a room with someone with a co-morbidity such as suppressed immunity, or perhaps they had a family member at home with this and were at greater risk from potential airborne infection? Washing hands before, during and after patient contact, and being mindful of staff practices as well I am sure reduced the potential for spread of infection. Patient's are not always honest when asked about recent or concurrent URI symptoms. When a patient is politely advised of the reasons to wear a mask, they usually submit. There is no reason to politicize this catastrophic infection or any other and sometimes, well constructed studies to prove something are just too slow and too difficult to conduct in real time.... I support the use of masks and honestly, if I were undergoing a surgical procedure, I would expect my surgeon and technicians to have the courtesy to protect me from their runny noses, their sneezes and their coughs....somehow this just makes sense.
Surgical masks are less meant to protect the patient from the surgeon but to protect the surgeon and others from splash contamination, which is very common in a surgical theater.
Julie, I think there's actually very little evidence that mask wearing does much in surgery - definitely not for anyone else but the surgeon, and I'm not sure that we have any hard evidence that it makes much difference if they're wearing one either! So if that's the crux of your point, it's a very weak one. We mask in surgery because it's a convention, not because we have any convincing peer reviewed evidence that it actually does anything. Sucked in by biological plausibility yet again...
It's rarely so simple, even in the extreme case of surgeons in theatre. Cochrane investigated this topic and found an absence of good evidence for decreased wound infection in the masked arm of the RCTs they selected https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD002929.pub3/ful
Here's another review https://pmc.ncbi.nlm.nih.gov/articles/PMC4480558/#bibr8-0141076815583167 that comes to the same conclusion.
Indeed, on the back of the Cochrane review NICE removed the mask guideline for theatre staff in the UK. Likely it's returned now.
None of these are home run trials, but they probably point to the fact that any signal, even in the most critical environment, is small.
*It may not be the most critical environment given the number of engineering and social controls that are already in place.
There's a surprising amount of literature on this if you chase the references in the papers.
Yes, I still want my surgeon to wear a mask. Unless it interferes with her technique, makes it difficult to breathe or see.
That's not a courtesy, it's a virtue-signalling lie. You are selling the lie that face diapers do anything at all.
Enabling lies is lying.
You are certainly entitled to an opinion on the use of masks in a health care setting. Let us not confuse opinion with fact here. Perhaps you would like to comment further and be specific about what you believe to be a "lie" as it relates to the importance of masks in reducing the transmission of certain infectious diseases. I can certainly cite recent studies and reviews about the effectiveness of respirators/surgical masks. Let me know if you would like to see the data. Civil exchange is welcome.
Just one brief question: Do you realize that surgery, where an incision is made creating a potential transmission route that *does not exist in nature*, is a very different case from a simple office visit? That’s why surgical teams have worn masks for decades, maybe even centuries, even at times when masking in other contexts was unheard-of. (Ditto for dentistry and other procedures requiring you to work inside the patient’s open mouth). It disturbs me that a degreed health professional can lose sight of such elementary distinctions.
A simple office visit is a rare event these days. And yes, working in the outpatient setting is very different than a surgical suite and oncology unit or ICU. If you are given a choice of walking into an exam room to see a patient who has respiratory symptoms, mild or severe, acute or chronic, would you yourself choose to err on the side of caution and wear a mask in that setting? Or would you roll the dice and hope the patient does not have TB or RSV? And your next patient is a mom with her baby who was recently discharged from the NICU due to prematurity....Think about that. The variables on any given day in any given setting are vast. That is my distinction for you to ponder.
Julie, it seems you see this as a simple, dramatic moral question: “Do we care enough to protect our patients and ourselves from harm?”
This would make sense if it were supported by the facts. You assume that if Patient #1 has a respiratory virus and you don’t mask, you WILL catch it – and transmit it to the baby (seroconversion within 15 minutes I guess!). If you do mask, you WILL NOT catch it and will keep everyone safe.
If wearing a disposable N95 were really that kind of magic talisman, I think we would have known it long, long before 2020. But it’s not, and to believe this requires something much closer to religious faith than scientific confidence.
The closest we have to solid evidence, I think, is that Cochrane Review meta-analysis from 2022 – which failed to find a significant benefit. That matches my own “anecdotal” experience. Particularly since the dawn of the Omicron Era three years ago, which forced me to face facts: the Covid virus was definitely aerosolized (not droplets), and masking was clearly pretty feeble to prevent its spread. Luckily, it had also become much less lethal.
So what can we say? As you put it, “the variables on any given day in any given setting are vast.” Are you sitting across a desk from me; briefly putting a stethoscope to my back; leaning in for a long hard look at my tonsils; or opening up my abdominal cavity with a scalpel? Am I sniffing slightly every five minutes, or sneezing and coughing uncontrollably? How old or young, how healthy or fragile are each of us? And what is circulating in the community: Tuberculosis, or RSV? There’s a difference, you know.
It may be that wearing an N95 makes transmission of “a respiratory virus” at least 8% less likely. Maybe even 12%. Depending on the circumstances. So, if I am bending low over a newborn, premature baby, perhaps it makes sense to invoke every protection possible: masks, latex gloves, alcohol wipes, maybe even grandma’s rosary.
But if I am sitting in my PCP’s office trying my best to hear and speak clearly, breathe freely and produce an accurate blood-pressure reading so he can figure out what's ailing me? In that case I think it makes sense to let my PCP use his clinical judgment (and let us do some shared decision-making) rather than impose a mandate on either of us.
How does that sound?