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Coronavirus: How Can Wearing Face Masks Do More Harm Than Good?

As COVID-19 cases have been increasing, we’ve repeatedly heard from the CDC and other health officials that members of the public should not attempt to purchase face masks to protect themselves from the coronavirus. Just days ago, the United States Surgeon General even tweeted about this specifically, saying: “They are NOT effective in preventing general public from catching #Coronavirus.” Most of us would agree that it is crucial that there is enough supply for the most at-risk, frontline healthcare workers — they are the ones actually dealing with potentially infected patients, while the rest of us have a much, much lower risk of being exposed. But beyond that, we’ve also heard guidance that wearing the mask itself may introduce more hazards than not wearing one. So the question is…

How is it that face masks are crucial to protect healthcare workers, but are ineffective or harmful to the general public?

The answer is relatively simple. For healthcare workers, the face mask itself is only a component of a much more comprehensive “Respiratory Protection Program” required by the Occupational Safety and Health Administration (OSHA) (29 CFR 1910.134). Only total compliance with this standard ensures someone is actually being protected. Simply “wearing a mask” can go wrong in a variety of ways:

Not selecting the right mask: Only masks approved by the National Institute of Occupational Safety and Health (NIOSH) are proven effective in filtering out airborne particulates and droplets, the primary way that coronavirus is transmitted. These masks are generally called “N95 respirators” or “filtering facepieces” and they will be clearly marked as NIOSH-approved. Many products may look like an effective mask, but without passing the strict NIOSH testing regiment, there is no way to ensure that their “filters” aren’t letting everything in the air right through.

No medical clearance: Before ever wearing a respirator, OSHA requires that workers are medically cleared that it is safe for them to do so. This must be done by a health professional. It is often more difficult to breathe while wearing a respirator, so issues such as pulmonary function, blood pressure, and pre-existing respiratory issues must be reviewed prior to use. Serious medical issues are a possibility.

Not performing a fit test: Probably the most important step in ensuring a respirator actually works is performing a “fit test.” A fit test is exactly what it sounds like: a comprehensive protocol that tests whether a respirator is able to form an air-tight seal around a person’s face. The coronavirus itself and its airborne droplet carriers are both microscopic. Any tiny gap in the seal, even so small to be non-visible, will lead to the outside air being drawn to the inside of the respirator. If there is any gap in the seal, you are essentially breathing the outside air and anything in it.

Performing the fit test protocol includes the use of chemical solutions, hoods, nebulizers or misting devices, and even digital devices in certain cases. It also involves a series of physical exercises that are meant to distort the wearer’s body and face in any way that can be anticipated — including the audible reading of a short passage that includes every sound in the English language! The goal of all of this is to show that that specific respirator forms an air-tight seal with your face. Only a trained professional can administer this test, and it must be re-performed at least annually to account for change in face shape. It is very common for workers to fail fit tests and be required to switch to a different size, model, or type — one that is more suited to the shape of their individual face. And it may go without saying, but facial hair often interferes with an air-tight seal, so workers generally must be clean-shaven for the mask to have any effectiveness. Ultimately, without the fit test, there is no way to know if the respirator is actually working (and it likely isn’t).

Training: Additionally, OSHA requires that any worker wearing a respirator must receive training. While it may seem that N95 respirators are straightforward to wear, there are specific directions to put them on and off to limit cross-contamination. Even with a perfect seal, if you’re touching your face or head with dirty hands to remove the mask (or adjust an improperly fitting one) you’re instantly introducing a greater hazard to yourself. There’s also a positive-negative pressure test that must be performed every time a respirator is worn to make sure the seal is tight. Additionally, information must be provided about how to know when the respirator filter is no longer effective. Without any of this guidance, respiratory misuse and cross-contamination becomes prevalent.

In summary, most of the rules are designed so that you can be sure that your respirator actually protects you and fits your face specifically. Without being part of a compliant respiratory protection program, you may be opening yourself up to the following major risks:

  • You are now respiring more due to restricted air flow inside of the respirator; if your respirator does not form an airtight seal, you are taking more frequent, deeper breaths of the air surrounding you.
  • Increased difficulty with respiration may exacerbate other health issues.
  • Thinking you’re protected, you may be more likely to put yourself in higher risk situations where you wouldn’t have normally (such as large crowds or near ill people).
  • You will be touching your face more often due to constant comfort adjustments.
  • Your respirator can become dirty with excessive moisture or other airborne microorganisms.
  • Your voice is muffled; you may have to get closer to people for them to hear you.

So then what is the best way to protect yourself if not respirators? Continue to follow current CDC guidance: wash your hands frequently, avoid close contact with people who are sick, and avoid touching your eyes, nose, and mouth.