Pictured: A surgical or aseptic mask (left) and an N95 mask/respirator offer different levels and types of protection to the person wearing the mask, and those around them.
by Kimberly Rivers
As the pandemic reached Ventura County, the public was told they didn’t need to wear masks. That stance softened on April 2, when Dr. Robert Levin, health officer with Ventura County Public Health (VCPH), suggested that the public can help stop the spread by wearing a cloth mask when out of their homes for essential activities.
“There is growing evidence that people can have COVID-19 without any symptoms and that they can pass it to others at this stage,” said Levin in a written statement. “Many people wear masks thinking it will protect them from a virus, and in certain cases it may. That may also be true for COVID-19 especially if accompanied by good hand hygiene and social distancing, but now there may be a better reason to wear a mask; it will decrease the chance of you spreading it to someone else if you have the infection asymptomatically.”
Levin’s statement specified that face coverings “should not be hospital grade . . . because there is a shortage and our health professionals need them. Masks should be homemade.”
Dr. Stanley Frochtzwajg, chief medical officer at Community Memorial Health System (CMH), agrees that the spread can be slowed by the public wearing cloth masks — but he stressed they should be only worn for a “brief period,” and he warned of a “false sense of security.”
“There are multiple layers to this,” said Frochtzwajg, speaking with the VCReporter on April 3. He said we have now been “told in California to wear masks all the time. The other part about the COVID-19 pandemic is that it is ever changing. This is the most dynamic environment . . . What we consider a protocol one day is thrown out the window the next week . . . We are learning as we are going forward.”
N95 and surgical masks
“The most critical one is an N95 mask, used to filter out a majority of viruses,” said Frochtzwajg, This is the type of mask needed to properly protect healthcare workers in all local hospitals from the novel coronavirus. “All other masks do not protect against the virus.”
According to the FDA, an N95 mask or respirator (both words are used interchangeably and describe the simple face covering with or without an exhalation valve) “is a respiratory protective device designed to achieve a very close facial fit and very efficient filtration of airborne particles. The ‘N95’ designation means that when subjected to careful testing, the respirator blocks at least 95 percent of very small (0.3 micron) test particles.” (1)
All hospital staff with any contact with patients that are COVID positive or suspected COVID positive must wear an N95 mask, full gown, head covering and face or eye shield.
“Right now we have no shortages of N95 masks,” Frochtzwajg said, but he is “concerned about our status once a surge occurs. It will be very difficult to project, hard to know for certain what those resources will be like.”
“The next level down are aseptic masks,” said Frochtzwajg. These are frequently called surgical masks, and the hospital is now requiring all staff, even those with no patient contact, to wear an aseptic mask. These masks are “used in surgery [to] prevent people [wearing the mask] who cough or sneeze or spit while they talk, or have juicy vocalization, from transmitting droplets to the people around them.”
The aseptic/surgical masks are “primarily meant to protect someone who unknowingly has the virus from spreading it.”
Most of us have a “tendency to adjust and touch our masks,” reminded Frochtzwajg. The virus gets into our bodies “through the mucous membranes, eyes, nose and mouth. Along with wearing an aseptic mask, you need to keep your hands away from your face . . . If you are just using an aseptic mask [that has been exposed to the virus], adjust it, scratch your eye, you’d get infected.”
Cloth masks: useful but limited
“The third level of masks . . . [are] cloth masks. They do have a purpose and utility but are really very limited.” Frochtzwajg explained that they can be a problem because, “cloth masks actually increase your likelihood of getting an infection” if they are worn for too long. (2)
“When the [cloth] mask gets wet it increases the likelihood of getting an infection. Cloth masks allow 97 percent penetration [of the virus] compared to medical masks [aseptic/surgical] that have 44 percent penetration . . . Cloth becomes a liability rather than a potential benefit.” The moisture on the mask becomes a “vehicle” for the virus to “penetrate inside,” and “almost acts as a culture media.”
“Summation of it all . . . a lot of people make a mistake in thinking that if they wear a mask they don’t’ have to think about the other protection modalities” – hand washing, touching your face, social distancing – “That is a fallacy.”
“Now with the [cloth] mask, social distancing becomes more critical, hand washing becomes more critical, hands away from your face becomes more critical.”
- “N95 Respirators and Surgical Masks,” U.S. Food and Drug Administration, April 5, 2020. www.fda.gov/medical-devices/personal-protective-equipment-infection-control/n95-respirators-and-surgical-masks-face-masks.
- “A cluster randomised trial of cloth masks compared with medical masks in healthcare workers,” British Medical Journal, C. Raina MacIntyre, et al., April 22, 2015. www.ncbi.nlm.nih.gov/pmc/articles/PMC4420971/.