On October 19, 2020, an article in the Wall Street Journal was written observing that some governors in States with surges of COVID are still insisting that masking in public settings should be a personal decision.  This conflicts with the public health guidance of CDC, CDPH, and our Governor, but is still an issue in the public domain in our state where it’s common to observe people in public without a face mask, or wearing the mask under the nose or mouth.  This may not only increase the risk of our health care providers (HCP) acquiring COVID, but data are emerging to suggest that those who acquire COVID while not wearing a mask have a greater dose exposure to COVID, and are likely to become sicker.  

During President Trump’s recent COVID illness, Dr. David Nace, AMDA President and Clinical Chief of Geriatric Medicine at the University of Pittsburgh, was quoted in our local paper as suspecting the President’s early severity of illness was likely due to the higher SARS-CoV-2 exposure from not wearing a mask.  In a subsequent email exchange, he noted that there are studies in other viruses that the amount of virus a person is exposed to impacts the severity of the illness they experience.  Dr. Monica Gandhi at UCSF published a convincing article on this subject with Dr. George Rutherford in the New England Journal of Medicine on Sept 8, 2020 (https://www.nejm.org/doi/full/10.1056/NEJMp2026913 ).  

Anecdotally, Dr. Nace observed that the senior communities in the University of Pittsburgh system instituted a universal masking policy in March.  In the second wave of COVID, their facilities have experienced outbreaks, but the majority of cases in residents are asymptomatic and of those symptomatic, most are atypical or mild.  He noted their 17% mortality is lower than the Pennsylvania state average.  In his facility, they had 17 cases, but no deaths.  During this time, their facilities didn’t change the management or hospitalization rate for residents with COVID apart from early isolation and cohorting.  He surmised that the best explanation for their better than expected results was their mandatory masking policy.  

Armed with this information, I’m glad our state has a mandatory masking policy and would encourage our HCP and visitors to mask in public not only to protect our residents from outbreaks, but to reduce the severity of illness should a transmission event still occur. Optimal masking requires cloth masks to be washed daily and immediate cleansing of hands after touching the mask surface, which may contain SARS-CoV2.   

In addition, many of us have not only experienced difficulty consistently accessing sufficient N95 masks for use in our facilities, but also have found them to be quite uncomfortable when worn all day.  Dr. Rebecca Ferrini in San Diego has identified and implemented a reusable and affordable alternative called, “Elastomeric Respirators”.  They have been widely used for industrial, mining, and military purposes. These are usually comfortable for all-day use and won’t deplete your PPE.  This should further protect your staff and improve their comfort.  For more information on this device when used in health care settings in place of N95 masks go to a June 2020 report:  https://www.facs.org/media/press-releases/2020/reusable-masks-061220

Please help your HCP, visitors, and communities make truly informed decisions about the value of medical masking in public.  The lives of our precious elders, staff, and communities are on the line.