It may not be a terrible thing if some percentage of people buy "unnecessary" Personal Protective Equipment. It creates some distributed supply in case something unexpected happens, even if under normal circumstances the equipment is unused.
It may not be a terrible thing if some percentage of people buy "unnecessary" Personal Protective Equipment. It creates some distributed supply in case something unexpected happens, even if under normal circumstances the equipment is unused.
Secondly disposable medical equipment, when used properly within a healthcare environment, is extremely wasteful. For most consumable items used in a hospital, they are covered in packaging with specific serial numbers and lot numbers that allow reconciliation if it's found that the goods are not sterile or have deficiencies. There is also a provenance or chain-of-command aspect that allows attestation of safety throughout the entire supply chain. While we might be talking about how to sterilize n95 masks, reuse face shields, and asking for donations of PPE from the public right now during a pandemic, the fact remains that in normal circumstances there is massive liabilities that hospitals and clinics would be subjected to if they started sourcing protective equipment from the public that could have been tampered with, may be slightly used and broken, or otherwise could cause harm to the patient and they'd be unable to identify the source of those resources. Everybody stocking a "handful" of PPE isn't a scalable solution to maintain a national supply.
This is one reason why we pay federal taxes.
There is currently a global pandemic afoot that is spread by droplets expelled from people's mouth and nose. What a tool was being used for 2 months ago isn't relevant; the situation is different now.
> Everybody stocking a "handful" of PPE isn't a scalable solution to maintain a national supply.
If masks or face-shields could be cleaned fairly easily then it probably is a scalable supply. Particularly if medical professionals are allowed to supply their own work tools.
It is very relevant. These face shields wouldn't protect anyone from airborne/aerosol pathogens or viruses. They have a very specific purpose and that isn't one of them.
If you're talking about adapting construction grade shields (like used for painting, etc) for medical use -- sure. But you aren't going to use a face shield as a replacement for a face mask, which is what it seems like you're arguing for.
If you're saying that you should wear a face shield in public to protect yourself from aerosolized virus -- that's not the point of a face shield. The particles can travel around the sides of the mask too easily. If you want to protect from small, airborne particles, you need a mask.
According to the MIT paper, a typical sneeze will travel over 20 feet.
Additionally, there is mention of the velocity of the particles may be able to penetrate the mask, so a face-shield could help with that, too.
And if so, why not drop $300 million to get one for everyone in the US? They're cheap, wash easily, and that's less than 0.02% of the last stimulus.
I'm certainly open to the idea that fluid mechanics are complicated and somehow air currents are going to do unhelpful things, but until I find someone with a paper on the topic I'd much rather be talking to someone wearing a face shield than not.
Plus obviously wearing a face shield will protect against self-inflicted infections from a contaminated finger.
And you'd be wrong. Sure, a face shield will protect you from liquid streaming out at you (partially). However, it isn't a liquid that you need to protect yourself from in this instance... it is aerosolized particles. And those travel in the air. So when you breathe in, that air can and will move around the face shield.
The sibling comment about smoke moving is exactly right. Smoke is a great example of how small particles can move and travel in the air. If you think that a face shield will protect you from something in the air, you'd be wrong.
Side note: this is how N95 masks are actually fit. (Well, not using smoke, but similar test). If you can smell the chemical used in the test, the fit is wrong.
If you really want to protect yourself from other people sneezing -- stay away from other people. That's why social distancing is still the primary, and best, recommendation.
If you're really curious, Ars Technica has a really good writeup of all of the relevant studies.
https://arstechnica.com/science/2020/04/should-you-wear-a-fa...
Most of the research above assumed either surgical or N95-style masks. There was one study that looked at use of cloth (non-medical, non N95) masks, and this was the key finding (from Ars, not the paper):
Wearing cloth masks resulted in significantly higher rates of infection, the authors found. They also noted that in their test, the cloth masks were only 3 percent effective at blocking particles.
Regarding everyone wearing (surgical) masks to protect others:
In a study published April 3, 2020 in Nature Medicine, researchers found that surgical masks reduced the detection of respiratory viruses in aerosols generated by infected people breathing or coughing in a breath-collecting machine.
Hoo boy that's misleading by itself. The control group was "use what you normally use", and had the following numbers:
> In the control arm, 170/458 (37%) used medical masks, 38/458 (8%) used cloth masks, and 245/458 (53%) used a combination of both medical and cloth masks during the study period.
Given those numbers, it's basically impossible to use this data to tell us anything about the efficacy of cloth mask vs. no mask. The control group did wear their masks less often, but it's still very unhelpful data.
> This may lead some members of the public to be lax about ... washing their hands frequently and thoroughly. Moreover, donning [a] mask may lead some people to touch their faces more, some argued.
> simply touching their mask could contaminate their hands if there are viral particles caught on the outside ... a mask wearer could then transfer virus particles from their mask to their face
"May". "May". "Some argued". "Could". "If". "Could".
> negating any benefit of having the mask.
So even with all the above steps that have to occur, it's still no worse than getting a face-full of Covid directly.
Almost every stupid, pointless, dangerous argument against masks boils down to:
People may not wear a mask properly. People may not wash their hands properly.
The first one is used as an argument against masks, so why is the second not only not used as an argument against hand washing, but also used in arguments against masks?
People don't always practice social distancing. So why don't people argue against that? Oh, because that too is reserved for arguments against masks.
It's fucking ridiculous. Why do some people continue to spend so much time and effort trying to discourage use of potentially life-saving items?
You're spreading actively dangerous advice, that has already been proven wrong. DO look up why there is that recommendation.
The details aren't clear on how the virus is spreading. The virus might have multiple modes of transmission. Closing 2 of them reliably a great deal. There are important things to do with "catching COVID" that aren't binary; starting doses likely matter as well.
I'd rather not talk to you in person if you aren't going to cover your face, tyvm :)
That is something that I've been wondering about too. I work in biotech but not as a scientist. These things are tricky to nail down as they seem to be very individual specific. Theoretically, in an exponential growth model, it wouldn't matter if you were inoculated with 20000 or 200000 virons, after the incubation period post-infection, you're going to be generating a huge amount, millions and millions, of virus particles in either case. Certainly, if you keep getting exposed, you're immune system is going to get overwhelmed quickly, but for a single event, I don't think it matters.
It’s analogous to containing a new virus outbreak before it becomes an exponentially growing pandemic.
Sounds reasonable, but how is a face shield a reliable way to close a mode of transmission if people aren’t spitting liquid in your face?
Plus, it stops me from touching my face.
No, it doesn't stop everything, but it's a buck.
You would be touching your face if you had correctly fitting PPE, because it's uncomfortable. https://twitter.com/gabbyjackson95x/status/12479391789623255...
So many people on HN and in tech have the same attitude that if they just spend 5 minutes thinking about something then they can intuit an answer and that they must be right. This is a dangerous way of thinking. If anyone took what you’ve been saying as correct they’d be endangering themselves and depriving medical professionals of tools they need.
A face shield would be better than failing to create a makeshift covering from a shirt for most people and it'd be resistant to decomposing so it could be stored long term in a home. It'd be a reasonable thing to stockpile.
[0] https://www.cdc.gov/coronavirus/2019-ncov/prevent-getting-si...
I also can’t imagine a situation where you can order and wait for a shield but don’t have the time or resources to get a surgical mask or cloth.
And obviously the shield alone isn’t going to protect you from particles. And it might not help slow the spread if you’re infected yourself.
But again I’m speculating. If the health professionals say they need them and the public doesn’t, I’ll defer to them. I’m not an expert in their field and I don’t want to pretend to be or cause anyone to think I am.
It seems like you're imagining that the mucus and saliva particles would behave like a gas, but it's a suspension of liquid particles in the air, which behaves slightly differently. Think of breathing onto glass -- a lot of the aerosol I expel adheres to the glass. Some smaller droplets may move around it, but it's still preferable to receive a smaller dose of the virus.
Could you explain why you believe that? I haven't found anything definitive on this topic.
I'm not sure whether the initial dose affects the severity of the disease, but it seems clear that it at least affects the probability of infection. The individual action hypothesis [1] posits that each individual pathogen has an independent chance of infecting a host, i.e.
P(no infection | n pathogens) = P(no infection | single pathogen)^n
So if one is exposed to a single unit of the virus, infection is theoretically possible but unlikely. At higher doses infection becomes overwhelmingly likely.I don't know how accurate the IAH model is, but there seems to be a good amount of evidence that infection rates are at least positively correlated with dose, e.g. [2].
[1] https://royalsocietypublishing.org/doi/full/10.1098/rspb.200...
[2] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2869824/pdf/120...
With an exponential curve, whether you start off with 10,000 or 100,000, given that it takes about 2 weeks for our adaptive immunity to kick in, the virus is going to be in the hundreds of millions in either case.
[I work in vaccines, but not as a scientist, so I'm just trying to absorb as much as possible here..]
I suspect that a lot of airbone infections are from inhaling small doses here and there though, considering how long mucus droplets can stay suspended [1] --
> Particles of diameters 1-3 μm remained suspended almost indefinitely, 10 μm took 17 min, 20 μm took 4 min, and 100 μm took 10 s to fall to the floor.
[1] https://www.mintie.com/assets/img/education/Aerosol%20transm...
Also, suppose you were living with a partner and both of you got infected. Both of you will continually shed and "re-infect" the other, so would we expect that the infection will necessarily be severe?
https://www.newyorker.com/magazine/2020/04/06/how-does-the-c...
And if the smell is less strong than it would be if you weren’t wearing the mask the viral load you’ve been exposed to is smaller. You are less likely to be infected and if you are infected your immune system has more time to ramp up so you’re more likely to fight it off.
Ideal scenario would be most of the smoke gets pushed down in a knee-wards direction, which is well within the realm of the imaginable.
You ARE the person in the faceshield (I assume you meant that instead of facemask), you don't control what other people do so assume they uncovered. The smoke is in the air, it can reach you. Will it get around that shield or not?
This is all about containing the spread.
Although I suppose in hindsight that explains why people were downvoting me.
If your plan is to only block most of the virus then perhaps you should rethink it.
It's like stating that a hole in the hull is not a problem because the rest of the ship keeps most of the water out.
This is thought to be why an unexpectedly high proportion of young, healthy doctors and nurses are getting seriously ill from Covid-19. Statically, you'd expect almost all of them to get mild disease.
Do you have any source on how face shields are an effective tool against atomized covid19 viruses? The general guidance is that facial masks are effective at barring infected people from emitting contaminated particles, but not good at stopping healthy people from having contact with the virus. Therefore why would an open face shield, which filters zero, be a better solution?
Face shields reduce flow of air around you. Think of the six foot rule, but add a few more feet. They also reduce projectile sneezes (and "say-it-don't-spray-it" talking, coughs, and even breathing) by quite a bit. Think about sneezing in your elbow, only much better.
It turns out that "feeling safe" isn't the same thing as being safe, and feelings of safety will not actually effect infection rates, but Americans can't quite grasp that. And, hey, feelings of safety are about all we've got now, so.
I was recently intubated 3 times in the last month and had no ill effects. I know that’s just an anecdote but no doctor ever told me it would be super risky. The alternative to not getting it however usually meant death.
No, that's another procedure. Intubating respiratory patients involves targeting the trachea and avoiding the esophagus. An esophageal intubation can be Very Bad.
That said, as an early advocate for face masks for the general public, I'm in 100% agreement that face shields are pointless for the general public. We don't need them.
https://www.theguardian.com/world/2020/apr/02/face-masks-cor...
The CDC is recommending then now. Do you disagree with their expert opinion (nevermind their stand a week ago)?
Finally, with respect to the mask wearer's protection, look into viral load.
You seem to have a mental model whereby any viral particle that bypasses your body's physical barriers has "won" - game over. But that's now how the immune system works. We want to minimize the viral load as much as possible, since with all known infectious organizations there's a dose-response relationship: the larger the dose, the worse the illness often is. Tiny loads are often effectively fought off my the immune system.
We this is vividly in a bacterial illness like TB. In TB, there's little risk if you pass a coughing TB patient in the hall. But if you spend the day with them in a poorly-ventilated office, your risk increases. If you live with the patient, your risk is very high.
The same principle applies with viral illnesses like Covid-19. And given that the only access route that is actively pulling viral particles into the body is the respiratory tract, it stands to reason that protecting that route has a higher payoff than protecting a lower risk route like the eyes.
That's not to say that people in high risk situations like Covid-19 wards of hospitals shouldn't cover their eyes! Obviously, they should and do. However, for most of us, the best protection we can use without using BL4 protection gear (obviously, not practical or needed for the general public) is to wear a mask. Mostly, the mask is to protect others from you, but depending on what kind of mask it is, it can also protect you from the virus.
Finally, most health authorities are now recommending that the general public wear masks. CDC changed their recommendations a week or two ago to recommend wearing masks. As usual, the WHO is moving slowly as large bureaucracies often do, but I don't doubt they'll also recommend them in the end as more evidence of their efficacy emerges.
In the context of intubation that is most definitely a bad outcome.
Hope not. It's endotracheal intubation. Tubing the gut (accidentally) leads to gastric distention as we ventilate the patient, leads to aspiration, leads to aspiration pneumonia, leads to huge increase in morbidity.
Your more general point that having a national stockpile of <insert-critical-item-here> for disasters of various kinds is of course valid, but that is true irrespective of the particular nature of the normal use of those particular items.
And we've learned that the federal government isn't particularly good at stockpiling. I hope we can find a way to have some non-partisan after-action committees to figure out how to do better for the next disaster.
Hopefully you are intubating a patient’s trachea and not not the esophagus.
I don't know where you are. In England healthcare professionals and their organisations have a statutory "Duty of Candour". They have to tell you when something went wrong, why it went wrong, what they're going to try to do to fix it for you, and what they're doing to prevent it happening again in future.
https://www.cqc.org.uk/sites/default/files/Duty-of-Candour-2...
It definitely cost more than a few dollars and is not disposable.
Also, according to the documentation, these are re-usable and can be sanitized w/ alcohol or H2O2.
No, but there's no harm in it either, and some potential benefit in case it takes a few days for the federal government to organize a response.
We all assume the government is going to make sure the food supply is maintained, but everyone is also buying some extra food just in case there's a temporary gap.
We don't need to choose just one way of preparing for the unknown.
Also, I was just saying the general public might purchase a few of these masks for themselves for their own use, not that hospitals might rely on the public for supplies.
A couple months from now, when pressure on the healthcare system is lower and manufacturing capacity is ramped up? Sure, I'm all for it.
I'm not talking about who should get priority for PPE right now. I'm just talking about the idea of the general public having a couple uses worth of PPE just in case. Is now the right time for them to prioritize buying PPE for themselves over hospital workers? No.
That being said, if I owned a commercial face mask, I would not feel bad. Hording/gouging is not equal to owning your own set of PPE.
In a medical setting, shields are typically used in conjunction with eye goggles and respirators when performing procedures that have a tendency to cause or be around splashing body fluids. Outside of someone sneezing or spitting on you directly, I can't think of an analogous situation that I come into on even a rare circumstance that a face shield would protect me from.
What situation that could conceivably arise from a pandemic requires an automatic rifle?
It's a generalised sense of "bad things are happening, I need to be prepared for bad things to happen to me".
Good thing that automatic rifles aren't available for sale to the civilian market[1] then, I suppose.
[1] Yes, the pedants will point out that it's theoretically possible with special licensing but it's very uncommon.
Still, the point remains - what situation could possibly arise from a pandemic that would require a <insert any type of gun here>?
I'm not saying it can't happen - there are always racist assholes out there. But the media will tell one story of a racist asshole harassing an Asian family rather than 100 stories of people being genuinely nice to each other in a crisis. Because we'll click on that one bad story and ignore the 100 nice ones.
I suggest you invest some time reading a recent piece by an Chinese-American author in the NYT: https://www.nytimes.com/2020/04/12/magazine/asian-american-d...
Rioting, looting, people breaking into your home, police “sick outs.”
See what happens if the electricity goes out or all stores are forced to close.
Let me put it another way: if you owned a gun, would "the electricity is out" be a reason to shoot someone?
Except you can't smell a virus.
Do you assume this? I assume that capitalism is keeping the food supply maintained. When that fails, I think we're up the creek.
As a good example, European agriculture is currently threatened because there are no foreign workers in the fields. The German government responded by better connecting unemployed workers to local farms, and by changing the rules to allow some foreign workers to come in.
That's just a hint of what governments are capable of. It pales in comparison to a war economy.
When someone comes up with data finding a safe way to do so, the masks won’t go in the trash. In the meantime, I’d you have the masks to spare, you -should- be using them safely. Masks are pointless if you use them in a way that will get you sick.
It seems to me that pretty much every society has struggled to deal with this. Perhaps because it isn't something that has many reasonable direct analogues in our collective experience?
It is very easy to spot deficiencies after the fact. Much harder to spot them before.
The TLDR is 70°C heat for 30 mins. Avoid alcohol, it kills the static charge in the mask fibres.
https://m.box.com/shared_item/https%3A%2F%2Fstanfordmedicine...
There’s no plausible mechanism of action for masks under which this is true. A properly fitted N95 will block 95% of particles which is less than the kind of hazmat spacesuit with face shield and positive air pressure you’d ideally be wearing if working with someone with Ebola or similar. Maybe it really is impossible to get proper fit on a reused mask. Perhaps it’s only as good as a normal surgical mask which blocks just under 90% of virus sized particles.
Every reduction in the amount of virus that gets into your lungs makes it less likely that you’ll get infected and if infected gives your immune system more time to ramp up. That’s why people care about viral load. Running through someone’s cough is less likely to kill you than being in a small poorly ventilated room with someone coughing uncontrollably for minutes at a time.
There's the data and very clear recommendations by the CDC on when and how to do it. Whats' the confusing part? I don't think anyone is suggesting this approach during non-crisis times.
There are multiple sterilizing procedures, and multiple material compositions for masks. Which ones were you referring to?
[0] https://www.battelle.org/inb/battelle-critical-care-decontam...
[1] https://www.bostonglobe.com/2020/04/02/metro/boston-hospital...
This is reusable, easy to sterilize w alcohol.
Here, in the Netherlands we heard they need 4 million facemasks a week. And we're a very small country!
You need to not only know how to use PPE, but know what it's limitations are, and what it's designed to actually protect you from.
Wearing a shield thinking it provides any protection from an aerosolized virus is a perfect example of having the wrong expectations from a piece of equipment.
PPE helps limit spread. The trick is to buy stuff which doesn't take away from doctors. Cotton masks. Face shields. Etc.
In contrast to nonwoven fabric, a toy factory can produce a billion face shields if you want it to. You can but them online for a buck (in quantities of 10). It ain't taking away from anyone.
Isn't one of the key criticisms of farm and manufacturing subsidies that they are wasteful uses of our budget while one of the arguments in favor of them is that it maintains our infrastructure "just in case"? What about trying to buy out a foreign company to control a coronavirus vaccine or mandating that all domestic companies fulfill federal government orders before any international orders so that we have enough materials "just in case"?
My point here is that the just in case attitude for non-essential goods like PPE normalizes the same thinking in other arenas and it is unclear where we should draw the line. It is a slippery slope.
yes? there's a national strategic oil reserve. that's exactly the thing it should do.