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COVID-19 and the Use of Masks: Malpractice Risks for Medical Practices

As we all know that COVID-10 is primarily a respiratory disease and the spectrum of infection with this virus can range from people with various symptoms. But people generally with strong immunity may not have reported any signs and symptoms for COVID-19.  According to the current knowledge, it is transmitted between people via respiratory droplets i.e., sneezing, coughing, etc. and via contact routes too. Droplet transmission occurs within a meter distance between two or more persons.

COVID-19 can also be transmitted through fomites in the immediate environment around the infected person. Thus, its transmission can occur directly by contact with the infected people, or indirectly by contact with surfaces in the immediate environment or with objects used on or by the infected person like a stethoscope or thermometer.

Some people infected with the COVID-19 virus may not develop any symptoms but they can shed viruses that can be transmitted to others. A recent study found that the proportion of asymptomatic cases ranged from 6% to 41%.

Use of masks during COVID-19 pandemic:

Masks should be used in the areas where there is community transmission of large-scale outbreaks of COVID-19. Similarly, masks have been adopted in many hospitals to reduce the potential of transmission by health workers and anyone entering the facility with COVID-19 to other health workers and the patients.

Members of WHO support the practice of health workers and caregivers in clinical areas where there is known or suspected community transmission of COVID-19, to continuously wear a medical mask throughout their shift. This practice reflects the strong fondness and values placed on preventing possible COVID-19 infections in healthcare workers and non-COVID-19 patients.

WHO suggests the health workers, including community health workers, who work in clinical areas should wear a medical mask continuously in their daily routine. They can skip masks during eating and drinking.

It is important to adopt the regular and continuous use of masks in potential higher transmission risk areas. These areas may include triage, family gatherings, physician practices, outpatient departments, emergency rooms; COVID-19 specified units, hematological, cancer, transplant units, long-term health, and residential facilities.

Health workers and care-providers must change their medical masks when they become wet, soiled, or damaged.

One should not touch medical masks to adjust it or be displaced from the face for any reason. If they are doing so, they should remove and replace it safely along with hand hygiene.

Care-providers should discard and change their medical masks after caring for any patient on contact/droplet precautions for other pathogens.

Administrative staff or any other member who does not work in clinical areas do not need to use a medical mask in daily routine activities.

Health co-workers or care-providers should not share or exchange their masks at any cost.

Alternatives to medical masks in health facilities:

Due to the shortage of medical masks, face shields may be considered as an alternative. One can use a cloth/fabric mask as an alternative to a medical mask. But it is not effective for the health workers working in clinical areas. One study evaluated that those health workers who use cotton cloth masks are at higher risk of influenza-like illness compared with those who wear medical masks.

As for other personal protective equipment (PPE) items, if the use of cloth masks in health care settings is proposed locally in case of shortage of medical masks, then the local authority should assess the proposed PPE according to specific minimum standards and technical specifications.

A new study found that vacuum cleaner bag masks can be the best alternative to medical and surgical masks. It can minimize the risk of infection of the novel COVID-19.

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