Masking and COVID-19 with Dr. Samantha Hill

Wearing a mask is one of the key recommendations in the OMA’s public health pillars for a safe reopening. This episode features Dr. Samanatha Hill, OMA President and Cardiac Surgeon, explaining why you should wear a face mask or face covering whenever you are in public and physical distancing is difficult.

Transcript

OMA Podcast Episode 22 - Masking and COVID-19 with Dr. Samantha Hill

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Voice-over: In this podcast the Ontario Medical Association looks at current health issues that are on everyone’s mind. Spotlight on Health gives you the straight talk. We’re Ontario’s doctors and your health matters to us.

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Anne Marie Flanagan: I’m Anne Marie Flanagan, and I'm the Director of Media Relations and Social Media at the Ontario Medical Association.

Dr. Samantha Hill: I'm Dr. Samantha Hill. I'm President of the Ontario Medical Association and cardiac surgeon. 

Flanagan: And we're here today to talk about masks and face coverings. 

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Flanagan: What's the OMA's position on mandatory masking?

Dr. Hill: Mandatory masking is such a great question. In a theoretical world, it makes a lot of sense. Everyone should be wearing a mask; therefore, everyone must be wearing a mask. But mandatory masking, the concept is that if someone's not wearing a mask, there's a penalty. And that fails to take into account all of the exceptions to the rule, all of the people who would be challenged, all of the reasons that might be quite reasonable for not being able to wear a mask.

COVID-19 has already affected the most disenfranchised populations more than the rest of the world. And we've seen that in groups of people who are less wealthy, people who are living in long-term care centres, people who have less access to resources in general. These are the exact same people who are going to have trouble getting their hands on masks. They're not going to be able to afford the masks. They're not going to be able to have access to machines to wash the reusable masks.

If we say masks have to be mandatory, does that mean if a homeless person is walking down the street without a mask that you throw them in jail? Is that appropriate? I think all of us would agree that it's probably not.

If you even just look at that map that was presented about areas where COVID-19 had hit harder than other areas, there are commonalities between the regions that seem to be worse affected. And amongst those commonalities are that these are regions that tend to have lower degrees of socioeconomic determinants of health.

So, it's easy to say, “physical distancing.” But what happens if you share an apartment with ten other people? You simply can't physically distance.

It's easy to say, “wash your hands.” But what happens if you don't have access to running water? It's easy to say, “don't go into the stores; order." But what if you don't have a credit card? What if you don't have a phone? What if you don't have a computer?

So, all of these advantages that many of us take for granted as part of our routine days—the ability to close the door, and isolate yourself on the other side of it—they aren't advantages that everyone has. And COVID has really shone a light on where those disadvantages lie, and some of the worst outcomes that are associated with them.

So, the OMA has stepped a little bit away from the language of "mandatory" because it assumes and it imposes a penalty, much more towards the language of "should." We believe everyone should be wearing a mask—whenever you are going to be outdoors, or in public indoors, whenever you are not certain of your ability to physical distance—but we're not going to cross that line into saying "mandatory" because we live in a world that is imperfect. And we need to remember to be kind to each other as well.

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Flanagan: So, is the OMA recommending to wear masks anytime you're in public indoors?

Dr. Hill: Yes. The OMA is recommending that we wear masks anytime that you are in public indoors. And the reason behind that is because we want to make sure that we continue to flatten the curve, and that we continue to reduce the risk of transmitting the disease from one person to the next.

 The whole idea about masks is that you want to make sure to protect the rest of society. At the end of the day, I don't want to be responsible for my neighbour's parents winding up in the hospital or, worse, dying of COVID-19. None of us do.

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Flanagan: There's been a lot of debate out there in the public about whether people should wear a face mask or other face covering when they go out. Does a face mask help to protect against COVID-19? And should people be wearing a face mask or covering in public?

Dr. Hill: People should absolutely be wearing a face covering, a mask, in public. It's not so much to protect yourself as it is to protect the people around you.

Flanagan: What if I'm sick with symptoms of COVID-19? What should I be doing then? Should I be wearing a face mask if I go out? Should I be staying home?

Dr. Hill: If you're sick with symptoms of COVID-19, which can be anything from a fever to a sore throat, runny nose, you should really just be staying home.

Even a face mask, a hospital grade face mask, won't provide 100% protection for people around you if you happen to have the virus. And so, we suggest, if you have any symptoms of the virus, that you stay home and you isolate, unless you need medical help.

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Flanagan: What's the medical evidence on wearing face masks?

Dr. Hill: What we know about face coverings is that there are different gradients of face coverings. So, there's what we call "hospital grade" and what we call "non-hospital grade."

Within hospital grade face masks, there are higher protections and lower protections, so that includes things like the N95 mask, or four different grades of regular hospital masks—none of which we're asking the general public to wear or use. What we're suggesting for the general public is that you wear any kind of cloth barrier; usually we talk about something that's woven and more than one layer.

And the reason for that, the rationale for that, is that it diminishes droplets that come out of your mouth when you're speaking, laughing, running, doing anything that would involve exhaling.

It's really important to wear your mask properly. A poorly worn mask is at best a distraction. It needs to cover your nose and your mouth. It needs to have a secure fit around your face. It needs to be looped usually onto the backs of your ears—there are some new things out there like buttons or extenders that you can use—but it's very critical that the mask be properly fitted to your face and that it provide full coverage of both nose and mouth.

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Flanagan: If you're wearing a mask, it's probably not a good idea to keep lowering it and lifting it back up as you talk to people or do things, right?

Dr. Hill: Absolutely. So, one of the funniest things I've seen recently is someone who had a mask firmly on his ears, tucked under his chin, while he was smoking a cigarette. And I thought to myself, “Well, that's not doing anyone a whole lot of good, is it?”

When wearing a mask, it's really important to try not to touch it. Similarly, we talk about, with COVID in general, just good face and hand hygiene, in which we say don't touch your face, don't touch your eyes. Similarly, don't touch the mask.

Everything you interact with has the possibility of carrying that virus back and forward, and you don't want to bring it close to your mucosal membranes. What I mean by that is your eyes, your nose, and your mouth.

Flanagan: And when you remove a mask, you're supposed to remove it from the ear loops, is that correct? And not touch the outer portion of the mask?

Dr. Hill: Absolutely. And so, you're just really trying to limit the spread of the virus. And so, should you have the virus, you're likely to be exhaling it, and as your mask gets moist, the amount of virus that's on the outside of the mask will increase. So, you don't want to transfer that to your hands. 

So, when we talk about removing a mask, we say, first thing's first. Hand hygiene to protect you from anything you may have come in contact with. Then, remove the mask by the ear loops. Take it, fold it inside out, and then hand hygiene again. And so the hand hygiene twice—which can be either hand washing or sanitizer, whichever one is easiest and most convenient for you—protects both you from what you've touched around you, but also other people from after you've touched the mask, which would theoretically be loaded with virus particles if you had the virus. 

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Flanagan: Sometimes it seems that people who are wearing a mask seem to think that they don't need to keep physically distanced.

Dr. Hill: The way the virus gets from one person to the next person, by the most part, is via these droplets that we've been talking about. And so, the further away you are from another human being, the less likely you are to be able to transmit the virus from one person to the next.

That's why, when we talked about really flattening the curve, we said, “Stay home. Don't get into contact with other people at all.” That reduces the risk of transmission to zero or close to zero.

That said, once we're going out and interacting with others, the idea is to try and limit the rates of transmission. Six feet away from you, we've reduced the virus particle from me to you by a certain quantity, but it's certainly not down to zero. When I add the mask, we reduce it even further.

And the goal of this, the goal of everything in COVID-19, is to remember that we're all in this together. And so, if I protect you, and you protect me, we're both protected. And if we all do that, then we lower the rate of transmission of COVID, and we continue to flatten the curve, and we continue to get in front of this.

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Flanagan: The province has introduced these new pandemic—we can expand our social groupings outside of our household into a small circle. But a get-together with your social circle is different than a get-together with a wider group of people. And could you talk a little bit about that, and what you do to protect yourself when you're getting together with folks that are maybe outside of your social circle?

Dr. Hill: What we're trying to do is allow people to come back to something that is more sustainable, something that is more normal, something that meets psychological and developmental and economic needs, while at the same time making sure that we continue to protect each other, that we continue to protect our healthcare system, and that we continue to enable public health to do their job in protecting us.

So, when discussing having get-togethers with people outside one's house, what we say is, “The government has encouraged us to limit ourselves to a pandemic social circle of 10 people or fewer.” So, if I have four people in my house, and you have four people in your house, we can combine those households because we're still under 10 people. 

When we do that, we don't necessarily need to be wearing that mask. We don't necessarily need to be keeping that distance. I do still recommend extreme hand washing and excellent hygiene between contacts, but we're considering those social circles an extension of our own homes.

If we get together with our classmates who are not part of our pandemic social circle, or if we get together with our workmates who are not part of our pandemic social circle, as we start to return back to work it's going to be really important for everyone to remember that the new rules of the new normal are still in place. And those rules are: keep your distance, wear your mask, and practice hand washing.

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Flanagan: Are we also benefited a bit by the weather and the fact that, if people are getting together, they're doing it outside more? Is that generally considered safer?

Dr. Hill: It's definitely considered safer. I think the big concept there is ventilation. So, if you're in a close space, and one of the individuals has the virus—COVID-19, or really any virus to be honest—and that space is not well ventilated, the virus particles continue to accumulate in the air and around you. And you get to a point where there are what we call a “higher virus load.” And that just means that there's more of those virus particles around waiting to attack you and your immune system.

When you're outdoors, there's always an air current. There's always somewhere else for the air to spread to, and that allows the virus to get further and further away, so you don't get that density, that—that clumping, so to speak, of virus.

The probability of you getting sick from a single virion landing on your shoulder is quite low. It takes a certain burden of viri to make you sick, and those situations are far less common and far less likely to occur if you're out in public.

That being said, they're not impossible. Which is why, even when we're outdoors in public, we do recommend that you maintain that six-foot distance, and that you wear a mask if you're not certain that you'll be able to maintain that six-foot distance.

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Voice-over: This podcast is brought to you by the Ontario Medical Association. It is produced and edited by Jodi Crawford Productions. This podcast is not intended to provide medical advice for specific situations and is for general educational purposes only. Please consult your doctor if you have symptoms or questions about your health.

For more information, please visit our website at oma.org.

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