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| Never done this? Then, like 90+% of those who bought N95s (when you still could), you have no idea if yours works right for you. But you'll find out with a live-fire test with Kung Flu, any day now. Well-played. |
A vivid, if unintentional, lesson in context from Borepatch's blog today, with a side-order of why Twatter isn't a good source for anything requiring more than 280 characters or two brain cells.
“Seriously people — STOP BUYING MASKS!” the surgeon general, Jerome M. Adams, said in a tweet on Saturday morning. “They are NOT effective in preventing general public from catching #Coronavirus, but if health care providers can’t get them to care for sick patients, it puts them and our communities at risk!”
Now, either the masks don't help and there's no point in anyone wearing them or they do help and the surgeon general wants to keep available stocks for health care workers. It cannot be both. But if this is the response from the surgeon general, you can stick a fork in it.
When one oversimplifies, it can become an unintentional lie of omission.
An N95 mask is worthless if you haven't been fit-tested to assure it works for you. (And for 25-33% of people right off the bat, it doesn't). For probably 90% of everyone ever, that's shocking news they never knew.
An N95 (or anything else) won't work if you have facial hair that blocks a tight seal.
It requires a bit more than just slapping one on to use it properly.
That knowledge applies to 0% of the general public. If you did time with Uncle Sam, you had it beaten into you vividly during a visit probably annually - to the tear gas chamber with your M17 or M40
series protective mask. Last I looked, prior service applies to something like 3% of the general population. Be generous, and double that info for those who deal with PPE every day at work.
So 90-95% of people have no effing clue about any of this.
That's why it's beyond asinine for Joe Average to get a pallet-load of the things, when he doesn't know Jack or Squat about what's what or why or how or anything else.
You might as well buy him a slide rule, FFS.
I have to get fit-tested every year. When people pilfered the hospital's entire supply of N95 masks last month (yes, really), everyone in the hospital had to get fit-tested again with the new brand. Anyone who was a fail with either brand had to have alternative PPE available to substitute. And we all undergo about three hour's refresher training annually in all the PPE we use, up to and including fully-encapsulated hazmat gear.
So, how much of that have you done? (For most any value of "you", not the OP or bloghost there).
Probably zero seconds, ever, other than buying the box.
Well-played.
And you (times 330M of you) buying up metric buttloads of masks that you don't know how to wear properly, and which may be utterly worthless because of zero training in proper wear, whiskerpuss, or poor fit, and made extra-scarce by China seizing the 3M plant that makes the go-to model in China, and declaring all N95s made there a "strategic national resource" unavailable for exportation until further notice, means there are that many less available for purchase by every hospital in the U.S., for use by the people that need them, and know WTF they're doing.
Now, knowing the rest of the story, go back and read the SG's comments in context.
Because I saw his media appearances, and that's how it was presented by the better media outlets. If you're looking for Twatter to fully inform you, you're short-changing your brain. (Whether anyone on Twatter has one in the first place is an open question. Little worthwhile is conveyed in 280 characters. Great for punchlines for those with tiny minds, but for conveying news you can use, not so much.)
Let's try to tell the tale better than FakeNews, shall we?
Otherwise we're just CNN-lite.
And surgical masks do, indeed, protect other people from your germs. That's why they're cleverly called "surgical masks", and why we slap them on everybody coughing and sneezing in the ER, and why they're worthless as PPE, except to everyone else, to mitigate your slobber and sneeze particles flying everywhere.
N95s and better, by total contrast and design, are specifically to protect the wearer from other people's funk. TB, measles, Ebola, and Kung Flu, for specific examples.
And at least one commenter already posting there didn't know that fundamental difference in PPE, because it's outside their knowledge base.
QED
The surgeon general was spot-on, and his comments and those at the OP illustrate the problem perfectly.
This is the same reason buying any medical gear, or really just about anything, without knowing WTF you're doing with it, isn't helping anyone, least of all yourselves.
If you're going to buy gear, you have to learn how to use it properly.
Gear alone is just stuff.
Gear + training = prepared.
gear + training + experience = gold-star prepared.
Let's deal with this the right way.
Lacking the context of someone "in the biz", I understand why anyone could have missed the bigger picture, and don't expect for a minute poster ASM826 (who ocassionally comments here) meant to misinform anyone. And his further comments in the same post regarding the likely course of spread of this infection remain spot-on, IMHO. As usual, RTWT. There's a reason that blog is on my bloglist.
It also illustrates why, for most people, PPE is a dumb idea, and why you should be focusing on avoidance and self-quarantine, not trying to half-ass how to wade out amidst it. The shortage of N95s will probably save more lives than if we had them in abundance. Just like with Ebola, where 1 in 3 commenters wanted to know how to go out into it and come back home, and God forbid, just like it would be in any CBRN or hazmat event. You can buy a fire truck and an SCBA. It does not therefore make you a firefighter.
If, OTOH, you managed to get N95s before they mostly became unobtanium, make sure yours works, fits, and you know how to use and wear it. Better yet, don't go out and play in it if you can help it in the first place. Otherwise, I'll see you in the ER. I have to play in it. You don't.
Other Business
Don't listen to what I've told you about Kung Flu.
Go read John Mosby's take on his Patreon site.
If you're inclined, sign up, and throw the guy a bone.
There's a reason his site is on my bloglist too.
31 comments:
Wearing a mask is definitely better than not wearing one at all. This is common sense. It's aerosolized.
Related Topic.
Discussion on the origins of COVID-2019.
https://harvardtothebighouse.com/2020/01/31/logistical-and-technical-analysis-of-the-origins-of-the-wuhan-coronavirus-2019-ncov/
And WHO says they underestimated the lethality of COVID-2019 too.
https://www.cnbc.com/2020/03/03/who-says-coronavirus-death-rate-is-3point4percent-globally-higher-than-previously-thought.html
"The World Health Organization had said last week that the mortality rate of COVID-19 can differ, ranging from 0.7% to up to 4%, depending on the quality of the health-care system where it’s treated. Early in the outbreak, scientists had concluded the death rate was around 2.3%."
Hopefully the US will be able to do better than 0.7%?
@MacD
No, it isn't.
Not if it doesn't fit tightly and perform as intended.
If that's the case, you'll find out.
In 2-24 days.
After You infect yourself, your family, your friends, your co-workers, and GOK who else.
A mask that isn't working that you don't know isn't working is worth about as much as a kevlar bullet-resistant vest that's actually full of cotton padding, or a life-jacket full of lead. With you tied to everyone you know by a leg chain. As you jump overboard.
That penny will drop eventually.
@Anonymous 11:09P,
What makes you think that would be the case?
If it's 4%, and 100M people here are exposed (out of 330M), that's 4M people dead by this time next year.
Which, by itself, is more than 150% of the current annual U.S. deaths for all causes, combined, currently.
If we get just 0.7% lethality, seven times deadlier than annual flu, and only expose 100M people, it would still be the #1 cause of death in the U.S.
https://www.medicalnewstoday.com/articles/282929#heart-disease
And that's the rosiest Pollyanna projection.
Think about this information carefully.
Sounds like someone doesn't want joe 6 pack to have any masks.
And YES. A mask, even incorrectly fitted, offers some protection. Sitting on a bullet proof vest isn't optimal but if the round comes up through the floor of, I dunno, the helicopter?, yeah it'll work.
And if you've got the firetruck etc etc but no training you're shit loads better off fighting a fire than the firefighter without the gear.
But to be fair. If you've got a helicopter but no idea how to fly it, you're worse off than the helicopter pilot with no helicopter. Because the former is just asking for trouble.
I wish I could get more people to read advice like this and actually get it through their thick skulls, but what it comes down to is that they just don't want to.
Just like they don't want to pay attention to what is taught in their local schools, or vote, or wash their damn ass because it will cut into their time doing whatever the hell it is they do, they can't be arsed to do boring things like "prepare for social distancing and self-isolation".
That's boring. Expensive. Takes thought, and effort. It's much easier and far more rewarding to buy every case of the cheapest mask at Home Depot and fantasize about being an astronaut, laughing at all of the poor plebs who did not have the foresight to buy their magical talismans in time.
Then they get all butthurt when it turns out they procrastinated too long, and can't find one in stock or on the cheap. Nevermind the import mess; the important thing to get mad about is that some people they don't know who wear funny blue pajamas and charge too much to stitch up their scrotum when they try to drunkenly vault over parking meters is telling them that even if they can find or afford their macguffin, they should chill out and leave some for those that need them for more than larping.
It's like a monkey in one pen seeing their neighbor monkey get a banana. Unacceptable.
I have M40's, because I know how to use them and I'd like to think they augment my ability to be an asshole to people with teargas. But I'm going to stay home while these idiots go out with their drywall masks and engage in the Toiletpaper Thunderdome at Costco.
There are other hospitals that have been cleaned out on PPE; just heard about one in my AO tonight. These people are already in a shit situation, and they show up for their shift to find zero masks, smack in the middle of the biggest (publicly acknowledged) outbreak in the US.
@Anonymous 12:41A
No, I just don't want Joe Sixpack to be a dumbass.
"Wish in one hand, and shit in the other, and see which one fills up first..."
I can tell people the truth, but I can't make them be smarter.
They have to want it.
Most don't.
Suture self.
"Sounds like someone doesn't want joe 6 pack to have any masks."
If the choice is between the staff at the local hospital having masks to do their job and you having a mask to make yourself feel better in the event you take the entirely optional step of not simply staying home and exercising common sense, then yes, I do not want you to have any masks.
In what universe are we better off with the medical staff unable to work? Do you think their getting sick, or others getting sick or sicker after going untreated, is going to result in a better outcome for you, personally? Or your family or other people you care about?
But, but, muh masks! Y'all just don't want use to have masks!
It was your own health care coworkers that stole the masks, either to sell or rathole. I know how to fit test. But as you pointed out in your clown show posts, the people responding were not wearing any PPE anyway, PPE you aren't wearing is just as useful as the gun in the safe. This is going to be bad, The R0 is high, the lethality is high. Hospitals are going to be overwhelmed very fast and then the 1st world will die at the exact same rates as everyone else.
1) True, but irrelevant.
2) Nice for you, but also irrelevant overall.
3) Everyone craters until shit gets real. I expect no less, anywhere.
4) I agree.
5) Predictably. And possibly worse than 3% or so.
None of which affects the OP, or my reply.
Untutored fools with equipment, and hoarding what they can't intelligently use, are stupidly amplifying the effects of this outbreak. Including on themselves and their families.
Let's assume (and I know it's not true) that you and all your coworkers are correctly wearing full PPE at work at all times. Goggles, gloves, masks, Tyvek suit, booties, heck throw in positive air breathing systems. You're not all wearing it outside of work. The kids aren't wearing it at school. The adults aren't wearing it at home.
The first person coming to work infected will contaminate the changing space that everyone is putting all this gear on in, along with the staff break room, the hospital cafeteria, the bathrooms.
It isn't just pointless for untrained persons to buy gear they don't know how to properly deploy. It's also pointless for anyone to wear it part of the time in an environment that is a threat 24/7.
Going in and out of a BLC-3 or BLC-4 lab is a chore and that presumes there is a clean space to decon before removing all the garb. Even if you assume (and I don't) that doctors and nurses are trained for this, most of the people working in hospitals are support staff, orderlies, janitors, and the like. They aren't trained and fitted for masks, let alone any of the rest of it.
It's only going to take that first infected person showing and going through triage in the ED to set the ball in motion.
Bearded military wearing masks:
https://www.gannett-cdn.com/presto/2020/02/24/USAT/67c7fbfe-3453-4658-a609-4ef76c237fb8-AP_APTOPIX_Italy_China_Outbreak_Europe.JPG?crop=3280,1845,x0,y166&width=3200&height=1680&fit=bounds
Being oil field trash, I get fit-tested every year for several respirators, both full-face and half-face. It isn't rocket surgery or brain science.
HOWEVER, as Aesop pointed out, a huge number of Joe & Jane Six Packs don't know how to do a positive & negative pressure check on their respirators/masks.
But more importantly, they simply can't be bothered to look up how, even though 10 min worth of Google-fu would educate them.
https://www.cdc.gov/niosh/docs/2018-130/pdfs/2018-130.pdf
Remember: if you have an AVERAGE IQ(roughly 100 pts), 49% of the US population is less intelligent than you.
And since the KungFlu can infect you through the eyes, it would seem to me that wearing a facemask without goggles is, shall we say, unwise. Why doesn't anyone mention the goggles? Aesop, do your ER folks wear both masks and goggles, and if not, why? Works? Doesn't? Not stocked? The SG doesn't want a run on goggles, too? Just curious - I'm planning for a lockdown on my farm as soon as it shows up locally.
And speaking of which, what is YOUR stay-at-home trigger point? Do you have one for KF like you did for Ebola?
@ASM826,
Yes.
All absolutely true.
You should be in disaster management.
Read today's post.
The point is gradually dawning on TPTB that they're going to have to screen everyone outside the building, and not let them in.
The greater point that it's going to sneak in the back door anyways, through the Gilligan Effect, and a long incubation period during which people may be fully infectious though asymptomatic, hasn't yet occurred to them. China had to learn that the hard way too.
That doesn't change the fact that fucktards hoarding things beyond their ken are
a) making life harder for medical workers, and
b) to a metaphysical certainty, countless Joe Fucktards are going to contract the virus wrongly thinking they're bulletproof, and spread things wider and faster than if they stayed home because they had no masks or other PPE
@VG,
Eye pro is part of the protocols.
So is limiting who deals with a potentially infected patient.
My stay-at-home point with this virus is threefold (maybe four-):
a) if I get the virus
b) if my employer tells me to
c) if the .Gov tells me I have to
d) Is it physically possible to get to and from work (gasoline, roadblocks, quarantines, etc.)?
Short of one of those three (four) intervening, there's no point in staying home.
There's no one to protect but me, and no one to give it to, except co-workers or other patients. My job is to take care of the people most in need of care, as long as that makes sense.
My aim is to do my best, using current normal protocols, not to catch it.
That is still possible, at this point.
Unlike Ebola, this virus is generally not a death sentence.
What's more critical is
*how long hospitals as entities are a viable concept in the first place?
(i.e. part of the solution, rather than part of the problem)
And
*how long do our supplies of PPE (let alone half of the other stuff we use) hold out?
I have no answer to either question.
BL-3 and -4 precautions only work because they presume to know which side of the door the pathogen is on.
With community transmission, the pathogen is on both sides of the door already and there is no "clean" area for donning and doffing. There might be a "cleaner" area, but short of a disinfecting shower, UV, and all the other precautions, which I KNOW the local hospital doesn't have, ASM826 is right. Staff will bring it into the hospital on the "clean" side, while patients bring it in on the "dirty" side.
Aesop, your license isn't a magic talisman or a shield, and you are by definition going out to play around in it (whether you have to or not, for values of 'have too'). You have the exact same issues as everyone else, outside of your work environment. The guy that operates the natural gas pipeline HAS to go out in it, as does the guy who unclogs the macerator at the sewage plant, and the guy who gets groceries to your local store. Never mind the guy who takes your contaminated medical waste away, or brings you clean linens and scrubs (or the 100 illegals working in that commercial laundry), or the guy who keeps the local nuke running smoothly. LOTS of people have needs, are not going to get masks from employers, and can't hole up for the duration.
If masks are pointless for all those people, even the ones with the training and experience to use them properly because they're not in a controlled and clean environment 24/7, they why should anyone bother, including healthcare workers? Serious question.
When asked, everyone starts sputtering "but I'm special" and I need protection. Looking at the infection rate among healthcare workers in China, why put yourself thru all the discomfort and trouble before you get it anyway? You are just delaying the inevitable if you choose to continue 'going out and playing in it.'
BTW I don't have a dog in this hunt. My masks were purchased long ago, well before the "panic" xxxxxx totally prudent xxxxx round of 'instaprepping'. I do know how to adjust and wear one properly. I'm old enough to remember when paper masks, no matter their shape or number of straps specifically WEREN'T respirators so that they wouldn't trigger the need for lung function testing or fit testing.
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The Surgeon General should either avoid platforms where he can't be clear, or use all the characters to convey info instead of wasting them on personal invective. If his message isn't getting across accurately that's on him, not the people hearing it.
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Your hospital has legal and ethical responsibility to control the assets they manage, on behalf of the owners and shareholders. That they failed miserably isn't MY problem, nor is it the free market's problem. It does cast doubt on all of their other operations though. If they can't follow rules and secure their facilities, how can we expect them to follow any of the other rules properly?
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Lots of voices have been warning that stockpiles of PPEs were inadequate, including yours. That healthcare facilities don't have adequate stocks is again, not MY fault. If they chose to not warehouse critical materials, and instead pushed those costs off on their suppliers, then the current situation (and ebola, and SARS/MERS/swine/bird/H1N1 and all the others) is entirely their fault and they can spend the money on the open market to rectify their mistake. LOTS of businesses are learning that lesson this month- you can only cost shift for so long before it bites your ass, and if you can't touch it, you don't own it.
Unfortunately, it looks like patients and staff will be paying a price too, while the management who made the decisions and the Wall Street funds and money men who demanded those sorts of decisions will probably get off without any punishment.
nick
We be self quarantined, and are well prepared for the long haul.
Arrg, you answered several of the points while I was typing.
Nevermind, carryon.
n
I bought a bunch of dust masks for the current festivities. They are valuable to me because they will keep my fingers out of my nose and mouth.
I learned before I could grow a beard that the n95 masks will NOT seal on my face. I wound up using a surplus gas mask for sanding bottom paint. Once my beard started to grow, that didn't seal so well, either. Good thing the copper paint wasn't super toxic.
" these idiots go out with their drywall masks and engage in the Toiletpaper Thunderdome at Costco."
Outstanding! Gold Star awarded....
One of those proofs we are overrun with educated idiots.
Had our "wise leaders" note the sarcasm marks simply read this blog and stated "N95 masks don't work without training and fitting and the supply is limited so unless you have training please refrain from purchasing them." they'd have gotten a positive outcome, increased their reputation for honesty and done it all without looking like J. Phineas Boob.
But nope. Its Honk Honk. Again.
Any assumption that those in decision making positions have any clue what they are doing assumes facts not in evidence, to steal a phrase from our host. To wit: apparently a 'medical professional' on 'self quarantine' in NH decided that self q includes attending an invitation only event. Explained to the wife last night that assuming competence is an error that generally gets compounded the higher up a person is in the organization. She didn't want to believe it till I reminded her to think about Large Corp where she works. Then the lights came on for her.
As was stated in comments on a different thread - average G2 is 100. I'd bet good money that the median is <100. Crucial factor when doing KungFlu math.
Re your last reply: We agree.
Granny if you wait until it shows up in your AO before locking down then you will probably end up with it since it has up to a 24day incubation period...That's why I've said we are all probably going to get it so buying a bunch of gloves and mask isn't going to really help you all that much what you should be doing is deepening your larder and making sure you have enough beans bullets and Band-Aids ..
do not need it, not trained on how to use it. shit, sub'n semi auto battle rifle for N95. sound familiar. let me guess when needed, I can get some at my local FEMA quarantine center.
"Explained to the wife last night that assuming competence is an error that generally gets compounded the higher up a person is in the organization. She didn't want to believe it till I reminded her to think about Large Corp where she works. Then the lights came on for her."
I have a good friend who spent quite some time in the Marine Corp. Things would come up at times in general discussions at work with the rest of us who had no military experience. The idea that things may look incompetently done but there is some higher justification that we are just not privy to. She put us pretty straight that in almost all cases it is because of straight up screw ups and genuine incompetence. The military is designed to muddle through these because they are inevitable - Murphy's law; Improvise, Adapt and Overcome. These principles exist for very good reasons.
And surgical masks do, indeed, protect other people from your germs. That's why they're cleverly called "surgical masks", and why we slap them on everybody coughing and sneezing in the ER, and why they're worthless as PPE, except to everyone else, to mitigate your slobber and sneeze particles flying everywhere.
N95s and better, by total contrast and design, are specifically to protect the wearer from other people's funk. TB, measles, Ebola, and Kung Flu, for specific examples.
And at least one commenter already posting there didn't know that fundamental difference in PPE, because it's outside their knowledge base.
QED
Weird folks have to gear up to go into those droplet precaution isolation rooms. With surgical masks.
Magical things that protect in only one direction...and not the user, apparently.
I, like many here, was already prepared ( as possible) for this. I agree that the SG should have been clearer as to why panic purchasing of masks was a bad idea for Joe Sixpack. Like the Great Depression, this event will leave a lasting impression and change of mindset for many folks. The smarter ones will stop buying crap they don't need and become part of the prepper community. As a professional mariner, I learned to look at things from a "what can go wrong?" point of veiw. I carried my kit ( half mask respirator, goggles, gloves, tyvek suit) with me on this trip to St. Martin. And lo and behold, two cases in the the hospital here, transferred from St. Barts where their presence sorely vexed the rich people who go there. Hope the US is still there when I get back.
The Surgeon General was crystal clear on that rationale in news interviews where they published his full comments.
For people who got all their information from 280-character Twatter Twits, not so much.
As I stated at the outset, context matters, and people who use Twatter for actual information on a topic are self-inflicted @$$holes.
The only cure for that is for them to break suction and pull their heads out.
People quoting Twatter as though it was the final statement on anything are shooting themselves in the foot. While it's in their mouth. I do not recommend this practice.
Hello Aesop, although this is a stinking issue that you have brought up indeed, kudos to that! People have been told to get their masks but it seems that they help not at all. Now who are we to blame for these misleads. I believe this is just another level on the ratrace, don't you think?
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