Wednesday, April 22, 2020

Why Masks And Gloves Will - And Won't Ever - Work

Masks and gloves will work to completely halt the coronavirus pandemic.
Except they won't ever.
I'll explain that in a minute, and both statements are true, but first, let's cover the basics.

Types of masks

This is the basic Mk 1 Surgical Mask. The one pictured ties; they can also be had with elastic ear loops. Function from one type to the other doesn't change, and doesn't matter.
People have been wearing them in Asia for decades (mostly with poor or no understanding of efficacy, just like here in the West). 
They have one purpose:
To keep your cooties, snot, and other effluvia, out of everyone else's business.
They are about 95-98% effective at this, IF worn properly.
"Properly" means exactly as shown, above. Period.
Nose over the top: Fail.
Worn under your chin: Total Fail.
Worn with enough facial hair to break the half-assed seal they provide: Major Fail.

The reason is simple: your germs can be rather easily blocked or hindered, by catching them on the mask inner side, so your exhalations, snot, and aerosolized droplet infectious material cannot fly 10M outwards at 300MPH every time you sneeze, or 5M outward at 100MPH when you cough. That factor alone keeps your germs inside your space, even in a sterile surgical suite, 98% of the time. If Pasteur had been born and figured out germ theory earlier, he could have been saving lives by the gazillion, just with this simple invention, in the medieval level of surgical practice enjoyed by medicine until the late 1800s, when the reality of this finally started to penetrate into the skulls of surgeons and physicians. But they didn't know it before then, and didn't know what they didn't know. No one did.

What these masks don't do, and never can, with any effectiveness, let alone approaching 98%, is protect the wearer from anybody else's germs. They aren't, and never were, designed to do that. The relatively massive gaps at the sides, top, and bottom, admit everything, bacteria, viruses, and everything else, such that the use of this mask to protect you is utterly pointless. Tests have shown they'll stop 10-60% of germs, some of the time. So, would you cross a busy highway if I told you you'd be missed by 10-60% of the oncoming cars? That's the point here. You'll get Ebola wearing this. TB too. Kung Flu? No problem. Even the common cold. They don't block anything that doesn't hit the fabric, and you suck in air all around the edges, 12-20 times a minute, and it only takes a few bacterium or viruses in aerosol droplets, even floating suspended in air minutes later, to do what you could have done with one uncovered breath. You'll get just as sick. Or perhaps even dead.

You wear those as a courtesy to others, and not as any sort of protection for yourself (unless you're a total moron, and/or all this is news to you, right now).

Note the warning stamped on the bottom. They're not kidding.
This is an N95 mask.
In fact, the very ones no one could get, because when Kung Flu broke out, 3M's plant in China was so nifty and vital, the ChiComs seized it. (Thanks a pantload, communist assholes!) Now we see what happens when you trust communists, and build factories in their countries. Take this lesson to heart. But I digress.

It's an N95 because it filters out 95% of everything you're worried about. Bacteria? No problem. Bacteria are huge. Think basketball huge. Viruses? Hell no, but. Viruses, by contrast, would be like grains of salt small. But. Viruses don't travel loose. They ride in droplets of spit or blood. Which are like baseball huge. So the N95 will catch those, and still work against not only big bacteria like TB, but also against viruses like Ebola, SARS, and Kung Flu.

What you can't see from a pic, and don't know unless you've played with them, is that these aren't a bare single layer of cotton or cellulose. They're diaper-thick layered with filtration capabilities. That big valve in the middle has a rubber/latex gasket, and it only allows air to pass in one direction: out. When you breathe out, everything goes; when you breathe in, it snaps sealed, and keeps the bad things out, and all the air you're breathing has to go through the filter around the valve. But.

You have to be fitted and fit-tested for this.
You have to wear the right size.
You have to be trained on how to put it on, and take it off, and how to wear it.
You can't have any facial hair, features, or deformities to prevent the entire perimeter from forming a good airtight seal all around.

Which is why, for 90% of the general public, it won't work.
Or rather, it will work - about as well as a screen door on a submarine.
That's what the Surgeon General was correctly telling people two months ago.
Until media illiterate baboons, and government PIOs, with less sense than God gave a baboon, tried to condense his two-minute explanation into a Twitter twatload of bullsh...rose fertilizer, and turned it into the bullet headline that "Masks don't work". Score another fail for media assholes. They do work, IF you know WTF you're doing to use them.
Most people don't.

And after you use one, the entire outside is contaminated.
Most of them are designed as single-use, and decon is possible with some types, but problematic. Those elastic straps that keep it sealed aren't designed for heat, and cleaning chemicals break them down as well. Which is fine for needing a limited number for a few cases, but not so much when everyone needs them all the time, everywhere, and there aren't enough. Or any.

You can go hog-wilder than this.
Like MOPP IV with an M40 series mask, as in the header pic.
Or a battery-powered PAPR (Powered Air Purifying Respirator):

The PAPR has Pros and Cons.
I love the pros, and I hate the cons.
I have full-face vision.
It does all the work.
It filters with CBRN/NBC levels of effectiveness.
I can't hear anything but the blower when I wear it, thus drowning out all the whiny kvetching from crybabies coming to the ER with pissant bullshit complaints, rather than bona fide medical emergencies.
It scares the shit out of people coming in with those, and they decide they really aren't sick enough to come to the ER when we've got active Kung Flu patients coming and going.

They fog up inside.
It's expensive. $300-$900.
The batteries only last an hour or three.
The filters are pricey too, and have to be replaced.
I can't hear things like lung sounds, which is kind of important with patients in respiratory distress, or trying to tell if the intubation tube is in the lungs instead of the stomach, and the other twenty things hearing and stethoscopes are good for in the ER.
It's hot to wear.

Then there are things like Level A encapsulated suits, which work great for BL-IV labs and chemical or nuclear accidents, but have all the pros and cons of a PAPR on steroids, and in full-body size. 

Gloves can be as complex, but we don't need to go there.
There's nitrile, which will stop just about everything (for awhile, i.e. long enough to use).
There's latex, which also works, unless you are or become allergic to the proteins in latex.
If you are, don't use latex.
Then there's everything else, which for our purpose can be summed up by saying: don't use these.
That concludes your glove familiarization, but rather more important is wear and use.
Gloves are generally single use.
I repeat for the learning impaired: Single. Use.
For the barracks lawyer wiseasses out there, anything over an hour is not single use.
You cannot, for example, wear one pair all day.
And you're supposed to wash your hands thoroughly both before and after use, because all gloves have microscopic flaws and leaks, sufficient to allow some level of leakage of fluids, and thus bacteria and viruses, every time you use them even before we talk about rips and tears. Some gloves are higher quality than others, but they all have flaws, and hand-washing as a part of wearing them isn't included in every protocol since forever by accident.
Didn't know that? Welcome to the fascinating world of aseptic reality.
You also can't touch contaminated things, then dig in your pockets, pull your mask down and pick your nose, rub your eyes, wear your dirty contaminated gloves into your previously uncontaminated car, and finger-bang your keys, steering wheels, and play with your cellphone bare-fingered while keeping the dirty contaminated glove finger in your lips. All of which examples I've already seen half a dozen morons do in just a few visits to the stores, drive-thrus, and such during this half-assed lockdown, already.
People who do that should lick the stripper pole, and pee on the third rail of the subway.
And they will.
So, if you wear the proper mask, properly fitted, and don and doff it and your single-use gloves, and wash your hands, and don't touch your face, particularly your mucousal membranes (i.e. your eyes, nose, and mouth) with scrupulous attention to detail, flawlessly, from now until whenever,
I can absolutely guarantee you'll never get Kung Flu, or most anything else.

You won't do that.
Or rather, some of you won't.
Oh, some of you will, and some will always do it better than others.
And anything 2M nurses can do, you can do.

But a non-zero number of 80-IQ Gilligans will break those asepsis rules, will become Typhoid Marys, get Kung Flu, and asymptomatically carry it to the vulnerable members of society, like they do, and kill 3% of the population, up to perhaps as many as 10M of their friends and neighbors. And that's all it takes to drop a turd in the punchbowl.

So, exactly how much turd are you okay with sipping?

If you have a fearless formula for how much turd in your punch ought to be acceptable, get a blog and explain that to me and everyone else.

If that weren't true, we could have just started to hand out N95s and gloves on Day One of this, and left society alone.

That said, I'd still favor giving people the benefit of the doubt, and letting them out with proper PPE, to try it.

It would give us one helluva leg up on common folk, with zero military, medical, or workplace PPE experience before now, understanding why you're not going to "deal" with an outbreak of anything more serious, like Ebola, any sort of CBRN/NBC event, or anything less but still lethal, without a shitton of equipment and training 90% of you and everyone else have never had, nor even heard of.

As seen in the opening pic, my military experience with serious HAZMAT gear taught me (exactly as it should have taught anyone from E-1 to O-10) that MOPP gear is like 4WD: it's to get you out of trouble, not to let you stay and play until you get into trouble.

In a pandemic, unless you have and can use metric fucktons of hot, cumbersome equipment, with absolute perfection, you're just going to kill people, by asking them to do unreasonable things with subpar/the wrong/no gear, and then you're just killing other people because you weren't bright enough to foresee the obvious well before it bit you in the ass. Or, you're just a sociopath. There is no Option Three. After stupid, and evil, you're limited out.

But anyone infected because of shoddy PPE use should go to COVID Jail quarantine, until the last day this pandemic exists, including years, if needs be. Call it the Gilligan/Typhoid Mary Rule.

And that's why masks and gloves work, but won't, to deal with this.
Now you know.

Haven't had enough? Thirsty for more?
Last week, Tam linked to this exhaustive (in every sense of that word) piece on masks, that goes to such depths of arcana that I wouldn't slog through it all if it was all I had to read on a desert island. That said, it seems to be absolutely correct, replete with references, and otherwise first-rate information. It's just all of it in the known world.

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