What do different masks actually do?

An example of a surgical mask while Dr. Bharwani was a surgical resident in Edmonton in 1983.
An example of a surgical mask while Dr. Bharwani was a surgical resident in Edmonton in 1983.

“The wearing of face masks during the 2019 – 20 coronavirus pandemic has received varying recommendations from different public health agencies and governments,” says an article in Wikipedia.

An editorial in the British Medical Journal (COVID -19: should the public wear face masks? – BMJ 09 April 2020) says, “Yes – population benefits are plausible and harms unlikely.”

Is there any direct evidence that wearing a mask would help? The editorial concludes, “…given the gravity of the pandemic, indirect evidence of benefit combined with the low risk of harm should outweigh the absence of direct evidence supporting mask wearing by the general public.”

It has been about five months since COVID-19 hit the headlines and spread infection all over the world. Since then one of the big topics of discussion has been “to wear or not to wear” a face mask. There has been so much disagreement and debate among health agencies and governments, it has left the public confused.

Some groups recommend that all members of the public wear masks, while others recommend that only COVID-19 patients and their caretakers should wear them.

In some countries it is mandatory to wear a face mask. On the other hand, other countries are still struggling to provide appropriate advice to the general public. To top it all there is an acute shortage of masks.

Types of face masks, from least to most protective, include:

  1. Cloth face masks: Although good quality evidence is lacking, some data suggest that cloth masks may be only marginally (15 per cent) less effective than surgical masks in blocking emission of particles, and fivefold more effective than not wearing masks. Therefore, cloth masks are likely to be better than wearing no mask at all (BMJ).

  2. Surgical masks: The standard surgical mask, also known as a fluid-resistant surgical mask (FRSM) is designed to provide a barrier to splashes and droplets for wearer of the mask. It fits fairly loosely to the user’s face. They are used for a variety of procedures in community as well as hospital settings. These are single-use masks. They should not be undone and dangled round the neck between procedures. It should be worn with eye protection.

    Surgical masks do not provide complete protection from germs and other contaminants because of the loose fit between the surface of the face mask and the face. Surgical masks may be labeled as surgical, isolation, dental, or medical procedure masks.

    Surgical masks are recommended for those who may be infected, as wearing a mask can limit the volume and travel distance of droplets dispersed when talking, sneezing, and coughing.

  3. N95 masks: Also known as respiratory mask. It is a disposable mask. Masks ending in a 95, have a 95 per cent efficiency. An N95 mask is a particulate-filtering facepiece respirator. It filters at least 95 per cent of airborne particles. It is the most common respirator used in health care.

  4. Face shields and medical goggles are other types of protective equipment often used together with face masks.

In summary, personal protective equipment, including devices such as N95 respirators, gowns, masks, gloves and face shields, are medical devices in Canada and are subject to requirements under the Medical Devices Regulations. They should be used appropriately. Hope the information provided here helps. Be safe. Stay healthy.

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Wellness During the COVID-19 Pandemic

Fairmont Banff Springs in Alberta, Canada. (Dr. Noorali Bharwani)
Fairmont Banff Springs in Alberta, Canada. (Dr. Noorali Bharwani)

“Yesterday is history, tomorrow is a mystery, today is a gift of God, which is why we call it the present.” -Bil Keane (American cartoonist)

As you know pandemic coronavirus disease (COVID-19) is an infectious disease caused by a new virus. COVID-19 has changed our lives and put our dreams on hold.

People are in quarantine and isolation.

What does quarantine mean? Quarantine sequesters healthy, asymptomatic people exposed to an infectious disease for the duration of the incubation period, to contain the spread of the disease (Canadian Medical Association Journal – CMAJ March 20, 2020). Example: Canadian Prime Minister Justin Trudeau, who was exposed and is asymptomatic, is under voluntary quarantine.

In contrast, isolation refers to separating patients with active infection from healthy, unexposed people, to prevent transmission. Example: Prime Minister’s wife, Sophie Grégoire Trudeau.

Quarantines are enforceable under the Canadian Quarantine Act. This law dates to the 1870s and was updated in 2005 after the SARS outbreak. It allows the federal health minister to enact measures ranging from screenings to mandatory quarantines at Canadian borders.

Quarantines may be necessary but can create hardship for individuals. Quarantine may cause adverse psychological effects. Some people quarantined in Toronto during the SARS outbreak had symptoms of posttraumatic stress disorder and depression, says the CMAJ article.

Quarantine brings financial hardship and stigmatization. To promote compliance, quarantined people need ongoing access to resource materials, open lines of communication and psychosocial support. Is that possible?

In the current environment, I doubt if there is anybody who is not worried or stressed. This can affect your general health.

Stress can make your heart pound, your belly ache, and your palms sweat. Stress increases the level of hormone cortisol. This can lead to increased hunger and binge eating. This can lead to obesity.

Other possibility is depression sets in and you may lose your desire to eat and start losing weight.

There are many ways to stay connected with your friends and family. Thanks to our technological advances we have cell phones, laptops, computers which keep us connected. We can send man to moon but unfortunately cannot prevent common cold or get immediate control of COVID-19. I guess, that is life. We will win this battle as well. Be optimistic.

There are many ways to keep yourself busy during this time of stress. Probably you have already figured it out. Children are not at school. Most of the adults are not at work. How do you stay busy?

I divide the day into three segment of three hours each. Three hours in the morning, three hours in the afternoon and three hours in the evening. About couple of hours are allotted in between each segment for nutrition and family time and some TV.

How do you utilise three-hour segments?

That all depends on your interest. If you are doing your office and business work from home then you have to allow enough time for that. You have to allow time to spend with your family and keep them active and entertained. You have to have time for yourself with yoga (if that is your interest), exercise, and meditation. There are many other options. Too many to mention here. Important thing is to prevent boredom.

Make a list of all the things you always wanted to do but were too busy to do before our lives changed. Stock up on healthy snacks. And let us hope for the best.

We all need good luck. So here it is from me to you! Stay safe.

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Understanding Factors that Determine Our Health

A teepee in North Battleford, Saskatchewan, in 1984. (Dr. Noorali Bharwani)
A teepee in North Battleford, Saskatchewan, in 1984. (Dr. Noorali Bharwani)

“The perception that health comes from the health care system is widespread. Yet the health care system accounts only for a small – albeit important – part of the overall health of the population, mainly through treatment. It’s really an illness care system,” says Dr. Trevor Hancock in the Canadian Medical Association Journal (CMAJ December 18, 2017). The title of the article – “Beyond health care: the other determinants of health.”

Hancock is an internationally recognized public health physician. The Canadian Public Health Association recently recognized his outstanding contributions in the broad field of public health with the R.D. Defries Award.

Our health care system is geared towards providing acute care. Most major determinants of health lie outside the acute care system. Health care system should provide major care towards factors that really make us sick, says Hancock.

Hancock says a 2014 policy brief found the health care system to be responsible for just 10 to 20 per cent of broadly defined health outcomes. It does not take into account other factors that affect our health. For example: our behaviour, our social circumstances, physical environment that includes pollution, and genetic factors.

This is hardly a new understanding. The Canadian government’s 1974 landmark Lalonde Report suggested four health fields:

  1. Human biology
  2. Lifestyle
  3. Environment
  4. Health care

Public health care service should attempt to reduce the overall burden of disease, ensuring clean water and air, clean and reliable energy, and quality early child development experiences.

Clearly most of these factors do not lie within the jurisdiction of the Minister of Health or the health authorities, says Hancock.

We need to broaden our concept of health policy and ask ourselves, in what way is current food, housing, transport, or economic policy bad for health, and, conversely, what would a healthy housing and transport policy look like, asks Hancock.

In another article, (CMAJ November 20, 2017) titled “No quality health care without strong public health,” Hancock says public health is in the same business as the rest of the health care system: saving lives and reducing suffering. But it does so by intervening before – rather than after – the onset of disease or injury.

Hancock says the objectives of public health are three:

  1. To focus on improving health in the population as a whole rather than through one-on-one care. It has been found that local and national public health interventions were highly cost-saving.
  2. To improve the patient’s experience of care. Prevention should be seen as the first step in disease management and a key marker for quality health care.
  3. The final aim is to reduce the per-capita cost of health care. This can be approached in four main ways: reduce the burden of disease, improve self-care so fewer people seek care, improve the efficiency and effectiveness of care services, or reduce services.

We have to strike a better balance between prevention and treatment. Let us intervene before the onset of disease or injury. That will save lives and reduce suffering. I will finish with the following words of wisdom:

“Nothing that has value, real value, has no cost. Not freedom, not food, not shelter, not healthcare,” says Dean Kamen, an American inventor and businessman.

Start reading the preview of my book A Doctor's Journey for free on Amazon. Available on Kindle for $2.99!