What guidance should physicians offer about mask protocol?

Watch the AMA's daily COVID-19 update, with insights from AMA leaders and experts about the pandemic.

In part two of a two-part series, AMA Chief Experience Officer Todd Unger talks to three epidemiologists who help answer lingering questions about COVID-19, including best practices for mask-wearing and preparing for going back to school.

Learn more at the AMA COVID-19 resource center.

Speakers

• Ilse Levin, DO, MPH, internist and epidemiologist, Mid-Atlantic Permanente Medical Group
• Harris Pastides, PhD, MPH, epidemiologist and president emeritus, USC
• Preeti Malani, MD, chief quality officer, professor of medicine, University of Michigan

Unger: Hello, this is the American Medical Association's COVID-19 update. Today we continue with part two of our two-part series with three epidemiologists who are helping to answer some of the many lingering questions about COVID-19. Let's just stay on the topic of wearing masks. Obviously, a lot of practical questions people have right now, I'm going to just name a few of those. If you could talk a little bit about it, but is it safe to reuse a mask? Do I need to wear one when I'm with my family or walking outside? Should children be wearing them? What kind of guidance do physicians need to offer about mask protocol? Dr. Pastides?

Dr. Pastides: Well, of course in an indoor setting, one should wear a mask as we contemplate reopening schools, both K through 12 and universities. I worry about little kids, how difficult it is for them to wear masks. I'm not an expert there, but I can only imagine the complexities there. This virus and the particles are extremely light. The wind will sweep them away for the most part not allowing the concentration of a dose that would cause an infection to enter somebody if they were biking or walking, just walking by other people. But I think if you're within that six foot window or you're in a crowded outdoor situation, even I would certainly recommend, and I think physicians and public health experts should recommend the wearing of masks, and certainly then as you move into an indoor setting.

I think the thing to remember, why vilify a mask for not being completely protective? It's not completely protective, nor is hand-washing for that matter, completely protective. Nothing we can do right now, short of the vaccine. By the way, that may not be completely protected either. So I think people need to understand that these are not master, not high-tech tools. They're the best we have. In terms of reusing them, I would use common sense. I reuse mine. I'll leave one in the car when I go into a supermarket and come back out. But after a while, after ... If you believe, or for a child, if you believe the child has just worn it too long, and it has become soiled or dirty beyond just a contamination, I would probably swap them.

Unger: Dr. Malani or Dr. Levin, anything to add there?

Dr. Malani: I would just add that for kids, making sure to mask is comfortable. Again, young kids are going to have some difficulty. The other piece is making sure they treat the mask like their underwear. Don't share them with your friends, change them every day and have a couple different pairs.

Dr. Levin: It's such a good point. It's a building block of protection, really. It's not one thing that protects us completely. But if we do each of these parts, it will add up to create a good protective barrier against the virus, and really that's what we want to do. It's important also to think about wearing that mask, it should be covering really nose, chin and not leaving that any exposed. I think kids wearing masks, if they're older is reasonable. I think small children, especially under two, I would worry a little bit about their ability to wear masks. So in those cases, I would recommend getting hats that have the large visors over them instead to protect their faces. The same might be true for someone who has breathing problems, maybe having a wide brim mask with a face shield attached to it.

Unger: Well, let's continue on with some of these practical questions. Dr. Pastides, you mentioned school. That's another place where people have a lot of questions. People are asking should they send their kids to school? Is daycare safe? Can I go to the gym? All of these questions about what I can do from my normal schedule from a year ago. What would you advise patients right now, Dr. Pastides?

Dr. Pastides: Well, I would, first of all, protect our elderly, our senior citizens from all of these situations. So if you're a 70-year-old person who volunteers in a school, I would not invite them in, I would not allow them in. If you are someone who goes to visit in nursing homes or works in them, that's a lockdown type situation. I think we've got to protect our elderly. They are absolutely more vulnerable, and others with chronic diseases that we all have heard about. But beyond that, I do believe, and it's not about herd immunity, but I do believe that working with the mitigation strategies that we have, they're trying to return to normal.

America is not a lockdown country. It's not going to work. But I do believe every institution needs not only a plan B, they need a plan C, D, E, F and G. When is an infection rate too high in a classroom? When is it too high for an entire school? If we shut down, are we ready to go online? So I think this is about being nimble, flexible, having many, many plans and not being so fervent about I was right, but admitting that maybe I wasn't right and moving to a plan further down the road.

Unger: Dr. Malani?

Dr. Malani: I would just add that the decision to return to learning, face-to-face learning is a really difficult one, and it's going to vary from community to community. For a lot of communities, they've made a decision that they can't do it safely, and also from a practical standpoint schools, and for that matter college campuses, are really built around togetherness and community. With the mitigation efforts requiring that you retrofit it in a way that it's just not practical. So we're going to find that a lot of people aren't going to be returning at least to a traditional face-to-face learning, and so that brings a lot of challenges, but also some opportunities.

Unger: Dr. Levin, any response to these kinds of practical questions about school or other kinds of things that people would like to do in terms of returning to activities?

Dr. Levin: Sure. I think just the one thing I think about with this is a nationwide surveillance system that is standardized across the country, I think, would be very helpful. Right now we really don't have that, and we do need to be able to open up and to be able to get back to living, but we need to be able to do it safely and be aware of the infections when they occur and be able to respond to those when they occur. So really supporting the development of a nationwide surveillance system for COVID-19 would be quite helpful.

Unger: So last question, looking at the big picture as an epidemiologist, what are the key pieces of information that you're looking for that can help us predict what the fall might bring or about future outbreaks? Dr. Levin?

Dr. Levin: I think better testing is one of the most important things. And unfortunately, working in this every day, we're still running into barriers. Again, rapid tests. Some hospitals have them, some don't. Being able to get tests back within a day even is not possible in some communities right now. So better testing and surveillance across the board for the entire country would be much more useful to us.

Unger: Dr. Pastides?

Dr. Pastides: Well, we have a better treatment already, thanks to the medical community. We have a vaccine in development. Very, very hopeful about that. I think we have a more compliant population, not uniformly, but more compliant relative to mask, hand-washing, et cetera. I think now the data back to the big data issue will show over the next few months what the variabilities and the vagaries really are here, who's at higher risk and why. But for goodness sake, we have flu season right around the corner. We have got to, as a country, come together, not vilify healthcare professionals, not vilify scientists and come together as a nation. We've been through this and worse before, we will get through this, and when we make a mistake, whoever we might be, we need to admit that and change our approaches.

Unger: Dr. Malani, any final thoughts?

Dr. Malani: Just to add, the pandemic has really been about difficult choices and they're going to be difficult choices ahead of us, and that it's going to change and some of it is going to be difficult for a lot of people. So kindness, respect, patience.

Unger: Well, those are great final thoughts. I want to thank you, Dr. Malani, Dr. Levin and Dr. Pastides for being here today and sharing our perspectives with us. That completes part two of our two-part series. If you missed part one, you can find it on AMA's YouTube channel. We'll be back tomorrow with another COVID-19 update. For resources on COVID-19, visit ama-assn.org/covid-19. Thanks for joining us today, and please take care.

Disclaimer: The viewpoints expressed in this video are those of the participants and/or do not necessarily reflect the views and policies of the AMA.