Unmasking The Truth

I’ve been teaching the engineering design process for the past two weeks to grade 9s in very difficult circumstances.  The engineering process underlies all the work we do in our stochastic, tactile technology/engineering program.  We aren’t rote learning to the same standardized answer, so blind obedience to processes won’t get us working results. We need to be organized, agile and able to step back and gain perspective in our non-linear problem solving circumstances like any good technician or engineer would when solving a complex, arbitrary problem.

I’m struggling with the half-baked safety plan we seem determined to follow at all costs.  Rather than get more frustrated with the optics, politics and bureaucracy that drive it, I thought, “why not apply the engineering process to my intolerable situation?”  

 

ENGINEERING DESIGN: COVID MASKS

  •  ASK:how do we resolve physically untenable policies around masks?
  • IMAGINE: a Heath Unit/Canada COVID19 compliant masking system that is effective and comfortable (if it isn’t comfortable it isn’t effective)
  • PLAN: collect data, research how COVID actually works, find existing solutions to best mitigate its spread
  • CREATE: build a testing system, create a solution based process
  • EXPERIMENT:  try different mask types and materials
  • IMPROVE: deliver an improved masking policy that is constantly in review

 

PLANNING:  DATA COLLECTION

It got up to 30°C/70% humidity in our it-has-never-worked-properly incorrectly ventilated classroom on Friday, which equates to a humidex temperature feeling like 41°C (that’s 106°F if you’re old school). I was rotating grade 9s outside to demask and breathe. It’s hard to learn when you’re seeing spots and can’t think straight… during a pandemic.

We were building circuits with Arduinos so I built a temperature/humidity sensor, which is how we captured data. Just for giggles I put the sensor on longer wires and put it up inside my mask while I was instructing. Curious about the results?

Inside the too small and tight, restrictive masks we’re required to wear all day every day at school the temperature is 4-5 degrees warmer than the outside air. I was getting readings of 33-35°C inside the mask depending on whether I was breathing in or out. But what gets you is the humidity. Inside the mask it was ranging between 92-97% humidity. Run that through the Canadian Humidex calculator and I’m stewing in what feels like 54°C all day, every day.

If I were in a climate controlled environment like the medical people who wear masks are this would probably be much more manageable, but I’m not.

CONCLUSION:  the small, restrictive medical grade ASTM Level 1 masks we’re required to wear might work in a well ventilated hospital, but they don’t work in schools where climate control is a distant dream.  When temperatures rise medical grade masks quickly become a liability more than a protection.
 
 
PLANNING:  ASTM Level 1 Mask RESEARCH:
 

WHERE & WHY ASTM1 MASKS WORK:  If you’re a medical professional working in a dentist, doctor’s office or hospital you’re working in a climate controlled environment that must follow strict guidelines.  In that context ASTM1 masks work effectively because the environment is supporting mask use rather than fighting it.
 
In an uncontrolled environment medical masks are restrictive and can cause discomfort which makes them a liability because people start fidgeting with them.
 
Staff struggling in uncontrolled climates (ie: most classrooms) resolve their breathing difficulties by breaking many of the rules for safe mask use:
 
I regularly see staff having to move restrictive medical grade masks around or wearing them with gaps or incorrectly just to get a breath.  Wearing a medical grade mask incorrectly is less safe than wearing a properly fitted non-medical grade mask correctly.  Discomfort from an improperly mandated masking policy drives this misuse.

PLANNING/RESEARCH: WHEN TO USE ASTM1 MEDICAL MASKS

ASTM1 surgical masks, such as are being provided to teachers, are medical usage masks that work in concert with a variety of other PPE options that teachers haven’t been provided with.  This video gives you an example of how medically focused these masks are:

What do ASTM1 medical masks do that a more comfortable, properly fitted non-medical option doesn’t?  Not much in the context of a classroom.  In a medical environment where a professional is working with COVID19 positive patients, a medical mask would be used in conjunction with a face shield to keep the medical worker safe in a known high risk situation.

 
“Medical masks are designed to protect against large droplets, splashes or sprays
of bodily fluid or other type of fluid.”
(Health News Hub.org).  In a medical context these masks provide a valuable level of protection, but an ASTM1 mask by itself isn’t a better barrier to COVID transmission, especially when worn incorrectly.
 
“It’s unlikely you’ll be infected in public by airborne viral particles.
The real threat is touching an infected surface and then putting your
hand to your face: Frequent hand-washing is a sure way to avoid
COVID-19”
  (Health News Hub.org)  A focus on cleaning surfaces and regular hand-washing would be far more effective than the false protection of a single layer of PPE/incorrectly applied medical mask.
 
Smaller class sizes, reduced bus loads and more frequent spot cleaning is a far more effective barrier to COVID19 transmission than stipulating a medical grade mask with no other PPE, but it does provide the appearance of greater diligence without the effectiveness and makes uneducated jumpy people think things are being handled diligently.
 

ASTM1 mask compliance in non-medical settings also puts Ontario’s public education systems at odds with the public health unit and Health Canada masking stipulations: “Due
to critical shortages during the COVID-19 response, we are implementing
and/or proposing a range of strategies to respond to the increased
demand for medical masks”
  Bins full of them outside every public school in Ontario every day isn’t helping to solve this world-wide shortage, especially when it’s done for optics rather than efficacy.
 

There are numerous well researched sources of information on mask usage this far into the COVID19 pandemic.  Its modes of transmission are known and technology is on hand to mitigate them, yet myths persist, like the idea that a medical mask is somehow a cure-all and significantly ‘safer’ than a correctly fitted cloth mask.  Every health agency in the world wouldn’t be advocating non-medical masks if they didn’t work.

 
 
PLANNING: RESEARCH: THE LIMITATIONS OF MASK ONLY PPE

“The coronavirus can spread through eyes, just as it can through nose and mouth” (American Academy of Ophthalmology) so demanding medical grade nose and throat protection while requiring no eye protection is wildly inconsistent and dangerously disingenuous.  The droplets that a properly sized and fitted cloth mask would stop and that an ATSM1 medical mask is designed to specifically stop 95% of would happen in a situation when a COVID19 positive person coughed or sneezed in your face without wearing a mask themselves, but with no eye protection you’re going to contract it anyway.  Rather than pretending to act from a sense of greater protection, more logical and consistent masking policies from the provincial government would not only make educational staff more comfortable but also less likely to contract the virus.
 

The appearance of medical safety, without the efficacy..

That educational staff are being required to wear poorly fitted and environmentally damaging ATSM1 medical masks at a time when they are vitally needed by people who would be wearing them with a complete set of PPE in an appropriately controlled environment is problematic.  The education system seems incapable of understanding or providing a masking solution that aligns with masking requirements everywhere else.  We need to stop acting like this is a marketing gimmick and start acting like it’s a medical emergency.



PLANNING: RESEARCH:  LACK OF CLARITY AROUND EFFECTIVE MASK USE
 
All medical mask directions stress a smooth seal with your face to ensure effectiveness, but another wildly inconsistent piece of Ontario education’s approach to mask adoption is demanding ATSM1 medically compliant masks with no direction around facial hair.  A beard or moustache that prevents a seal around the nose and mouth makes the mask all but useless, but there has been zero direction on the mandatory removal of facial hair.  The CDC as well as other health groups have made suggestions on facial hair that allows for a proper mask fit, which is a challenge.  CBC’s piece on it suggests a larger cloth mask would actually be more effective than smaller medical grade mask that won’t cover the beard. Another piece suggests COVID19 droplets spat onto your beard from a virus carrier can live for hours, but wear an ATSM1 mask incorrectly and the powers that be are happy.  The only conclusion that can be drawn is that ATSM1 mask usage by Ontario educators is a marketing move and not a medically viable choice.  That so many teachers seem to be buying into it is astonishing.
 

You’ll find a lot of panicky accusations saying this
is a conspiracy theory from early in COVID19, but it should be fairly
obvious that a beard would prevent a ‘tight seal’ as required in any
surgical mask directions.CDC has always recommended shaving for medical professionals wearing medical grade gear.

 
CONCLUSION:
 
It appears Ontario public education is using ASTM1 level masks to produce a sense of false protection in the education system.  By ignoring the more difficult and expensive medically proven ways of preventing COVID19 spread, such as resolving decades long HVAC issues in schools and not providing the full range of PPE required to provide medical levels of protection, Ontario’s pick-and-choose safety approach with an emphasis on medical mask use without any other criteria is both ineffective and misleading.

CREATE/EXPERIMENT/IMPROVE: FINDING A MORE EFFECTIVE MASKING SOLUTION

For staff with breathing and size issues the Chinese manufactured disposable ATSM1 masks are all but ineffective.  A policy that allows for public health/Health Canada compliant masks would not only produce staff in less physical distress, but also provide greater safety for everyone at this difficult time.
 
SPECIFIC REQUIREMENTS FOR MASKS:
  1.  Must fit the wearer’s face (current one size fits all masks do not fit all user faces)
  2. Masks must be comfortable enough for 150 minute continuous usage scenarios
  3. Masks must be breathable enough that users aren’t constantly pulling them away to breathe
EXPERIMENT:

Purchase a variety of mask types and sizes and experiment with them to find effective fit and duration results.  In a  medical situation professionals choose a mask from a selection of sizes and types.  They aren’t all handed the same sized and shaped mask as educators have been.  By experimenting with appropriate fit and breath-ability options a more effective masking solution would reveal itself.  None of this happened in preparing for the new school year.  This doesn’t appear to be happening now either.


IMPROVE:  COVID19 IS STILL BEING UNDERSTOOD SO RESPONSIVE CHANGE SHOULD BE BUILT INTO ANY PLAN
 
With COVID19’s transmission still under review by major players like the CDC, the safest route would have been to provide remote learning for the majority of families so that social isolation bubbles could persist.  Schools should have only been opened up to students in need or for specific classes that require face to face instruction.

A more cautious and medically researched approach to this school year would have prevented the current increases in cases, but the provincial government picked what it liked in terms of medical advice and ignored the rest, while using medical mask usage to whitewash any questions of efficacy.
 

The latest data suggests that droplet transmission happens when people are in close proximity to one another.  In this scenario it is much more important that staff and students have properly fitted, comfortable masks than it is to have a splash ready ATSM1 medical grade mask.


Beyond a metre the droplets tend to fall out of the air, though this is in question too.  If airborne transmission can happen from infected droplets that hang in the air for hours, the only logical choice would be to shut down face to face schooling again as a single infected person in any school would be spreading COVID19 indiscriminately anywhere they travel whenever they remove or incorrectly wear their mask.  Even a properly fitted mask is up to 95% efficient so COVID19 transmission would occur anyway with enough exposure.

Following WHO’s current understanding that COVID19 is most easily spread in close quarters, it’s vitally important that staff and students have comfortable, properly fitted masks that they aren’t constantly touching and making ineffective.

IMPROVE: A FLEXIBLE, MEDICALLY DRIVEN MASK POLICY FOR ONTARIO SCHOOLS

By experimenting with a variety of sizes and types of masks Ontario education could create a more effective masking policy that better protects its staff and students.
 
By closely following medical research on transmission and management, Ontario education could provide timely updates to its masking and PPE policies that keep people safe.

Larger, systemic issues like poor classroom ventilation and class sizes will have far more efficacy than a simplistic and misleading one-size-doesn’t-fit-all masking policy.  Some boards (mine included) have taken steps to reduce class sizes but in some cases the Ministry intervened and prevented boards from creating smaller class sizes.  In our case the cohorted solution to class sizes has downloaded all of the effort in making it work on classroom teachers which is creating marathon sessions of face to face classes while teachers are simultaneously expected to manage the other half of the class online.  This is twice the preparation and work along with the impossible expectations of being in two places at once – all day, every day.  Doing this while wearing an ill-fitting mask with breath-ability issues in a poorly ventilated classroom is a combination that will hurt many employees.  Rather than enforcing a misleading, half-finished medical masking policy, a focus on these other urgent matters would produce better outcomes for all involved.

NOTES & LINKS:

Advice on the use of masks in the context of COVID-19:  www.who.int/publications/i/item/advice-on-the-use-of-masks-in-the-community-during-home-care-and-in-healthcare-settings-in-the-context-of-the-novel-coronavirus-(2019-ncov)-outbreak

news.lvhn.org/fact-or-myth-facial-hair-and-covid-19/

nymag.com/strategist/article/face-masks-for-beards.html 

“Dr. Sten Vermund, infectious-disease epidemiologist and dean of the Yale
School of Public Health, he told us he trimmed his own facial hair down
“so that the mask could completely cover my beard.” The key, he added,
is to make sure there are no gaps and that the mask is hugging your
skin, not your facial hair.”
 
virologydownunder.com/flight-of-the-aerosol/

A well written article by a pile of doctors that explains how viral transmission happens.  An airborne virus is a terrible thing.  Whether or not COVID19 is airborne is still in contention, but the latest from CDC suggests it is

www.scientificamerican.com/article/how-coronavirus-spreads-through-the-air-what-we-know-so-far1/

Currently, WHO guidance
considers surgical masks to be adequately protective for healthcare
staffers working with potential COVID-19 patients, and advises using N95
masks in limited situations, such as when intubating patients, which is
known to generate small particles from deep in the lungs. Healthcare
workers who follow these recommendations have been generally protected
against the virus, WHO notes.”

Medical masks for medical work…

 

healthnewshub.org/cloth-mask-vs-surgical-mask-vs-n95-how-effective-is-each/

“A dual-layered cloth mask is sufficient to protect people in public settings. It’s unlikely you’ll be infected in public by airborne viral particles. The real threat is touching an infected surface and then putting your hand to your face: Frequent hand-washing is a sure way to avoid COVID-19”

“medical masks protect people from the wearer’s respiratory emissions. But it’s designed to protect against large droplets, splashes or sprays of bodily fluid or other type of fluid.”

 
“The challenge before many healthcare workers in combatting the disease
would be a daunting task unless proper administrative, clinical, and
physical measures are taken within the healthcare settings”
– wouldn’t hurt if educational administration followed proper measures too…

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