Sawbones: A Marital Tour of Misguided Medicine - Sawbones: Masks

Episode Date: March 30, 2020

The COVID-19 outbreak has recently pushed masks and other protective equipment into the forefront of the global conversation, especially as a shortage threatens medical professionals on the front lines. This week on Sawbones, how masks changed the world of medicine, and what happens when there aren't enough to go around. Music: "Medicines" by The Taxpayers

Sawbones is a show about medical history, and nothing the hosts say should be taken as medical advice or opinion. It's for fun. Can't you just have fun for an hour and not try to diagnose your mystery boil? We think you've earned it. Just sit back, relax, and enjoy a moment of distraction from that weird growth. You're worth it. that weird growth. You're worth it. Alright, time is about to books. One, two, one, two, three, four. Hello everybody and welcome to Saul Buns, Emerald Tour of Miss Guy,

the medicine I'm your co-host, just macaroy. Can I'm Sydney Macaroy? Instead, tell me if I'm off base here, but as this coronavirus situation continues to unfold, we didn't think it made sense to every weekend, we can wake out, sort of, give you what you're already obsessively reading

on your phone 19 hours a day. I assume I am. I assume everyone else's sure so we Thought that we could do some episodes that might provide a little additional context a little background a little history because as they say History is the roadmap by which the lines of the future are drawn by navigators. Do they say that? As they say. That's a lot, but they say. It is a lot. It's weird that that caught on as a saying, considering how kind of convoluted it is.

Riverboats, yeah. Yeah. I'm surprised there's anybody. I mean, congrats to Isaac Newton. I don't know how that quote hang in there. Hung in there so long, but congrats to you, sir. I wanted to do some topics that would be true to the spirit of our show, medical history,

exploring medical history and how did we come up with things and all the mistakes we made. But we're adjacent to, I think, the relevant issues of today because there are on everyone's mind and it felt disingenuous to just pretend like it's not happening, but at the same time, I know that a lot of people like to listen to podcasts to escape a little bit.

So I thought we would start with a history of medical masks, of surgical masks and 95 masks, and then obviously we can talk a little bit at the end about what that means for healthcare workers today, but let's delve back into the past. Let's go hop in the sub-n's time machine a new trademark that I've just invented. Before people began wearing masks, they had to accept that they needed one, which doesn't seem like a huge hurdle except as we know if you listen to our show.

They're all huge hurdles. We had to understand really the idea that there were germs that spread disease that could be expelled through your mouth, right? Or like somewhere on your face. And that sort of started, like, and we've coiled this a little bit,

but like this idea of like protecting yourself from bad air, right? That's true, that's if you look prior to, I mean, really the history, as we get into the history of the mask itself, it's late 1800s, early 1900s, is the birth of the mask. Prior to that, if you did wear some sort of facial covering for a, quote, unquote, medical

reason, it would be because of the measumatheria of disease, the idea that bad air, some sort of bad smell, something like that carries disease with it, and you might inhale it and get sick yourself. So you have a mass that would sort of filter the bad air. Exactly. Sometimes with like a saturated proporee. Yes. Now you were talking about plague times, the big beak masks that held the little, yes,

something good smelling. Actually, you know, it's funny. You could either put something good smelling in the nose to like repel the bad smells or you could put something bad smelling that would Also repel other like it was so much worse. Given the choice There were many ways to repel bad air. I'm totally gonna go the first one though if I'm gonna smell it all day I think I definitely would want to go I would say the popery one out for most people There were also prior to that there were like some

Suggestions of masks from like plenty of the elder, our friend plenty of the elder, who wrote natural history about everything, everything natural, the history of all natural things. The whole natural world, as I understand it. He advised that if you needed to wear a mask, and again, this would have been a very sort of non-specific use case. If you need one for whatever you might, we don't know why you need them,

but if you did, he recommended animal bladders as a good material to use. I don't know enough about animal bladders to know, that would be a good pick or not. I'm not gonna try. Yeah. I guess. I don't know.

Let's not. I don't know. Let's not. We don't need to go to there. No matter how desperate things are, animal bladders are low on the list of suggested alternative materials. DaVinci advised using a wet cloth for protection, like protector face. That is actually a bad idea. The wet is bad.

I will get into wet masks are not great masks. Does she doesn't get up into the mix a lot on these salmons? I always had to imagine that if you look into the history of mask wearing, there's a lot of overlap between medical and occupational type hazards. Are you trying to prevent some sort of disease state or are you trying to prevent a noxious

and inhalation injury of some sort like, you know, whether you're doing art of some sort or in, you know, your work as a minor or in certain kinds of factories, that kind of thing. So like you get a lot of crossover. But I'm assuming it's a different, very different sort of filtering that you need. Not really.

Really? No. No. In 9595 mask that we'll talk a lot about at the end of the show and that you've heard a lot about probably in the news is used in occupational hazards like to prevent inhalation of substances just like it is in the medical world. Yeah. But the first kind of concept of like the masks as we know them today and wearing them for the reasons we wear them today really starts in the late 1800s with a German bacteriologist who actually helped create the field of hygienics.

He was one of the early like, you know, keeping things clean and keeping ourselves clean and preventing diseases, a field unto itself and should be respected and studied and, you know, taught. Carl Fluege, who... That's a good one. Yeah. Fluege.

Fluege. Who demonstrated that you could spread infectious particles, you know, germs as we were beginning to understand them through tiny little droplets in the secretions from your nose and mouth that you couldn't see. So the idea that like not just coughing or sneezing, which we kind of, I mean, you know, right? Because like it's wet. Right.

You know, if you cough and stuff flies out of your mouth, okay, if you sneeze, it's wet. So you assume there's something there. So the idea that there were germs and that wasn't too wild to accept. But just talking, do you expel, you know, my new secretions when you talk. It's like just now occurring to me. It's just now occurring to you. Not not kidding. I never really thought I just always sort of thought I was through like spit.

It's just now occurring to me. You're just you can you can be I mean, obviously the a matter of number and like what season I get, but I just assumed it's through like droplets. Well, they're they're they're're my new microscopic respiratory droplets that are being expelled when you talk. They're microscopic. Yeah. Okay. Wow.

Man, I'm just, I really am growing a lot as a person. His work focused largely on tuberculosis, and he talked about the idea that tuberculosis could be spread by these invisible droplets that he called fluege droplets. largely on tuberculosis. And he talked about the idea that tuberculosis could be spread by these invisible droplets that he called fluegae droplets. Yeah, of course it did. Apparently didn't stick. Unfortunately, right?

Like if that have been Carl, maybe just let that one go by. You don't even, you got your fluegae droplets all over me for the rest of the time, that's your like, on the germ spit, like the microscopic germ spit, that's my thing, that's my jam. I take it, I take it, if they were called Sydney droplets, who, it's bad. Never mind.

It's the first name made it weird. Yeah, the first name to be my, but then macaroy droplets and it's like you get to own it. So I want to like, smear all droplets. Equal credit to macaroy, I can remember. I can't get to own it. So I want to like, smear all droplets. Equal credit to to macaroni. I can relate to the name. Anyway, so he began advocating for masks because of this understanding. He began, you know, not just after brachylosis, but specifically that and then other illnesses could be spread this way. And the initial masks that he started advising people to wear and the other physicians kind of took up and

agreed with were basically just like you know those rolls of gauze. Yeah, just that stretched across your face a couple times. Like wrapped around your whole head or like? Well, I mean it was that material and you could hold it in place however you wanted to. But yeah, you could just wrap it around your head. That's how mommy's got started. And eventually, this doesn't seem like enough. I should keep going. No, but. What did you do for Fast Forward, mommy? Mommy.

Just some, and they weren't very common at this point too. You gotta know, this was like the very beginnings of a handful of people wearing these things and everybody else going, okay. It's one of the hardest things is like so often people doing the right thing throughout history. The first people doing the right thing look totally bonkers. Yes. And it's like I don't know how do you tell the difference between that and regular one. So I just don't know. And I mean we're talking about worrying masks at a time where we still haven't

like Lister hasn't done his thing yet. Right. So, like, the whole idea of, like, a sterile field in surgery has not been introduced. Gloves are not a thing yet. So, this is a radical idea. Someone who we have not, I don't think we've talked about on the show before is Dr. Alice Hamilton. And I've now, sometimes when I'm doing research,

I get sidetracked by somebody, and I just end up reading everything about them, and then I think, well, this is a whole other episode. And so Dr. Alice Hamilton, for good reasons, not for solbona and reasons. For good reasons, is there ever enough her own episode of solbona? But so at some point I'll do that.

But anyway, she built upon this research, and we'll get into, she was an amazing figure in early occupational health and is partially responsible for ocean. It was an amazing person. But she built on this research and showed that scarlet fever could also be spread by what she called invisible sputum.

And she further showed that the number of, or showed that if nurses wore masks while caring for patients with scarlet fever, that you could reduce the number of people who would also get sick. Because that was a common problem, is that you'd be tendants to the ill would be caring for them. And because we didn't really understand exactly, or we were just beginning to understand how disease was spread, they would get sick, or they would carry it over to some other patient who didn't have scarlet fever to begin with, but now also would have that. And so just wearing these masks, they cut down on the rate of nurses and attendants

to the sick that got sick themselves. She also advocated, she was one of the first to advocate for surgeons wearing masks while they're in the operating room. Yeah, because they got people open and you don't wanna get stuff in there for sure. Right, and again, she was talking about not just like coughing and sneezing because that seemed obvious.

Like, well, I'll just turn my head. I won't sneeze in patient. Right. I won't sneeze into the patient. But I may be a surgeon, but even I, a common surgeon. Just talking. Just talking. She pointed out, no, but you're talking in the OR and you're talking, you're spreading

these respiratory droplets into the patient. And it's funny because in some of her studies, like she actually counted, no, but you're talking in the OR and you're talking you're you're spreading these respiratory droplets into the patient And it's funny because in some of our studies like she actually counted like do you know how many words the average surgeon even says in surgery and How much they're talking while they're doing this and which is sort of like a subtle burn I feel like yeah on surgeons like do you know How much you talk in the But you do I mean you're in there a long time. You do talk. Where I work, it's teaching hospital, everybody's talking and asking questions and explaining things. So, masks became a recommendation in the OR because of that.

And as more people begin to kind of accept the idea that maybe masks are important, they begin to see like, okay, we could use them in the operating room. That's a good thing. We can use nurses can wear them. That could be good. And doctors, anybody who's in close contact taking care of patients to avoid getting sick could wear them. And then Dr. George Weaver in Chicago in 1918 showed that showed that not only could you put masks on medical personnel, but you could reduce the risk of diptheria if you could also put masks on the patients. Yeah, that makes sense. So you began to say like, hey, we've heard that here now with COVID, right? Like the idea of putting masks on the patients.

Right. So he did, he talked about like reducing the risk of diphtheria among the nurses and among the other patients. And then building on that, Joseph Capp said the same thing for members of the military. This was during World War One now, and he's caring for a lot of sick people, right? You know, members of the military who all have different things and are in one room kind of together. Sure, right. And he observed that cross contamination was a big problem.

Like this person would come in with smallpox, this person would come in with scarlet fever, this person had meningitis, and then they'd all get the same things. Right, right. So put masks on the patients. So now we have built on like doctors, nurses, patients, everybody could wear masks.

It's not common to do, I feel like you don't see it a lot. And but it's only through, you know, TB movies or whatever. But I guess you got to put masks on the patients. Yeah. Does that happen a lot in actual hospital? No, no, we don't, unless they're leaving the room sometimes. Like if they're having to go down for an x-ray

or some sort of study like that, then they put masks on when they leave the room. But most of the time when the patients, because I mean, we're talking about a hospital where like you're right next to the, like the patients are all right next to each other. So now we can, if the patient needs to have their own room and the people coming in the room are using appropriate PPE, personal protective equipment, then you shouldn't have to worry so much about that. Makes sense. But in a large military hospital, or, you know, the beds may be pretty close together, and

everybody's talking to each other, way more important. It's also worth noting Dr. Weaver was also, he started to talk about the importance of cleaning and sterilizing the masks, if you're going to use them again. And we understand at this point, germs and stuff. Yes, yeah, we are into the early 1900s where we've begun to understand the drug theory of disease. Yeah, and also about the fact that wet masks don't work. Why is that?

They just absorb the ability of them to capture particles is reduced because they've because of the liquid that's been absorbed there. Oh, weird. Yeah. Physics. So, now, like I said, now we have this idea that nurses, attendance, and doctors, and now the patients themselves could all wear masks, and they were showing greatly reduced numbers

of infection among all parties because of this. And then the question began to turn to, okay, so we know that masks can work, but what kind of masks? Is there a good mask? Yes, because we're still just using rolls of gauze, basically at this point. And so then the question is, well, we could probably improve on this. This was used out of, it is what we had. Right. So maybe there's, there's a certain

mask that's better. So the initial studies were just comparing like course gauze to medium gauze. So what they call butter cloth, not like, not like your shirts, but like, but like a very, a very close knit gauze. Right. And the way that they would test the masks is they would get volunteers to rinse their mouths with a bacterial solution. So just like swish and spit this solution of serratia is the kind of bacteria in case you're interested. And then they would have them put a mask on and they would lay out like auger dishes, petri dishes on a table in front of them.

And then they would talk with the mask on of the different substances. Talk to the petri dishes. Yes. And they could talk and they would have three different trials. Talk softly with the mask on. Talk loudly with the mask on and then cough with the mask on to the petri dishes. And what it showed is that the closer the mesh, the fewer bacteria that were able to get through, whether you were talking softly, loudly, or coughing.

It doesn't matter if you shout out the petri dishes. You can shout out the petri dishes all day, but if it's close enough mesh, the bacteria can't get through. And again, they proved that the wet mask wasn't helpful. And this was around the same time. By now we're moving into like, Lister's developed sterile technique and Hulstead made gloves and people started wearing gloves. And alongside of this, it just became commonplace.

If you were going to work in an operating room You should wear a mask and the standard with you know first it was the surgeon Then it was all the attendance and then it was you know what if you walk in that operating room you probably get protected for these bad germs They tried to find like I said they knew a close mesh was better They continue to try to build upon that. They did, like, for a while, like a deflection mask, which was, like, completely impenetrable and then had these, like, wings on the side to, like, force the expelled, whatever, back behind you. It's a little intense, kind of a, uh, I don't know, Dr. Fate helmet deal.

But it rocketeer looking. What they found is that like, while that might change the direction of the expelled germs, it does not reduce the number of expelled germs that are collecting in the operating room as a whole. Like you could still swab around the operating room and find bacterial colonies growing. So while this was maybe a step forward,

it was not, we were not quite at the place where we had the best mask yet. Yet, how do we get to the best mask? Well, I'm gonna tell you that, Justin. But before we do that, let's go to the billing department. Let's go. The medicines, the medicines that ask you lift my cards before the mouth.

The medicines that ask you let my God for the mouth. All right, Sydney, walk me down the road to the best math. Where do we begin? We begin with an outbreak of plague and a Chinese physician named Leine Tay Wu, who was called in by the Chinese Imperial Court to help deal with this new outbreak of plague. It was different than the plague that we had been used to in history, different than like the bubonic plague. It was faster, it was more deadly, people got very sick, very quickly. It was an outbreak in northern China, and they weren't quite sure how to deal with it, what to do about it. And he realized pretty quickly, he was called in to examine these patients and evaluate them

and try to figure out what was going on. And the commentary at the time was that this must be spread by fleas, right, like the plague is known to do. But he said, I think this is airborne. I think that there's this coming from patient to's, there's coming from patient to patient. I think they're expelling it to each other. This is like a, a pneumonic form of the plague, a lung form of the plague.

And he, because he had this theory, he decided, well, if I'm going to examine these patients, I need protection for myself. I don't want to, I don't want to inhale this and get sick too. So he took The gauze masks that people were using and he actually layered them with like cotton to filter out more material Oh smart and so he built these new masks that he would wear To help protect himself and it took a while when he first Proposed this method of transmission and this mask to wear,

a lot of people were like, whatever. No, this is not going to take it. And a lot of the reaction too was very racist from physicians throughout, especially the Western world. Like, I don't even know, we're not going to wear that silly mask because it was a lot bulky.

It was a lot bigger than the masks that they were used to. And they're like, no, we're not going to do this. But it was put to the test when a famous French physician, Dr. Mesne, decided he was going to prove this new doctor wrong, this young doctor wrong by going and examining the patients himself without a mask on to show that there's no danger. And it's totally fine. Certainly the better way of doing that. And then 48 hours later, he died. Wow! That's a lot of germs he got, huh?

That is what is recorded. Perhaps it was not quite that fast. One way or another, he did get sick. It was just the two of them. So, Lee and Tae-Woo got to report like, Oh, no, it was about 48 hours. It was just before the hours. It was wild.

And then, he went, I'm fine. After that, people believed it. And that was the mask that, as we went through all these years of operating room masks, the surgical masks, it was quickly the mask that took over from the gauze mask, the cloth masks, the deflection mask that I described, all these different masks just did not outperform

this filtered layered, gauze cotton mask that soon became synonymous with physicians. Like especially if you look back to the Spanish flu days, there are so many. Somebody pointed out that the picture of somebody wearing one of those masks in a black and white picture in a newspaper was so photogenic that they thought that was part of why it caught on so quickly because it's that white, big white rectangle across your face that would show up so well in these pictures. And those are just, you can find tons of them of medical professionals wearing these

masks. And so everybody wore these masks. And anyway, this was the type of mask that was the standard in medical care for a very long time. Until really, we get to the tuberculosis outbreaks, the multi-drug resistant tuberculosis outbreaks of mainly the 1990s. Wow, really?

Yeah. After HIV became more commonplace, we saw more patients than we had before that with tuberculosis and specifically with strains of tuberculosis that were resistant to a lot of different medications. And because of that, the standard gauze cotton mask, the surgical mask, I should say, at this point, we're just calling it the surgical mask.

The surgical mask was not enough to protect you from tuberculosis. Is the surgical mask like what Lee and Tewu created? Yes, it was, it was, well, it is, it is not identical, but it builds off that. I think this is like really thin though. It is, it is pretty thin. Well, I mean, yes, because now we have the technology to do the same thing he did without multiple layers.

All right. Yeah. But the same idea, like a filtering mask. But not a respirator. This is not what we would call a respirator, which is where we get into the N95 mask. So for tuberculosis, we needed better masks. These surgical masks, masks were not going to cut it. And so really at this point you see the medical community kind of turn to specifically

like the mining industry into like the industrial world to look for something better for health care workers to wear. The original respirators because it was not too long into mining that people started to figure out that you got sick for mining. I mean, even if we didn't know what Black Lung was, co-workers and pneumoconiosis, we knew that people got sick when they did certain jobs, not just mining, but all kinds of occupations where you will inhale things that can be damaging. And so, the initial respirators that they would have people wear were these big, giant, bulky, like I saw somebody say, basically, if you can imagine being in a really hot,

enclosed space, wearing rubber wrapped around your head, that's what it was like, the original respirators. And as you can imagine, that would be incredibly uncomfortable. Can you help me clarify respirator? Because whenever I hear the term respirator, I'm always thought of like something mechanical that has some sort of mechanical component to it. What is it? What does it mean a respirator? It has to do with just the ability of the mask to like redirect. Like I'm going to get, tell you what, I'm going to get into the actual way that N95 works, and I think that will answer the question better. So, they, so the original, like I said, the original respirators were not easy to wear,

and as a result, we're not worn all the time. Right. If something is that bulky and uncomfortable, you're going to get a lot of people who aren't really compliant with it because they can't, you know, they're going to maybe pass out because they're so hot. So anyway, in 1970, the Bureau of Mines and the National Institute for Occupational Safety and Health said, we need to have some sort of single use respirator, something that isn't this big bulky head thing that you can just wear like a mask that will still

Protect you and filter out particles and all that kind of stuff, but Won't make you pass out while you wear it, and that is by 1972 they had created 3M had created the first single use in 95 dust It was for initially a dust respirator. And it is called that because it filters out 95% of particles that are 0.3 microns or smaller. Okay, or larger, sorry, 0.3 microns or larger. Yeah, that's where the 95 comes from. Not very catchy still. In 95. In 95. It's easy to find. Sounds intense. Yeah, it does. It sounds like this is the 95th one, we find. I write. The original respirators before the N95 had had like fiberglass in them to use this like

a filtering material. So instead they use these, basically it was like, it was described as like stiffer gift ribbons. And they had all these like, there was like a melted polymer and they created all these tiny little fibers, like imagine little piles of sticks. There's a good way to think about it. And there's big spaces in between them.

And as particles, so that's in that mask between you and the outside world. And as whatever the particles are are whether we're talking about Workplace exposures like Silica or talking about Coronavirus or any other sort of viral particle or germ as they pass through your mask Into your face

They have to go through all these sticks and they get stuck like her plunk It's just like her bloc. Like her plunk. It's just like her plunk. It's like playing her plunk with germs. In addition, they also have an electrostatic charge that pulls things to them, all these little sticks. Oh, unlike her plunk, maybe. This is why this is a respirator and not a mask. All of this technology that I'm describing.

It's not just filtering. No. Right. And because there are all these, but you can still breathe through it. I mean, that's the other thing though. Like something that can stop that many particles, you run the risk of it not being breathable.

Yeah, they messed that up for years and it was a tough time, I would say for everybody. Well, the old respirators were almost impossible to breathe through. I mean, especially if it was hot and you were down in the mind for a long time. So this really solved that problem. And the other thing that was great about the N95 respirator is that the particles add to the filtering ability. Ooh, okay.

So the longer you wear it, the better it works. Oh, that's smart. Yeah, that's so cool. To a point. Oh, that's smart. That's so cool. To a point. Oh, of course. To a point. And I'm assuming there's not a little sticker that turns from green to red when that happens. No, there is no.

But there is a point where it's got so many particles in it that, like, you can't breathe. Yeah. And then it's bad. Then it's bad. Even a layman can take it out work anymore So like in a dusty environment it works for about eight hours You you could probably get more use out of it In certain medical situations, but generally speaking that's the recommendation Which like you have to add up for yourself if you're going to reuse them.

Time, how long were you? Where did that day come from? Oh right, so I have to. Yeah, and count up the hours and everything so that you keep track. So this technology existed, the medical community in the 90s turned to this and said, this is what we need. This would help us with tuberculosis. We would like to start using these masks.

And up until now, this is the only context in which I wore an N95 mask. What do you mean? tuberculosis. OK. When I was introduced to the IDN medical school, I was told, you need an N95 respirator if you're caring for somebody with

tuberculosis. You'll almost never need one of these things. But we're required to go through what's called a fit test where basically they take you to a room, they put the mask on you. There's like a little metal piece over the bridge of your nose that they have to like kind of flex where you can, you know, so that you want a tight seal. If it doesn't have a tight seal to your face, it doesn't work. It won't appear to you, right? Right. So facial hair is a huge problem, as you can imagine, to get a tight seal to the

face. Um, so you put it on, you make sure it's adjusted properly. You got a tight seal and then you can spray something in the room, like something that smells bad and see if you smell it. If you don't, then it worked. Great. It's a fit test. Cool. So that was part of everybody, I think, in any kind of not just in med school, but if you're going to do any sort of like clinical medicine of any kind, whether you know, Dr. Nurse Respiratory there, but everybody, you

would have to get one of the, you would have to do one of these fit tests so that you know how to properly do the mask, right? And to make sure, that's also how they make sure the masks work. That's why there are only certain masks that are certified for this, that can actually work. Like, and if they don't carry that seal of approval, you can't be certain that they're going to work the way that they should. But these aren't something that you were putting on day in and day out.

Almost never. I could count on one hand the number of times I had to wear one because we thought perhaps a patient had tuberculosis and so when we cared for the patient we had to wear one in the room. Even when I cared for tuberculosis patients when I've worked overseas, I didn't wear them regularly. They weren't available either, but I also didn't wear them. I do not have TB. My PPD is still negative. Why not wear them with every respiratory thing that you suspect?

Because for the vast majority, they're not necessary. For the vast majority, your surgical mask is okay. You could get away with that. And you also, of course, are gonna wear other proper protective equipment, depending on, what room you're in and what you're doing. But for the majority, especially if you talk about like, in the OR, if you wear, the surgical mask

was really created to stop the doctor from infecting the patient. Right, okay. And so you can, if you are the one stop the doctor from infecting the patient. Right, okay. And so you can, if you are the one who is concerning to be the vector of disease, a surgical mask is fine. Okay. That will, that will hold in the vast majority.

I'm not saying it's 100%, but it will work just fine for those purposes. The N95 is not necessary for most cases. Wait, overkill. Yeah, it's just, I mean, it's, it's great when you need it, but you don't need it most of the time. Except, and like you said, it is important to note that facial hair messes with them. They're not really, they don't work great for kids most of the time. For most of us, they work most of the time. They're not for everybody.

There are some issues, but now we need them. A lot of them. Yes. issues. But now we need them. A lot of them. Yes. Now we need a lot of them. All of our healthcare personnel that are caring for patients with coronavirus, with novel coronavirus, with COVID-19 need this. You can put, like I said, a surgical mask on a patient. I've seen that recommendation a lot, who is either a person under investigation or been diagnosed. You can put the surgical mask on the patient right away if you didn't have access to an N95 right away. And that is going to help, but it doesn't help if the patient needs an airway. If you're going to be intubating a patient, then you can't.

You need protective equipment. Yeah. You the medical professional need protective equipment. So, now we need N95s, we need these respirators. It's really weird, because it was really something that I could count on one hand a time, number of times I wore in the hospital, up until now. And now, like I said, you can reuse them,

but you have to be really careful because they are, like if you walk into a room and are exposed to coronavirus particles on the exterior of your mask. Yeah, that it's bad. Well, now it is contaminated. And you can't then just wear that same mask into the next room with a different patient, especially what if they don't have it.

Right. And more more more worryingly, if you go to remove that mask and you touch the surface of the mask. Of course. Yeah. That's a big problem with masks is not touching them because they don't work very well if they're they're trapping viral particles on the outside and then you're touching them. Touching the outside of it.

Yeah, that doesn't work. So while they can be reused, it's ideal. In an ideal world, you wouldn't have to. And if you are going to reuse them, you have to put some sort of covering over the outside of it. So like you'll see, it's commonplace at least around here to put an N95 on and then put a surgical mask over top of it. Okay. Now you still should not wear it into another patient's room ideally. I have read that across the country and across the world people are doing that because they have no other option.

Of course, of course. This is your mask for the week. Make it make it last. But ideally what you would do is if you're gonna reuse, just reuse it for that one patient over and over again. But- I heard some people are, and you did this, right, like leaving their masks outside the patient's room. In a paper bag, yeah. Again, if the mask is wet, it's not going to work, so don't- Don't get a wet.

Yeah, I mean, if it's wet, you need a new one. Don't get a wet. Don't feed it after midnight. I mean if it's what if it's wet, you need a new one. Don't get away. Don't feed it after midnight I don't even know how you do that And then of course alongside the in 95 respirator now To properly protect yourself when carrying for a patient who has coronavirus You need gown you need gloves and you need some sort of eye protection Ideally those face shields have you seen those? Yeah.

That's the best. That's better with that. And an N95 underneath is much better. Goggles are all that was available when I was recently working. And so goggles will help. But ideally, one of those face shields is better. Let's keep going in your tear ducts.

Just anywhere in your eyes. Sure. Not just the tear ducts, but anywhere on your eyes. But especially the tear ducts you think. Sure, especially the tear ducts. And then of course hand washing, not touching your face, not touching the outside of your gown, your gloves, I mean your mask. There's a very specific way to don and doff, personal protective equipment. And before, I mean, that's important to know,

like it's not something that you can just throw on and go in a room and be safe. You have to know how to put it on and take it off appropriately. Or else you'll end up accidentally infecting yourself or perhaps someone else. The cloth masks, that's a big question a lot of people have asked about the homemade masks.

Sure. It's sort of, it's a big question a lot of people have asked about the homemade masks. Sure. It's sort of, it's a double-edged sword. If you, if they're made effectively and used appropriately, there is a place for them. And certainly, if we're not going to have enough standardized, you know, NIOSH certified in 95 masks, we need something. Yeah. And I've seen recommendations out there like, well, you can just use a bandana. Well, no, that's not. That that's that's barely effective at all. So these masks are

definitely better than that homemade masks. There's just there are ways to make them. I've seen a lot of people including are using like filtering material, which is way better than just like a piece of cotton. Right. And so those are better. But the thing is like if you're going to wear them, again, you cannot get them wet. They need to be sterilized. If you're going to reuse them, some of them that are cloth can be washed and sterilized and all that in between uses.

And so you would need to do that and completely dried out. And they certainly shouldn't be used to give you like a false sense of security. Right. You know that you're still at risk. Exactly. And so if we're talking about as an adjunct for medical personnel who have no other options at that point

and needs something to keep them safe, then this is great. And all the people who are making them, thank you, you're doing a huge service. Keep it up. Yes, we need these. However, if you're making one so that you can wear it so you can go back out in public and go hang out with friends or go not social distance because you think that you have this mask on and now, you know,

now you're safe, no, then they would be giving you a false sense of security. No, you can't, they're not going to do that. You know what, don't do it with, even if you haven't had an N95. Well, no, well, you shouldn't be, right? You shouldn't be wearing a surgical mask. You shouldn't be wearing it in N95.

You should not be wearing those around just so that you can go, if you are a well person, just so that you can go be out in the world more, no. Healthcare workers need that equipment, not you. Stay home. That's the best thing you can do. So, you know, I think it's, I think it's a tough thing. I know a lot of doctors have said it shouldn't come to the point that we have to use homemade masks, but obviously it has come to that point in some parts of the country. And they're definitely better than trash bags and bayonanas, which are also being used.

If they do keep you from touching the outside of your mask, that's the other thing I thought they would be very helpful for. You won't accidentally grab the front of your N95 if you've got that barrier there. The other thing though is just stay home. Yeah. That's for everybody else who's not a healthcare worker and essentially doesn't have an essential business that they have to work at. Just stay home. Yeah, please. I'm worried about, you know, I'm of course a little bit biased here because I'm care very much about one particular health care worker, but you know they're doing their best and it's bad in some

places and we'll get worse. So do what you can do to this thing that you can do if possible, please. Yes, so do you stay home and let the healthcare workers wear the masks so that they have them when they need them so that they can take care of. And if you know any of them, you also sick. I've been driving around like when I'll go to pick up like groceries or dinner or whatever, on my essential trips that I'm where I'm sterile

and just gargling hands and hands. I don't know, we don't have hands hand sanitizer. That would be good though. We do wash our hands. Yes, yes. 20 seconds. Cindy's mom got us one pack of chlorox wipes that she used to disinfect after the hospital. Those are pretty intense. Those are like, those are not made for your skin. They are not for skin. They are, those were for my phone and my watch. And yeah, that is what those were for when I came to the door. And then I would wipe down the door handle. Yeah.

But I see, like, I still see some local dummies like hanging around, especially like teens and 20 year olds. If you know any local dummies and you're at neck of the woods Tell them to like just take it seriously please Just yeah, I feel like if everyone could reach out to one Local dummy then we could we could get to a lot of them. I would not call them that though if you're going to reach out There's probably I would say the more effective ways is to say, hey, I'm concerned. That you're dumb.

No, but your behavior may end up in you getting sick or somebody you care about getting sick. And, you know, can I help? Is there anything, you know, is there a reason why you need to be out now? Maybe there's an errand you need, maybe you need food or something and I can help with that. And you know, let's talk about this from six feet away. Or even better like,

could we talk on the phone about it? Could I, now that I've insulted you, could I have your number so I can call you from the safety of my home and discuss with you why you shouldn't be doing this? I resorted to just shouting up the window. Six feet, six feet, come on. Please, please. I would not advocate calling the window. Six feet, six feet, come on. Please, please.

Please, I would not advocate calling the police. I've seen that advocated. I would not, I would not advocate that. There's a lot of other issues, I think, with that using that as like your... Just paintball guns, folks. No, kidding. This is a joke said she's

So man, I don't know. I mean the best you can do is just remind people that like You're not a bad person you care about others Just you know, I know you're not about I know you're not doing this because you are malicious and wish harm And you probably don't think this is a big deal, but it is. And I'll give you the benefit of doubt and say, I know you're a good person who wants to do the right thing. And so let me just encourage you. Yeah.

Folks, that is going to do it for us for this week. Thank you so much for listening. Thanks to the taxpayers for these. They're some medicines. It's the intro and outro of our program. We are going to be next. Let's see, or actually, I guess, well, this coming Friday, next Friday, I don't know when exactly you're listening to this, but it will be on April the 3rd from 8 to 11 PM Eastern time.

Brother Travis is doing a Cincinnati Underground Secret Society show to raise money for equipment for healthcare workers responding to COVID-19, tickets start at $5 and are available at bit.ly-4dslash-cusslive. Bit.ly-4dslash-cusslive, Sydney and I will be on that stream. At some point, we hope you'll join us in raising some cash. Yeah, and thank you everybody out there for staying home and staying safe and watching your hands being good believers in science.

Stay hopeful, stay home. That is gonna do it for this week. No worries in science, not believers, no worries. No worries, not as catchy. That's gonna do it for this week. Until the next time, my name is Justin McElroy. I'm City McElroy catchy. That's a good idea for us today, this week. Until next time, my name is Justin McArroy. I'm Cindy McArroy.

And it's always don't drill a hole in your head. Alright!