Masks and Protective Equipment

Posted by Nurse Linda in Life After Paralysis on April 08, 2020 # COVID-19

The regulations for wearing masks have changed. This is due to several factors. The COVID-19 virus is spreading faster than was first thought. There are several issues that surround this. As more testing is being conducted, more individuals are being found to be positive. This creates more people able to spread the virus. Every individual who has the virus can spread it to many people. Those can then spread it to even more and so it continues. Masks Coronavirus

Reasons for the quick spread is in part due to the ability for COVID-19 to spread even before a person knows they have it. If there are no symptoms, people think they do not have it, engage with others and the spread becomes out of control. The more people who have the virus, the more it is spreading. As there currently is no treatment or vaccine, COVID-19 spreads without barriers.

Any barrier to your respiratory system will help decrease your risk of contracting COVID-19, if you have a spinal cord injury, other risk factors or not. Wearing a mask will help decrease an individual’s risk of contracting COVID-19, not the risk factors that affect your body’s response to it. The risk of contracting COVID-19 is the same for everyone. Everyone has an equal opportunity for contraction of COVID-19. Therefore, everyone should protect themselves.

How your body will respond to COVID-19 is affected by the risk factors that you have in your individual health status. These include your age of 60 or above (now more specifically age 65 or above), having a heart condition, asthma, diabetes (especially uncontrolled) and immunosuppression among others. Some of the people who have immunosuppression include those with spinal cord injury, those with other neurological disease, those with organ transplants and those who receive chemotherapy. Additional risk factors are listed on the webpage:

Due to the high risk that everyone has for contracting COVID-19, health agencies are mandating that everyone wear a mask. This can include surgical masks, cloth masks or homemade masks. The mask must cover your nose and mouth. A mask helps protect your respiratory system. To fully protect your respiratory system, your mouth AND your nose must be covered. I often see people with a mask that they wear just over their mouth. This is insufficient. Both nose and mouth need to be covered.

For these reasons, new restrictions are being placed on the population. Primarily, masks should always be worn outside of your home and by everyone. This could help stop the spread of the disease as well as reduce your risk of catching it.

The N95 mask is the best for controlling the spread of viruses as it blocks about 95% of viruses. Since these masks are in short supply, they should be used by those who are directly caring for individuals with COVID-19. Healthcare professionals in the field and in-home care are at highest risk for contact with the virus since they are either working with individuals who have confirmed cases of COVID-19 or are working with people who have the most risk factors if they contract COVID-19.

Since masks are difficult to obtain, you might need to create one. The key aspect for a mask is that you need to be able to breathe through it, but it should be thick enough to hamper the COVID-19 virus from getting through. Several layers of cotton cloth should be used. The mask should conform to your face, especially around the bridge of the nose. There should be no open areas around the nose, cheeks or chin. Open edges break the barrier of the mask which allows viruses and bacteria to enter. Cotton fabric works well for face masks as it is a breathable fabric and washes well.

To really be effective, a mask should be worn for about 20 minutes and then changed. After about 20 minutes, the mask becomes damp from your own breath, even though it might feel dry to touch. You can extend wear time if you add a filter to line your mask. Moisture allows bacteria and viruses to travel through it more easily. If you are out, you may need to find a safe place to change your mask.

Cloth masks can be washed and dried. It is best to wash them in hot water and dry on high heat. This will help destroy bacteria and other germs or viruses that could contaminate your mask. Putting a hot iron on a clean, cloth mask after washing may also help kill some of the germs.

There are many patterns and instructions for making a face mask at home. The best suggestion for mask creation information is directly from the CDC:

In addition, there are numerous tutorials on the web. Things to be sure to include in your face mask if sewing or folding is to include a twist tie or folded strip of aluminum foil at the nose area of the mask to provide that closure across the nose and top of the cheeks. Be sure the mask fits snuggly around the rest of your face. If you are making a mask for a child, adjust sizing to fit their smaller face and head. If the tutorial says a mask is as good as the N95 or similar to the N95, it is not the same.

Since COVID-19 is a new virus, there has not been time to test homemade masks effectiveness for this virus. There is a study of homemade mask use for the flu by A. Davies, et al. (2013). Testing the efficacy of homemade masks: Would they protect in an influenza pandemic? Disaster Medicine Public Health Preparedness. This study indicates homemade masks are a barrier for the flu virus.

Filters have been added by some people because the N95 is an air filtering mask. Homemade filters can be helpful, but they are different than the N95 filter. Be careful of the product you choose to act as a filter. Some microscopic particles or fibers can break off and get inhaled directly into the respiratory system. Particles can become irritants to the lungs or sometimes even cancerous when inhaled. Check your product list of materials contained in the filter fiber you are considering using.

Some people are using coffee filters or paper towels as their filter. Use several layers within your homemade mask. Their effectiveness for COVID-19 is unknown. They also breakdown when wet so even the moisture from your breath can affect them. These types of filter are not washable or reusable. These should also be changed about every 20 minutes.

The CDC instructions specify: ‘Cloth face coverings should not be placed on young children under age 2, anyone who has trouble breathing, or is unconscious, incapacitated or otherwise unable to remove the mask without assistance.’

Children under 2 might not understand or be able to remove the mask if breathing is hampered. There might not be enough oxygen in or carbon dioxide out of the mask for a child under 2 years. Individuals with spinal cord injury who have limited arm/hand function should not go out if a mask is needed. If you must go out to something critical like a medical appointment, the individual should be extremely and carefully observed if it is necessary to wear a mask to ensure they are breathing effectively.

Since COVID-19 likes to enter the body, perhaps now is also the time to wear protective eye covering such as safety glasses. These fit tightly around the head. Some of the wrap around style sunglasses have a similar fit, although they might not be as secure around your face. Since you are lower positioned, this could protect your eyes from those microscopic droplets that people expel when talking without even knowing it.

Gloves can be worn when pushing your chair to keep the COVID-19 virus or any debris off your hands. You will still need thorough handwashing. Be careful not to touch your gloved hands to your face or remove them with mouth assistance.

The best defense against COVID-19 is to stay safe in your home. The next few weeks are going to be critical in slowing the spread of the virus. Unfortunately, we are just starting to see the full power of the virus. The predictive models indicate the next two to three weeks will be a critical time. These models are only as good as the number of the population that will follow the shelter in place rules.

Keep a social distance of 6 feet when talking or visiting. If your care giver goes out of your home, it is time to consider if they should now be wearing a mask when providing personal care or if they are in less than six feet from you. This is not specified by the CDC, but common sense dictates extra precautions should be taken at this critical time. With the increase in precautions, set by the CDC, you do not want any additional risks in your home.

Follow the rules of hygiene. Wash your hands and face frequently but especially after being out. Wash your rims and wheels, canes and walkers before coming into your home. Change clothes after being outside. Wash the worn clothes immediately. Do not leave them laying around. If your shoes touch the ground, change those as well. Have outdoor shoes and indoor shoes. Wipe down surfaces in your home as well as frequently touched surfaces such as your phone, computer, car keys and fob, door knobs on your home and car, and frequently touched instruments in your car.

The more people who follow the recommendations, the quicker this will be pass us. We can do this, and we will! Nurse Linda

Pediatric Consideration: Kids are restless. Their routines have been turned upside down. No school, no play dates, no park. They do not understand why, nor do we want to frighten them with lengthy explanations. A simple acknowledgement of the problem is all that is necessary for younger children. Teens can be helpful in finding information. As a parent, you will need to decide what level of information is best for your child.

Provide some structure to your child’s day that is like what they would be doing at school. Use social media to contact other parents so your children can see each other. If they are small, they might not have much to say, so you will need to help guide the conversation with the other parent. Knowing their friends are doing well will help settle their curiosity.

Follow the CDC guidelines for masks for children. Under 2 years, masks should not be worn because the child might not relate wearing the mask to difficulty breathing. The mask can obstruct the gas exchange of breathing. A build up of carbon dioxide within the mask might make baby sleepy which may not be distinguished by the parent as a problem as sleeping is what babies do. It is probably best not to take the baby out of the house if possible or only to the car and then to the daycare if you are an essential worker. Nurse Linda

Linda Schultz, Ph.D., CRRN, a leader and provider of rehabilitation nursing for over 30 years, and a friend of the Christopher & Dana Reeve Foundation for close to two decades. Within our online community, she writes about and answers your SCI-related healthcare questions in our Heath & Wellness discussion.

For more resources on the coronavirus, visit the Reeve Foundation COVID-19 Information Center.

The National Paralysis Resource Center website is supported by the Administration for Community Living (ACL), U.S. Department of Health and Human Services (HHS) as part of a financial assistance award totaling $8,700,000 with 100 percent funding by ACL/HHS. The contents are those of the author(s) and do not necessarily represent the official views of, nor an endorsement, by ACL/HHS, or the U.S. Government.