Way back in early February, before people in America really knew about the novel coronavirus now called COVID-19, Influenza A and B both went through our elementary school like wildfire.
The kindergarten wing was hit particularly hard, and one day when I came in to volunteer with small group centers, more than a third of my son Gabe’s class was absent.
I finished playing Uno with my four eerily small groups of children and went to tell Gabe goodbye.
After sanitizing with the natural hand sanitizer I had with me, I smooched the top of his head and said, “See you after school, buddy – wash your hands a lot and don’t touch your face!”
The little girl next to Gabe looked up at me and, curiosity in her voice, asked, “Why? Why not touch his face?”
I reacted in surprise, not realizing at the time that apparently most people didn’t yet know this. “That’s where germs can get into your body, through the holes on your face,” I stammered. Not the most eloquent explanation, I know!
I clarified with a few more sentences, and she nodded very solemnly, eyes wide, then said slowly, keeping very still:
“I’m trying not to touch my face…but my forehead itches!”
It was a hilarious story that I told many times in the next week, but in retrospect, it has more foreboding.
Who would have guessed at that time that “Don’t touch your face” would become part of the national lexicon and that handwashing for 30 seconds would finally join our collective habits?
I was ahead of my time with that advice, and those two are definitely the best and most proven practices to reduce the spread of contagious disease.
Face coverings (i.e. masks) are the new player in the game, at least here in America.
“If We’re Going to Wear Masks, We’re Going to Do it Right”
I’ve been saying that to my family this month after we learned that our kids would be required to wear masks all day at school.
Although we considered keeping them home to avoid the masks, we chose to send 3 of our 4 kids in person, so I’ve been training them “how to wear a mask” as I learned from Elisa Song, MD, in her wonderful online program Integrative & Functional Medicine Strategies for the Pandemic. (You can get a taste via her free pandemic masterclass HERE.)
“Earloops only!” I’ll belt as we get out of the van.
“Hang it up, fingers away from the inside!” come the instructions as we return to the van.
My husband started questioning my vigilance.
“I know you have good intentions, dear, but I’m not hearing ANYone else say this. I’ve never seen an article about it. The government doesn’t seem to be saying anything other than ‘face coverings required.’ Don’t you think people would be shouting this far and wide if it really was important?”
I decided to reach out to my colleagues who are medical doctors and ask them what they thought.
They agreed – with both of us.
YES, I’m right. There are proper and improper ways to wear masks to protect the wearer (and others around us).
YES, my husband is right. No one is talking about this — and that’s a real problem!
If there aren’t articles going around on every school Facebook page where students are required to wear masks even part of the day, and if parent groups aren’t encouraging each other to do this right IF we’re going to have to do it, then I’m going to write the protocol you can share.
Even though mask-wearing is intended to protect others around us from our own potentially contagious bodily fluids if we’re an asymptomatic carrier, we don’t want to invite harm to ourselves in the process!
What is the Purpose of Wearing a Mask During the COVID-19 Pandemic?
The CDC says:
Masks are meant to protect other people in case you are infected, and not to protect you from becoming infected.1
The CDC also states it this way on their page about “How to Wear Masks”:
Wear a mask that covers your nose and mouth to help protect others in case you’re infected with COVID-19 but don’t have symptoms.2
This is VERY important to remember, and I know we’ve all heard that a million times, but I think a lot of people still carry the false belief that they themselves are safer with a mask on.
I was talking to a friend who said an elderly family member of hers did some traveling this summer, “but she was safe, she wore her mask all the time,” she reassured me.
I said, “You know masks are supposed to protect others, right, not ourselves?”
“Of course I do!” she shot back. “But if everyone is wearing them then everyone is safe.”
Well…I really think that this friend and her relative aren’t the only ones who can say with their intellect that masks protect others but somehow believe in their bones that it will protect them.
My husband pointed out that sometimes we get a lingering cognitive memory somehow that we just can’t shake.
For example, if we’re planning to go to the beach on a Friday, and then something comes up and our plans change, often my brain will still be thinking about the picnic lunch I’m planning to pack for the beach and mentally tallying to make sure I have enough food on hand for all six of us.
And then THUNK! The actual reality clicks in that we’re no longer going to the beach, and I’ve been wasting brainpower planning out our meal.
Somehow my brain imprinted the first plan and couldn’t quite overwrite it with the second.
I believe this is happening to a lot of people with masks.
They at some point have believed or learned erroneously that masks would keep them safe from the coronavirus.
Even though they’ve since learned differently, that masks are really a potential act of service to others, their brain is holding onto that former knowledge and can’t quite overwrite it completely.3
So let’s repeat again what the CDC says: “Masks are meant to protect other people in case you are infected, and not to protect you from becoming infected.”
Also please remember that the masks and social distancing are only supposed to reduce the spread, not eliminate it, as none of these practices are 100% efficient. That’s not even the goal here.
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CDC: Cloth Masks are Good Enough
The COVID-19 coronavirus is between 0.06-0.12 microns, which is extremely tiny, like 1/40 the width of a human hair!
However, the CDC says cloth masks are enough:
The masks recommended are not surgical masks or N-95 respirators. Those are critical supplies that must continue to be reserved for healthcare workers and other medical first responders, as recommended by current CDC guidance.4
In Michigan, our Executive Order from the governor (not a law, which should be noted) requires facial coverings in all public places and for schoolchildren under sixth grade. Cloth masks are allowed, but face shields are not.
Our school has gone beyond the state’s minimum requirements for returning to school and will be requiring all ages to wear masks all day long. (source: PDF)
I’m nervous about this actually putting my children at risk, bringing pathogens to their faces.
My concerns aren’t just about “catching corona” as the kids say, but that in general, we’re creating an environment where more germs and toxins are brought directly to their faces because a school (and a child) is not exactly a lab situation with hamsters.
Quick note: Some folks ARE actually saying officially that mask-wearing may protect the wearer from catching a more severe case of COVID-19, but notice that the only studies are done on hamsters in masked cages who aren’t, ahem, tugging at their mask all day.5 Any real-life scenarios could be confounded by people simply getting better at basic hygiene as the pandemic continues, OR by the virus getting less contagious and less severe naturally, which is the expected course for any new virus. It’s called “reversion to the mean,” according to John M. Barry’s book The Great Influenza.6
These child-sized organic masks from Etsy are what we bought for some of the kids, and Gabe loves the fit.
Could a Mask be Dangerous for the Person Wearing It?
I watched a video recently with some health experts recommending universal masking, and they said, “Masks help people touch their faces less.”
I’m not sure if I need a study for this, and you don’t either.
Watch people the next time you’re out in public.
If the average adult touches their face somewhere between 16-23 times an hour, “less” than that should be a significant reduction, perhaps 50%.7
I’m going to take an educated guess that people wearing masks touch their faces at least double those numbers because they’re constantly adjusting their mask and tugging at it!
Even in a doctor’s office, I asked my PA if he thought the mask was helpful, “because you’ve touched it about 23 times since I got here 5 minutes ago.” He agreed it was just for appearances to patients.
When we’re talking schools and children required to wear masks, I predict higher face-touching instances than adults.
So at a very basic level, masks may actually increase the spread of contagious disease by:
- causing the wearer to touch their face more often
- creating a moist environment where bacteria can thrive, right near the nose and mouth
- collecting pathogens including viruses when stored improperly, then delivering them directly to the face (as in the case of a person setting their mask down then wearing it again, jamming a mask into a pocket that may be contaminated, or any other instance where a mask touches a surface that hasn’t been recently washed)
A group of hospitals in Canada released a Recommendations for School Reopening document (PDF, accessed 8.27.20) and noted each of the above situations along with concerns about children’s mental, social, and academic health while in masks. There’s also a concern about generating a false sense of safety, as I explained above.
My goal today is to mitigate some of the physical health risks to the wearer as much as possible through proper mask-wearing protocol.
RELATED: Boost your immunity during the pandemic!
How to Wear a Mask Properly, as Recommended by Doctors
I ran this by a dozen MDs, DOs, and NDs, and even with their extremely busy schedules, 8 of them approved and contributed to the following steps to wearing a mask safely and properly:
- Wash your hands before putting on your mask (or use hand sanitizer if water is not available).
- Touch earloops only when putting your mask on. For gaiters, touch the sides by the ears only.
- If you have a nose wire (disposable or cloth) adjust it once when you first put it on and don’t adjust again.
- Wear the mask over both your nose and mouth.
- Breathe through your nose only.
- After that, don’t touch the part of your mask that touches near your nose! In other words, don’t pull the mask down at the nose, adjust using only the ear loops no matter what, and if you need a breath or “mask break,” use only the ear loops. This is totally possible!
- Don’t pull at the outside of your mask or touch the outside, even after you’ve taken it off when possible.
- Take masks off by earloops only.
- Make sure the inside of your mask doesn’t touch anything, including your hands or tables.
Show This Video to Your Kids!
If you can’t view the video above, click “Wear a Mask Safely to Protect YOU” to view it directly on YouTube.
Honestly, almost all these protocols could be boiled down to:
Earloops only, don’t touch the mask!
Extra Notes for Little Kids (& Adults Who Never Grew Up)
I can’t wait to start hearing stories of what kids creatively do with their masks…sigh.
Share these notes with your kiddos!
- Sharing is great, but your friends and pets don’t need your mask.
- Keep the mask out of your mouth.
- Masks aren’t blindfolds. Or headbands.
- Slingshots are fun, but not the same as masks.
- Masks aren’t the new stress ball — don’t fiddle with them.
- What else? 🙂
Approving doctors for this list include:
- Dr. Elisa Song, MD
- Dr. Ana Maria Temple, MD
- Dr. Madiha Saeed, MD
- Dr. Shiroko Sokitch, MD
- Dr. Joel Warsh, MD, MSC
- Dr. Deborah Matthew, MD
- Dr. Valencia Porter, MD
- Dr. Sheila Kilbane, MD
The other docs didn’t respond; no one disagreed with these protocols. The other stories and research in the post are my own.
The doctors I asked to approve this list range in mask-belief from those who feel like kids shouldn’t even be wearing masks all day to those who want to sanitize any surface a mask touches the moment it’s picked up.
Some don’t think masks are effective at all while others told me, “The most important thing is that people wear the masks, even if they can’t get this part right.”
But…how realistic are these expectations, especially for children?
It’s going to be an interesting school year…nonetheless, I’ll be reminding my own children that if we’re going to wear a mask, we’re going to do it properly, to cause the least risk to our own bodies.
Yes, masks don’t only cause us to potentially bring more germs to our face, exactly what they’re trying to avoid, but those wearing masks all day without proper medical exams and training could be at all sorts of other risks.
Teachers are reminding kids to wear their masks over their noses to protect others, but they need to include protocols to protect the kids wearing masks too, like NOT touching the nose area (which many teachers are doing purposely as a silent reminder to the kids to pull up their masks, le sigh).
My goal is to have my family wear masks as few minutes as possible while still respecting others and the rules and regulations, and I’m on a new mission to help YOU protect your family from the risks of wearing masks too.
Read all the safe mask wearing posts:
- How to Take a Mask Break
- What’s Better: Cloth or Disposable?
- How to Wash Face Masks (including 5-minute hacks for busy mornings if laundry was forgotten!)
- Risks of Face Masks You Can Mitigate
- Dangers of Face Masks
- Centers for Disease Control. (2020, August 27). Coronavirus Disease 2019: Frequently Asked Questions. Retrieved from https://www.cdc.gov/coronavirus/2019-ncov/faq.html Accessed August 28, 2020.
- Centers for Disease Control. (2020, August 7). How to Wear Masks. Retrieved from https://www.cdc.gov/coronavirus/2019-ncov/prevent-getting-sick/how-to-wear-cloth-face-coverings.html Accessed Sept. 1, 2020.
- Dolcourt, J. (2020, May 1). Will homemade face masks keep you from getting sick with coronavirus? What to know. Retrieved from https://www.cnet.com/how-to/will-homemade-face-masks-keep-you-from-getting-sick-with-coronavirus-what-to-know/
- Centers for Disease Control. (2020, July 31). How to Protect Yourself & Others. Retrieved from https://www.cdc.gov/coronavirus/2019-ncov/prevent-getting-sick/prevention.html
- Weise, E. (2020, July 15). Wearing a mask doesn’t just protect others from COVID, it protects you from infection, perhaps serious illness, too. Retrieved from https://www.msn.com/en-us/news/us/wearing-a-mask-doesn-t-just-protect-others-from-covid-it-protects-you-from-infection-perhaps-serious-illness-too/ar-BB16LciZ
- Gerhaghty, J. (2020, May 11). More Than You Ever Wanted to Know about Viral Mutation. Retrieved from https://www.nationalreview.com/corner/more-than-you-ever-wanted-to-know-about-viral-mutation/
- Citroner, G. (2020, March 10). You Probably Touch Your Face 16 Times an Hour: Here’s How to Stop. Retrieved from https://www.healthline.com/health-news/how-to-not-touch-your-face
- Face Mask: How to Put on (Don) and Take Off (Doff) PPE. (n.d.) Retrieved from https://www.registerednursern.com/face-mask-how-to-put-on-don-and-take-off-doff-ppe/
- PRIMED Medical Products. (2020, April 9). How to Wear a Face Mask Safely – Medical PPE Donning and Doffing [Video file]. Retrieved from https://www.youtube.com/watch?v=qx4tpwnSrbk
- Donning Doffng Mask Instructions with Pictures. (n.d.) Retrieved from https://www.umassmed.edu/globalassets/coronavirus-new/donning-doffing-mask-instructions-with-pictures.pdf
- How To Don & Doff a Face Mask. (n.d.) Retrieved from https://www.opro-tec.com/us/blog/post/how-to-fit-a-face-mask
- Yu, C. (2020, March 30). Donning and Doffing N95 Mask for Reuse. [Video file]. Retrieved from https://youtu.be/EhxpJFDHAeI
- Song, E. (2020, June 30). Flying with Kids During a Pandemic [Blog Post]. Retrieved from https://healthykidshappykids.com/2020/06/30/flying-with-kids-during-a-pandemic/
- Centers for Disease Control. (2019, March 5). Interim Guidance for the Use of Masks to Control Seasonal Influenza Virus Transmission. Retrieved from https://www.cdc.gov/flu/professionals/infectioncontrol/maskguidance.htm
- Centers for Disease Control. (2020, August 7). Considerations for Wearing Masks. Retrieved from https://www.cdc.gov/coronavirus/2019-ncov/prevent-getting-sick/cloth-face-cover-guidance.html#surgical-masks