Oregon Indefinite Mask Requirement is Subject of Debate

Poorly Fitting N95 Mask No Better than a Cloth Mask

Consumers Reports Advising People to Wear Efficient Tight Fitting Masks

When will Vaccinations Make It Safe Not to Wear Masks?

Concern About Mutations and a New Virus Wave

Various Agencies Require Unvaccinated People Wear Masks

Americans Will Continue Wearing Masks Post COVID

____________________________________________________________________________

 

Oregon Indefinite Mask Requirement is Subject of Debate

As states around the country lift COVID-19 restrictions, Oregon is poised to go the opposite direction — and many residents are fuming about it.

A top health official is considering indefinitely extending rules requiring masks and social distancing in all businesses in the state.

The proposal would keep the rules in place until they are “no longer necessary to address the effects of the pandemic in the workplace.”

Michael Wood, administrator of the state’s Department of Occupational Safety and Health, said the move is necessary to address a technicality in state law that requires a “permanent” rule to keep current restrictions from expiring.

“We are not out of the woods yet,” he said.

But the idea has prompted a flood of angry responses, with everyone from parents to teachers to business owners and employees crying government overreach.

Wood’s agency received a record number of public comments, mostly critical, and nearly 60,000 residents signed a petition against the proposal.

Opponents also are upset government officials won’t say how low Oregon's COVID-19 case numbers must go, or how many people would have to be vaccinated, to get the requirements lifted in a state that’s already had some of the nation’s strictest safety measures.

“When will masks be unnecessary? What scientific studies do these mandates rely on, particularly now that the vaccine is days away from being available to everyone?” said state Sen. Kim Thatcher, a Republican from Keizer, near the state’s capital. “Businesses have had to play ‘mask cop’ for the better part of a year now. They deserve some certainty on when they will no longer be threatened with fines.”

Wood said he is reviewing all the feedback to see if changes are needed before he makes a final decision by May 4, when the current rules lapse.

Oregon, a blue state, has been among those with the country’s most stringent COVID-19 restrictions and now stands in contrast with much of the rest of the nation as vaccines become more widely available.

At least six states — Alabama, Iowa, Mississippi, Montana, North Dakota and Texas — have lifted mask mandates, and some never implemented them. In Texas, businesses reopened at 100% capacity last month.

 

Poorly Fitting N95 Mask No Better than a Cloth Mask

Researchers, from the University of Cambridge, carried out a series of different fit tests, and found that when a high-performance mask – such as an N95, KN95 or FFP2 mask – is not properly fitted, it performs no better than a cloth mask. Minor differences in facial features, such as the amount of fat under the skin, make significant differences in how well a mask fits.

The results, published in the journal PLoS ONE, also suggest that the fit-check routine used in many healthcare settings has high failure rates, as minor leaks may be difficult or impossible to detect by the wearer. While the sample size was small, the researchers hope their findings will help develop new fit tests that are quick and reliable, in the case of future public health emergencies. The current study only evaluated the impact of fit on the wearer of the mask – the team will evaluate how fit impacts the protection of others in future research.

The COVID-19 pandemic has made well-fitting face masks a vital piece of protective equipment for healthcare workers and civilians. While the importance of wearing face masks in slowing the spread of the virus has been demonstrated, there remains a lack of understanding about the role that good fit plays in ensuring their effectiveness.

“We know that unless there is a good seal between the mask and the wearer’s face, many aerosols and droplets will leak through the top and sides of the mask, as many people who wear glasses will be well aware of,” said Eugenia

O’Kelly from Cambridge’s Department of Engineering, the paper’s first author. “We wanted to quantitatively evaluate the level of fit offered by various types of masks, and most importantly, assess the accuracy of implementing fit-checks by comparing fit-check results to quantitative fit testing results.”

For the study, seven participants first evaluated N95 and KN95 masks by performing a fit check, according to NHS guidelines. Participants then underwent quantitative fit testing – which uses a particle counter to measure the concentration of particles inside and outside the mask – while wearing N95 and KN95 masks, surgical masks, and fabric masks. The results assessed the protection to the mask wearer, which is important in clinical settings.

N95 masks – which are a similar standard to the FFP3 masks available in the UK and the rest of Europe – offered higher degrees of protection than the other categories of masks tested; however, most N95 masks failed to fit the participants adequately.

In their study, the researchers found that when fitted properly, N95 masks filtered more than 95% of airborne particles, offering superior protection. However, in some cases, poorly-fitted N95 masks were only comparable with surgical or cloth masks.

“It’s not enough to assume that any single N95 model will fit the majority of a population,” said O’Kelly. “The most widely-fitting mask we looked at, the 8511 N95, fit only three out of the seven participants in our study.”

One observation the researchers made during their study was the width of the flange of the mask - the area of the material which comes in contact with the skin – may be a critical feature to fit. Masks which fit the greatest number of participants tended to have wider, more flexible flanges around the border.

In addition, small facial differences were observed to have a significant impact on quantitative fit. “Fitting the face perfectly is a difficult technical challenge and, as our research showed, small differences such as a centimeter wider nose or slightly fuller cheeks can make or break the fit of a mask,” said O’Kelly.

Self-performed fit-checks are attractive because they save on time and resources and are often the only method of fit testing available. However, this study, and studies of fit-check systems in other countries, indicate that such fit-check systems are not reliable.

The researchers hope that their results will be of use for those who are working on new technologies and programs to assess fit, so that healthcare and other frontline workers are adequately protected in the case of any future pandemics. Additionally, they hope these results will bring attention to the importance of fit in clinical-grade masks, especially if such masks are to be widely used by the public.  This study did not evaluate the impact of fit on protecting others, which is a future area of research. 

Reference:
Eugenia O’Kelly et al. ‘Comparing the fit of N95, KN95, surgical, and cloth face masks and assessing the accuracy of fit checking.’ PLoS ONE (2021). DOI: 10.1371/journal.pone.0245688

 

Consumers Reports Advising People to Wear Efficient Tight Fitting Masks

For almost a year, many Americans have been wearing cloth face coverings to limit the spread of the coronavirus—but without clear guidelines on which types or brands of consumer masks are best. That changed last month with the publication of the first-ever standard for “barrier face coverings,” created through ASTM International, an organization that creates voluntary performance standards for thousands of consumer products.

It will take time for companies to start selling cloth masks labeled with the new ASTM certification, but manufacturers can start taking advantage of the standard immediately. 

While surgical masks, N95 masks, and other medical-grade personal protective equipment have long had established standards in place, this new standard for everyday face masks is a first and is meant to provide a benchmark for both manufacturers and the general public. Manufacturers will be encouraged to comply with the standard, and consumers will be able to have confidence in compliant products, knowing that they are certified.

The new standard, which applies to face coverings worn by the general public and workers outside of healthcare settings, will provide guidelines for how well masks should filter out airborne particles, as well as for their breathability, fit, and labeling. The standard will also provide guidance on cleaning and how long masks can be used.

To meet the standard, manufacturers need to have their masks tested by an independent third-party lab. The products that pass will be able to note on their labeling that they are certified as ASTM-compliant, which will signal to consumers that those face coverings have been vetted.

The standard will be a big help to consumers, says Linsey Marr, PhD, a professor of civil and environmental engineering at Virginia Tech in Blacksburg who studies airborne viruses. Currently, “most people have no idea what to look for or how to judge a mask when shopping for one,” she says. “The No. 1 question I hear from members of the general public [is], ‘How do I know this is a good mask?’ With the new standards, manufacturers can share their mask’s filtration efficiency, fit, and breathability, and consumers can easily pick masks with higher numbers.”

The lack of an established standard for consumer face masks “was a gap that we recognized back in the springtime,” says Jonathan Szalajda, deputy director at the National Personal Protective Technology Laboratory at the National Institute for Occupational Safety and Health, and co-chair for the ASTM working group that created the new standard.

While it would have been ideal to have the standard in place sooner, arriving at one was complicated, requiring input from a group of manufacturers, government officials, academics, medical experts, and consumers. And compared with the typical ASTM process, “this was lightning-fast,” Szalajda says.

“It’s been a Wild West with regard to these types of products, and there really needed to be a baseline established for identifying some minimum level of performance,” he says. “We understand that not everyone—for instance, small sellers—will be able to meet the ASTM requirement, but the hope is that this standard will provide for better products in the workplace and for the public.” 

ASTM came up with two classifications for the mask standard: a lower level 1, which is the minimum level required to meet the ASTM standard, and a higher level 2, for manufacturers that want to produce face coverings that go beyond the ASTM minimum.

Level 1 ASTM-certified masks will have to show via independent testing that they can filter out at least 20 percent of particles smaller than a micron, which is roughly the size of the respiratory droplets that generally carry the coronavirus. Level 2 ASTM-certified masks will have to show that they filter out at least 50 percent of these particles.

By way of comparison, the ASTM-certified masks will be required to filter out far less than an N95 mask but will still offer much more protection than do most consumer face coverings currently on the market, says Jose-Luis Jimenez, PhD, professor of chemistry at the University of Colorado in Boulder. Right now, “I can guarantee you that half of what is sold doesn’t meet either level 1 or level 2 of the new standard,” says Jimenez, who studies aerosols. “So as the standard starts to be applied, consumers will have a way to choose.”

Marr agrees that “the new standards are very useful, in that they address the three most important qualities in a mask: filtration, fit, and breathability,” she says. “The standards for filtration are a minimum, and people will be able to choose masks that have much higher filtration efficiencies if the manufacturer provides this information.”

Ultimately, having the standard in place is a win for consumers because it should elevate the quality of the face coverings available on the market. 

Until ASTM-compliant masks are available, experts say to look for snug-fitting masks that fully cover your nose and mouth, and that don’t have valves or vents, which increase the risk of you breathing in unfiltered air and breathing it out, possibly exposing people around you. For more on how to find and wear a mask that offers the best protection, see “5 Ways to Upgrade Your Mask.”

 

When will Vaccinations Make It Safe Not to Wear Masks?

The vaccination rate is accelerating but the States where vaccination is low are the same ones where people will stay indoors to keep cool. This  proved dangerous last summer.

Nearly 100 million Americans are fully vaccinated and new coronavirus cases are at their lowest level since last October. Could the vaccination campaign finally be winning the race against the coronavirus in the United States?

That's the big question the nation has been waiting to answer. While some researchers say it's still too soon to know for sure, a growing number of epidemiologists, infectious disease researchers and public health experts think the country might have reached — or be about to reach — that crucial inflection point.

"I think we've hit a tipping point," says Dr. Ashish Jha, the dean of the Brown University School of Public Health. "We've really turned a corner on this latest wave. And I think that the worst days of the pandemic really are now behind us."

Jha and others base that conclusion on several factors. First of all, a significant proportion of the U.S. population — an estimated 34% — already has some immunity to the virus from having been exposed to the virus.

Secondly — and most importantly — the vaccination campaign has now inoculated a significant number of people. More than 43% of the population has now gotten at least one shot, and a third are fully vaccinated. That's getting very close to where other countries, such as Israel, started to turn the corner and experience a precipitous drop in infections.

The combination of natural immunity from people who were exposed and vaccination "means we may be closer to 60% population immunity already," Jha says. "That's why I'm pretty confident we have turned the corner."

And, in fact, the number of people getting infected every day in the U.S. has finally begun to fall again, after months of rising slowly. Over the past two weeks, the average number of new daily infections has dropped 27%.

"I do think we've hit a turning point," says Dr. David Rubin, director of the PolicyLab at Children's Hospital of Philadelphia. "We're seeing a significant, substantial decline now. And we hope it just deepens over the next few weeks."

Now, not everyone is so optimistic. Infections are finally falling in Michigan. But the virus is still spreading fast there and in other places, such as Oregon, Washington state, and parts of Colorado and Arizona. And many experts worry people are letting their guard down too soon.

"Time will tell," Dr. Thomas Frieden, a former director of the Centers for Disease Control and Prevention, wrote in an email to NPR. "Michigan-like outbreaks remain quite possible until we have more immunity."

"There was a fourth surge, whether it's already receding isn't yet knowable," he adds. "It didn't feel so bad because it was so much smaller than the third. It has been a bit larger than the second and may not be over yet."

Jennifer Nuzzo, a senior scholar at the Johns Hopkins Center for Health Security, is also cautious. "I think we're getting close to the tipping point, but I want to see a few more weeks of declining cases before I can say that we're there," she says.

But others are more confident the country has reached a long-awaited threshold thanks to vaccination.

"The results of vaccination have been truly astonishing in terms of its value of getting us back to normal and liberating us from this pandemic," Rubin says.

The vaccines look like they've even been able to stave off the threat posed by the variants, including the B.1.1.7 variant, which is the highly contagious strain first spotted in Britain that is now the dominant in the U.S.

"We have created a wall which is preventing the variant, particularly the UK one from the UK and others, from spreading and surging," says Dr. Eric Topol, a professor of molecular medicine at Scripps Research.

The optimism also comes from several mathematical models of the pandemic that try to factor in, among other things, the spread of the variants, the level of vaccination and how much people are following public health guidance such as wearing masks and social distancing.

"The model for every state shows that if the state isn't already in decline, they should start to see a decline in a few weeks," says Dean Karlen of the University of Victoria in Canada, who has been modeling the effect of the variants on individual U.S. states. "And hopefully, we'll start seeing the decline go faster and faster, assuming the vaccination rate continues."

All that said, the country isn't completely out of danger. The number of people getting infected every day remains high. And there are some worrying trends, mostly notably a recent sharp drop-off in vaccinations.

"We're starting to try to vaccinate those who have been a little more hesitant or harder to reach or have been having trouble accessing vaccines," says William Hanage, an epidemiologist at the Harvard T.H. Chan School of Public Health. "It is really, really important that we do reach those people."

In addition, vaccination rates vary a lot across the country. A big worry are places where not enough people are rolling up their sleeves, such as some Southern states like Alabama, Georgia and Mississippi.

"If you remember back to last spring, many of the states across the South thought that they had escaped COVID-19. Then it started to get hot. People went indoors into the air conditioning. That was a perfect storm for spread of COVID across our Southern states last summer," says Dr. Megan Ranney, an assistant dean at Brown University.

"I worry because those are the same states where our vaccine numbers are not great. And so it sets them up potentially for a rise in COVID-19 cases again," Ranney says.

So even those who are convinced that the nation as a whole has hit a tipping point acknowledge that individual metropolitan areas, states or regions with low levels of vaccination could experience outbreaks throughout the spring and summer.

And many are predicting another surge could occur in the fall if too few people have gotten vaccinated by then, and people retreat back indoors because of the colder weather.

 

Concern About Mutations and a New Virus Wave

Dr. Paul Offit, director of the Vaccine Education Center at the Children's Hospital in Philadelphia said, “This virus is continuing to mutate". "The thing I'm most worried about is that this virus will mutate to the point that immunity induced by natural infection or vaccination doesn't work at all. That's the most important reason to vaccinate."

The longer a virus circulates among unvaccinated people, the more opportunities it has to mutate. And if the mutations are significant, they can lead to more problematic variants -- including some that could partially or fully escape vaccine protection.

"It's already starting to happen," Offit said, citing the B.1.351 and P.1 variants. While vaccines are still effective against those strains, "these variants have now started to escape from the immunity of natural infection or immunization. They don't completely escape, but they've started to escape."

So the key to ending this pandemic isn't just getting vaccinated. It's getting vaccinated as soon as possible, before the virus mutates into variants that we can't control with our current vaccines.

"The vaccine is the most important pathway to ending this pandemic. That means we've got to get everyone in our country vaccinated," says US Surgeon General Dr. Vivek Murthy.

 

Various Agencies Require Unvaccinated People Wear Masks

LA County requires unvaccinated people to wear masks.  Unvaccinated or partially vaccinated people are still asked to wear masks when they are near other people who may be not fully vaccinated.

The Transportation Security Administration announced on Friday that it will be extending mask requirements for all travelers through Sept. 13, 2021, according to an agency tweet. This includes at airports, onboard commercial aircraft, on over-the-road buses, and on commuter bus and rail systems," the agency tweeted.

The TSA’s initial face mask requirement was put into effect on Feb. 1 and was set to expire on May 11, according to an agency news release.

CDC says Unvaccinated people — defined by the CDC as those who have yet to receive both doses of the Pfizer or Moderna vaccine or the one-shot Johnson & Johnson formula — should wear masks at outdoor gatherings that include other unvaccinated people. They also should keep using masks at outdoor restaurants.

Fully vaccinated people do not need to cover up in those situations, the CDC says. But everyone should keep wearing masks at crowded outdoor events such as concerts or sporting events, the CDC says.

Americans Will Continue Wearing Masks Post COVID

• In a new survey, a majority of people in the United States indicated they will continue COVID-19 safety protocols, such as wearing masks and keeping physical distance, even after the pandemic eases.
• A majority also plans to make adjustments at their place of employment.
• Experts say the survey represents a good trend, but they note a number of people may revert to previous behaviors once they think the pandemic has ended.

Pandemic precautions are getting old, but they’re effective.

That may be why many people in the United States plan to continue them after the threat of COVID-19 eases up.

At least that’s how they felt in January when surveyed by The Ohio State University Wexner Medical Center.

The national survey of more than 2,000 people found that most plan to continue with precautions such as hand hygiene, avoiding crowds, and wearing a mask in public.

“There’s reason to be optimistic about the results in a general sense,” said Dr. Iahn Gonsenhauser, Wexner’s chief quality and patient safety officer.

“The survey represents people’s best intentions right now, but people have a tendency to regress a bit from intent,” he told Healthline.

“In other cultures, wearing masks in densely populated urban centers has been a matter of daily life for a long time,” Gonsenhauser said.

There’s been some reluctance to accept mask wearing in the United States. But of those surveyed, 72 percent said they’ll continue wearing a mask in public after the pandemic.

“It will be interesting to see if the lessons learned from this experience will apply to other areas,” Gonsenhauser said.

“People gloss over that in a typical year we lose 50,000 to 70,000 people to influenza. That’s not the case this year due to masking. We’ve hit a 130-year low,” he said.

“Will people process this and come to recognize that there’s a lot of opportunity to impact life outside COVID-19 with the same measures? What would a future without significant flu look like in terms of a decrease in lost lives, business productivity, and healthcare savings?” he said.

Gonsenhauser noted that over time, people do tend to revert to ingrained behaviors. It may be that a small subset will continue wearing masks in crowds.

The Centers for Disease Control and Prevention (CDC)Trusted Source has long advocated for proper handwashing to help prevent spread of disease.

It’s a habit that may have finally taken hold due to COVID-19. In the survey, 90 percent of respondents said they’ll wash or sanitize their hands more frequently post-pandemic.

Dr. Charles Bailey is medical director for infection prevention at Providence St. Joseph Hospital and Providence Mission Hospital in Southern California.

Bailey told Healthline that handwashing and respiratory etiquette are changes we should be incorporating into our lives.

“Hand hygiene and covering your cough with your elbow, not your hand, are behaviors that hopefully catch on. Not washing hands especially is an unrecognized factor in COVID-19 spread,” he said.

Of those surveyed:

• 80 percent want to continue avoiding crowds
• 76 percent will avoid shaking hands, hugging, and embracing others

“Again, people have the best intentions during this time while there’s still ongoing trauma of experiencing the pandemic,” Gonsenhauser said.

“We have a tendency in these moments for grand perceptions of how it will fundamentally reshape the nature of our culture and how we behave in social situations. In a few years, or even months, things may revert back to normal,” he said.

Shaking hands is part of American culture, and Bailey thinks it may make a comeback.

“Some will do elbow bumps or foot taps, but most will get back to shaking hands. There are risks in life. A totally risk-free existence is not very worthwhile, and people recognize that,” Bailey said.

During the pandemic, the practice of blowing out the candles on a birthday cake is another thing that has fallen out of favor. Bailey suggested many people will get back to that as well.

“I don’t see it disappearing in the majority of families, especially with family and close friends, when people are not obviously ill. The pendulum will swing pack toward pre-COVID normalcy to the extent it can for those individuals who have been tainted with lifelong COVID or in a germophobic situation. Some will never be the same,” Bailey added.

In the survey, 73 percent of respondents said they plan to stay home when sick.

While that’s always been sound practice, many jobs in the United States don’t provide paid sick leave.

“This is less of a problem in the upper income bracket. People in lower socioeconomic brackets have a different set of challenges in staying home from work,” Gonsenhauser said.

“It’s part of what we’ve seen all along and is continuing to drive disparities in outcomes due to the flexibility to stay home when sick,” he said.

Gonsenhauser believes employers have a responsibility to ensure a safe work environment, noting that having employees who feel compelled to go to work when sick is also bad for the bottom line.

“There’s a responsibility on both sides that is coming to the forefront and, hopefully, will make a difference in the future,” Gonsenhauser said.

Bailey said that workplaces will have to make adjustments.

“Some companies can be more efficient with part of the workforce off-site,” Bailey said. “They can make changes in terms of more spread-out workspaces and availability of hand hygiene to attract workers back to the workplace. Companies that can will probably retain more people.”

“Businesses will have a vested interest in following some type of COVID-19-era practices to draw in customers who need to feel comfortable, and also to avoid being caught by surprise by the next flare-up and paying the consequences again with draconian government measures in place,” Bailey added.

When comparing today to the 1918 flu pandemic, Gonsenhauser said we’ve already moved through some parallels in initial de-escalation of precautions.

One big difference between then and now is that we have vaccines.

“They didn’t, and that will change what the next phase of this looks like. Certainly, we’re in a race against variants that are more transmissible. At the point we start to see new cases outpacing the vaccine, that will be trouble and will extend the pandemic,” Gonsenhauser said.

“There’s no reason to think that will happen, but the behaviors we engage in over the next handful of months will determine how long this lasts,” he said.

So, how do you know when a pandemic is over?

You don’t. At least not in real time. It’s something that can’t be defined other than in retrospect, according to Bailey.

“Maybe in five years we can say the pandemic seems to have ended in the fall of 2021 or spring of 2022. It’s not obvious because it’s something that goes through cycles. So, we just don’t know,” he explained.

It’s that uncertainty, Bailey said, that creates a variety of behaviors based on individual comfort zones.

One crucial factor is communication.

“It’s an iffy proposition if there’s not consistent messaging or it’s not consistently received by all people,” Bailey said.

“To the extent that somebody believes it’s over and we can close the books on COVID-19, they’re more likely to get back to pre-COVID-19 normal. Those that have lingering doubt that it’s really gone will be more likely to continue with risk mitigation,” Bailey said.

Change may come more quickly than we may presume at this point, Gonsenhauser said.

“There may be a growing resistance to continuing precaution measures once the numbers look more manageable. So many people are so burned out and so ready,” he continued.

Bailey suggested there’ll be a variety of behaviors, none of which are wrong.

“Some may look at the end of COVID-19 as a reason to adapt a ‘carpe diem’ philosophy until they have some event happen to make them realize that’s not wise. Some will maintain pretty much as before. Others will lead a ‘subterranean existence’ as a result of their experience,” he continued.

But it will be a defined era, Bailey said.

“I hope people have been able to retain some optimism through this, and that it can help guide their future life to be happier than it might be if they can’t put the COVID-19 era behind them,” he added.