Senior medical officer (SMO) of the Kingston Public Hospital, Dr Natalie Whylie, is appealing to ordinary Jamaicans to opt for cloth masks instead of surgical and medical grade N95 mask respirators which she says are not unlimited in supply and should be left for health care workers who need them more.
“I see a lot of persons wearing surgical masks, persons on the streets, and the Government of Jamaica is committed to providing adequate levels and numbers of personal protective equipment but we have to realise that the First World countries where these are manufactured are struggling in terms of supply so I would appeal to Jamaicans that if you don’t need to wear a surgical mask, that you wear a cloth mask so that those surgical masks can be allocated to the health care worker who need it more,” Dr Whylie said in an interview with the Jamaica Observer.
Asked whether this appeal was not better made to persons dispensing or selling the masks to Jamaicans, Dr Whylie said “what some governments have done is to mandate, but the Jamaican Government has not taken that approach because we are a democratic society so you can only appeal.
“I have seen persons on the streets with medical grade N95 mask respirators and that poses a personal challenge to me because there is not an unlimited supply internationally. I know there is a lot of panic in the society but persons have to be informed,” the SMO said in urging citizens to rely on credible information sources such as the Ministry of Health and the World Health Organization in making their decisions.
The Centers for Disease Control and Prevention (CDC) does not recommend that the general public wear N95 respirators to protect themselves from respiratory diseases, including coronavirus (COVID-19). According to the CDC, those are critical supplies that must continue to be reserved for health care workers and other medical first responders. The CDC instead recommends that members of the public use simple cloth face coverings when in a public setting to slow the spread of the virus, since this will help people who may have the virus and do not know it from transmitting it to others. It further recommends everyday preventive actions, such as hand washing and maintaining at least six feet of social distancing, to help prevent the spread of respiratory diseases.
It further points out that most N95 respirators are manufactured for use in construction and other industrial type jobs that expose workers to dust and small particles. However, some N95 respirators are intended for use in a health care setting. Specifically, single-use, disposable respiratory protective devices used and worn by health care personnel during procedures to protect both the patient and health care personnel from the transfer of microorganisms, body fluids, and particulate material.
In the meantime ,Dr Whylie said already over 1,200 front line workers from the South East Regional Health Authority (SERHA) have been fit-tested for specialised masks for treating COVID-19 positive patients. The sensitisation trainings were conducted last month.
“The mask fit-testing is a process and it really is done to ensure that the health care worker wears a N95 mask respirator that fits their face correctly. The shape of everybody’s face is different so you have to wear a mask respirator that fits and is sealed to your face properly so that you are adequately protected against the potential to inhale aerosolised respiratory secretions which may contain COVID-19 viral particles. So the fit-testing is a process, it was done by an occupational hygienist. This is someone who has the requisite certification in doing the fit-test process,” Dr Whylie outlined.
“A hood is placed over the person who is being fit-tested and there is a process which ensures that the N95 mask respirator that that particular health care worker will use is one that fits their face and they are also taught how to ensure that when they put it on that it is sealed so that they are adequately protected against aerosolised respiratory secretions. The hood is part of the mask fit-testing process. The hood is not worn over the health care worker’s head when they are on the field,” she explained further.
In explaining who comprised the 1,200 fit-tested so far she said, “a lot of times when persons hear about health care workers they think about doctors and nurses but there are other paramedical staff who support our activities as well as administrative staff. So they have to be fit-tested, the support staff, depending on what they do, because sometimes in the undertaking of their duties they may become exposed. So they are not a nurse or a doctor but, for example, a physiotherapist is an essential part of the respiratory therapy, so they also have to be fit-tested because they work alongside nurse and doctor to assist in respiratory therapy.
“So the numbers that were quoted, included physiotherapists, ambulance drivers, ambulance attendants, radiographers but the priority was given to nurses and doctors, 90 per cent are nurses and doctors. But we did ensure that, so let’s say, for example, a situation is unfolding and you need a porter to assist with a patient and the porter in the engagement of his duties may also be exposed, then we also had to fit-test a certain critical number of those persons so that they too can support. And what we have done is place those persons in those critical areas,” the KPH SMO noted.
In the meantime ,she said the 1,200 is not the totality of the efforts.
“The process continues, it is ongoing, because certainly when you count nurses and doctors you are looking at close to 800 persons for just a KPH alone. It is an incremental process, we selected the literal front line persons first but as you can imagine we work on shifts, staff is rotated periodically. The ultimate aim is to ensure that every single worker, front line and support staff who may be exposed to aerosolised secretions is fit-tested so that if you need to wear an N95 mask in the undertaking of your duties you know the mask respirator that is the one that suits you based on your face. Sometimes it has to be done over because if you gain or lose weight the shape of your face may change and then you will have to be fit-tested over, so it is an important thing from an occupational health and safety point of view to ensure the safety of the health care worker,” Dr Whylie stated.
On the question of the masks being difficult to put on and wear for long periods leading often to marks left on the face of wearers she said while this was so, they will be around for awhile.
“Yes, but you know what? This has to be our new normal. Even the general population has to realise that we will all be wearing masks for a little while and certainly the health care worker has to wear their personal protective equipment (PPE), which may include a fitted N95 mask respirator, but I can tell you from my own experience, it fits closely to your face, I have asthma and so sometimes it is challenging for me to breath through. When you take off the mask it leaves a mark on your face because it is sealed but at the end of the day each health care worker has a responsibility to themselves and, by extension their family so you have to wear the PPE”.
“We are used to wearing gowns and gloves and boots and caps and surgical masks; we will get used to wearing the N95 masks because we have to wear it in order to protect ourselves and the Ministry of Health has adjusted its policy and so its mandatory for wearing in certain areas,” Dr Whylie said.
And on the matter of fitting health professionals with facial hair with N95 masks, Dr Whylie admitted that there have been challenges.
“We have asked persons to shave their beards and to remain shaven during this period. Some didn’t want to because they look so cute and young; but I tell you we have a challenge, we do have some workers who because of their religious practices they don’t want to shave and so some of them we have had to reassign them because for religious reasons they don’t want to shave and I mean that’s their constitutional right. So what we have done is reassign them to do tasks within their particular professional skill set where their exposure is less and their faith is not compromised,” she told the Observer. According to Dr Whylie, this challenge was posed by “different categories of health care workers”. Asked how many had opted not to shave she said “it was not a significant number of persons”.
According to the CDC N95 respirators are not designed for children or people with facial hair. It said because a proper fit cannot be achieved on children and people with facial hair, the N95 respirator may not provide full protection.
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