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Interview

Face masks: What GPs and patients need to know


Matt Woodley


29/03/2021 8:34:04 PM

UPDATED: Record case numbers in NSW, lockdown extension in Victoria, dozens of cases in the ACT, snap lockdown in the NT: Australia tightens restrictions as much of the country sits on a COVID knife edge.

Young woman wearing a face mask.
New mask rules have been introduced in a number of locations.

A version of this article was first published in July 2020. It was updated at 6.10 pm on Monday 16 August to reflect new information on restrictions across the country.

The Delta variant is well and truly here, and its highly contagious nature is presenting a major challenge to a country that had previously revelled in the success – and freedoms – of its COVID-zero strategy.

New South Wales
With the state recording 478 cases and seven deaths on Monday 16 August, its worst of the pandemic, all of NSW is at under stay-at-home restrictions.

Since 5.00 pm on Saturday 14 August, people throughout the state must stay at home unless they have a ‘reasonable excuse’ to leave. They are not allowed to have visitors in their home from outside their household, including family and friends.

People in the 11 hotspot local government areas (LGAs) must wear a face mask outdoors, as well as indoor areas other than their home. The LGAs:

  • Fairfield
  • Canterbury-Bankstown
  • Liverpool
  • Cumberland
  • Blacktown
  • Parramatta
  • Georges River
  • Campbelltown
  • Bayside
  • Strathfield
  • Burwood
People elsewhere in the state are required to wear a mask in all indoor areas of non-residential premises and:
 
  • at organised outdoor gatherings
  • on public transport
  • in all indoor construction sites
  • in a major recreation facility (such as a stadium)
  • when working in a hospitality venue.
More information on mask rules is available on the NSW Health website.
 
Victoria
Victoria remains in the grip of its latest COVID outbreak and its sixth lockdown will be extended until at least 2 September after the state recorded 22 cases on Monday 16 August.

The extension, which applies to Greater Melbourne, includes a number of tougher restrictions, including a nightly curfew from 9.00 pm to 5.00 am. In addition, exercise is limited to two hours and can only be with one other person.

People must wear face masks everywhere except in their home. This includes indoor places and outdoor areas, unless they have a medical exemption

Importantly, masks can no longer be removed to drink alcohol outdoors.

More information is available on the Victorian Government website.
 
Northern Territory
A new case on Monday 16 August has triggered a snap three-day lockdown for Greater Darwin and the Katherine region.

People in these regions can only leave home for five reasons:
 
  • Medical treatment (including COVID tests or vaccinations)
  • To access essential goods and services (such as groceries and medicines)
  • For work that is considered essential and cannot be done at home
  • For one hour of exercise a day, with one other person or people they live with (not further than 5 km from home)
  • To provide care and support to a family member or person who cannot support themselves
All people in lockdown areas must wear a face mask at all times outside their homes, including during exercise. Children under 12 and those with a physical or mental health condition who cannot safely wear a mask are exempt.

More information is available on the NT Government website.
 
Australian Capital Territory
The ACT recorded 19 new locally acquired cases on Monday 16 August, taking the total number of active cases in Canberra to 28.

The ACT has been in a seven-day lockdown since 5.00 pm Thursday 12 August. Reasons to leave home:
 
  • Shop for essentials (such as groceries and medicine and supplies essential for personal needs or for vulnerable people)
  • Obtain essential healthcare (including a COVID test or to receive a scheduled vaccination)
  • Exercise outdoors for no more than one hour per day, with one other person or your household group
  • Provide essential caregiving services
  • Undertake essential work
Face masks are mandatory during the ACT lockdown. People aged 12 and older must wear a mask at all times when leaving home, including in workplaces. Exemptions include:
 
  • if the person has a physical or mental health illness or condition, or disability, which makes wearing a face mask detrimental to their condition
  • if the person is consuming food, drink or medicine
  • if the person is communicating with a person who is deaf or hard of hearing and visibility of the mouth is essential for communication
  • if the person is in a vehicle alone or only with members of the same household
  • due to the nature of a person’s essential work
  • while undertaking vigorous exercise outdoors
  • because of an emergency.
More detailed information is available on the ACT Government website.

newsGP last year spoke with long-time Melbourne GP Dr Vicki Kotsirilos after she had seen increasing numbers of patients presenting with queries and concerns about face masks when the Victorian Government made them mandatory in July 2020.

Dr Kotsirilos said some had worn masks incorrectly, while others questioned their purpose altogether. She discussed her experiences and what she learnt from practising in an area where mask has been commonplace.
 
What do GPs need to know about face masks?
There are two types of masks available to the community – disposable and cloth masks.
 
I encourage patients to purchase or make the proper masks according to the Victorian Department of Health and Humans Services [DHHS] guidelines. Cloth masks can be washed in hot water and detergent, as it is well known that hot water above 56°C can kill the virus.
 
Pharmacies and post-offices are good places to buy masks, as many sold on the internet may not be appropriate. P2 masks should not be used because they are difficult to take on and off without contaminating hands, are expensive and not as accessible.
 
Cloth masks must have three layers of closely woven fabric [cotton on the inside, cotton blend in the middle and polyester outer layer] and fit snugly around the patient’s face. Care is required when removing the masks to avoid touching the outer and inner surface of the mask.
 
I encourage patients to use cloth masks because they are recyclable and better for the environment than disposable masks.
 
What are the most important things to consider when discussing masks with a patient?
If patients ask why they need to wear a mask if they are feeling well, it can be helpful to explain that 80% of people who have contracted coronavirus either show no symptoms or mild respiratory symptoms like a mild flu, posing a real danger to those with chronic diseases and other high-risk groups for whom the virus is a major threat.
 
If we all wear masks we are protecting ourselves and others – being well can be deceptive, as people can be harboring the COVID-19 virus or infection and not know it, unwittingly spreading the virus.
 
Patients should be reminded that face masks are not a replacement for physical distancing, rigorous hand hygiene, or sneeze and cough etiquette. In addition, if they have any respiratory symptoms, no matter how mild, that they stay home, not go to work or school and get tested for COVID-19.
 
If they are unwell and live with other people, a mask worn in communal areas such as the kitchen may help.
 
It’s important to instruct patients on how to put masks on and take them off carefully to avoid hand contamination. I also provide patients with a link to the Government website to reinforce these instructions.

Dr-Vicki-Kotsirilos-article-1.jpg
Melbourne-based GP Dr Vicki Kotsirilos has first-hand experience discussing mask use with patients.
 
What if a patient is skeptical about the value of wearing a mask?
While most patients are now open to wearing masks following the latest Government announcements, some patients find them ‘suffocating’ and difficult to wear for long periods of time.
 
The real challenge will be in certain work environments. At our clinic, for example, where physical distancing is not always possible, all our staff are required to wear masks and we also separate ourselves to have our lunches.
 
They are encouraged by our receptionists to have a phone consultation with the doctors if they have any respiratory symptoms. If they are unwell and need to come in, we now ask patients to wear masks.
 
Some GPs report that patients have requested medical exemptions from wearing a mask. Are there any scenarios in which this may be appropriate?
GPs should not advise against wearing masks, as we must consider the vulnerable groups at high risk of catching COVID.
 
But it’s also important that we reassure patients asking for an exemption that it is vital now for everyone in the community to be dynamic and make short-term sacrifices for long-term community health gain.
 
Medico-legally, if the patient catches COVID and we’ve given them an exemption, we may be at risk of providing incorrect advice against health authority guidelines. However, we must also understand the patient and try to explore what works for them.
 
There may be other reasons why a patient might feel they can’t wear a mask, but whatever it might be, it’s important that GPs try to work with the patient to modify the protective clothing or mask for their benefit and the community as a whole.
 
Of course, we empathise with the members of our community who may experience anxiety and/or claustrophobia from wearing a mask.
 
However, it’s also imperative to consider the anxiety experienced by people in our community when we see people who aren’t wearing a mask. It’s a very stressful time for frontline healthcare providers and immunocompromised people particularly.
 
We need an attitude shift towards mask-wearing. Wearing a mask should not be connotative of ‘fear’ and ‘COVID-19 conspiracy’, but a symbol of compassion and union to keep our communities protected and healthy.

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A.Prof Vicki Kotsirilos, AM   22/07/2020 8:08:31 PM

The Victorian Department of Health and Human services just issued this statement for medical exemptions of masks following the above interview:

"Exemptions will be “a relevant medical condition — including problems with breathing, a serious skin condition on the face, a disability or a mental health condition”, according to Victoria’s Department of Health and Human Services.
The department has specifically flagged asthma as an exemption."


Dr Samir Munaim   24/07/2020 12:44:30 AM

Need more detailed rules for exemptions to satisfy our patients otherwise all those with mild asthma would ask for exemption.Today 5 of my patients ask for exemption letter.


Dr David Lee   1/08/2020 8:31:34 AM

I do not give any patients exemptions letter. I just print them a health summary. So many selfish people in this country.


Dr Ruth Sophie Ratner   5/01/2021 7:44:12 AM

Are there any tips for how not to flip a hearing aid out when removing masks? I've heard of a few (very expensive) losses!


Dr Michael Smith   5/01/2021 8:51:12 AM

This article does not offer proof that face masks are of any benefit. If the evidence is sketchy, then how can we confidently encourage our patients to don them?


A.Prof Vicki Kotsirilos, AM   17/01/2021 1:45:13 PM

This review explores studies and effectiveness of masks Source: https://www.cell.com/med/pdf/S2666-6340(20)30072-6.pdf


Dr Md Zahidul Haque   18/01/2021 12:05:29 PM

"anyone who has trouble breathing wearing a mask" - Really!
2 patients so far brought to me this as their valid evidence to get exemption. Saying "anyone" & "trouble breathing" gives open ticket for everyone to seek a letter just by saying they have trouble in breathing. Either this language needs to be changed, or GPs need criteria given for it's use. This is another evidence how GPs get difficult situations, which could have been managed better.


Dr Israt Ara Khair   13/02/2021 9:12:24 AM

I totally agree with Dr. Zahidul Haque.The two words “ anyone “ and “difficulty breathing “ need more clarification. Does the difficulty breathing needs to be objective or GPs should take patients word for word? These loopholes in the statement put GPs in a harsh and vulnerable situation.


Dr William Lancashire   7/05/2021 2:12:24 PM

Thank you for putting up the paper However I am not entirely convinced by studies on hamsters. For all the valid criticisms of DANMASK 19 it is still the only study done in mitigating measures and Covid 19. Here in British Columbia we have been wearing masks for over six months and infections are increasing. Are masks contributing to the increase ? I think not but they ain’t preventing infections either. Possibly a return to evidence base science with regard to Covid 19 might not be a bad idea. I will now put my head below the parapet and await the onslaught. By the way my sixth viral pan/epidemic since I qualified as a doctor.


A.Prof Vicki Kotsirilos, AM   9/05/2021 8:38:47 PM

This study is also useful that found that well-fitting, three-layered cloth masks can be as effective at reducing the transmission of COVID-19 as surgical masks.

Journal Reference:
Joshua F. Robinson, Ioatzin Rios de Anda, Fergus J. Moore, Jonathan P. Reid, Richard P. Sear, C. Patrick Royall. Efficacy of face coverings in reducing transmission of COVID-19: Calculations based on models of droplet capture. Physics of Fluids, 2021; 33 (4): 043112 DOI: 10.1063/5.0047622

Summary of study:
University of Surrey. "Cloth face coverings can be as effective as surgical masks at protecting against COVID-19, study finds." ScienceDaily. ScienceDaily, 28 April 2021. <www.sciencedaily.com/releases/2021/04/210428113723.htm>.


Dr William Lancashire   11/05/2021 3:07:59 AM

Models are not evidence. Surely our experience with covid has taught us that!


Dr William Lancashire   11/05/2021 3:17:33 PM

Models are not evidence. Surely our experience with covid has taught us that!


Dr Paul Vernon Jenkinson   18/06/2021 11:50:34 AM

Models are certainly not evidence.
cf Climate models ,approx 50 since 1980,and every one has been wrong!
The above study presents no data at all.It is purely observational.
Aren't we a little more sciency than that.


Dr William Lancashire   4/07/2021 1:38:37 AM

Sorry Prof Vicki but as this is my sixth viral pan/epidemic and in the previous five the use of masks was the least of our problems. But when as GPs we are not honest with our patients we run into trouble. The appalling mixed messaging over vaccinations in Australia beggars belief.
Wear a mask don’t wear a mask. I don’t care but please get a vaccination. As our Provincial Health Officer here in British Columbia said “the best vaccination you can get is the one you are offered. She is absolutely correct. Data matters not models.


A.Prof Vicki Kotsirilos, AM   28/07/2021 7:20:04 AM

Recent studies have found masks are quite effective:

World-first study shows effectiveness of masks in preventing COVID transmission

https://www.burnet.edu.au/news/1473_?fbclid=IwAR3_htaaGKkBmV3N_0BB6lAjcL78jKNRv9nlvfMz919FapSS59nY5xNnkMo

https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0253510


Dr Fiona McCormick   28/07/2021 3:25:06 PM

Way back in March 2020 I did a search on COVID prevention and found an article referring to an early case, who travelled on two buses - wearing a mask on the second but not the first. This was during the Chinese winter, all windows up, recirculated hot air heating. The conclusion was that mask wearing reduced likelihood of COVID transmission. So I started advising friends/family/patients to wear masks at a time the collective Australian wisdom was not to wear masks because of no evidence to support mask wearing: turns out this advice was given due to supply issues. People looked askance at me in the supermarket, wearing a hoodie/safety glasses/mask and gloves! Fast forward to delta: we may have no current data however it would be remiss not to recommend mask wearing. Study published online in April 2020: Influenza Other Respir Viruses. 2020 Jul; 14(4): 472–473.


Dr Slavko Doslo   18/08/2021 8:48:18 AM

Good day to all of you my fellow doctors
I wonder, would anyone of you allow anyone with those cloth mask to be present in theatre when is performed orthopaedic surgery for hip or knee on us or relative or any other patient. would be safe to perform surgery using those masks
Thank you
But I would not allow any in my theatre
we know how to wear mask in theatre ( I hope we did few visits to operating room and scrubbing)


A.Prof Vicki Kotsirilos, AM   20/08/2021 7:51:17 AM

Thanks Dr Doslo
Fabric / cloth masks are only for community use - not for hospital settings.