Interview

Face masks: What GPs and patients need to know


Matt Woodley


29/03/2021 8:34:04 PM

UPDATED: With multiple COVID cases in NSW, new mask rules are in place across Greater Sydney.

Young woman wearing a face mask.
Masks are now compulsory in Greater Sydney on public transport and in public indoor venues.

A version of this article was first published in July 2020. This article was updated at 3.40 pm on 6 May to reflect new information on restrictions in New South Wales and Western Australia.

Multiple local COVID cases in Sydney have promoted the New South Wales Government to re-impose a number of social-distancing restrictions across Greater Sydney, including Wollongong, the Central Coast and the Blue Mountains.

From 5.00 pm Thursday 6 May, masks are compulsory on public transport and in public indoor venues, including retail, theatres, hospitals and aged care facilities. Front-of-house hospitality staff must also wear face masks.

Additional restrictions: 

  • No more than 20 guests (including children) can gather in a household
  • Drinking while standing in indoor venue is not allowed
  • Singing by audiences at indoor shows or at indoor worship is not allowed
  • Dancing is not allowed in indoor hospitality venues or clubs, except for at weddings (where it is recommended no more than 20 people are on a dancefloor at one time)
  • Visitors to aged care facilities must be limited to two people
The Greater Sydney restrictions are currently slated to remain in place until 12:01 am Monday 10 May.

The Western Australia Government has also announced some restrictions are set to be eased this weekend. From 1.00 pm Saturday 8 May, masks will only be required on public transport, at events or venues with more than 1000 people, and in hospitals, disability and aged care facilities. High school students will not be required to wear masks, and masks will no longer be required at gyms or at work.

Additional changes:
  • People will be able to have up to 100 visitors in their home (up from 30)
  • Nightclubs and the casino will reopen, but will be subject to the two-square-metre rule.
  • Stadium capacity will return to 75%, though masks will be mandatory.
  • Visitors to hospitals, aged care facilities and disability centres will be limited to four visitors per day
Earlier this year, newsGP 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?
It helps to reinforce that when patients go out to public areas for the four reasons allowed during lockdown, wearing a mask is advisable [and mandatory in Victoria] even if people feel or appear to be well.
 
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.
 
In areas outside of Victoria, it may be helpful to reassure them that masks need only be worn when out in crowded environments where physical distancing cannot occur; for example, supermarkets or public transport.
 
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.

​More information on face masks is available on the Queensland Government website.

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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!