Face masks: What GPs and patients need to know

Matt Woodley

22/07/2020 4:11:08 PM

With mask use mandatory in Victoria and encouraged elsewhere, newsGP speaks to a Melbourne GP about how to broach the issue with patients.

Daniel Andrews and Brett Sutton wearing masks.
Victorian Premier Daniel Andrews and Chief Health Officer Professor Brett Sutton wearing masks ahead of a scheduled press conference.

Dr Vicki Kotsirilos has practised in metropolitan Melbourne for more than 30 years.
She has recently seen an increasing number of patients presenting with queries and concerns using face masks. Some have worn them incorrectly, while others have questioned their purpose altogether.
Dr Kotsirilos spoke to newsGP about her experiences and what she has learnt from practising in an area where mask use is now 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.jpgMelbourne-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 are reporting 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.
For example, if they’re feeling claustrophobic or anxious, we can advise them to modify a cloth mask so that it’s loose and comfortable, or modify a scarf. That is actually permissible – you’re allowed to wear a scarf around the mouth and nose, but still make it a very light mask with three layers.
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.

*The DHHS issued an update regarding lawful exemptions following this interview:

Lawful excuses or exceptions for not wearing a face covering

A face covering is not required in the following circumstances: 

  • Infants and children under the age of 12 years 
  • A person who is affected by a relevant medical condition – including problems with their breathing, a serious skin condition on the face, a disability or a mental health condition. This also includes persons who are communicating with a person who is hearing impaired, where the ability to see the mouth is essential for communication.
  • Persons for whom wearing a face covering would create a risk to that person’s health and safety related to their work, as determined through OH&S guidelines.
  • Persons whose professions require clear enunciation or visibility of their mouth. This includes teaching or live broadcasting. 
More information, including further lawful excuses or exceptions, is available on the DHHS 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.