Posted in Covid-19, Employment, Health, news, Politics

COVID Directive Non-Compliance: Why Businesses Have Difficulty Enforcing Customer Rules

As the COVID pandemic continues to see daily new surges in cases, mounting pressure is on state officials and businesses to contain the numbers or risk another shut down.

This week, Nevada Governor Steve Sisolak cited the following startling numbers as it pertained to face mask coverings:

49% compliance in 204 businesses inspected.

50% compliance seen at bars, restaurants, bar areas

61% compliance at gyms, salons, tatoo shops, auto sales and maintenance.

Northern Nevada fared better than Southern Nevada with 85% vs 65% compliance respectively.

As a result, the Governor warned businesses that there would be “swift and decisive action” if the mask requirement was not enforced.

On the surface, one would think the “No Mask No Service” rule would be easy to follow. However looking deeper into why there is such a high rate of non-compliance we find the following:

Many businesses do not have enough staff to enforce the law

When reopenings were allowed after weeks of shut down, many employers and businesses owners struggled to attract employees to return to their posts, hence many businesses opened up with less staff.

Mask the rage: How to talk to people who don't wear face coverings ...

Moreover, many businesses were not fortunate enough to be granted funds under the Paycheck Protection Loan program, hence has very little operating funds to staff robustly upon reopening.

Many employees are outnumbered and scared to approach non-masked individuals who may become violent

Some are pregnant, have orthopedic injuries or are smaller than their customers and are too afraid to engage them.

“Refusing service” can trigger one with mental illness to turn violent.  Rejection, accosting, and negative interactions can be perceived as “attacks”, putting an employee who is not trained in tactical movements or negotiation at risk.

In early May, a security guard was shot when he asked a customer at a Michigan Family Dollar store to wear a mask per company policy.

One week later a shooting occurred at a McDonald’s in Oklahoma City because a customer was asked to leave when she wasn’t following social distancing guidelines.  Three employees needed to be taken to the hospital but all recovered.

Also in May a customer threw a bottle of hot sauce at an employee and went on a “rampage” after being asked to wear a mask.

Then in late May, an Aurora, Colorado Waffle House customer allegedly shot a cook when asked to wear a face mask or risk not being served.

Videos have been taken throughout the country of enraged customers being asked to wear a mask, some turning violent.

The average restaurant or store does not have a security detail to protect their employees and other customers if someone doesn’t want to follow the new laws.

Businesses fear risking a public relations nightmare

If a staff member refuses service to a customer for not wearing a “mask”, the incident may be filmed and go viral on social media before the business has a chance to defend itself.

Moreover, some staff get overwhelmed by their jobs and the mask order and make poor judgement calls.

“No Mask No Service”, How To Avoid Being Accused of “Corona Discrimination”

For example, Zahur Abdiaziz, was refused service at Marissa’s Bakery in Minneapolis when she came in wearing a hijab instead of a mask. The employee behind the counter could be heard saying “no mask no service”, appearing to not acknowledge that the hijab was covering her nose and mouth, allowed within state guidelines. The bakery has apologized and the fate of the employee has not been disclosed.

Zahur Abidiaziz

The amount of new guidelines restaurants, bars, gyms follow in regards to customer volume restrictions, masks and social distancing, may be acceptable to many in the community, including officials hoping to lessen spread of the highly contagious SARS-CoV-2. However some restaurants may find them cumbersome, at times dangerous, and difficult to enforce all the while they are operating at losses.

State officials may need to provide guidance and protection for those employees who are not in a safe position to enforce a law, which many customers find unpopular.

Great Gift!!

Daliah Wachs, MD, FAAFP is a nationally syndicated radio personality on GCN Network, KDWN, iHeart Radio and is a Board Certified Family Physician

Posted in Covid-19, Employment, Health, news

Diagnosed With COVID? Now What?

As multiple states find test positivity rates rising, more patients are calling their provider or seeking telemedicine consults asking what they should do if they have COVID.

Some courses of COVID-19 are mild with symptoms such as cough, fever, fatigue and muscle aches resolving in a few days.

Yet other people may find their symptoms linger or worsen.

Symptoms of a COVID-19 infection may include:

  • Fever
  • Malaise
  • Fatigue
  • Headache
  • Body aches
  • Cough
  • Sneezing
  • Nasal congestion
  • Sore throat
  • Rash
  • Loss of taste
  • Loss of smell
  • Loss of appetite
  • Weakness
  • Chest Pain
  • Shortness of Breath
  • Dizziness
  • Poor concentration

and more…..

So many ask, what can I do at the start of COVID?

Inform contacts and work

If you think you have COVID or tested positive, you should make those aware who have worked, lived or socialized with you during the last 14 days (as SARS-CoV-2 may have an incubation period of 2 weeks).

Isolate

This is easier said than done but must be executed immediately.

  • Wear masks and maintain at least 6 feet of distance from housemates.
  • Open windows periodically to get fresh air (if weather, safety and low pollen counts allow).
  • Sleep in your own quarters (if possible).
  • Disinfect surfaces that you touch and avoid sharing items such as the remote, utensils, door knobs, etc….
  • Wash hands regularly

Stay hydrated, well nourished and well rested

Many of us when we’re feeling ill go for the hot chocolate and carbs, but remember to eat a balanced diet and stay hydrated. Sleep may also be difficult so make sure you get some well needed rest when your body tells you too.

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Westfalia Technologies’  https://www.westfaliausa.com/

Look for worsening symptoms and seek medical care

If one has difficulty breathing, for example, not only can this symptom imply COVID but it may also suggest a bacterial pneumonia or cardiac issue (which can both be complications of COVID as well). Seek medical care when any of your symptoms worsen or persist or include any of the following: chest pain, shortness of breath, dizziness, confusion, poor concentration, severe fatigue, severe muscle aches, non-blanching rash, and bluish lips or skin.

Formulate a plan

Know, before an emergency can arise, where you will go and who will take care of the kids, pets, etc. Contact your insurance carrier to find out which hospital or doctors are in network. If you have a medical provider reach out to them and inquire what they wish for you to do in case you start to see severe symptoms.

Are there preventative/post-exposure medications one can take?

Unfortunately we lack sufficient evidence to suggest taking certain medications for prevention or during early COVID. The National Institutes of Health does NOT recommend any use “of agents” pre- or post- exposure unless enrolled in a clinical trial.

However, some medical experts have suggested Vitamin C, Zinc and Vitamin D supplementation as well as daily famotidine.

Dr. Paul Marik of Eastern Virginia Medical School developed the following protocol:

Eastern Virginia Medical School

However, because clinical evidence has not been shown for these to be used outside of a clinical trial, most hospitals and medical institutions do not encourage their use.

Why Some Critical COVID Patients Are Lying On Their Stomachs

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Daliah Wachs, MD, FAAFP is a nationally syndicated radio personality on GCN Network, KDWN, and iHeart Radio.

Posted in 4th of July, Employment, Health, news, Politics

Gov. Cuomo Cuts COVID Health Benefits for Those New Yorkers Who Voluntarily Travel to High Hit Areas

In an effort to preserve the progress made in fighting the COVID pandemic, Governor Cuomo has signed an executive order to cut COVID health benefits for those residents who leave the state and travel to high hit areas.

States grappling with surges in COVID cases (higher than 10% positive test rate) include:

  • Alabama
  • Arizona
  • Georgia
  • Florida
  • Mississippi
  • Nevada
  • South Carolina
  • Utah
  • Texas

Any New York residents travelling back from these states need to self quarantine for 14 days, according to another executive order given this last week. Fines up to $10,000 could be levied according to the order.

According to the the Governor’s website, he states:

New Yorkers have controlled the spread of this unprecedented virus by being smart and disciplined, and our progress to date is illustrated by the current low numbers of new cases and hospitalizations,” Governor Cuomo said. “But as we are seeing in other states who reopened quickly, the pandemic is far from over and we need stay vigilant. We’re prepared to do the aggressive testing and contact tracing required to slow and ultimately control any potential clusters of new cases like the one in Westchester County. If we are going to maintain the progress we’ve seen, we need everyone to take personal responsibility — that’s why I’m issuing an executive order that says any New York employee who voluntarily travels to a high-risk state will not be eligible for the COVID protections we created under paid sick leave.”

Benefits were extended for COVID related illness in March allowing paid sick leave and protection from losing one’s job. Companies with more than 100 employees are to grant 14 days sick leave and those with 11-99 employees and some (netting over $1 Million) with less than 10 employees are given 5 days sick leave.

This is a developing story…

Great Gift!!

Daliah Wachs, MD, FAAFP is a nationally syndicated radio personality on GCN Network, KDWN, iHeart Radio and is a Board Certified Family Physician

Posted in allergies, Employment, Health, news

Runny Nose And Congestion Can Imply COVID Infection

As employees return to work battling allergies, many are being sent home if they exhibit any signs or symptoms of COVID.

Initially these included cough, fever and/or shortness of breath. But as COVID positive cases were investigated and reviewed, officials found a myriad of symptoms reported by patients including nausea, diarrhea, loss of taste and sense of smell.

Last month the CDC updated their list of symptoms that could be associated with a COVID-19 infection, including runny nose and congestion.

According to the CDC website:

People with COVID-19 have had a wide range of symptoms reported – ranging from mild symptoms to severe illness.Symptoms may appear 2-14 days after exposure to the virus. People with these symptoms may have COVID-19:

  • Fever or chills
  • Cough
  • Shortness of breath or difficulty breathing
  • Fatigue
  • Muscle or body aches
  • Headache
  • New loss of taste or smell
  • Sore throat
  • Congestion or runny nose
  • Nausea or vomiting
  • Diarrhea

Severe symptoms can include chest pain, worsening breathing, change in skin color, dizziness, confusion, severe headache and more, prompting immediate medical attention.

Runny nose and congestion were incorrectly used by many patients and medical providers as “disqualifiers” that they had a COVID infection, when we needed to remind patients that COVID could manifest in a variety of symptoms. Moreover someone could suffer from allergies and COVID at the same time, so as to not exclude the viral disease based on having additional symptoms not yet listed on the CDC website.

The CDC further explains: This list does not include all possible symptoms. CDC will continue to update this list as we learn more about COVID-19.

As allergy season plagues most the nation and resurges in the Fall for many, common symptoms such as sneezing and nasal congestion can prevent many from returning to work or school, requiring isolation.

There is no clear cut way to diagnose or exclude a diagnosis of COVID without testing. Hence many employees cannot return to work until their testing proves negative or they have completed their period of isolation, despite swearing that “all I have is allergies!!”

If you suffer from allergies for months on end…..you’re not have an easy time no matter how you look at it…..

____________________________________________________________________________________________

What are allergies?

Allergies are the result of the immune response to a foreign particulate that our body senses.  One could be allergic to pollen, dust, dander, food, insects, mold, metals, transfused blood, grafts, medicine and anything the body senses as a foreign intruder.  Even though these may be individually harmless, a hypersensitivity reaction occurs as a result of their intrusion into the body.  IgE antibodies find the allergen (intruder) and activate mast cells in the tissue and basophils in the blood.  When these cells get activated, they release substances to help protect the body, including histamines, leukotrienes, and cytokines. These help the body attempt to sneeze and cough the allergen out, wall off the antigen, signal more antibodies, or produce tears and nasal secretions to flush it out.

What are symptoms of seasonal allergies?

Symptoms of allergies could include any or a combination of the following:

  • Sneezing
  • Coughing
  • Wheezing
  • Runny nose
  • Eye watering
  • Red Eyes
  • Itchy eyes
  • Itchy skin
  • Rash
  • Itchy throat
  • Fatigue
  • Congestion….. to name a few.

How do they differ from a cold?

Colds may have very similar symptoms to allergies.  However they are different.

The common cold is caused by a virus.  When one gets infected by the virus they may feel malaise, fever, and achy.  This does not occur with allergies.

Moreover, nasal secretions from allergies are usually clear.  In a cold, the mucous could be thicker and with color.

The same holds true with sputum.  During an allergy the cough may have little to no mucous and if so, be light-colored.  Thick mucus could be a sign of an infection.

An allergic sore throat will seem more dry and scratchy.  A sore throat from a cold is more uncomfortable and less easy to soothe.

Allergies may persist or be cyclical.  Cold symptoms will usually subside after a few days and rarely persist longer than 10 days.

Can allergies lead to a cold?

Yes and no.  Allergies should not in and of themselves cause an infection. However they may make one more vulnerable for a virus or bacteria to take over.    Hence a bronchitis, sinus infection, or pneumonia could uncommonly follow an asthma attack.

Are seasonal allergies dangerous?

As stated previously, if one is susceptible to colds, an allergic attack could make them vulnerable. Moreover if one suffers from asthma, an allergy attack could incite an asthma attack.  Very rarely would we see a life threatening anaphylaxis to an allergen such as pollen.

Allergy season is here: What are the worst offenders?

How can we prevent and treat allergies?

Avoiding, or decreasing exposure to the allergen is key.   We suggest the following:

  1.  Be aware of your local weather and pollen counts.  If the weather begins to warm and regional vegetation is blooming, allergy season may be upon you sooner than you know.
  2. Avoid outside pollen from coming into your house.  Avoid the urge to open all the windows during Springtime as wind will bring the pollen in.
  3. Clean your air filters.  Replace air filters frequently and consider using HEPA Filters
  4. Wash off pollen from your hair and clothes before you sit on the couch or jump into bed.
  5. Close your car windows when you park.
  6. “Recirculate” the air in your car
  7. Discuss with your medical provider if you are a candidate for medications such as antihistamines, nasal corticosteroids or leukotriene antagonists.  
  8. If you suffer from respiratory illnesses or a chronic medical condition, discuss with your medical provider if you need to start your allergy medication before allergy season hits. Some of these medications may take a couple of weeks to reach therapeutic levels.

How can I find my local pollen counts?

Local tree, ragweed and grass pollen counts can be obtained here.

Great Gift!!

Daliah Wachs, MD, FAAFP is a nationally syndicated radio personality on GCN Network, KDWN, iHeart Radio and is a Board Certified Family Physician

Posted in Covid-19, Employment, Health, news, Politics

Employee Requests for Mask Exemptions Continue to Rise

Requests for exemptions from face mask use have skyrocketed over the last few weeks.

Issues such as breathing difficulties, anxiety, skin irritation and panic attacks are prompting many to ask for accommodations at work.

Nevada this week joined states such as California, Oregon, Washington, Maine, Rhode Island, Kentucky, New Jersey, New Mexico, and New York in mandating use of a mask when being in public.

But many employees find the employer mandates of mask wearing too restrictive.

Employers, however, run the risk of business sanctions or closures if they don’t comply with employee mask directives. Moreover, any failure to comply with medical-related requests could put them in violation of the ADA (Americans with Disabilities Act).

What should employers/business owners do if employees do not want to wear the mask?

Both employers and employees have options.

Most state mandates exclude mask use for those who suffer medical ailments that can be exacerbated by a facial covering.

An employee can provide medical documentation from their medical provider requesting the accomodation.

An employer can also allow flexibility in face mask coverings, hence allow employees to design their own, if the ones offered through the company will not work.

An employee also can also ask to not be scheduled for shifts until the mask mandates are over. This might fall under unpaid leave, but it is still an option for those who do not want to lose their job for failure to wear a mask.

Employers can offer frequent breaks for those who get “mask fatigue”.

Mask Fatigue: Do Workers Need “Mask Breaks?”

This week, however, the Department of Justice warned employers of fake exemption cards, threatening ADA violations and fines. They state, “The Department urges the public not to rely on the information contained in these postings and to visit ADA.gov for ADA information issued by the Department.”

SLO County Public Health Department warns of fake face covering ...

Why are masks being mandated?

A mask that covers the nose and mouth provides a barrier to and from the outside environment, or from one’s mouth to others. The effectiveness of the barrier in preventing pathogen spread varies depending on the materials used and how often it is cleaned or replaced.

Mask-Materials-Effectiveness-1-Micron-EN-1024x744

N95 respirators appear to be the most protective.  They are designed to keep pathogens out during oxygen and carbon dioxide exchange.  They are made from non-woven polypropylene fibers and they are >95% efficient at filtering 0.3-μm particles (smaller than the average 5μm particles given off during coughing and talking).  Breathing can be easily managed while wearing a properly fitted N95 mask. However most state mandates allow flexibility in material choice for one’s mask.

Because studies have shown a properly fitted and worn mask to prevent the spread of some pathogens, it’s considered an extra tool in the fight against COVID as the country sees a spike in cases.

Business “Mask and Social Distancing Requirement” Puts Employees at Risk of Customer Violence

Great Gift!!

Daliah Wachs, MD, FAAFP is a nationally syndicated radio personality on GCN Network, KDWN, iHeart Radio and is a Board Certified Family Physician

Posted in Employment, money, news

Three Months Later, Many Workers Are Still Unemployed and Without Unemployment Insurance

As states begin to reopen in phases, millions of Americans are returning back to work. However, many businesses continue to be shuttered leaving their employees dependent upon other resources such as unemployment insurance…..if they can get it.

By the end of May, media sources reported 40 million had applied for unemployment benefits, and many were lucky enough to be approved, being awarded an additional $600/week offered throughout the CARES Act.

Yet across social media platforms, thousands of people have been seeking answers as well as others who are in the same boat….not having made any progress on the unemployment insurance front, weeks after being let go.

In the beginning, gig workers and independent contractors weren’t able to file for benefits initially promised under the Pandemic Unemployment Assistance Program. In Nevada, those workers weren’t eligible to apply until May 16th, 2 months after the state locked down.

The Nevada Department of Employment, Training and Rehabilitation has been overwhelmed for months, with those applying encountering delays in benefits being told there were due to glitches, jammed phone lines, downed websites, and issues with the banks. Although the department did add more staff, issues have continued to mount.

One Las Vegas resident stated, “They paid me for three weeks but they owed me several weeks prior to the day they started paying me. When I inquired about the back dates. I wasn’t able to continue filing my weekly and they never said anything about that. I hope they are looking at my tax return to make my weekly benefit higher. But they should continue paying me the minimum which is only $181 per week plus the federal extra. I’ve been stuck like this for 2 weeks and all they tell me is I will be able to file in 7 to 10 more working days. After being months behind they really shouldn’t be holding back anything especially once they started paying me and there are no issues. The only issue is I need my money now desperately.”

He keeps receiving the following message:

Image may contain: text

He adds, “There is no reason why I’m not able to file now and there is no excuse for them not letting me know that this was going to happen once they submitted my inquiry. There are no answers and there is no help.”

Local employment departments request those needing help to apply online or continue to call their call center, but frustrations are building.

Many businesses have been slow to reopen as customer volume restrictions prevent the need, and finances, to staff robustly. So unemployment continues to be high, despite many wanting to return to work.

Social media groups such as Nevada Pandemic Unemployment Assistance are offering platforms to ask questions and voice issues.

Some are going to the media, and others, in states such as Florida, are writing their Governor.

But many, unfortunately are waiting, and waiting, hoping to get through or get some financial relief…..or their jobs back.

This is a developing story…..

Great Gift!!

Daliah Wachs, MD, FAAFP is a nationally syndicated radio personality on GCN Network, KDWN, iHeart Radio and is a Board Certified Family Physician

Posted in coronavirus, Covid-19, economy, Employment, Health, news

Did Your Period Change During the Lockdown? Here’s Why…..

Many women have reported their periods have been irregular since the start of the pandemic, not surprisingly though as 2020 has been one of the most unpredictable years yet.

However, some feel it’s because they lack the “syncing” that occurs when women are around other women, such as in the workplace.

The theory of women who live or work together subsequently menstruate the same time during the month has been suggested for centuries. In 1971, Dr. Martha McClintock from the Department of Psychology in Harvard tested this theory on 135 females from a college dorm and found a “significant increase in synchronization” in college roommates and/or their best friends as it pertained to their monthly cycle. This was called the “McClintock” effect.

However multiple studies since then have debunked this theory finding no major evidence of menses syncing among women who are in close proximity to each other.

So if being separated from one’s coworkers is not the cause, why would periods change?

Menstrual cycles can vary in regularity due to multiple factors. These include:

  • Stress
  • Change in exercise
  • Change in diet
  • Change in weight
  • Thyroid disorders – or issues with taking one’s medication regularly
  • Sexual activity
  • Pregnancy
  • Hormonal disorders such as polycystic ovarian syndrome

For those who had strict work, eating and exercise schedules, lockdowns prevented gym attendance and allowed for more stay-at-home-and-eat-activity.

Moreover fear of COVID, being layed off and trying to teach and entertain the kids who would have been in school all these weeks added copious amounts of stress in a short period of time.

Cycles may come every 21-35 days with a 2-7 day menstrual flow. Some women are able to consistently predict the day and time of their next period, whereas others venture a guess that could range up to a week. So menstrual cycle changes are not that uncommon throughout a woman’s reproductive years. However, if one becomes irregular after months of regularity, skips a cycle or finds their bleeding to change significantly, this should prompt an evaluation by their medical provider.

Will returning to work get you back on your schedule? It could, but then again, it could be your “new normal”…..Either way, don’t expect your female work comrades to sync your cycle anytime soon.

Great Gift!!!

Daliah Wachs, MD, FAAFP is a nationally syndicated radio personality on GCN Network, KDWN, and iHeart Radio.

Posted in coronavirus, Covid-19, economy, Education, Employment, Health, news, Politics, school

Trump Vows Another Shutdown Will Not Occur In the Fall – But Does He Have Control?

Image above from AP/Getty Images

Speaking at a Ford plant in Ypsilanti, Michigan, President Donald Trump vowed he would not allow the country to shut down again if a second wave of COVID plagues us this Fall.

He stated, We are going to put out the fires. We’re not going to close the country. We can put out the fires.”

Although his optimism was applauded by many who have found the economic downturn from months of business closures to be irreparable, many wonder if he actually has control of stopping a second country shutdown.

In early March the Trump administration tried to contain the panic, and keep businesses open, however other powers were at play.

Schools closed down first. With school closures, many employees could not leave their children unattended and needed to stay home.

Then traffic to many businesses slowed, as many chose to “shelter in place” for fear of being exposed to COVID-19. Employees of businesses chose to stay home as well in fear of exposing vulnerable family members to the virus.

Then as death tolls were reported, Governors began to institute stay at home orders and business closures.

As businesses reopen and schools ready for the new school year, many teachers and parents are preparing for a bumpy road ahead.

Even if a COVID second wave spares us, influenza is notorious for causing death, and each year takes its toll on the pediatric population.

Concerned parents may easily call for school closure and online learning because of flu, COVID, school shootings, or any other issues that could tragically affect children.

If schools close this Fall for any reason, employees will be forced to stay home and the cycle can occur all over.

Many businesses are transitioning to work from home models, however many businesses still require traffic and in person customer service such as restaurants, salons, movie theaters, shops, etc.

I believe our healthcare system will, as Pres. Trump suggests, be able to address new COVID cases, however, whether the administration will have the ability to mitigate the panic or calls for business shutdown is entirely another issue.

Daliah Wachs, MD, FAAFP is a nationally syndicated radio personality on GCN Network, KDWN, and iHeart Radio.

Posted in coronavirus, Covid-19, economy, Employment, Health, masks, news

Business “Mask and Social Distancing Requirement” Puts Employees at Risk of Customer Violence

In early May, a security guard was shot when he asked a customer at a Michigan Family Dollar store to wear a mask per company policy.

One week later a shooting occurred at a McDonald’s in Oklahoma City because a customer was asked to leave when she wasn’t following social distancing guidelines.  Three employees needed to be taken to the hospital but all recovered.

Then last week, an Aurora, Colorado Waffle House customer allegedly shot a cook when asked to wear a face mask or risk not being served.

Employees who work for small businesses who are struggling to follow the new reopening restrictions are putting their lives at risk when a person with mental illness does not want to follow the new laws.

Government officials may not be aware that “laws” being implemented need assistance when it comes to enforcement and the average restaurant or store does not have a security detail to protect their employees and other customers if someone doesn’t want to follow the new laws.

“Refusing service” can trigger one with mental illness to turn violent.  Rejection, accosting, and negative interactions can be perceived as “attacks”, putting an employee who is not trained in tactical movements or negotiation at risk.

A video has gone viral of a Costco employee asking a customer to put on his mask. The customer was not violent but refused to wear one, so his shopping cart was confiscated. Fortunately the altercation ended there, but do altercations need to happen in the first place?

costco-tison-1589985758

If an employee feels a customer is beginning to get angry they should:

  • Not engage the customer
  • Get a manager or someone designated to deal with customer complaints
  • Contact local authorities or call 911 if they feel they are at risk of being harmed

Most government officials will not close a business down if the incident (in which an altercation was diffused by providing service) was documented and reported.

When laws and ways of life change quickly and rules are forced on already stressed employees and customers, chaos can ensue.  State and government officials need to be aware of the consequences that can result without proper guidance in how to execute these rapidly changing rules.

 

Daliah Wachs, MD, FAAFP is a nationally syndicated radio personality on GCN Network, KDWN, and iHeart Radio.

 

Posted in coronavirus, Covid-19, Employment, Health, news

Do N95 Respirators and Facial Masks Cause Respiratory Difficulty?

With the CDC’s (Center for Disease Control’s) recommendation to cover one’s face to prevent the spread of coronavirus, and state official’s guidelines on returning to work, many Americans are searching for ways to cover their nose and mouth throughout their eight to twelve hour shift.  Some are able to access top of the line masks such as the N95 respirators while some have made and used decorative cloth face coverings.

However, mask fatigue and reports of “difficulty breathing” while wearing a facial covering begs the question, “are some of us losing oxygen or building up carbon dioxide while wearing a mask?”

Mask Fatigue: Do Workers Need “Mask Breaks?”

Last month a car accident in New Jersey was reported when a driver, wearing an N95 mask, became syncopal and passed out, “crashing” the vehicle.  The report was later revised as authorities believed it could have been a “contributing factor” to the accident. The driver was treated for non life-threatening injuries.

A mask that covers the nose and mouth provides a barrier to and from the outside environment, or from one’s mouth to others.  The effectiveness of the barrier varies depending on the materials used.

Mask-Materials-Effectiveness-1-Micron-EN-1024x744

N95 respirators appear to be the most protective.  They are designed to keep pathogens out during oxygen and carbon dioxide exchange.  They are made from non-woven polypropylene fibers and they are >95% efficient at filtering 0.3-μm particles (smaller than the average 5μm particles given off during coughing and talking).  Breathing is easily managed while wearing a properly fitted N95 mask.

In breathing, we inhale air, extracting the oxygen in our lungs, while exhaling carbon dioxide, a byproduct from the body’s metabolism.

However, some people may require less of a barrier in order to get the oxygen requirement they need.  These individuals include those who may suffer from heart conditions or respiratory illnesses, such as emphysema and COPD. They may breathe too shallowly, not releasing the carbon dioxide that has accumulated.

If one has difficulty releasing the carbon dioxide they build up, they can become hyercapneic.  Hypercapnea is a condition where one may present with headaches, dizziness, fatigue, shortness of breath, difficulty focusing and if severe can cause muscle twitching, confusion, abnormal heart beats, seizures and fainting.

In 2006, a study of 212 healthcare workers found 37.3% to suffer from N95 mask related headaches, most of whom reported an average of 6 a month. Authors concluded that continuous use of mask wearing (approximately 4 hours) could induce headaches and shorter durations of use may mitigate the frequency and severity of the risk.

Infectious disease expert Amesh A. Adalja, MD, senior scholar at the Johns Hopkins Center for Health Security in Maryland, told Health, “Someone wearing an N95 mask for a prolonged period of time may have alterations in their blood chemistry that could lead to changes in level of consciousness if severe.”

Studies could be designed to give more conclusive data on blood oxygen and carbon dioxide level changes as one wears a mask for certain periods of time, but for now, we don’t have definitive guidance on how long a mask should be worn to prevent hyercapneic symptoms. We are, however, urged to wear masks to prevent our spread of germs.

Therefore, for those who may be susceptible to breathing issues and are working long shifts that require facial coverings to be worn, I suggest speaking with one’s medical provider as management may be needed for their respiratory and/or cardiac condition.  Mask breaks can also be an option. Mask breaks can occur outside or in “safe rooms” that are not open to the public to allow one to get some uninhibited air before replacing the mask and returning to one’s work.

Daliah Wachs, MD, FAAFP is a nationally syndicated radio personality on GCN Network, KDWN, and iHeart Radio.