We all know that a surgical face mask can only give us maximum protection if we only use it once. Technically, every time you remove your mask, it must be disposed of to prevent inoculating yourself with viruses. However, in the real world, when you are paying approximately $2 for a surgical face mask, you would want to maximise its usage to make it worth the money – right? In this case, by wearing your face mask for as long as possible, it can not only protect you from COVID but also your bank account too. Let’s be real, if you are travelling only a short distance between stops then there is no reason for you to remove your mask only to have to put it back on again (hopefully not the same mask you’re removed from your face). Otherwise, try to think of your car as an extension of your home. Would you wear a face mask in your home? Obviously not unless you are not feeling well and there are other people in your house with you that you want to protect.

Anyway, I was amazed that many of you reached out to me after reading my last article. There were many questions about face masks in general. I think it would be a good time now to address some of the questions here that I’ve received over the last couple of days. These are the questions I believe many of you might find useful to know.
One of the most frequently asked questions was –

Does the mask protect the people wearing them or the people around them?

Very good question. A face mask is designed to contain the source. This means that it is more effective in preventing the spread and evaporation of large expelled droplets into smaller droplets that can travel a lot further. In other words, it provides the most benefit for people with COVID or suspected COVID infection from passing the virus to other people. However, it also can protect people wearing the mask from getting infected if another measure is also in placed (e.g. social distancing etc.)

How do you wear a mask properly?

Wearing a mask correctly is crucial in protecting you from being exposed to COVID or preventing you from spreading the virus to people around you. Their level of creativity I’ve seen from the way people are wearing their face masks was alarmingly difficult to comprehend. Some of you might say – at least I’m making a conscious effort to wear one.

However, making an effort to wear a mask and wearing them properly are entirely different concepts and should not be taken lightly. Quite frankly, if you are not wearing it correctly, I would suggest you might as well don’t even bother!

·         Before touching the mask, make sure your hands are clean.
·         Inspect the mask for tears or holes; do not re-use surgical face mask that has been worn.
·         When you are wearing a surgical face mask. It is extremely important to verify which side is facing out. I’ve noticed many people are wearing their face mask inside out. It is worth noting that the white side is usually the inside of the mask and the top side is usually where the metal wire is.
·         The face mask must cover your nose, mouth and chin, and make sure there are no gaps between your face and the mask.
·         Always remember to pinch the top metal wire and mould it to the shape of the bridge of your nose so that it gives a proper seal.

Does the type of mask we wear matter?

Interesting enough, this is a common question circulating within the group. I could pick out studies that have compared the efficacy of different face mask materials. However, in my honest opinion, always chose the mask that you can wear comfortably and consistently for a long period. In other words, for the general public, I would choose comfort more than anything else. I see some people walking along the street wearing an N95 respirator. Is this overkill? I’m not in a position to say that. However, I don’t see it as necessary outside a medical situation like working in a COVID intensive care unit. A typical disposable surgical face mask would be the most ideal. But a cloth mask would do the job nicely as well with the added benefit of comfort.
The whole point of asking everyone out and about to wear a face mask is to reduce the risk of community transmission rather than absolute prevention. In other words, any face mask that covers your nose and mouth would be beneficial.

Should I wear a face mask with a valve?

As I was walking along St Heliers Bay last weekend, I saw quite a few people wearing a reusable face mask with a plastic valve. It certainly captures my attention immediately – but in a bad way. It made me subconsciously try to stay away from them. The answer to this question is simply – No! Although a valve may make breathing a little easier for people with claustrophobia or respiratory problems. The valve may allow unfiltered air and droplets to escape into the surrounding air at high speed every time you breath out. This is because the valve filters are designed to filter the air you breathe in, but they don’t filter the air you exhale.  Considering that the main reason for wearing a face mask is to reduce the amount of air exhaled to get into the environment, using a face mask with valve filters defeat the purpose of face covering.

Mask can cause carbon dioxide build-up?

A patient of mine asked me whether wearing a face mask could make us feel unwell because he read somewhere saying that wearing a face mask could lead to carbon monoxide build-up under the mask. This is an interesting and logical question. However, a simple answer to this is not true. This is because no matter how well fitted a face mask is, the mask will offer an adequate airflow which makes an accumulation of carbon monoxide impossible.

If we’re practising social distancing, do we still need to wear masks?

Wearing a face mask, washing your hands, and keeping your distance are the three gold standards to prevent transmission of COIVD-19. There is a significant amount of evidence available to suggest transmission of COVID-19 through inhaled droplets. In other words, wearing a face mask is important to stamp out COVID-19 and we should always wear it and maintain social distancing if possible.

I hope you have found my answers to commonly asked mask questions helpful – if you have other questions about them, feel free to email me.

To your health,

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Anyway, ever since Health Minister Chris Hipkins announced Kiwis should be encouraged to wear a face mask in public places 2 weeks ago, I’m starting to see many people are proactively wearing them when they are out and about – especially with level 3 lockdown in place since last Wednesday. For many of you who have been following my weekly blog, I touched on the effectiveness of wearing a face mask back in early March this year at the start of our COVID-19 pandemic. You can access this article here. Although there weren’t any clinical trials at the time on the efficacy of wearing a face mask to protect against COVID-19. The information I gathered from other research (mainly investigating masks in influenza and clinical setting) at the time pointed to the fact that wearing a face mask can be useful and that it is equally important compared with washing hands with soap or an alcohol-based sanitiser. This is because COVID-19 is mainly transmitted through contact as well as droplets.

However, the Ministry of Health and WHO guidelines at the time suggested that there was insufficient conclusive evidence to suggest the potential benefits of wearing a face mask on preventing the spread of COVID-19. So why did the Government’s stance on wearing a face mask change notably? Just over 3 months ago when the director-general of health Dr. Ashley Bloomfield repeatedly said there wasn’t enough evidence to either support or discourage mask use and now recommended just the opposite.

One of the reasons is because the original recommendation from MOH and WHO was based on what was once thought to be an infectious disease with a low occurrence. And of course, if a disease has a low incident rate, it would make sense not to preach that the whole population should start wearing a face mask at the start of the pandemic. However, it was not until later, the world realised that the low occurrence was merely a result of not having sufficient testing and hence gave health agencies a false sense of security.

Another reason which I believe plays a significant factor is that New Zealand isn’t culturally prepared to wear masks publicly, unlike some countries in Asia where the practice is much common due to their previous experience during the SARs outbreak in 2003. New Zealand, on the other hand, was not affected by the previous influenza pandemic and hence no public education was deployed to preach the importance of wearing a face mask to prevent the spread of influenza.

Thirdly, there are more and more studies emerging in support of the use of face masks. One of the laboratory experiments investigated the effectiveness of various masks and barriers when covering the mouth to block respiratory droplets. The study involved using a high-speed video capturing the speed of hundreds of droplets generated when a person speaks. A damp washcloth came out the winner with almost all droplets captured and blocked. Another study – although not COVID-related evidence – suggests that the number of droplets and aerosols emitted from someone who had influenza or the common cold were greatly reduced when wearing a face mask. However, the most compelling evidence was from a recent study that investigated the COVID-19 growth rate before and after wearing a face mask was made mandatory in 15 states in the US. It suggested that wearing a face mask led to a slowdown in the daily COVID growth rate. Strong evidence from another study looked at COVID-19 deaths across 194 countries and identified that countries with cultural acceptance and government policies supporting the wearing of masks by the public had a lower death rate.

I personally welcome and support the government’s change in their stance on mask-wearing. I believe the Ministry of Health and the New Zealand government may have finally come to terms that both pre-symptomatic and asymptomatic transmission is common. You just simply can’t look in a crowd and tell if a person is infected or not. Also, based on history, community transmission is always an inevitable fate of a pandemic and it is one that is occurring the very moment as we speak. It does, therefore, make so much sense to ask everyone to wear a mask.  It’s just simply a no-brainer. New Zealand is suffering emotionally and financially from this COVID pandemic and we simply cannot take chance anymore.

On the last note, I came across a research article yesterday where the researcher performed a simulation on how many people required to wear masks to reduce community transmission. Based on the simulation, the researchers predicted that 80% of the population wearing a mask would be enough to flatten the community transmission curve more than maintaining a strict lockdown. In hindsight, this makes us wonder would NZ business be in a better financial position if we were to make mask-wearing mandatory at the start of the pandemic. Just food for thought.

To you and your family’s health,

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In reality, I think you must tell,…we all should tell simply because the majority of people have bad breath and don’t know it! As unconventional as it may sound, you could be doing them a favour if you are direct with them. Ask yourself a question, wouldn’t you want to know that you had stinky breath? I would for sure! Because the last thing I want to do is run around talking to patients thinking I have the breath of roses where in fact it’s a breath from landfills! Also, the earlier you find out, the faster you can figure out the root cause of it and can deal with it quickly. Because quite frankly, a mint or two may not always be the panacea we thought of it to be.

When we think about bad breath, we always relate it to a rotten tooth or bad food choices like eating loads of garlic or onions. Believe me or not, there are, in fact, more causes of bad breath than the common two.

One of the things that I would always suggest people focus on first is to practice good dental hygiene. Look, I’m no dentist, but the repetitive take-home message each time I receive from my dentist is to brush, brush, brush and floss, floss, floss. The reason brushing is not enough because the pulled pork burger that you had for lunch is most likely stuck between the tiny gaps between your teeth without you realising it. The shredded pork between your teeth will then undergo a breakdown process initiated by the bacteria that are already present in your mouth. As the food breakdowns, more bacteria will be replicated and cause a foul smell (or odour). These bacteria will produce a sticky film called plaque on your teeth, and if not brushed away, those irritating plaque can eventually form plaque-filled pockets between your teeth and gums causing inflammation.

Brushing your tongue is a manoeuvre; many don’t see a point doing but contributes a great deal to the cause of bad breath because the tiny “hairs” on your tongue, besides giving you a sense of taste, they are also particularly good at trapping bacteria and hence producing bad smell. So next time when you are doing your morning routine in the bathroom, make flossing a part of it. Make your kids do it too and help them start a habit that they will thank you for later on in life. I know that the “floss dance” your kid learned from their school mates was traumatising to watch, but maybe that is the only way to get your kid to floss their teeth. Who knows, they may spread the word at school and you could be doing the world a great favour.

I remember once a patient of mine asked me how to get rid of bad breath for good. The first question I ask her was, do you get dry mouth? Many people don’t realise that dry mouth is a major contributing factor to bad breath. Why is that? Well, your saliva is your body’s natural defence against bacteria because it has an antiseptic property. Also, the role of saliva is to moisten the mouth, neutralize acids produced by plaque, and wash away dead cells that accumulate on the tongue, gums and cheeks. If not removed, these dead cells decompose and can cause bad breath. Now, this leads to the next question – why do we get dry mouth? Dry mouth can be a medical condition but many people get dry mouth from the medication they are taking. Medication that causes dry mouth such as antihistamines, antidepressants are some of the few medications that can indirectly be producing bad breath through drying your mouth.

Dry mouth also naturally occurs during sleep. This is because when you are sleeping, the production of saliva usually reduces, and the bacteria in your mouth can take advantage of this and can cause morning breath. This is particularly worsened when you are a mouth breather. When you breathe through your mouth, the saliva will evaporate and can dry out your mouth and compromising your mouth’s ability to rinse away food particles or dead cells.

One piece of advice for all of you to prevent your mouth from drying is to drink lots of water. Drinking coffee, fizzy drinks or alcohol can result in a drier mouth. So, water is a must, and you should drink plenty of it to cleanse and keep your mouth moist. You could also try chewing gum or sucking on hard candy to stimulates the production of saliva.

Another major cause of dry mouth that I come across frequently is skipping meals. Skipping meals is not only the worst way to try to lose weight, but it can also cause an unpleasant smell in your mouth. This is because when you don’t eat, your body will slow down the production of saliva. As we all know from earlier that saliva helps cleanse our mouth by washing down and food particles and stop our mouth from smelling foul. When you produce less saliva, your mouth becomes dry and creating the perfect conditions for bacteria to flourish, and sequentially leading to bad breath. If you have to skip a meal (which I don’t usually recommend), make sure you still keep your water intake up because this will help stimulate your salivary glands to produce sufficient amount of saliva to help keep your mouth moist and eliminate any bacteria that can generate bad breath.

Have you ever noticed someone you know who smokes usually have bad breath? This is because cigarette smoking causes bad breath in 2 ways. Firstly, when you have a puff of a cigarette, the chemical compounds increases the amount of bad smell producing compounds in a person’s mouth and lungs. Secondly, cigarette smoking can dry out your mouth, leading to lower saliva production. So if you know of a friend or family member who smokes, now is the time to break them the bad news that you always wanted to break. Maybe telling them if they have bad breath may be enough to motivate them to quit. (If any of you who want to quit smoking but don’t know how –talk to me as I have spent many years helping many patients quitting the habit for good.)

Anyways, everyone at some stage of their life will experience episodes of bad breath. However, it is one of the embarrassing health issues that is not widely talked about. There is light at the end of the tunnel when it comes to managing it. Hence there is no need to brush it under that mat. Finding the root cause of it is crucial but acknowledging the problem takes courage. Whether is bad breath of a bothering health issue, make this year the year you finally do something about it.

To you and your family’s health

Chris

Pharmacist

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