It was 2pm. He had been at it for four hours. The OPD chamber in a hospital had a transparent plastic curtain that separated him from the chairs across the table. The doctor sighed. His uncharacteristic display was muffled by a N95 well-fitted. mask. He felt strangely tired and light-headed and suppressed his urge to stretch and yawn. He was waiting to see the next patient, a sixty year old lady. The doctor smiled and nodded as Mrs Bandopadhyay, a portly woman, made her way into the room. The untidy hair and casually-draped cotton saree indicate a hurry to leave someone in discomfort. Her son, half a stride behind, helped her settle in a double-seater chair. maskShe couldn’t hide her anxiety at being in hospital during the Pandemic. Realizing that his smile was gone, he realized the severity of the Pandemic. maskThe doctor had a light conversation in which the son revealed that he was the CEO of Gurugram’s start-up.
‘So, how are you doing Mrs Bandopadhay’The doctor observed amusement at the doctor’s nasal twang coming from behind, mask had started to sound more and more like Bob Dylan’s. The son encouraged, ‘Katha Bole’She encouraged her to speak her medical concerns into her ear. As if on cue Mrs Bandopadhyay launched into a barrage in Bengali, her gestures implying a bloated stomach. ‘For how long has this problem been there?’Dr. Bandopadhyay asked. He repeated the question twice as loud, but Mrs Bandopadhyay was not fazed. Noting the imploring look in the doctor’s eye, the son leaned towards his mother and repeated the query in Bengali. ‘From the time I had the hysterectomy’Without blinking an eye, she replied. The son, taken aback at her response, reminded her of the hysterectomy which was more than 10 year ago. ‘Wasn’t the problem worse after all the mithai you had for Durga Puja’, he said, his terse tone conveying ‘I told you so’. ‘And what may be the location of the pain?’I enquired with the doctor. The doctor gave little away by sweeping his hand across her entire abdomen. The doctor’s trained mind wanted to ask so many other questions, but he chose not to. Instead, he called for an ambulance to transport the lady to the examination chair. He noticed tenderness in the lower abdomen and ordered blood tests.
The masking protocol for COVID-19 pandemics has adversely affected interaction between patients, healthcare providers, and has hampered both verbal as well as non-verbal communication. A high level of fatigue is caused by high volume conversations in which there are no supportive facial expressions. What science is behind this phenomenon? masks?
The ‘Dead space’The volume of air inhaled, but not used in gas exchange, is called natural dead space. The natural dead space is the area between the tip of your nose and mouth and the windpipe, throat, windpipe, and bronchi. It is located just short of the alveoli of the lungs. Wearing of masksThis increases the dead space from 150-180cc to 65-112%, which results in a 37% decrease in the gas exchange volume for the lungs. The blood level of carbon dioxide (CO2) increases when air is reabsorbed from the enhanced dead space. This change is more pronounced with N95 than with surgical or fabric. masks. The N in N95 stands for National Institute for Occupational safety and Health of the United States while 95 signifies the 95% filtering capacity for particles above 0.3μm. Multi-layered surgery masksFabric masksThey offer less protection, allowing penetration of 44% and 97% respectively of particles of this size. Hypercarbia, an increase in blood CO2 (increase in blood volume) causes headaches and dilatation of the cranial blood vessels. Hypercarbia can also stimulate the locus coeruleus, which increases adrenaline production and triggers anxiety and panic attacks.
Hypercarbia can be demonstrated with all types masksThe N95 is the only way to see a significant drop in blood oxygen (O2) levels. The O2 concentration in the air is determined under the maskThis is significantly lower than the 20.9% in room air, which is at 18.3%. A study involving 53 neurosurgeons from the US showed that N95 can cause a drop of blood oxygen, an increase in heart rate by 15-20%, and a higher respiration rate. High O2 and low CO2 may cause confusion, disorientation or diminished cognitive abilities, listlessness (dizziness), and inability for patients to concentrate. A study of 343 medical personnel wearing N95. masks71% of those surveyed reported headaches, while 24% experienced impaired cognition. The wearing-time of a pair of glasses was associated with an increase in headaches. maskIn just 3 hours, 30%
The N95 can increase the resistance of the airways by 126% during inhalation, and by 122% when exhaled. Moisturization maskCondensation further increases resistance to breathing. Mask Induced Exhaustion syndrome (MIES) is a combination of increased airway resistance and increased dead space. These adverse changes, which appear to be insignificant at first, become more serious when they are repeated over longer periods. The main causes of headaches are a persistent rise in BP and heart beat, which can lead to oxidative stress. Endothelial dysfunction is also known to accelerate aging and arteriosclerosis. Avoid strenuous activity such as running or brisk walking. maskAs all the ill effects are amplified, People with co-morbidities or older age are at greater risk. Neurologists have shown that this is true. masksHyperventilation can lead to epilepsy. Patients with chronic lung diseases and those on dialysis are more at risk of compromising cardiopulmonary function. During pregnancy, the CO2 level in the mother should always be lower than that of the fetus to allow for diffusion of the gas from the unborn child to the mother’s blood. Hypercarbia could alter this vital maternal-fetal carbon dioxide gradient. Wearing of masksPsychological issues have been linked to this. A feeling of deprivation of freedom and loss of autonomy is augmented by the inability to perform natural actions like touching one’s faceDrinking, eating, and snacking. This could lead to anxiety, depression, increased stress-related illnesses, and social withdrawal. Children are more at risk due to their smaller airways, decreased respiratory reserve, and increased brain hypoxia sensitivity. Aspergillus, a fungus that causes excessive sneezing in ENT doctors has been linked to increased inflammation of the linings and sinuses. 33% of people have voice problems. mask users. Loud speech and acoustic filtering cause vocal cord incoordination, and impairment of clarity of speech. Humidity and obstruction to blood flow in the lymphatics. faceBy wearing a tight-fitting garment maskThis is combined with the presence bacteria and fungi. virusOn the maskMore skin and nasal infections.
The doctor noticed that he was short of breath as he lifted the laptop bag from his shoulder and began to walk towards the elevator. He was proud of his physical fitness at 61. Disconcerting symptoms included a persistent headache, choking sensation, and strange pains on the left side. Slowly he made his way to his office, where he crashed on the couch. He sat down and began to take off his shoes. maskHe inhaled deeply, taking in much-needed oxygen. He also made a mental note of the appointment to make his own medical checks later that day. He knew something was wrong. He wasn’t like this a month before.
The mask provides protection. This is a fact that is undisputed. Similar to a bulletproof vest. But would you wear a bulletproof vest during peacetime or routine travel? Delhiites are forced by law to wear a maskEven if you drive alone in your car! The maskhas become a symbol both of conformity, pseudo-solidarity. The law enforcers must rethink this strategy. Wearing of maskThis could create a false sense security which may lead to a reduction in the implementation of other WHO-recommended measures like hand hygiene or social distancing. CDC recommends that disposable diapers be used to provide enhanced protection. maskWear it underneath a cloth maskTo increase effectiveness. While the benefits are obvious, the drawbacks of prolonged use are not.
The doctor spent several hours that afternoon performing medical checks. Although cardiac tests were normal, a CT scan of the sinuses revealed a pan-sinusitis due to allergic inflammation caused by Aspergillus. Pulmonary function tests revealed mild bronchial asthma, with 20% reversibility. The pulmonologist and ENT surgeon recommended inhalers, nasal sprays, and anti-allergic medication. He returned to his OPD room, realizing that the Pandemic would solve the problem. The diagnosis was at least made. He could continue to work.
Masks are used to hide the identities of superheroes such as Flash, Batgirl, Spiderman and Batgirl. They also strike fear into the hearts villains around the globe. Wearing PPE is an act of defiance. maskThe identity of the provider. They may not be as impressive as superheroes, but they do a tough job. Unfortunately, their healing abilities and tissue regeneration powers are not the same as Wolverine. Covid-19 has claimed the lives of hundreds of nurses, doctors, and other healthcare professionals.
To communicate effectively with face masks, it has been recommended that the listener’s attention be drawn before speaking and that one may talk louder, slower and with use of hand gestures. You can reduce background noise by closing doors. It is important to pause often to ensure that the conversation continues. You can prevent headaches by taking short breaks, neck massage, increasing hydration, and switching between N95 or surgical. masks.
It was 7 o’clock in the evening. It was time to go home. The cellphone rang. It was the resident doctor. Mrs Bandopadhyay’s CT scan showed colonic diverticulitis with perforation and she had been directed to the emergency for hospitalization. The doctor donned his N95, and made his way to emergency. The fatigue, the headaches, the hypoxia and the stress were all forgotten. As if you were on a battlefield. The stakes were too great. Batting in the dark on a wet wicket. The show must continue. Where was the third umpire?! Oh, wait. He must be in a mask too!
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