The Great Mask Debate

On this episode of ADVENTing, Dr. Kandula and Dr. Handler discuss the NBA vs MLB starting to play agian before wading into the great mask debate.

- Hey, Dr. Madan Kandula with ADVENT, here with our latest addition of ADVENTing. I'm here with my cohost, Dr. Ethan Handler. How are you doing?

- I'm doing well.

- [Both] Doing well.

- We got sports back in the viewfinder these days, right?

- Yes, we do. Yes, we do.

- And, have you watched any baseball?

- You know, Stephanie and myself were watching baseball last night and she's like what are those cutouts behind the mound? She's like, this is really strange. She like went and googled it. But yeah, so we were watching a little baseball yesterday, but with like the funny faces like sitting behind the dugout.

- Gotcha.

- It's pretty interesting.

- It is.

- And then just watching clips of the Bucks, of course.

- Yeah. Bucks, they're coming.

- I know.

- Do they play Fri-

- Friday. But I guess they're already, nothing really matters for the playoffs cause they're already-

- They're already in.

- Their seasons gonna be held, where it's at.

- Oh really?

- I think, yes.

- Oh, I don't know that, okay. Yeah, the Knicks, I mean one kind of interest of the moment, topic on this particular subject is just sort of like the- There's NBA, which is, they're bubbled, right. They live in a bubble. So that bubble, here's my understanding of bubble. That bubble was: they got tested at their homes or wherever. Their home towns. Those that were negative flew down to Orlando, probably tested.

- Uh huh.

- Went into their isolation, their um, yeah their quarantine, right. They were in quarantine for like fourteen days. I think they were getting tested through that, and certainly I think they get tested at the back end of that. So that's pretty-

- They're pretty bubbly.

- That's pretty sound. I mean this is all, like, nobody's ever really had to do this in real life. So that's pretty, to me when I think about it like that's pretty sound. Like okay, you're gonna test, okay you're negative, you're still, uh, incubation period so you might be positive. But they're trying to catch people before they are all grouped together and interact, and so, then I would assume they've got a plan if somebody tests positive that they pull out, and they blah blah blah, so.

- Yeah, but it seems like they're having, I mean it's not like they're in this bubble and they can't do anything, like a lot of the bubble life, like they have these Instagram hashtag kind of stuff and it's pretty funny and they seem to be having a lot of fun. Like, somebody described it as going to summer camp, with your buddies-

- For like two or three months, like it'd be pretty awesome.

- Yeah I bet you they're having- I bet you they're having some fun down there. And them M.O.B. though is different .

- Well, they, yeah. Their plan is not, does not have a plan, so it's kind of like just- Be responsible.

- I mean they've gotten testing but there's no specific quarantine that I know of.

- Right.

- And they've got limited travel, so their games are different than their normal travel schedule. It's bigger teams, like there's more baseball players per team than NBA players. Um, less contact. This is where it's a little like "well", but it's also outside, um, you're not in somebody's face when you're playing, kind of thing. So like-

- Although they say there's still like high-fiving, and giving some ass pats and other sorts of stuff.

- Exactly.

- So it's not exactly non-contact.

- Yeah but it's like, theoretically I'd say baseball should be kind of low-ish risk, other than when you're in the locker room. On the playing field. This is where you can't separate it. Baseball should be kinda better suited than in the NBA.

- In theory.

- Kinda, sorta. I don't know where the NFL's gonna fit in cause it's-

- I don't even know, do they have any sort of plan? I haven't been following.

- No, I think they've got a sort of half-assed like "We're gonna test" and, cause they're starting training camp like this week. So that, I mean I think recipes for problematic situations are you know, those situations, we get a bunch of guys or gals living together, that's easy to spread stuff.

- Okay.

- But speaking of spreading stuff around. So masks are the topic of the year, right.

- Yes they are.

- We've touched upon this previously. Um, this is not, I rarely do this. We're gonna do this specifically. This is- I'm a doctor, you're a doctor, correct?

- Correct.

- Okay, they let you through med school.

- They did.

- Surprising.

- I did graduate. I did pass my boards, yes .

- Seriously? I didn't know that.

- Seriously.

- This is new news to me. So you're actually, you're board-certified fill in the blank. E.N.T.

- E.N.T., yeah, although don't ask me to run a code. Cause I can't anymore, but yes.

- So, though when we talk about- so we're both board-certified otolaryngologists, so we deal with noses and throats and that's what we do. Um, we are not-

- We are not epidemiologists.

- We are not epidemiologists, we are not mask experts, we went to medical school, we certainly have some knowledge, but when we speak about some of these things we're not offering you medical advice. Do not take this as the gospel, is my point here. But I'd say I think what might be helpful for the world, uh in my opinion, is a little bit of forthright, frank talk about masks.

- Yeah.

- And masks in general because we, at this point, we're in Wisconsin, that's where we're taping this, and you know the kind of masks have sort of weaved their way in and out of our world and they're kind of back because our case numbers are up a little more.

- Right.

- And I think there's some truths, there's some- Truth is relative, and I'd say there's some foregone conclusions about masks that ought not to be foregone, and there's some differences between the various types of masks that I think ought to be called out.

- Yep.

- And I think that's really our goal today is to just to kind of talk through that frankly.

- Yeah, and there's some inherent contradictions with the different kind of policies that are out there and the various masks that people wear. So, I think it's just a matter of discussing what those are and being honest about it, and then you know, you and I might have differences of opinions about what we need to do to get through this certain time period, or maybe not, so who knows. Let's see where it goes.

- So you first donned mask in medical school.

- Wait, you're talking about like when I first started wearing masks?

- Yeah. Well okay, Halloween excluded.

- Yes .

- Excluding Halloween .

- I've lived my life wearing a mask, actually, it's metaphoric .

- But in medical school, when you went in to the O.R. you put a mask on?

- Yes, correct.

- Correct?

- Yes.

- Why?

- Now I put on a mask because that's actually to- it is shown to decrease the rate of infection, like surgical site infections, one.

- Is that why you put the mask on? I put the mask on in medical school because they told me to put a mask on, right?

- Oh, one hundred percent.

- In my medical school we never had a mask class. We never sat there, and nobody ever said "oh, you know, we wear these surgical masks and we were them to keep infection away from patients or keep us away from patients".

- Well, I mean-

- It was sort of talked around, but I don't know that anybody ever talked about "hey"-

- I remember talking about, talking through that. You know I remember in the E.N.T. and this probably predated, this came after you, cause I don't think robotics was around when you were-

- No.

- In medical school. So, when transoral robotics, which is the big surgical robot that did cases in the tongue and whatnot, through the mouth. Korea had the biggest trial, and there was always this discussion around how they still, you know, didn't wear a mask in certain O.R.s, and like, cause it's not ubiquitous everywhere, not everybody always wears masks. But I think there is plenty of data that shows wearing a mask versus not does decrease the rate of infections, like post-op infections.

- Yeah, I wouldn't- it depends. Then I'd say, well, it depends on the case, likely.

- Yes. You mean like clean versus a non-clean case, et cetera?

- Yeah, exactly.

- Sure, sure, yeah.

- You know, so that's where, I think there's-

- Wouldn't you worry if you're surgeon- if you had your abdomen open and they had a coughing spell with no mask on?

- I would, because I've been conditioned to be concerned about that, not because I have actual absolute rock-solid evidence.

- Sure.

- I'm just saying. I guess my main point here is that there are foregone conclusions that aren't- I'm not saying you shouldn't wear them, but I'm just saying there are parts of the world, pre-COVID, and I'm sure even in COVID too, where wearing a mask in the operating room is not normal.

- Or like on some of these medical missions you're reusing masks which would be, you know, a ghastly thing to do here in the U.S.

- Right, are they less people- Are their lives less worthy in a medical mission than they are here?

- No.

- Obviously not, right?

- It's the resources that you have, and you do the best you can.

- And so that's what I'd say. That's our reality today in the moment, is take the resources that you have, you do the best that you can with them, knowing that it is not- dogma is for fools, and if somebody's sort of handing out dogma like, cause I've hear this and I've heard masks are, you know, "you're a sinner if you don't wear a mask", and then the flip side: "you're a sinner if you wear a mask" and I'd say "well you're probably a sinner period."

- Maskless or not. You specifically are a sinner, without any doubt, and me too. But it's, the mask is, I guess, now fast forward to COVID and where we live right now, masking in the current world is trying to decrease the spread of COVID and as a society. And early in COVID it was actually there was recommendations on high, dogma, "masks are bad", "don't do them", blah blah blah blah blah. And part of it might of been their actual thought of "masks might be harmful", more likely it was a "we don't want to run on masks, we need masks for our medical providers". So they wouldn't, they can't tell you that when they're saying that, but that likely is in the back of their heads.

- Oh, I have no doubt. I think that you can- you know, transparency around that could've both helped and hurt at that time, because again it was kind of like seeing where things were heading and if we were gonna have a shortage and then people go run and buy all the masks that are needed by healthcare.

- And that's a challenge, you know. And so people, and it's caught crediting issue because people are like "well, why did you say this back then? Because now you're saying something else." But also now we have a more of a robust supply of masks, so it's a, it's a challenge.

- It is a challenge.

- The messaging has been a challenge.

- Yeah, yeah. Well it is, but I'd say- um, how do you say this? It's proof positive of it's the resources that you have and what are you going to do with those resources? And um, that's true. So your dogma has to be shaded with those sorts of things. And I think that part of it- Right now, you know we're filming this almost in August here, but basically right now there are many locales where mask-wearing is mandatory, outside and inside, some places inside, I mean it's kind of a patchwork across the country. Even there though there's- not all masks are created equal. And we've talked about a little bit about this in the past. There are various types of masks-

- Right.

- That were designed for different reasons. Um, in my opinion, and this is my personal opinion, a mask that is- The purpose of a mask right now in this pandemic is to keep your respiratory droplets to yourself, and so if someone's trying to wonder what a respiratory droplet is if live in a cold environment and walk outside if you've ever seen your breathe freeze, those are respiratory droplets. And if you put something over your face you'll notice that there are fewer respiratory droplets being spewed. So A: anything that's covering your face is going to diminish that. The, the less porous that thing is, the less, the fewer droplets that are going to come out of there. And the flip side is that there is this thing called N95 masks which are very- they're not porous at all, and they really keep things out. N95 masks protect the wearer, that's why they were designed. N95 masks weren't designed to protect the world, they were designed to protect you from the world, and specifically caustic environments. Whether that's industrial, or medical. But I, have I worn an N95 mask before COVID? I don't know that I ever have.

- You know, I remember getting fit tested in residency as part of a requirement.

- Oh yeah, maybe I did.

- You know so like, but that's it. Otherwise, you know, unless we were going in to a room where a patient had T.B., or some sort of airborne illness that you had to wear an N95 mask, we never did.

- And that would be the one instance now that I think about it, is those folks that were in isolation that you have to put the N95 mask on, but that was rare, really rare.

- Exceptionally rare.

- A few times a year, maybe. But now, you know I think that's where it's tricky, is that, okay, N95 sounds- it is safe. It's hard to breathe through an N95 mask, and so there's definitely some pros and cons there. I don't, I mean and so the various types of masks, I mean I've got mine. This is my personal favorite, the sort of-

- This used to be a stocking and now it's a mask.

- The, the wreaking havoc on the world, uh neck gator, bring it up over your face, and the reason I like this is that basically I can bring it down like almost a scarf, and then I can pull it up when I need to. This is not, this is not an N95 mask.

- No.

- No, not even close.

- But it's trendy, cause I've seen some of my buddies in California, them and all of their families have a scarf thing that they can kind of pull up.

- I'm a man of many trends. And I'm bringing the neck gator, full force.

- That's a Dolce & Gabbana. You could get a lot of money for some of those.

- Believe me, believe me. Yes it's very, very .

- Yeah, so should we go through?

- Yeah.

- And so this is kind of your typical cloth mask, but kind of multi-layer, alright, and this is lift a golf brand, but anyway.

- Nice, all right.

- True, true lengths.

- It does look like ladies underwear.

- Yeah.

- Did you get that in a ladies lingerie, uh-

- Exactly, yes .

- Sixth floor, ladies lingerie.

- So it's a little bit stringy. So, and then here's your typical, this is your typical surgical mask, and this is what we might wear, ours are a little different, they might tie in the back, but this one's kind of multi-ply I guess.

- So here on this though, those ones are pretty porous, right? So it's easy to breathe through them relatively speaking.

- They're more porous but they're less porous than this. And I think the best analogy that I heard most recently is like, you know imagine you had multiple chain link fences and you kind of like cross hatch them, right?

- So rather than just a chain link fence that something can fly through, have three or four and kind of offset them. So it just makes things harder to get in that of.

- Yep.

- Versus-

- But it's easier to breathe.

- It is easier to breathe.

- Out of all these, I'd say the surgical mask, I don't know about your lingerie mask. But I'd say this mask is pretty easy, I'd say my neck gator is pretty easy.

- Yeah, I mean yes, it's good air .

- This is also, like sort of lingerie-esque. But yes.

- But yeah, but it- you know interestingly enough this is probably easier to breathe through than both of these perhaps, but also more protective, because of the way that the fibers are structured. And then here's your typical N95 mask, which you know, it's interesting that like you could wear this and not be fit tested and have it not function the way it's supposed to.

- Or if it's fit tested, which most people aren't being fit tested because we just don't have the capability of doing it. But if it's fit tested it will, I mean it's a really tiny thing, so coronavirus might be what they call 0.3 microns whatnot, and this might protect up to 0.5. So again, it has to find the exact way in on that tiny microscopic level, which ain't gonna happen really.

- No. But I'd say, but even- not that I want everybody- if somebody's not wearing an N95 mask- if somebody is wearing an N95 mask improperly it's basically defaulting back down to surgical mask. You know what I'm saying? Like, if you had leakage around it it means you're more vulnerable, but you're still protecting the world from your breath. And so I think that's kind of a take home point here is if you are wearing protection, or if you're wearing a cover over your nose or your mouth, then it's both protecting you and protecting others. Um, I guess that's really the take home.

- I guess that's the general- like for the general population, I imagine the idea, and you know we've talked about this, is like, you're not wearing a mask to protect yourself, it's to protect others. And I think that's the more global, general concept, versus N95 is going to protect you as much as it's protecting others, I would imagine.

- Yeah, have you heard of the peeing analogy?

- No, what's the peeing analogy?

- This is good, this is the best explanation-

- Now we're getting into bathroom habits, this is great.

- Okay, alright, let's just pretend that I'm not wearing pants. And we're standing up here.

- You have no clothes. You're the with clothes.

- Just, going back to lingerie, we're both naked and we're standing here, right.

- Oh I think I know where this is going.

- You know where this is going? And I just pee, alright. We're about this far and I'm you know, my bladders full and I just gotta pee.

- Yeah.

- If I'm not wearing pants, I guess you could be wearing pants, but regardless, for whatever reason we're both naked, and I'm peeing and the pee is likely to get on you, if I'm talk- we're having a conversation.

- Or at least it's gonna hit the ground and spread.

- And spray, cause we're both exposed. Now, now, this is going somewhere. Now, if I put pants on, you're still naked, I think, whatever you wanna do you could do. But I've put pants on, now I decide to pee, it's possible my pee might splatter on you but it's not very likely because I've got protection on, right?

- This is a great analogy, yeah.

- Now, now, okay.

- Now what's the difference between a man and a woman?

- That's too complex.

- Okay.

- We're talking about me and you, okay.

- Cause then this six feet distance thing doesn't really matter as much it's just going down the leg.

- Now here's the thing, now. If I have pants on and you have pants on, and I pee, the likelihood of my pee getting on your legs is really hard.

- This is actually a great analogy.

- Right? So, it's , but a mask would be very similar. So if I am infected, and you are not, and I, you know same thing, if I have a mask on I'm kind of keeping my infection to myself. It's still possible. If I have a mask on and you don't, can- yeah. If we both have masks on it's pretty darn hard for that to spread, generally speaking. And so I'd say that little peeing analogy I think is pretty, pretty- I mean it's an analogy, so it's not perfect, but I'd say it's pretty-

- Did you come up with it on your own?

- No, no, no, no. That's like a, that's a, I don't know.

- That's a good analogy though.

- A Facebook, google, whatever that is. I think it's pretty accurate, and it's honestly as much thought put into that as I've ever put into this concept. I think conceptually that makes some sense. I think the other challenge I think that folks have with masks, any masks, this mask, that mask, is that it is harder to breathe with a mask on that it's not. I think, you know something I was just talking about earlier today, there- this gets back to what we do, specifically. So at ADVENT we deal with nose and throat issues, we deal with folks who have compromised airways, and we fix those airways to get them back on track. Putting a mask on, whatever you airway is like, compromises your airway. And so I think many people don't like putting masks on because they don't like to compromise their airway. They don't like to compromise their airway because the airway is the most important thing you have as an animal, as a living being. If you airway is compromised, um, you can die.

- Right.

- And so people don't get that deep when thinking about it but I think a lot of the kind of blow-back against masks comes back to the fact that people don't want to compromise their airway, and they don't conceptualize why they don't want to do that, they just know that "when I put a mask on, I don't like it, and I feel anxious", and I think there are patients we deal with all the time that have that feeling constantly. And there are other patients we deal with all the time that put a CPAP mask for instance on, and have that similar sort of claustrophobic feeling. And so long story short, I'd say masks and mask-wearing is, um, it's relatively simple, but it's not as simple as it sounds, and I think there's a little bit of this that's out there, I've never heard it pointed to as specifically as much as I'm trying to do right now, but not that's it's a bad thing, but I'd say your airways are very important, and if they're compromised, um, it's unnerving, and that's a human reaction.

- Yeah, yeah, I agree. You know and I've seen patients that've talked to that same thing. They're "I'm already congested, and when I put the mask on it's really hard to breathe." I think that, you know, it's important to probably draw a distinction between that and like, "hey, it's proven that your oxygen levels are at a decline, it's gonna make it, you know, an emergency situation for you". And obviously you and I are in a unique situation as are most surgeons or anesthesiologists who've built a career around wearing masks all the time. It's certainly so we're used to it.

- Yep.

- Um, but you know hopefully this is a short finite period of time where we can kind of, you know, cohesively gather around kind of an idea and get through it and move on with our lives, and do what we can to help ourselves and help others, and like be done with this as fast as we can, you know.

- Well, hopefully so, exactly. So, yep, I guess one final shout out here, I guess we were just named Top Workplace again. We've been named this a few times by a few different organizations, this is by the journal Sentinel. Um, you were the dissenting vote I think. . You're the one, you're the one ADVENT employee who was like, who just gauged us.

- They said it was anonymous.

- No, I got your, I got your form, it's right here.

- Big Brother's watching.

- Right here is Ethan Handler's, um, wow.

- Guilty.

- Guilty, yes.

- Well, anyway, but that's-

- I won't be on ADVENTing episodes here to come.

- Exactly. So anyway, if you have liked this, please subscribe to us on YouTube, and give us a shout out, give us a like, and we will be back next time. Take care.

- Have a good one.

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