The COVID-19 pandemic has focused our attention on facemasks like never before. At Alder Hey Children’s Hospital we are lucky to have an Innovation team, so we are always questioning how we do things.
When the pandemic hit, facemasks became the norm so it was natural for us to try and improve them and create the best possible coverings for our staff, children and young people, culminating in our latest medical device standard – a transparent version. But, the big question is: why did it take a pandemic for us to do this?
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The evolution of facemasks is long and convoluted, from holding sweet smelling herbs in front of the doctor’s face to avoiding foul smells in the plague eras, before their eventual use by surgeons to prevent wound infection at the start of the antiseptic revolution in the late 19th and early 20th centuries.
A recent research article published in The Lancet analyzed archival photographs of operative scenes and documented the gradual change from no mask wearing in theatres to almost universal appearance in the early 1930s.
No doubt this was fueled by the mandatory mask wearing for the public during the Spanish flu pandemic in the early 20th century. But, after this initial rapid uptake and innovations in design, the mask seems to have become relatively unchanged, with the only tweaks being in the move from reusable cotton to disposable melt-blown plastics.
As a pediatric surgeon I have worn an identical surgical facemask at work for the past 20 years. To be honest, I haven’t given them a lot of thought, they are as much part of who we are as caps and scrubs. All our working practices were adapted to the fact that the operative team around you had their faces covered. To an extent it was even welcome, when you needed to hide a yawn or your look of uncertainty.
It was a real culture shock to see the whole population dropped into this habit of facial covering in situations that were totally naive. Struggling to order in shops, looks of bemusement in corridors and the constant fidgeting and mask adjustments. In my own working life, it became odd to feel the loss of your facial expressions when communicating with families and other staff members outside the operating theatre, almost like driving without indicating or having no wing mirrors. A situation made 100 times worse for anyone who relied in some way on lip reading, which is roughly 1 in 6 of the population.
For people who have hearing impairment, or where English isn’t their first language or even for any of us in a noisy environment, we rely on facial expression and lip reading as well as speech to follow a conversation. This supplements what we are hearing and reinforces the messages we are receiving. Lip reading specifically, cues in the listener to the types of sounds the speaker is making by the shapes of the lips and mouth whilst talking, avoiding confusion and mishearing words and sentences.
This awakening to the impact of facial covering on communication was the catalyst behind our transparent mask. Our speech and language therapy teams at Alder Hey, immediately flagged the problem of covering facial expression, not only for how they teach children to speak, but as a broader impediment to communication in the clinical setting.
We started with this concept of improving the lives of our patients with hearing or communication difficulties that needed both the protection of their clinicians wearing masks, but also the ability to see their faces. But why stop there?
Healthcare is widely regarded as more of an art than a science, with the bedrock the doctor-patient relationship. Why should we handicap ourselves by removing one of our key modes of communication, when it was perfectly possible to make a transparent facemask? This concept travels right back to the ground zero use case of the surgical mask in theatre. If you can make a mask that improves communication but still protects as well, why wouldn’t you use it?
On the face of it a logical answer is to move entirely to transparent masks, but change is never that easy. With 100 years of fashion and conformity to deal with it’s pretty hard. Suddenly dropping the traditional surgical face mask for a transparent version becomes as monumental in surgery as it would to doctors relinquishing the stethoscope.
Equally many people long to go back to the days that we no longer wear facemasks in clinical areas, but is that sensible? Hospitals are full of sick and vulnerable people. Should we not take every step possible to reduce the amount of virus being transmitted in the air?
This isn’t just about coronavirus; it is about all respiratory viruses and I wonder if this period will make us treat respiratory hygiene as importantly as hand hygiene. I must admit that I have also quite enjoyed not getting the number of coughs and colds that I normally pick up as a children’s doctor.
The challenge is therefore to make these masks as unobtrusive as possible and I am pretty sure that transparency is the key.
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If better respiratory hygiene is the future of healthcare environments, then the wearing of masks will continue to be a key component. I hope that we can use human ingenuity to realize the benefits of mask wearing in this century, just as we did in the last, without the loss of seeing each other’s smile.
I see face coverings as a legacy from the pandemic and so we must learn to live and indeed thrive with them, especially in a health setting. Transparent masks are part of that legacy and if we need to live with them then let’s make them as appealing and as friendly as possible. I just wish we had done this sooner.