Time to ditch the face shield – Manila bulletin

UNDER THE MICROSCOPE

Dr Raymund W. Lo

Recently, the IATF announced that it is considering lifting the requirement for facial protection in outdoor spaces. Face shields have been allowed to be removed in theaters. Alright, but is it really necessary to wear face shields in public?
Let us examine the matter in more detail. The requirement for a face shield was instituted in the second half of 2020 when the hygiene theater was at its peak. Plastic / acrylic dividers have flourished in most establishments and on public transport. Even motorcyclists have been forced to cross “drumsticks” barriers, again made of plastic, between the driver and passenger. Even hospitals have entered into the act. I had gotten into the habit of wearing closed goggles to protect my eyes from the start, which helped protect my eyes from exposure to the virus better than a face shield. But no, management demanded that everyone wear face shields. My protest fell on deaf ears.

Now all plastic barriers are virtually gone, including on jeeps, buses and motorcycles. Why? Because they have been shown to be ineffective and, in some cases, were more likely to catch the virus than to keep it away. Does the same apply to face shields?

Let’s look at the evidence, both medical and technical. Some experts have referred to certain reviews that have offered evidence of effectiveness in reducing viral exposure. So I looked at those newspapers to see what the “hard” evidence was for the use of face shields in public.

In theory, the goal is to protect the mucous membranes (eyes, nose and mouth) from exposure to the SARS-CoV-2 virus which can enter the body through these portals and attach to ACE receptors. The face mask, especially the surgical types, N95 and KN95, perfectly protect the nose and mouth.

Eye protection comes in many forms: glasses, protective screens or safety glasses. According to Princeton University Environment Health Safety, eye protection should: 1. Protect against specific job hazards 2. Fit properly and be reasonably comfortable to wear, 3. Provide unrestricted vision and movement, 4. Durable and cleanable, 5. Allow unrestricted operation of any other required PPE.

The Occupational Safety and Health Administration (OSHA) and the Centers for Disease Control recommend eye protection as the preferred method of protection (I was right from the start). He cited the lack of a good peripheral facial seal and that little is known about the effectiveness of face shields in preventing the transmission of viral respiratory diseases (Safety of Goggles versus Face Shields in the COVID-19 Era (AAO.org).

This is because the most common and cheapest face shield available locally, which is probably the most widely used, has gaps on the eyebrows, sides, and under the chin, making the wearer susceptible to exposure to severe damage. small aerosol droplets swirling in the air. A wind engineer from the University of the Philippines recently said that face shields may actually increase the risk of exposure to Covid-19 instead of helping prevent the spread of the disease. He said: “Face shields tend to create a region of negative pressure, so they act like a suction and suck out what’s in the air, most likely including the virus.”

Although the WHO says face shields can be used as eye protection against respiratory droplets, in conjunction with face masks, especially medical masks, a Wayne State University study indicates that “plastic face shields add little protection for face masks ”. According to Dr Teena Chopra, “The role of face shields in preventing transmission is not supported, and if transmission through the eyes is considered to be an important factor, such as among healthcare workers, dentists and dental technicians, glasses may provide better protection than a face shield.

A review in the Lancet by Chu et al (June 1, 2020) found no strong randomized trials to better inform the evidence for interventions, including eye protection. In their discussion, “these data suggest that wearing face masks protects people (both healthcare workers and the general public) from infection with these coronaviruses, and that eye protection may confer an additional benefit. . The “might” barely gives a sense of certainty to eye protection, again noting that the term encompasses both face shields and goggles.

In summary, the medical evidence for the effectiveness of the face shield against respiratory viral infections is questionable and low-certainty at best, apart from being bundled with goggles which provide better protection and may well be responsible. of the low margin of eye protection. is.

Now let’s move on to the possible harmful effects of wearing face shields. Besides the possible increase in viral infection by air convection, the poor optical quality of the plastic used in face shields has been reported to be responsible for some accidents, violating the major principle of medicine: first of all, do no harm.

There is the ecological damage caused by the removal of large numbers of plastic face shields which add to the degradation of our environment and the production of microplastics. The Philippines has been identified as one of the major producers of plastic waste and eliminating hundreds of thousands, if not millions, will surely bring us to the forefront of plastic polluters.

Think of the economic damage to our poor compatriots who can barely afford three meals a day but still have to fork out 15-20 for an unnecessary face shield. Multiply that by the millions of face shields needed. Isn’t that a cruel and unusual punishment? How much more suffering can Filipinos endure?

Adding insult to injury, we are forced to wear an item that has been determined to be subject to bribery and overpricing. What a painful reminder to have something perched on your nose that may have been paid for in your taxes and still need to redeem. Job had not been so patient.

We can only pray, “Deliver us from this evil, amen!” “


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