One thing that must be borne in mind and can be observed all around is that there are masks... and there are masks.

Some masks being used have one-way valves to ease breathing. Unfiltered air leaves these masks, offering no protection to anyone but the wearer.

Cloth masks (preferably multiple ply) will stop droplets being spluttered about but retain moisture so, if you are spluttered upon, you will also retain anything nasty in those droplets.

Cloth masks have also been found to be ineffective in high-risk situations but for general purposes, do offer some level of protection.

If absolutely everyone wore a clean mask and followed other sensible precautions such as distancing, washing hands, not touching the outside of the mask and them touching faces etc etc, then certainly, these would be very good preventive measures.

Sadly, even casual observation shows that most communities in most countries are unable or unwilling to follow, respect or even understand basic rules. If, observably, a lot of adults are unable to do this, it is not at all likely that their children will behave any better.

Excellent points. I do see many kids though that are doing very well wearing their surgical masks. They are handed to each child as they walk into the school, with hand sanitizer. (I take note of your comments on the ported masks. There are the people who wear no mask; maybe don't care about themselves or others; then the ported mask, they care about themselves but no one else it seems. They were saying that the mask is to prevent you from giving the virus to other people, and not so much catching it yourself. But then the ported mask is a total fraud because you are exposing everyone around you potentially, but disguising it by wearing a mask. Wow, figure that one out?

It's not going well, here is one school on first day back. Crowded indoors and I don't see one mask!

Basically we have to ensure that the close interaction should be avoided. Let students come to school for a day in a week so that the love the change and understand the situation in a better way.

Thanks to Hermann Gruenwald for concern about the school students

Not sure

Some of the schools that went back last week are now closing again because of outbreaks. It is difficult, even if they enforce masks. Plus, all it takes is one infectious person.

Update: PPE does work, including masks.

This partly answers the question. PPE in hospital works. The same may not apply to children, for obvious reasons.

September 25, 2020

What Is the Incidence of Nosocomial COVID-19?

Carlos del Rio, MD reviewing Rhee C et al. JAMA Netw Open 2020 Sep 9

With rigorous infection control measures implemented, nosocomial COVID-19 is a rare event.

During the height of the pandemic in Boston, hundreds of patients were admitted to hospitals for COVID-19. Investigators studied patients at one Boston hospital who were diagnosed with COVID-19 on hospital day 3 or later or within 14 days after discharge to assess the risk for nosocomial acquisition of SARS-CoV-2. Measures implemented for infection control evolved over time but included screening for symptoms; testing for SARS-CoV-2; dedicated COVID-19 units with airborne isolation rooms; personal protective equipment; universal masking of staff and, later, patients; and visitor restriction.

Between March 7 and May 30, 2020, of the 9149 patients admitted, 697 (7.6%) were diagnosed with their first episode of COVID-19. Median length of stay was 7 days. Of the 697 patients, 12 (1.7%) were first diagnosed on hospital day 3 or later. The median time from admission to diagnosis was 4 days. After review of their records, the investigators classified these 12 patients as definitely community acquired (4), likely community acquired (7), or definitely hospital acquired (1). Among the 8370 patients discharged from the hospital during the study period for non-COVID conditions, 11 (0.1%) tested positive for SARS-CoV-2 within 14 days after discharge. Of these, only one case was thought to be hospital acquired.

COMMENT

Multiple studies have raised the alarm about nosocomial transmission of COVID-19. This study demonstrates that a well-implemented infection control program — one that includes routine testing of all admissions, serial testing of patients with clinical syndromes suspicious of COVID-19, universal masking of staff and patients, and limiting visitors — is effective in making hospital-acquired SARS-CoV-2 a rare event. For the foreseeable future, hospitals should continue to make these interventions part of their standard of care, much like universal precautions became standard of care after the emergence of HIV in the 1980s, and work with employees so that “battle-weary” staff don't let their guard down, as recently occurred at the exact same hospital where this study took place. Such incidents notwithstanding, patients need to be reassured that contracting COVID-19 is unlikely in a hospital or clinic where infection control measures are enforced.

EDITOR DISCLOSURES AT TIME OF PUBLICATION

Disclosures for Carlos del Rio, MD at time of publication

Consultant/Advisory BoardInfectious Diseases Society of AmericaGrant/Research SupportNIH/National Institute of Allergy and Infectious Diseases; NIH/National Institute on Drug AbuseEditorial BoardsClinical Infectious Diseases; JAIDS: Journal of Acquired Immune Deficiency SyndromesLeadership Positions in Professional SocietiesInternational Antiviral Society–USA (Board of Directors); American Conference for the Treatment of HIV (Board of Directors)

CITATION(S):

Rhee C et al. Incidence of nosocomial COVID-19 in patients hospitalized at a large US academic medical center. JAMA Netw Open 2020 Sep 9; 3:e2020498. (https://doi.org/10.1001/jamanetworkopen.2020.20498)

Carlos del Rio, MD

So this would imply that as there are very low nosocomial COVID-19 infections, that the staff are getting infected outside of the hospital. Again, speaking for better protection outside of the hospital, in the staffs' personal lives, to decrease the infection rate in hospital workers. Thank you and stay safe, Gary Ordog, MD