Face shields in the Philippines are blurry but DoH got it right. The good shields work.



“There is not much evidence to support an argument the public should wear face shields with masks, but there is some, and it is solid. It would however be much better if the public wore respirators, which properly fitted need no adjustment during a day of wearing,” concludes a study group on the Duterte Face Shields debacle.

“In the Philippines, people wear face shields advertised as ‘anti-virus’ covering the tops of their heads, not their face, and sloppy imitation procedure masks covering their chins, not their mouths and noses. The appearance is creepy and the effect is dangerous,” says a Manila-based doctor with the Department of Health who does not want to be identified because she is not authorized to speak to media.


by Sharon Santiago and Micheal John


“The current rule of thumb is wear a face shield and face mask when you leave your home anywhere in the Philippines, else you violate the rules,” was the advice of a medical PPE study team. Read on.

FPMag assembled  three doctors, two nurse practitioners, and one PPE specialist into a Zoom conference and sought the best possible advice on the face shield question, for readers in the Philippines and all around the world.

One thing that stood out first and unanimously from the group of experts, without any equivocation, is that the Department of Health (DOH) in the Philippines is absolutely correct in adducing that the efficacy of a respirator and face shield combination is better than 95% in preventing the spread of COVID-19 and preventing the wearer’s infection of SARS-CoV-2.

Also, the medical expert group of clinicians agreed that, “the combination of a procedure mask and category 1 face shield will possibly provide 90-95% protection for nearby persons at a distance of about one metre or more. A SARS2 infected person with one of the new variants should not be near anyone and such infected persons poses a high risk unless wearing a fit tested FFP respirator such as an N95 which blocks small particles of the virus both exhaled and inhaled.”

There is substantial evidence from studies published in the Lancet and elsewhere that efficacy of the face shield and FFP respirator together can reach 100%.

“Acting on the advice of health experts and in view of the Delta variant, President Duterte declared that the wearing of face shields, both indoor and outdoor, is still mandatory,” Presidential talking head Harry Roque said last week.

According to the “Philippines News Agency“, a propaganda publication of the Duterte regime,  “Presidential spokesperson Harry Roque retracted his earlier statement that face shields will no longer be required outdoors except in enclosed public spaces such as commercial establishments, malls, and public transportation”.

This follows a previous announcement that Philippines President Duterte made saying that face shields would no longer be mandatory since, as Philippines Senate president, Vicente Sotto III, put it at the time, ‘no other country in the world was mandating face shields’, or words to that effect.

The Philippines Department of Health responded saying in a published statement on its website, “We understand the concerns raised on the government’s policy on wearing of face shields and we are open to dialogues in improving our health policies. However, the nationwide case trend is plateauing and not decreasing. The increase in cases is slowly shifting in other regions outside the NCR [National Capital Region]  plus.”

“With this trend,” the statement continues, “we can’t afford to relax the policies on personal preventive measures. We can consider loosening up these measures when we see a continuous significant decline in our daily COVID-19 cases and/or once a significant portion of our population, especially the vulnerable sectors, the elderly and then persons with comorbidities, have been fully vaccinated,” health undersecretary Maria Rosario Singh-Vergeire said.

Problem 1: The face shields that most Philippines’ citizens seem to be wearing do more harm than good in risk settings because they are pieces of plastic attached to hoaky plastic sunglass frames that leave wide openings at the top and bottom of the so-called shield. That makes them air scoops and exhalation distributors.

William Lindsley, a research biomedical engineer at the USA National Institute for Occupational Safety and Health, explained that “a medical face shield is good against the really big particles that you can see with just your eyes,” he said.

“But as the particles get smaller, [microscopic] it’s just easy for that to go around the face shield and be inhaled.”

“Unless the wearer has a filtration face piece respirator under the shield, one to three micron particles of the virus will be inhaled,” said Doctor Nassima al Amouri in the expert group. “This obviously makes the case that a shield and respirator combination is the gold standard and what Dr. Peter Collignon in his Lancet article, “Eye protection might be the missing key,” is reinforcing,” she added.

Face shields used in an aerosolized hazard environment such as the exhalation of droplets by an infected person wearing the shield or the inhalation of droplets from an infected person nearby the wearer, must be closed at one end to create an isolated chamber. The same applies to protective goggles worn in a high risk environment. Goggles must seal to the face and protect the eyes while a FFP respirator protects the nose and mouth, explained one of the doctors in the study group.

no useful properties for preventing infection by infectious disease

In the past, FPMag has warned on these pages, the Presidential spokesperson in the Philippines, and the Mayor of Baguio City, of the dangers of wearing this improvised PPE, nevertheless, both continued to wear the dubious devices and both became ill with COVID-19. Coincidence? This type of shield has no useful properties for preventing infection or avoiding aeroslized or small particle transmissions by infectious disease pathogens because of its design which in no way resembles a medical safety device. The irony is that this so-called shield is more expensive than a medically correct face shield. The fake Face Shield Anti Virus Face Protection hood face Isolation virus  are sold from Manila by family members of government officials on Lazada and Shopee, according to an FPMag investigation, along with N95 masks, officials at 3M, said were ‘fakes’. For God’s sake, Philippines, somebody has to tell you…


This illustrated item above might be useful for a butcher to block blood droplets while hacking with a big knife into a side of beef but for protection against a deadly aerosolized pathogen in a high risk environment—and one never knows if the person who coughed as they pushed past them was infected—they are dangerous. A person who through bad luck wandered into a high risk area, would be in grave danger from aerosolized pathogens if not wearing an N95 respirator.

Why? “Because any motion of air caused by walking or turning the head causes a flow of air through the scoop that is created, past the unprotected eyes, and probably passing an unprotected nose if an ear-loop mask is worn and slipping,” explained nurse Karinna Angeles from Manila in the Zoom study group.

“That same channeling of air draws the exhaled particles out the top or the bottom depending on the  angle of the head. Hence this type of shield does not protect either the wearer or the nearby population,” explained Michele Francis, a nurse practitioner and administrator in charge of several clinic units in Venezuela.

Problem 2: Masks that loop on the ears do not provide adequate protection to the wearer or bystanders in high risk scenarios because the ears become pivot points and the mask will gradually slide down off the nose leaving the nose uncovered with a double open ended  face-shield-scoop channeling air to both the nose and the eyes and exhausting exhalation up or down or both.

According to the CDC, limited assessment of ear loop designs indicate they may pose difficulty achieving a proper fit,” says the US Food and Drug Administration in a published warning.

“Such ear-loop masks also require constant adjustment and most untrained persons grab the mask at the middle and tug it upward. They now have all the pathogens blocked at inhalation, on their fingers. That is 100% likely to include dozens of familiar bacteria particles both dead and alive, rare disease, and, if the wearer is unlucky, particles of COVID-19. Where will those fingers go next? It takes very few particles of the B.1.617.2.1 to infect a person,” the study group agreed unanimously and reported.


Face shield with procedure mask worn high on the nose.

File photo: Face shield with procedure mask worn high on the nose with the metal forming insert well fitted. 2nd Best option to an FFP respirator and shield. Photo Credit: Courtesy The RINJ Foundation


Procedure masks are intended to keep, as “source-control devices”, the wearer’s spittle off the patient in the O/R or in procedure rooms or examination rooms. They were never intended to protect the wearer. Good three-layer or more procedure masks offer a little protection, but not so much.

 


“Wear a respirator if personal protection is what you need,” say members of the study group.  “As source control devices procedure masks are excellent.”

Category 1 medical face shield, and FFP 3M N95 Respirator

Category 1 medical face shield, and FFP 3M N95 Respirator
Photo credit: source supplied. Dr. Anderson

The best respirators or procedure masks tie at the back and top of the head.

In a field test reported by the Lancet, a large group of health care workers wearing a proper, inexpensive, top-sealed face shield, and a properly fitted respirator, had zero infections.

Thirteen studies (including 3,713 participants) focusing on eye protection found that face shields, goggles, and glasses were associated with lower risk of infection, while wearing a surgical mask, compared with no eye covering.

An inexpensive  Category 1 Medical Face Shield

Wear a face shield. This type is best because it blocks a throughput of air from top to bottom.

This respirator must be fitted correctly in order to have function and avoid necesity for adjustment while wearing a shield. The shield must seal closed at the forehead and fully wrap around the face. It must not be open at both ends. A genuine disease-prevention  Category 1 Medical device. Wearing a FFP respirator and a face shield that snugs tightly to the forehead, to go shopping, will help protect the respirator enabling greater reusability of the respirator. The US centers for Disease control do not recommend the use of a face shield.  In 2021, nothing but a FFP Respirator is indicated say most medical experts, however, an increase in efficacy against aerosolized large particles of SARS-CoV-2 has been proven recently for the combination even though the increase with the shield is only slight.

Wearing a properly fitted N95 mask or equivalent with a proper medical grade face shield properly fitted provides better than 95% efficacy at preventing the wearer from becoming infected, and 99% protection against infecting anyone else, but some studies indicate 100% efficacy in the latter case.

 

SARS-CoV-2: eye protection might be the missing key

“Eye-protective face shields have been proposed  to prevent community transmission,” says a detailed report Published online February 23, 2021 by doctors Minas Theodore Coroneo, and Peter John Collignon

In the report, doctors Minas Theodore Coroneo, and Peter John Collignon, say “a large study showed that 19% of health-care workers became infected, despite wearing three-layered surgical masks, gloves, and shoe covers and using alcohol rub.

“After the introduction of face shields, no worker was infected,” they continued.

Read the full Lancet study in PDF form: The-Lancet-SARS-CoV-2-eye-protection-might-be-the-missing-key


Limited Data on Face Shields as protection from biological hazards. Study says face shields should be adjunctive to other PPE (including masks, goggles, etc.).

A recommendation in a study conducted for the NIH, (US National Institute of Health) in February 2016, “Face Shield for infection control”, sets out as a conclusion that, “Face shields are PPE that are commonly used as barrier protection for infection control purposes by numerous workers.

“There currently is no standard regarding face/eye protection from biological hazards and this deficit needs to be remedied as quickly as possible,” the report continues.

“Due to the lack of a good facial seal peripherally that can allow for aerosol penetration, face shields should not be used as solitary face/eye protection, but rather as adjunctive to other PPE (protective facemasks, goggles, etc.).

“Given the dearth of available data regarding the appropriate use of face shields for infection control, scientifically sound research needs to be conducted on the use of this form of PPE,” the study concludes.