The image went viral: a young woman, looking frankly at her phone as she takes a mirror selfie. She's wearing scrubs, and there are angry red bruises pressed into a half-moon below each eye, on the bridge of her nose, and on her forehead. The widely circulated caption is in Italian; it explains that the poster is a nurse, and her injuries were caused by the face mask she has to wear to protect her own health while she does her job during the coronavirus pandemic.
"I'm physically tired because the protective equipment hurts, the gown makes me sweat and once I'm dressed I can't go to the bathroom or drink for six hours," the caption reads. "I am psychologically tired, and so are all my colleagues who have been in the same condition as me for weeks, but this will not prevent us from doing our job as we have always done."
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The N95 face masks that are worn by healthcare workers who are in close contact with COVID-19 patients are air-tight. They have to be, since the virus is easily transmittable, and travels in tiny respiratory droplets that can quickly make their way into your eyes, nose, and mouth and infect you with the virus. But the seal a mask creates can be painful, and lead to irritation and bruising, especially since doctors and nurses are wearing the masks for hours at a time.
"Generally, frictional forces caused by medical devices (or other objects in contact with skin) distort cells and tissues, resulting in sustained shear that leads to skin and subdermal tissue damage," according to an article in Wound Management & Prevention.
"The problem is pressure for duration. You have something on your face for your whole shift, and that can be anywhere from eight to 12 hours," says Shannon Sovndal, MD, an EMS medical director in Boulder, Colorado and the author of Fragile.
"Two months ago, I would put an N95 on for maybe five minutes at a time," Dr. Sovndal explains. "I would go into one patient's room and put on my N95, and then... I would just take it off. And if I had to go back into that room again, say 45 minutes later, I'd just grab a new mask."
Of course, this was before COVID-19 became a global pandemic, and healthcare facilities were facing life-threatening shortages of personal protective equipment (known as PPE). Now, workers are wearing masks for much longer.
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"The problem here is that we have a limited supply, and we're assuming everyone has an infection when you're going into their room. Because of that, you just have to put it on and live with it," Dr. Sovndal says. "This is totally atypical from normal operating procedures... You're wearing a mask for eight hours a day. If you're wearing an N95 mask for an extended period of time it's going to be uncomfortable and you're going to get those spots," he says.
Healthcare workers across the world are sharing their own images of their bruised faces, along with pleas for people to follow hygiene and social distancing recommendations. Flattening the curve of COVID-19 is the best way to reduce the burden we're placing on local hospitals and protect our healthcare workers. You can also support hospitals and healthcare workers by pushing for more PPEs and donating any you have on hand. And if you know a doctor or nurse personally, they may welcome one of these gifts.
This is the face of someone who just spent 9 hours in personal protective equipment moving critically ill Covid19 patients around London.
— Natalie Silvey (Stay at home - save lives) (@silv24) March 21, 2020
I feel broken - and we are only at the start. I am begging people, please please do social distancing and self isolation #covid19 pic.twitter.com/hs0RQdvsn3
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