Aside from a brief leave of absence at the very beginning of the pandemic, I’ve been interpreting in-person as an on-site freelance medical interpreter in Richmond, Virginia since COVID-19 became a major part of our lives. During that brief break, I managed a group of local volunteers donating handmade masks to essential retail and service workers in my area. All in all we managed to donate over 4,500 masks, 26% of which went to Spanish-speaking essential workers. I started sewing my own masks in March of 2020 and since then I’ve been reading everything I can get my hands on about mask and other PPE (personal protective equipment) usage during the pandemic, especially for healthcare personnel.
I’ve been through quite a few iterations of my PPE get-up, and now I have many of my interpreting colleagues who are returning to in-person interpretation coming to me and asking for advice. Believe it or not, PPE has been a bit of a learning curve for me, not just in terms of efficacy, but also in terms of comfort, fit, and even trying my best not to scare the ever-loving bejesus out of young children! I’m going to share my different PPE setups here, why they worked, why they didn’t, and links to purchase the exact same things I use every day in the field.
If you’re interested in seeing my current configuration, please scroll to the bottom of this article and read the last two versions of my PPE setup (versions 4 and 5).
Two-ply Cloth Mask with Elastic
Beginning in early March 2020, I began to wear two-layer cloth masks. At that time, you couldn’t find fabric or elastic in stores, and shopping online was near impossible because everything was either out of stock or shipping was severely delayed. Fortunately I had some leftover fabric and some pillowcases that I ended up using. For elastic, I’d use hair ties that I either had extra of or my husband would scavenge for at the grocery store. At this time my masks didn’t have nose wire because I couldn’t find anything to use for it!
- Low level of protection
- Uncomfortable elastic
Three-ply face mask with ties, nose wire; glasses
Around June I would intermittently wear my husband’s protective glasses for household projects, but he’d occasionally take them back from me, and in one case I lost them on the way to an assignment. On top of that, they’d fog up terribly. I discovered that tie-on masks with nose wire provided a much better fit (now that I could actually get my hands on makeshift nose wire), and upgraded my masks to have three layers of fabric. I also discovered that my hair that I decided to stop cutting (let’s be real, going to the salon can be a big exposure risk) could go up in a ponytail that actually held my mask up better.
- Eye protection! (Relatively low profile)
- Better-fitting mask
- Mask with more protection
- Glasses would fog up like crazy
- Easily lost the glasses or dropped them
- Still a cloth mask
Three-ply cloth mask with ties, nose wire; face shield
In early August, I ordered one brand of face shield, but even after removing the protective film from both sides, they were horribly difficult to see through and incredibly foggy. I ended up finally finding a brand of face shields (Krebs – Made in the USA!) that fit comfortably and weren’t incredibly difficult to see through. To this day, even though I no longer really use them, you can see them hanging up on the wall in my office in the background if you ever see my YouTube channel or meet with me via Zoom!
- Better-fitting mask
- Mask with more protection
- Some level of eye protection
- Can still see clearly because it doesn’t fog up badly
- Great splatter/splash protection
- Doesn’t scare the kids
- Would randomly run into things or smack my face shield
- Young children would come up to me and stare curiously at their reflection in my face shield
- Germs can still pass behind the face shield and go into my eyes
- Still a cloth mask
KN95 with Fitted Protective Glasses
As I was reading more and more about eye protection, I found out that the key to really limiting your exposure through the eyes was sealed eye protection. I bought a pair of goggles in November, but they were HUGE on my face and ill-fitting. I still held on to them just in case I had any prolonged inpatient assignments.
Fortunately I ordered these absolutely amazing MySandy safety glasses after seeing some hospital staff wearing them. They’re actually quite fashionable, come in a variety of attractive colors, and have a lip on the sides of the eyes. They’re not completely sealed, but they’re also not completely open. They also came with a lanyard so I wouldn’t lose them like the last pair of glasses I had. Oh, and they’re also adjustable, which I actually didn’t find out about until January because I’m a genius.
While the MySandy glasses fog up less than my previous eye protection due to the KN95 mask’s fit, they still definitely fog up after prolonged use. I was aware of and had tried some anti-fog sprays with little success; there was definitely a limit to how long they worked. I was working assignments up to 8 hours and needed a convenient way to de-fog my eye protection every few hours, which led me to investigating individually-packaged anti-fog wipes. I lucked out, because the first brand I tried was a roaring success. If I had a long assignment, I could just throw a couple of packets in my pocket and take a quick trip to the restroom periodically to wipe down the inside of my glasses.
My Switch to KN95s
It was also during this upgrade that my local medical supply store started stocking KN95 masks with regularity. I decided to take the plunge and get some, knowing that the holidays were coming up and people would likely be reckless with congregating and having family gatherings. I didn’t feel comfortable buying KN95s online because I had heard about counterfeit masks and was unable to find a seller reputable enough to feel comfortable purchasing through. By purchasing them in person, I could look at them and ensure they were legitimate.
An ear saver is a piece of plastic, fabric, or ribbon with some kind of button or hook that you can place behind your head and wrap your mask’s elastic loops around, instead of putting the loops behind your ears. There are a few different styles (most of which eventually become uncomfortable for me) but the style that I’ve found to be most effective and comfortable is this one.
I ran into some issues with the KN95 masks due to my small face! Because my local medical supply store is getting KN95s through whatever distributor has them available, the masks vary in style and size. Some fit my face better than others, while others are so loose that they don’t form a good seal on my face (essential to offering maximum protection). I knew ear savers were a good option, but the styles of ear savers I had used previously would slide down the back of my head (even if I wore a ponytail) and eventually the elastic would pull on the tops of my ears, which made them hurt. I actually found this style of ear saver to work incredibly well at making a tighter seal around my face and opening up the mask loops enough to where they wouldn’t tug on the top of my ears.
- Glasses look almost like regular glasses
- Glasses come with a lanyard
- Mask is greatest level of protection I can get right now
Sealed lab goggles and KN95 mask with cover
With new, more infectious strains of SARS-CoV-2 becoming more widespread, as well my increased level of exposure working predominantly with unmasked pediatric patients (they’re either too young to wear a mask or have impairments that prevent them from doing so) I knew I had to upgrade to sealed eye protection. Just the other day, I was interpreting for a very young child who decided to walk up to me while I was seated, and proceeded to cough in my face. I had already made the switch to sealed eye protection, and having that extra level of protection gave me peace of mind I didn’t even know I needed!
In short, yes. A review of research published in October 2020 in the journal Clinical Ophthalmology states, “the eye is a potential route for SARS-CoV-2 transmission and infection.” That being said, the risk is relatively low compared to other routes of infection, such as respiratory tissues. Now, with that being said, there is still a lot we don’t know about these new strains, and being that they are more contagious, I decided to err on the side of caution and protect myself, especially given my high level of exposure.
These HoneyWell UVEX goggles were recommended to me by a dear friend of mine who is a chemist in New York State. They are currently teaching in-person classes at a university and at the time they recommended these goggles to me, they had not yet been vaccinated. Their level of exposure was also high, and these were the goggles they recommended to their students. I expressed concern that they would be too large for my face, but they assured me that they weren’t huge on their tiny face. On top of that, my friend wears their prescription glasses underneath their goggles.
These goggles are occasionally off-putting for some of my pediatric patients, which is why I always either bring my MySandy glasses in my pocket or even wear them under my UVEX goggles if I’m interpreting for children.
Cloth Mask Over KN95?
You’ll also notice in this photo that I’m wearing a cloth mask over my KN95. Because KN95 masks are expensive and designed to be disposable, I use masks three times before I throw them away. When I say three times, I mean I wear a different mask to each facility I interpret at in a day, meaning I can wear up to 4 masks per day! I was wearing a cloth mask over my KN95s to extend their use and keep them cleaner (and I’d use these amazing mask brackets to keep my KN95 from pressing up against my mouth and getting soggy) but for some reason I can’t seem to find any research on, the CDC says on their website not to wear another mask over a KN95. I’m assuming it’s because the extra level of protection it would offer is minimal at best, but many healthcare workers wear masks over N95 respirators to extend their use. If you happen to have more information on this, please reach out to me!
The CDC now recommends double-masking (wearing two masks) in certain cases. Basically: wearing a cloth mask over a disposable surgical mask is recommended. Wearing cloth masks of at least two layers is recommended. If your cloth mask is 1-2 layers, you could benefit from wearing another 1-2 layer cloth mask over it. Do NOT wear two disposable surgical masks at a time. These are recommendations geared towards the general public, not healthcare workers.
With my KN95 masks, I do what’s called the “paper bag method” that a lot of healthcare personnel used at the beginning of the pandemic when even hospitals couldn’t find medical masks. They would put their used mask in a breathable paper bag with their name on it and reuse it. I mark my bags with the day of the week, the type of mask, and with a little mark each time I use it. I will not use that mask again until the next week. It’s not an ideal system, but as the only person working in my household, I simply can’t afford to spend hundreds of dollars on masks (and my local medical supply store wouldn’t be able to handle it either).
So, let’s go ahead and move on to the pros and cons of this (hopefully) final iteration of my PPE evolution! No solution is perfect, and I’ve found the more protection you use, the more bits and bobs (like anti-fog wipes, ear savers, mask brackets, etc.) you have to utilize to mitigate issues.
- Greatest level of protection
- Goggles are a great fit, even for small faces like mine
- Nearly eliminates any and all anxiety I have from the risks of interpreting in person in medical settings
- Ready for nearly any level of risk associated with an interpreting encounter
- I get to make the joke that I switched to goggles so patients/providers could, “See my pretty blue eyes more clearly!”
- Goggles can scare the little ones, but I can mitigate this by bringing my safety glasses as a backup
- People sometimes look at me like I’m crazy for wearing the goggles
- Unsure of why the CDC says not to wear cloth masks over KN95
- Masks are expensive ($3 each)
- Masks can be large for my face (vary between manufacturers/brands/batches but fixed with ear savers)
- Elastic can hurt ears (fixed with ear savers)
These are some medical masks (surgical masks and KN95 masks) that are popular on Amazon. I’m not sure as to their efficacy but I thought I’d show some options here just in case.
Looking for Cloth Masks?
If you’re unable to get your hands on KN95 or N95 masks, are not working with known-positive COVID patients, and want to maximize your protection, you can certainly double-mask with surgical masks and cloth masks (see detailed breakdown of double-masking in the section “Double-Masking Do’s and Don’ts” in the gray box above my paper bag method photo or this page on the CDC website). Surgical masks are much easier to find (and don’t need to be certified like KN95 masks or N95 respirators) but with so many cloth masks out there, it can be incredibly difficult to find a brand or style that fits correctly and is comfortable.
You remember that mask group I started that I mentioned at the beginning of the article? Well, my right-hand woman from that group, Judi, created her own Etsy store where she sells the masks she makes. As you can imagine, after having made thousands of masks over this past year (including donating hundreds, if not thousands, to local folks in need) Judi’s gotten quite good at it, and I recently bought a few of her masks to use. Let me say, while my husband was absolutely blown away, I’m not at all surprised at just how well-made and well thought-out her mask designs are.
So please, if you’re interested in purchasing cloth masks, consider purchasing from Judi. She’s an amazing person and her mask designs are based on feedback from hundreds of people. This is a great way to support small business! I promise you won’t be disappointed with these masks, and I also don’t get a red cent from recommending these to you. I just adore Judi and the high-quality masks she makes.
Questions? Problems? Concerns?
If you have any questions about PPE, problems that you can’t seem to find a solution for, concerns with any of the recommendations I make here, or anything else you’d like to add, please feel free to comment or contact me! Figuring out PPE has been a long journey full of twists and turns, but I’m always open to suggestions and having productive discussions.