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The worst exposure is in the airport, while you wait.

Last week, my husband and I went on a post-vaccination, we-miss-being-empty-nesters vacation to use some of my airline credits I had accrued from cancelling all my speaking engagements from 2020. We had to change destinations when Georgia dropped its mask mandate, so off to the Carolinas we went.

The airport was insanely busy. I hope most people were vaccinated, but I have my doubts. About 36 percent of people have had one shot, and around 22-25 percent of the country is fully vaccinated. Georgia has the lowest share of people fully vaccinated, as of April 12: just 15 percent. Ohio, where I live, is at 21.6 percent, and I’ve administered about 0.00025 percent of those shots personally!

The biggest risk in traveling is not on the airplane. The way the circulation, ventilation, and filtration is set up makes the form of travel relatively lower risk. The worst exposure is in the airport, while you wait, where people are congregating shoulder to shoulder like sardines, in insufficient seating.

Here are the common mistakes that make me crazy:

  • People wearing only a face shield. It is recommended to wear a mask in combination with a face shield. The face shield may stop some forward-trajectory droplets, and may protect the wearer’s eyes, but aerosol can travel around the edges.
  • People wearing masks with valves or vents. This may protect the wearer, but it just spews any germs they are emitting into the air around them. If you wear that kind of mask, you should wear a surgical mask over it.
  • Men wearing single-layer gaiters. You can wear a gaiter, but it either has to have two layers of fabric, or you need to fold it over to double up the fabric.
  • Of course, the most prevalent issue is the below-the-nose mask wearer. Think about it – when you normally breathe, your mouth is closed and all your air is inhaled and expelled through your nose. The nasal mucosa is from where the virus gets shed. The point of masks is to capture droplets and aerosol with hitchhiking viral particles. Your nose has to be covered, in addition to your mouth.

It’s as though people think wearing masks is for show, and not for function. Having a mask draped from an ear loop, or wearing it as a chinstrap, isn’t doing anyone any good. Also, the virus doesn’t give special dispensation to you if you are eating. When you remove your mask to eat or drink, you are exposing your airways and making yourself vulnerable. When I travel now, I avoid eating in the airport or on the plane.

I had to request that customer service personnel lift their mask back up over their nose often on this trip. It is exasperating to me. If you have to touch your mask constantly to readjust it over your nose, it is defeating the purpose of wearing a mask. It also signals disregard for your client or customer. If you have had to do it multiple times in the first hour of your shift, it is likely that’s how the day is going to go. Get a mask that fits!

There is another solution, too. The below picture shows a face mask support frame made by a company called 4Ocean (4OCEAN face mask support frames). There are other manufacturers, but I personally like 4Ocean’s mission to remove trash from the ocean and rivers to repurpose the plastic. The frame helps secure your mask over your nose and under your chin, and keeps it in place.

From my research, I recommend and practice double masking. This consists of wearing a surgical mask (not an N95 respirator) and a cloth mask atop it to improve the fit. This protects both the wearer and other individuals best. My homemade masks have a pocket in which to insert the surgical mask. This enables my plastic frame to keep my masks out of my mouth when I talk, but gives me adequate protection.


When can we stop wearing masks?! We are nowhere near herd immunity, which is likely to require more than 70 percent of us to get vaccinated. Vaccination protection is not 100 percent, and the COVID-19 variants are more contagious. Sadly, I think we are going to be wearing masks for a while longer yet.

My husband says I am vaccine-obsessed. He is right. I inquire at every meal, and each of our servers was either partially or completely vaccinated. This made me happy, because they are at high risk from their patrons.

We are in the uptick of the next wave, which I predict will be pretty big because of spring break and Easter encounters, especially considering the baseline from which we are starting. Vaccination is in a race with the variants. I hope and pray we win.

Do your part. Wear masks responsibly and get your vaccination. Lives may depend on it – perhaps your own.


Erica E. Remer, MD, CCDS

Erica Remer, MD, FACEP, CCDS, has a unique perspective as a practicing emergency physician for 25 years, with extensive coding, CDI, and ICD-10 expertise. As physician advisor for University Hospitals Health System in Cleveland, Ohio for four years, she trained 2,700 providers in ICD-10, closed hundreds of queries, fought numerous DRG clinical determination and medical necessity denials, and educated CDI specialists and healthcare providers with engaging, case-based presentations. She transitioned to independent consulting in July 2016. Dr. Remer is a member of the ICD10monitor editorial board and is the co-host on the popular Talk Ten Tuesdays weekly, live Internet radio broadcasts.

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