Daniel Prude's death has been ruled a homicide.

By Karen Pallarito
September 03, 2020
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A 41-year-old Black man’s arrest and subsequent death after being restrained by police in Rochester, New York, and placed in a “spit hood” is under investigation by the state attorney general’s office. The county medical examiner ruled Daniel Prude’s death a homicide due to “complications of asphyxia in the setting of physical restraint."

Whether the spit hood played a pivotal role or had anything to do with Prude's death remains unclear. But the incident spotlights a piece of personal protective equipment (PPE) that is likely unfamiliar to many civilians. What do we know about these head coverings? Here’s what we learned.

Spit hoods look like oversized hairnets or mini pillow cases

A spit hood (aka spit guard, spit mask, or spit sock) is placed on a person, such as someone who is being apprehended, to prevent the person from spitting or biting. It's meant to protect law enforcement officials and emergency health care workers from exposure to diseases that can be transmitted through saliva or other bodily fluids.

Use of spit hoods by law enforcement is “pretty common and especially inside jails,” Paul J. Pfingst, a former San Diego district attorney now with the law firm of Higgs, Fletcher & Mack, tells Health. “I have never heard of any incidents involving the [spit hood] resulting in any serious injury."

As for the Rochester case, Pfingst said the ongoing investigation may reveal whether it was a contributing factor in Prude's death. Often, spit hoods are used when disruptive individuals act out due to drugs or mental illness, he says. “One would have to eliminate the contribution of the spit sock in an asphyxiation case” as being a contributing factor that “put someone over the top,” he points out.

A Google search reveals different designs and manufacturers. Medline Industries, Inc., based in Northfield, Illinois, offers a see-through spit sock manufactured by Stearns Wear. It’s made of “breathable material” and “designed to fit comfortably over the head while held in place with elastic.” MDS Associates, a Lancaster, New York, supplier, sells a translucent anti-spit hood “that resembles a small pillow cover.” It slides over the detainee’s head, sans ties or elastic, to prevent officers, their vehicles, and equipment from exposure to saliva, blood, mucous, or vomit.

There’s little data on their protective value, nor how safe they are for the wearer

So how much do we really know about spit hoods' health and safety implications? Perhaps not as much as we should, according to researchers who studied their use by police in England, Wales, and Northern Ireland.

The researchers' August 2019 review in the Journal of Forensic and Legal Medicine turned up “a paucity of information” on the number of police officers who have contracted infectious disease due to spitting or bites, even though these devices are ostensibly being used to protect officers from such health hazards. In the absence of data, researchers float the possibility that the use of spit hoods is “a form of mechanical constraint rather than a means to prevent transmission of infection.”

Separately, a team from the University of California, San Diego (UCSD) looked at the safety of spit hoods, specifically whether wearing one causes “a clinically significant impact on breathing.” People have died as a result of breathing being limited by a spit hood, the researchers point out. But there are no published studies on their use and safety, they write. So the team conducted a small pilot study in which they measured 15 healthy subjects’ vital signs in a controlled setting. Compared with baseline readings, there were no clinically significant changes in breathing while wearing a spit sock, they reported in the February 2019 issue of the American Journal of Emergency Medicine.

A follow-up study by the UCSD team, published this May in the Journal of Forensic and Legal Medicine, tested another spit mask design. Again, the study involved 15 healthy people. Wearing a spit mask produced no clinically significant changes in heart rate, oxygen saturation, respiratory rate, or blood pressure when comparing baseline measures to readings taken 5, 10, and 15 minutes after donning the mask, the study authors reported.

"Our preliminary work supports that the spit socks do not impact ventilation," says Gary M. Vilke, MD, a study author and professor of clinical emergency medicine at USCD. "This makes logical sense in that the spit socks are largely loose mesh and go around the head—allowing air to get in from many different directions," he tells Health.  They're also "much looser fitting and more porous" than the masks people are wearing to protect against COVID-19, he says. "And to my knowledge, nobody has asphyxiated from a COVID mask."

The takeaway on spit hoods

In Rochester on September 3, Black Lives Matter protesters took to the streets after the release of video footage showing Daniel Prude being restrained and placed in a hood, according to the Wall Street Journal. Prude, who had a history of mental illness, died seven days after the March 23 incident, the Journal reported.

Is it important to protect our first responders from infection? No question. Are spit hoods the way to go? The jury is still out. As the Irish/British research team noted in their paper, spit guards are controversial and often polarizing, dividing human rights advocates and law enforcement professionals. If anything, the tragic incident in Rochester highlights the need for more rigorous scientific studies.

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