Dr. Roger Hicks: The governor’s order
We are not done with COVID-19. Case numbers continue to rise here at home in Nevada County, in California, in the U.S. and the world. After having no new confirmed cases in Nevada County residents since April, our case numbers have gone up by more than 80% since the beginning of June. Numbers in surrounding counties are increasing, and the state had the largest number of new cases this past week since the start of the pandemic. Some of that may be due to increased availability of testing, but free testing has been available to anyone who wants it since May 5 through OptumServe at the Grass Valley Veterans Hall and in the Truckee area. It is likely a combination of pent-up cabin fever, more contact between people with reopening businesses and rescinding the stay at home order, the influx of visitors over the Memorial Day weekend, and the recent protests.
So what do we do? All indications are that this is not going away anytime soon. It is a virus new to humans, so very few people have any immunity to it. There is no vaccine and no effective treatment. Right now, the only way to fight COVID-19 is to control the spread.
The tools we have for controlling the spread are:
Limiting contact with people outside of your household,
Social distancing when you are out,
Testing and contact tracing, and
Masks have been in the news lately so let’s talk about them. Like many things concerning COVID-19, the recommendations around covering one’s face in public have changed as we have learned more. The Centers for Disease Control and Prevention (CDC) and the World Health Organization (WHO) initially said that healthy people did not need to wear masks unless they were taking care of someone who was ill. This may have been partly motivated by the critical shortage of medical masks for healthcare workers, but it was bad advice. Both organizations pivoted in April to recommend that everyone wear a cloth face mask in public. Now it is mandatory in California and 14 other states, the District of Columbia, and many counties and cities across the country. Why?
We know that people infected with SARS-CoV2 (the virus that causes COVID-19) are contagious for several days before they develop symptoms and that many have very mild symptoms or don’t feel sick at all. The CDC and WHO said wearing a face covering in public helps keep people who have the virus from spreading it to others.
A new study by the National Academy of Science concluded that airborne transmission is the primary way the virus is spread, and that masks are the most effective way of stopping it. An international team of researchers looked at infection control measures in New York City, Italy and Wuhan, China. Social distancing, testing, contact tracing and mandatory masks were started at the same time in China, while in New York and Italy, face coverings in public did not become mandatory until weeks after the other measures. The study shows that infection rates in New York and Italy did not start to drop until face coverings became mandatory. The researchers estimate that face masks prevented more than 66,000 cases in New York and 78,000 infections in Italy from the time they became mandatory in those places until May 9, when the study ended.
The virus is spread by droplets created when we cough, sneeze, laugh, shout, sing, talk or just breathe. There is direct transmission, when an infected person coughs or sneezes on someone else, and indirect transmission, when droplets fall on something that is then touched by another person. Large droplets tend to not travel more than a few feet and settle out of the air quickly. Smaller droplets, called aerosols, stay in the air much longer and travel farther. We knew that face coverings prevent shedding of the larger droplets, but new studies show they also stop creation and inhalation of the virus-containing aerosols. The National Academy of Science study concludes that “wearing of face masks in public corresponds to the most effective means to prevent interhuman transmission, and this inexpensive practice, in conjunction with extensive testing, quarantine, and contact tracking, poses the most probable fighting opportunity to stop the COVID-19 pandemic, prior to the development of a vaccine.”
For some it has come down to a question of whether the Governor’s Executive Order has legal standing. To me, that is not the issue. The question is “are masks effective in helping stop the spread of the disease?” There is mounting evidence from around the world that they are.
The pandemic has been brought under control in places where masks are mandatory. We can do it here, too. We are all in this together, and we are stronger together. Keep your space and cover your face!
Dr. Roger Hicks is the Medical Director for Yubadocs Urgent Care in Grass Valley and the founding president and current Director of the California Urgent Care Association.
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