Dr. Roger Hicks: What’s the story with the masks?
To mask, or not to mask — that is the question. If you’re feeling confused about whether you should wear a mask, when and what kind, you’re not alone. Like many things having to do with COVID-19, the recommendations have changed since the start of the pandemic, and now — believe it or not — wearing a mask has become politicized! Let’s leave politics out of this discussion and stick to what we know from science.
Part of the confusion has come from conflating the two very different purposes for wearing a mask: to protect the wearer from getting infected by others and to protect others from getting infected by the wearer. Protecting the wearer is more difficult: it requires personal protective equipment (PPE), including medical a grade respirator, such as an N-95 mask that has been tested for a leak-proof fit to the face of the wearer, meticulous putting on and taking off of the mask, eye protection, gloves and a gown. Protecting others by blocking outward transmission, called source control, is much easier and can be achieved with cloth masks.
What is source control? Suppose you find a dandelion in your garden with an intact seed head, ready to be scattered by the next gust of wind. You want to prevent those seeds from landing in your garden and making new dandelions. One way is to put a net over your garden to keep the seeds out. It would have to be very fine mesh, tight to the ground on all edges, but not so tight as to break your plants. Alternatively, you could try to catch each of the little seed parachutes one by one after the gust. Or, you could put a small paper bag over the seed head and prevent the dispersal in the first place.
We know that the COVID-19 is caused by the SARS-CoV2 corona virus. It hijacks the infected person’s cells to replicate, then bursts out of the cells into body fluid in the lungs, nose and mouth. You may have seen the green laser images showing how far the tiny droplets released by coughing or sneezing can travel. Studies have shown they are produced not only by coughing or sneezing, but also by normal speech, which can create thousands of droplets per second. Other studies have shown each droplet can contain hundreds of thousands of viruses and that the droplets linger in the air for eight to 15 minutes. We know the virus is transmitted primarily through these droplets in the air, and to a much lesser extent, by touching surfaces where they have landed.
Research has shown that people can transmit the infection before developing any symptoms and that a significant percentage of infected people — somewhere between 20% and 40% — never have symptoms at all. The result is that nearly half of the cases are transmitted by people unaware they have the infection.
There is currently no effective treatment or vaccine for COVID-19. It seems unlikely there will be a vaccine for many more months that has been proven to be both safe and effective. That means the only way we have to combat COVID-19 is to control the spread of the virus.
Source control through wearing face coverings in public is a key part. The more people that wear masks the more effective they are. In Asia, where face covering is commonplace and not controversial, masks are not just protective barriers, they are symbols. They affirm the wearer’s civic-mindedness and conscientiousness and signify the wearer takes the pandemic seriously. Cases and death per capita are a fraction of ours in places where mask wearing is common, such as Hong Kong, South Korea, Taiwan and the Czech Republic.
We are not any of those countries. We have a different culture here, one of rugged individualism, self-reliance and independent thinking. Making public sacrifices for the common good is not always an American priority, especially when it seems like our personal liberties are at risk. We tend to bristle at the thought of anyone requiring us to wear a mask. At the same time, we have laws and regulations to protect us from harming each other. Think of seat belts, motorcycle helmets, and stop signs. We aren’t allowed to poison the air or water, even on our own property, because of the effect on our fellow citizens.
What kind of mask? Cloth masks, preferably made of multiple layers of a finely woven material, work well for source control. Leave the N-95’s masks, which are still in short supply, for first responders and health care personnel who working closely with patients. Avoid masks with exhalation valves because they do not filter the air going out and thus permit droplet release, putting others at risk. Always remove your mask by the ear loops or elastic strap — not the part that covers your face.
Can businesses require customers to wear masks? Yes — just as they can require them to wear a shirt or shoes.
Do I need to wear one outside? If you are more than six feet from any household member, probably not.
Are there downsides to wearing a mask? Yes — they can be hot and uncomfortable and make your glasses steam up. Some fear they give a false sense of security, leading people to go out more often or relax other measures. Masks work best when combined with social distancing, frequent hand washing, and testing and contract tracing.
The bottom line is masks are recommended or required because COVID-19 is highly contagious, there is asymptomatic or pre-symptomatic transmission, and there is empiric evidence from places where mask use is common that it works. So, even if you think you don’t need to wear one because you’re never going to get COVID, please put one on in public. It’s not to protect you, it’s to help prevent spread of the disease. Do it for others. It’s a way to say I care.
Stay in place, 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.w
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