bookmark_borderWhat About Masks?

For the general public, wearing a mask is more to protect others FROM you, rather than protecting yourself from others. Wearing a mask must not give you a false sense of security of “protection” from the virus—whether it is a simple cloth mask, a simple surgical mask, or a cloth mask with a “filter”—it must be used in conjunction with proper handwashing (or hand sanitizer in lieu of soap and water availability) and not touching your face (eyes, nose, mouth).

The CDC recommends wearing masks for the public in situations where social distancing of 6 feet cannot be maintained, especially in areas of significant community transmission. Important:

  • “This means that the virus can spread between people interacting in close proximity—for example, speaking, coughing, or sneezing—even if those people are not exhibiting symptoms.  In light of this new evidence, CDC recommends wearing cloth face coverings in public settings where other social distancing measures are difficult to maintain (e.g., grocery stores and pharmacies) especially in areas of significant community-based transmission.”
  • “It is critical to emphasize that maintaining 6-feet social distancing remains important to slowing the spread of the virus. CDC is additionally advising the use of simple cloth face coverings to slow the spread of the virus and help people who may have the virus and do not know it from transmitting it to others. Cloth face coverings fashioned from household items or made at home from common materials at low cost can be used as an additional, voluntary public health measure.”

On April 1, 2020 (updated April 4, 2020), The Atlantic published the article “Everyone Thinks They’re Right About Masks.” My takeaways from the article at the time (on April 2, 2020) that still ring true (emphasis mine):

  • “The mask debate is so intense because both the stakes and the uncertainty levels are so high. “We’re trying to build the plane while we’re flying it,” Hanage said. “We’re having to make decisions with quite massive consequences in the absence of secure data. It’s a nightmare for your average cautious public-health professional.””
  • “There’s still a good case for masks, though, even if they can’t stop viruses from getting in: They can stop viruses from getting out. “I’ve been slightly dismissive of masks, but I was looking at them in the wrong way,” Harvard’s Bill Hanage told me. “You’re not wearing them to stop yourself getting infected, but to stop someone else getting infected.”
  • “Some commentators have argued that countries that have thus far succeeded in curbing their COVID-19 outbreaks have widely used masks. But this relationship isn’t as perfect as it might appear. China advocated mask use early on and still struggled to contain the disease. Japan uses masks widely but is now seeing an uptick in cases. Singapore reserved them for health-care workers but still flattened the curve of infections. Many successful mask-using countries relied on other measures, such as extensive testing and social distancing, and many were ready for the pandemic because of their prior run-in with the 2003 SARS epidemic.”

Another article published in Forbes from April 1, 2020, Should Everyone Wear A Mask In Public? Maybe—But It’s Complicated was a nice overview of the issues regarding mask use. Takeaways:

  • “Did the CDC or WHO Mislead People? No. Both the CDC and the WHO have difficult jobs in finding and interpreting incomplete, complex and sometimes contradictory evidence about a disease in real time as it’s raging across the globe… The CDC and WHO are working from the best evidence they have access to at the time, and interpreting that evidence—while gathering new evidence for a newly emerged disease that has different characteristics than any previous disease—is not a simple or fast task, even in the best of times. And these are not the best of times.”
  • ““The question a month ago was will they protect you, the wearer, and the answer is still, they probably won’t protect you,” Eli Perencevich, the University of Iowa infection prevention specialist I spoke to for the last article, said when I spoke to him today about the topic. One of the biggest reasons they won’t protect the average wearer is that most don’t wear them correctly—even when trained—and unconsciously engage in counterproductive behaviors, such as touching the mask frequently.”
  • “Even if it could be shown that mask-wearing is strongly correlated with reduced transmission after controlling for factors such as testing and contact tracing, we don’t know the mechanism. Would it be the physical barrier of the mask itself that’s preventing transmission, or could it be, as Gregory Poland, MD, an infectious disease expert at the Mayo Clinic, suggested to me, that the mask is an indicator of a constellation of behaviors that collectively reduce transmission? That is, does wearing a mask lead someone to touch their face less often (there isn’t evidence of that yet, and self-reported anecdotal evidence is unreliable), and is wearing a mask a constant psychological reminder to do other known infection prevention behaviors, such as frequent, rigorous hand-washing and keeping a good distance from other people?”
  • “If the mask is mainly a proxy for other good behaviors, then telling everyone to wear one is only helpful if everyone also follows those other behaviors as well. In countries where mask-wearing, even not during a pandemic, is common, that’s less of a concern. But in countries where mask-wearing is extremely uncommon, such as the US, recommending at the very beginning of the epidemic that everyone wear a mask could have risked providing a false sense of security: People may have been less conscientious about extremely important, effective behaviors that are more mundane, such as hand-washing, or very difficult, such as social distancing.”
  • “As much as everyone wants to believe they will wear them correctly, they actually underestimate how difficult it is to do so: you must wash your hands before and after putting it on, never touch it, wash your hands immediately if you accidentally touch it, and keep it clean and sanitized in between wearing. We all have heard repeatedly how often we touch our faces. If you wear a mask, you might touch your face less—but you might touch the mask itself just as often or nearly as much, which contaminates your hands and then contaminates anything you touch until you wash your hands.”

bookmark_borderConversation with Tom Frieden on Coronavirus

On April 13, 2020, Helen Branswell, senior infectious diseases and global health reporter for STAT, hosted a chat with Tom Frieden, current president and CEO of the global public health initiative Resolve to Save Lives. Dr. Frieden is a former director of the CDC and commissioner of the NYC Department of Health.

I highly recommend watching this chat including the Q&A session at the end. It is about a 40 minute investment of your time. Notable takeaways:

  • We need to continue working together around the world and learn best practices from each other
  • The time we have been sheltering in place was buying us time to prepare to continue fighting it so we can BOX IT IN* – widespread testing, isolate the infected, find the exposed, quarantine the exposed
  • Current state of testing for disease – tests are pretty good although difficult to get a good sample, but still need to ramp up testing
  • Current state of antibody testing – most of the tests out there are “junk” – we need reliable tests and also, we don’t know whether everyone gets antibodies nor whether or how long they confer immunity – however, it would give us good epidemiologic information on how much it has spread in the population
  • MASKS – outside of healthcare front line or anyone taking care of the sick, more important for actively sick to use to prevent spread (but they should be staying home anyway)
  • MASKS for general public is a judgment call – but important to ensure that they aren’t being taken from healthcare workers, they don’t give undue increased confidence of protection – still more important to WASH YOUR HANDS AND NOT TOUCH YOUR FACE
  • Don’t ask “when can we reopen” – this is about data, not dates – we have to maximize public health protection while minimizing economic dislocation.
  • This virus is here to stay – we need to learn how to live with it. There will be waves of outbreaks, we need to keep them small and contained clusters so we don’t have to come back to this type of lockdown.

*BOX IT INclick here for the briefing document (downloaded April 19, 2020) for more detailed information.