The confusion on masks

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    ‘For those who do not believe wearing a mask minimizes, if not prevents, infection, would you allow the surgeon operating on you or your loved ones not to wear a mask during surgery?’

    A GROUP of 10 physicians, dressed in white coats, with the logo America’s Frontline Doctors on their uniform, spoke in front of the Supreme Court a few weeks ago, claiming, among others, that face masks do not protect anyone from getting infected with COVID-19, and, therefore, useless. Investigation revealed most of them never even got close to COVID-19 patients, much less frontliners, and that some of them were not even practicing, none of them surgeon or infectious disease experts. Their claims were preposterous and a public disservice, a disgrace to the medical community. Fake information that poses a risk to life is criminal.

    Science behind the advice

    The rationale for the recommendations to wear a face mask, do social distancing, not touching your face, frequent hand washing, and good personal hygiene (and even staying home for the most vulnerable seniors) is to minimize, if not avoid, the SARS-CoV2 virus of COVID-19 from getting into our body, through the mucus membrane of the eyes (conjunctiva), the nose (nasal mucosa), and the mouth (buccal mucosa) into our blood stream, leading to COVID-19 infection.

    The size of the SARS-Cov2 virus determined by electron microscopy is between 60 to 140 nanometers, our invisible enemy. The virus is spread by droplets, which is “sprayed out” when an infected person breathes, talks, sneezes, or coughs. Depending on the air current velocity, the larger size virus, after a few seconds of release in the air will drop to the floor (could contaminate the shoes), and the smaller ones could be airborne and travel farther than six feet, infecting people through airborne transmission. Infectivity depends on the dose (number of virus particles), the integrity of the person’s immune system, co-morbidities (medical conditions the individual has), and health in general.

    Viral dose

    A single cough could spray out 3,000 droplets that travel 50 miles per hour. Majority are large and simply fall to the ground. One sneeze shoots out 30,000 droplets at a speed of 200 miles per hour. The smaller ones are airborne and could travel distances, depending on the air current. The droplets from a single cough or sneeze by an infected person (symptomatic or not) could contain 200,000,000 (yes, millions!) of virus particles. A person infected with COVID-19 could be infectious (transmit to others) five days before the symptoms appear. It is, indeed, treacherous. This was why I had been saying early on (February) “that a little dose of healthy paranoia and vigilance are most beneficial in minimizing the risk of getting infected,” to suspect everyone near you in public places to be a carrier/infected.

    Wearing a face mask and social distancing (avoiding close contacts and crowds) are beneficial. In my personal case, I also wear long sleeve shirt, a cap, protective goggles, and gloves when going to stores. As a surgeon and a high-risk senior, I do not think this is an overkill, not fearful but cautious. The virus is obviously more infectious (more efficient) in close quarters, compared to the outside, where the air could scatter and diminish the concentration and dose of the virus.

    Type of mask

    The US-CDC and the WHO recommend the use of N95 mask approved by the National Institute of Occupational Science and Health (NIOSH), which filters out 95 percent of the viral particles, especially good for healthcare workers. Homemade non-woven (material) masks are a second choice, especially the triple layered ones (coffee filters as added layers). It is important that the mask must cover the nose and the mouth, and that it fits snugly all around the face, to prevent virus particles from being inhaled. The use of mask does not guarantee 100 percent warding off infection. That does not mean we should discard them. Home or car security alarms, firearms, condom, Medicare, and other things in life do not provide us 100 percent guarantee, but they are still beneficial, so we continue to use them. Together with social distancing, frequent handwashing and other healthy behaviors, the use of face mask has been proven to significantly minimize getting the infection. Surgical masks are more protective than cloth masks. (Children younger than two years of age, or those with shortness of breath when wearing one, should not wear mask; discuss alternative with your physician).

    Evidence

    Since we are dealing with a very infective disease, potentially fatal, we must stick to medical facts and scientific findings, not with anecdotal claims or political spins.

    The current CDC and WHO guidelines, implemented after realizing COVID-19 is a high prevalence disease as evidenced by the raging pandemic, have been proven to be effective in cutting down the spread of COVID-19. More than 50 countries and 33 states and the District of Columbia have mandated the use of mask in public places.

    In 198 countries, the COVID-19 death rates among those with government or cultural policies favoring mask wearing were much lower. The COVID-19 growth rate before and after mask was mandated in 15 states in the District of Columbia found that “the first five days after the mandate, the daily rate slowed down by 0.9 percentage points compared to the 5 days prior; at three weeks, the daily growth rate had slowed down by 2 percentage points.”

    Case reports are useful clinical data. Researchers Chin-Hong and Rutherford filed these two: “A man flew from China to Toronto and subsequently tested positive for COVID-19. He had dry cough and wore a mask on the flight, and all 25 people closest to him on the flight tested negative. The other case: Two hair stylists in Missouri, last May, infected with COVID-19, had a close contact with 140 adults. Everyone wore a mask and none of the clients tested positive.”

    The Institute of Health Metrics and Evaluation forecasted 33,000 deaths would be avoided by October 1, if 95 percent of people wore masks in public. The best scenario is for 100 percent of people to wear a mask in public.

    Common sense

    As I stated in a previous column, plain common sense will convincingly show the value of masks. Those working with fumes or dusts wear mask; welders, spray painters, sewage workers, all wear mask. When you cover your nose when someone near you farts, you get much less of the “aroma.” If there are 20 persons, 10 wearing a mask, and the other 10 not wearing one, and you spray their faces with flour or washable paint, which group would have less flour or paint on their faces? If the spray were a sneeze from a COVID-19 patient, which group would get a much larger dose of the virus and more likely to be infected? Remember, the lower the viral dose, the lesser the chance of infection, everything else being equal.

    One final question: For those who do not believe wearing a mask minimizes, if not prevents, infection, would you allow the surgeon operating on you or your loved ones not to wear a mask during surgery?

    You Honor, I rest my case.

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    Philip S. Chua, MD, FACS, FPCS, a Cardiac Surgeon Emeritus based in Northwest Indiana and Las Vegas, Nevada, is an international medical lecturer/author, a Health Advocate, and Chairman of the Filipino United Network-USA, a 501(c)3 humanitarian foundation in the United States. Websites: philipSchua.com and FUN8888.com Email: [email protected]