The good mask in the public: What does the fox say?

Hi, I'm angry. I'm angry at questionable leadership decisions when the right ones don't seem too hard to make, at widespread misinformation by media - whether social or cable, the lack of empathy for thy neighbors, moody Midwestern weather. I'm angry because we are scrambling every piece of PPE at the hospital where I work, yet people are debating whether wearing a face mask in public is worth the effort, including the Commander in Chief. So what does the fox say?

One of the key things that graduate education teaches is critical thinking. Looking at data and evaluating what is the closest to the truth such data reflect. So leaving emotions and voter preferences aside, let’s look at the numbers (the truth is almost always in the numbers.)

Slovakia is a Central European country (for those who missed their Geography lessons) of about 5.5 million people. The country adopted early measures to fight the pandemic including mandating a cloth mask and a pair of gloves in public. To date, Slovakia has 485 cases with zero (!) deaths. Before you ask, yes, COVID-19 tests are available in the country.

Ireland, on the other hand, which I tend to dub ‘Slovakia of the West’ due to certain shared patterns of political history, has counted 4604 cases and 137 deaths thus far. The population of Ireland is a little under 5 million and one where the mantra that “masks are of limited benefit” is still being perpetuated on both social and public policy levels.

One of the concerns raised around policies mandating universal masks in the public is that such mandate would decrease the availability of masks for the medical staff that needs it the most. With unshakable faith in at least remnants of sanity left in the American public, I consider this sheer alibistic nonsense: there is absolutely no reason to believe that the good American people would hoard medical masks to wear in public under such policy. People would simply don on scarfs, ski balaclavas, dig out the sewing machine or rely on their talented crafty circle of friends. Worst case scenario, those can be easily bought on Etsy or Amazon.

A white paper by Yale researchers (https://papers.ssrn.com/sol3/papers.cfm?abstract_id=3567438) showed that each additional cloth mask worn by members of the public actually increases the availability of medical masks (duh!) and prevents further infection spread.

The second point may seem contentious, but it sort of begs the application of common sense: asymptomatic carriers are the biggest threat for the virus spread, as they have no reason to self-isolate due to lack of any symptoms, yet those individuals are very much capable of spreading the virus.

If we are unwilling/unable to adopt the Korean model of widespread testing which I still fanatically advocate for (it works!), this is the next best thing: unable to identify who is a silent carrier, let’s presume everyone is and act accordingly. You may think that you are perfectly safe to be around because you are not coughing and/or normothermic, while in reality you may be spreading a bug that will make vulnerable people sick and may even kill some of those. Is this really worth it to your consciousness over donning a scarf over your mouth?

To put it bluntly and from an entirely selfish perspective: Look, I don’t want to be intubating people in the ICU just because you weren’t willing to cover your trap in public (there, I said it.)

Recent Nature paper (https://www.nature.com/articles/s41586-020-2196-x) showed that the virus is never present in urine or blood, but the virus sheds massively from your upper respiratory tract during the initial phase of infection when the symptoms are likely to be minimal (if any.) So unless the shedding of the virus is mechanically blocked by - I don’t know, a piece of cloth, you will be spreading the virus with every breath you take (and I sure as hell don’t want to be watching you do that.)

If you do decide to do the socially responsible thing and don a piece of cloth over your nose and mouth (looking better than ever before), you may wonder: how effective is this, really?

A paper from this week published in Nature Medicine showed that Coronavirus-carrying droplets were blocked by a simple surgical mask in 100% of measurements (https://www.nature.com/articles/s41591-020-0843-2.

Still not convinced it’s the right thing? Let me tell you about a patient from rural Midwest who has been battling metastatic kidney cancer for the past few years. He comes to the office appearing somewhat pale, in pain and accompanied by his wife of 52 years.

I love those stories of decades-long marriages and always ask such couples with unabashed curiosity, and they always love to share. We end up talking about how they celebrated their 50th anniversary. He smiles with his sunken eyes, and somewhere in the back of my mind, I wonder how much time he still has. His immune system is suppressed from having cancer and being on chemotherapy, he is old and gaunt.

Then we discuss the star of the day - COVID-19 - and his protection in the public. I give both of them a long lecture on using a mask whenever in the public, as statistically, he is the person likely to do poorly should he contract it. They nod and seem to get it.

However, his wearing a mask does not quite protect him from contracting the virus if everyone else walks around with their mouth and nose uncovered. Even our waiting room is full of people who may or may not harbor the virus, and almost nobody is wearing a mask.

He nor his wife don’t have any masks. I sigh and slip them a surgical mask I have been saving in my pocket, as I cannot stand the idea that this vulnerable soul should die of a virus named after a weak beer having made it out for almost six years with incurable cancer. But I need your help to achieve this.

So when it comes to wearing a mask in the public, the fox says: yeahyeahyeahyeahyeahyeahyeahyeahyeahyeahyeahyeahyeahyeahyeahyeah!