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Universal mask wearing could be a way out of coronavirus crisis

The COVID-19 crisis has had an effect on virtually all Americans and, for that matter, all inhabitants of the planet.

Many Americans pin their hopes for relief on a vaccine or a silver-bullet medicine — neither of these are likely to appear any time soon. There is still talk of letting the pandemic run its course and hope for herd immunity. Sweden tried this approach, with disastrous results.

We all are impatient to return to the pre-coronavirus “normal.” No one wants to see the continued devastating death toll and large numbers of ill individuals. We want to return to work and school, and we want to avoid another lockdown. But how?

In the past several months, much information has accumulated worldwide on what has worked and what hasn’t worked in this pandemic. New evidence suggests that universal mask wearing could be the answer we are waiting for.

COVID-19 is spread primarily by droplets (little globs of fluid and mucus) that are expelled when we talk, cough or sneeze. The droplets travel relatively short distances before they fall to the ground, thus the 6-foot social distancing. However, some of the virus expelled is in much smaller particles that become airborne — they remain suspended in the air indefinitely. This fact explains why outdoor activities are generally safer than indoor gatherings. The virus survives on surfaces for a while, but touching contaminated objects is an uncommon mode of transmission of this disease.

Face coverings serve two purposes — to protect the wearer and to protect the public. These two functions sometimes overlap. The common type of face covering designed to protect the wearer is the N-95 mask, which must be fitted to the face (to prevent air flow around it). These masks contain special filters that remove the viral particles from inhaled air. They are expensive and typically used by health care workers who knowingly expose themselves to infected patients. The more widely used masks, made of cloth or paper (including surgical masks), are designed to prevent exhaled air from spreading droplets into the environment. While it makes sense that this type of face covering may provide some protection to the wearer, it was not known until recently whether they actually do.

By now, everyone knows that the elderly and individuals with some underlying illnesses such as high blood pressure and heart disease have a high risk of death from COVID-19. But from the beginning of the pandemic, experts were puzzled why some young, healthy people became severely ill and sometimes died. It was also unclear why the mortality rates for COVID-19 varied so much from country to country.

With COVID-19 and some other infectious diseases, it is not as simple as, “You get it or you don’t.” The severity of the illness with this coronavirus appears to be related to the size of the inoculum — how many viral particles you inhale. This phenomenon at least partially explains why so many health care workers became severely ill and died early in the epidemic. They were literally breathing in millions of viral particles from the sick patients who were coughing in their faces in the emergency rooms. A useful analogy to understand the “size of inoculum” concept is rain. How wet you get depends on how hard it is raining, how long you are outside, how you are dressed, etc.

This concept of “viral load” may explain why, in communities where everyone wears masks, many people still get infected but the infections are generally less severe. There is much talk about asymptomatic infections — individuals are infected (and contagious) but continue to feel just fine. The incidence of asymptomatic infections in the current pandemic is generally thought to be 20-40%. An important finding in recent studies is that where everyone wears masks, the incidence of asymptomatic infections can increase to 80, 90 or even 95%. This is great news because those people are probably just as protected against recurrent infection as those who were sicker (and probably as people who get vaccinated, when/if we have an effective vaccine).

This revolutionary information gives us a possible pathway to stop the pandemic without waiting for a vaccine. Universal mask wearing could eliminate the need for future lockdowns and could allow businesses and schools to function. Easy access to testing with rapid results and contact tracing will still be needed. To put it simply, we now have a practical, inexpensive method to control COVID-19 — but do we have the will?

Michael C. Sinclair, MD, lives in Vermontville.

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