To Mask or not to Mask?

I decided to write a blog about the hot topic of masks to look logically at the issue. 

Q.- Why are masks being recommended or mandated? 

A- The SARSCoV2 virus is thought to be transmitted by respiratory droplets and aerosols. Droplets are small liquid particles produced by breathing, coughing, sneezing, laughing, singing or talking. If you are alive you are producing droplets with your saliva and mucous from your lungs, nose  and throat. Respiratory aerosols are a suspension of fine solid particles or liquid droplets in air. (It has a broader definition but I’m focusing on respiratory sources of aerosols) Aerosols are smaller in size than droplets and so can stay suspended in air for a longer distance and longer time. Both droplets and aerosols can contain viruses and bacteria. SARSCoV2 appears to be transmitted via both droplets and aerosols. A mask acts as a barrier to limit the ability of the droplets and aerosols (henceforth called spit for simplicity)  from leaving you and flying towards someone else. Masks aren’t perfect, but helpful. Here’s an article from the New England Journal of Medicine  called: Visualizing Speech-Generated Oral Fluid Droplets with Laser Light Scattering  N Engl J Med. 2020 May 21;382(21):2061-2063. They had someone speak the words “stay healthy” with and without a mask and showed that masks significantly decreased the droplets that were measured by their laser device. Watch the video- impressive!

Q- But I don’t have any symptoms! Why do I have to wear a mask? It’s annoying and hot!

A- There is some evidence that people who are asymptomatic or presymptomatic can still spread the virus. Some people have virus in their throat but have not gotten sick from it. We aren’t sure why. As long as you are in your own home, or outside at a distance from others, a mask is not required. But if you are in breathing or spitting distance from other people, then you could potentially infect each other. 

Q- The government can’t tell me what to do! I have my constitutional rights! Doesn’t a mandate violate that?

A- The government is not mandating that you wear a mask in your own home. That would be infringing on your rights. Masks are an effort to protect public health. There are people out there who are more vulnerable to this virus than you might be and they don’t realize it. Only 12% of the population is metabolically healthy which means that 88% of us have obesity, hypertension, diabetes and autoimmune diseases that put us at risk for COVID-19. So even if you are young and think the virus can’t possibly harm you, you could be wrong. Young people have gotten sick and died. And there are young people who have gotten a milder version of COVID-19 and were left with chronic, longer lasting symptoms and lung damage. Doctors who are taking care of COVID-19 patients share that it is a very unusual virus. People who know they are at risk have a responsibility to protect themselves from possible exposure by staying home, ordering grocery delivery if possible and avoiding indoor gatherings. Those of us who are “healthy” have a responsibility to do what we can to protect ourselves and those at risk. 

Q- I read on Facebook that masks cause your carbon dioxide (CO2) to go up and your Oxygen to go down and damage your lungs. Or even cause pleurisy! They say you breath your own bacteria and viruses and make yourself  sick. What about that?

A- I spent 5 years in a surgical residency and 5 years in surgical practice wearing a mask every day for many hours per day. I never passed out from low oxygen levels or high carbon dioxide levels. I never got pneumonia or pleurisy. The health care workers who are on the front lines now wear masks and shields all day long. If they pass out it is from not having time to eat or drink water because of the thousands of sick people rolling in their door for weeks and months.  The most common cause of pleurisy is viral, not mask wearing. If you have an oximeter, that gadget you put on your finger to measure oxygen levels, put on a mask and check your levels for an hour or 2 and see what it shows. If you already have compromised lungs, like from chronic bronchitis or chronic obstructive pulmonary disease, then maybe it’s more of an issue. Then you could try a face shield instead.  

Here’s my results from my mask experiment: baseline without a mask: 96%

One hour later with continuous mask wearing and measuring on the same finger: 98%

The initial reading of 96% could have been from my finger being cooler, but my oxygen obviously did not decrease after 1 hour. I had no symptoms from mask wearing.

Q- Why did the whole country have to shut down? There are some states that had very few cases but they had to close too with all the negative economic impact. 

A- That is a tough call. It seems like the countries who have been more careful about social distancing and masks have controlled the spread of the virus better. The numbers have been a challenge to interpret because at first, there wasn’t enough testing. Then the accuracy of the testing was questioned. When there were delays in restricting access to nursing homes by visitors, that seemed to allow the virus to run rampant in some places. The larger cities needed to limit the number of people who were getting sick and requiring hospitalization because they have a limited number of beds and health care workers and ventilators. This virus acts differently than the influenza virus. It is easier to catch (infectivity) and in some people is deadlier than the flu. 

Q- Why can’t we all just catch the virus, become immune and move on? Like we used to do with chicken pox?

A- The SARSCoV2 virus is very different from other viruses. In order to be protected from catching a virus again, you have to have made neutralizing antibodies to the virus. That means the type of antibodies that prevent the virus from being able to enter your cells and make more of themselves and make you sick.. Not everyone is able to respond to the virus by making the right kind of antibodies. If you do form neutralizing antibodies, we still don’t know how long they will be effective. So if you intentionally expose yourself, you may be one of the ones who become critically ill and dies instead of having a mild case and forming neutralizing antibodies. Kind of Russian Roulette, right?

Q- Why does SARSCoV2 seem to effect the African American and Latinx communities more than other communities?

A- There are probably many reasons. One important one is access to care. I don’t have statistics here, but people who are uninsured or live in an area that has limited choices for health care are going to have different outcomes. This is an area that I am learning more about, so not pretending to have any expertise. I have not seen evidence that there is a genetic difference.

Q- When are we going to have a vaccine so we can be done with this?

A- Multiple labs and pharmaceutical companies are working hard to develop a vaccine. Some viruses are more difficult to work with than others. The HIV ( human immunodeficiency virus) still does not have an effective vaccine. But there are preventive pharmaceuticals and multi drug treatments that have been effective. In order to have an effective vaccine for SARSCoV2, the vaccine needs to prevent infection when the person is exposed to the virus. No vaccine is 100% effective, including the influenza vaccine which is often only 40% effective. And some viruses are able to mutate and change their genetic make up requiring the vaccine to be adjusted for the new mutation. So a vaccine is not going to be the magic wand that makes SARSCoV2 go away. It will take a long term effort of vigilance, scientific studies, preventive measures and lifestyle health changes, socially distancing and masks to turn things around. A lot of what we were used to doing in our day to day lives will probably be different for a long time. 

I know masks are inconvenient, but if they help protect you and people you care about, isn’t it worth it?