To Mask, or Not to Mask - That is the Question!

Are you confused about the ever changing Covid crisis? 

One day the experts are saying, "don't wear a mask and homemade masks don't work." 

Now the recommendation is to wear a mask (if you have one), or wear a scarf or homemade mask....but don't buy surgical or N95 masks because they're needed for medical providers! 

On the one hand, we're being told to shelter in place, but we can can go to the grocery store and Lowe's and Home Depot.  When Covid first hit the news wire, the virus was reported to be less dangerous than the flu, and now we're hearing the opposite.  The death rates from Covid are being described as 1%-3%, compared to the flu rate at .1%.  But those statistics may not be accurate because a lack of testing is likely missing many people who had or have Covid and were/are either asymptomatic or mildly symptomatic. 

And just how long are we supposed to be on quarantine?  That time frame keeps changing, too.

It's no wonder if these seemingly conflicted messages are driving you crazy.  Don't worry, you're not alone.  I thought I'd take a moment to explain my thoughts on Covid based on what I know about infectious diseases and what is being reported.  As I said to many when the threat of Covid reared its ugly head, the epidemic (now a pandemic) raised a lot of questions. 

The numbers being cited from China in January and February did not seem to be consistent with the alarms that were being sounded in our country.  I, myself, was left with the impression that Covid was to be taken seriously, in a similar light that influenza is to be taken seriously.  But back in January and early February, my cynical side thought that the virus hysteria may have been driven by the media and possibly politics.  However,

I did acknowledge the possibility that the government had been provided information, not yet made available to the general public, that suggested this virus was bad, REALLY BAD, and hence the reason for the hype.


Once things started to unravel in Italy, it seemed that panic set in.  But even then, there were no recommendations for Americans to wear a mask when out in public, and in fact, many of the leading health "experts" advised against doing so.  And now, this weekend, we're being told to protect our faces. 

I realize that most of you are left frustrated.  I have heard comments that the government and health experts alike "lied, and are clueless and bumbling."  While not trying to defend my colleagues who seemed to do a 180 degree turnaround, I do think it's worth a little explanation for this shift, but I will throw in a little cynicism, too!

Back in January and February, there were no calls to wear masks in large part because the purpose of a mask is really to prevent the mask wearer from giving an infection to someone else.  For instance, physicians and nurses are all the time exposed to patients in the office and hospital setting that present with colds, bronchitis, bacterial pneumonia, etc, and as a routine, they do not routinely wear masks to protect themselves.  Exceptions do exist to this, such as a patient with tuberculosis. 

In fact, in the OR we do not routinely wear N95 masks, we simply wear surgical masks so our saliva doesn't get into the surgical wound when we talk.  The reason that masks are now being advised is because we have learned a lot more about this virus.  Let's face it, China wasn't the model of transparency when dealing with Covid.   

We now know that the numbers of those infected by Covid but are asymptomatic are very high.  So it is much more contagious than first thought. 

The reason to wear masks is for those with a mild or unknown case not to infect the vulnerable, ie the elderly, so they do not develop a severe Covid infection.  The call for masks is not really to protect yourself, but instead protect your family members or patrons at the grocery store and help stop the spread. 

However, the request to wear scarves or homemade masks while preserving the medical grade masks for health care works understandably raises eyebrows.  I'm certain that people wonder that the public was not advised to wear masks because of the global mask shortage.  While that may indeed have played a part, I do think that the overriding reason that masks were not advised at the beginning was because of the true purpose of wearing masks.  And masks can be helpful to prevent infection for the mask wearer if the mask wearer is not abiding by the 6 foot rule (or is on an airplane), and someone sneezes or coughs on them.  And that's why masks are being hoarded by hospitals right now...the patients coming to the hospital are very sick, with high viral loads, and hence health care personnel are at risks for getting infected by secretions and coughs, especially because the 6 foot rule obviously does not and cannot apply. 

When I look at the numbers being reported by SC DHEC, and taking into account the reports I have received from Roper and East Cooper, there are concerns that cases are expected to really ramp up over the next couple of weeks.  That means that more and more Charlestonians will either be sick or are unknowing carriers of the virus.  Since the virus is so contagious, I do feel that erring on the side of safety and wearing a scarf or mask (if available), makes sense. 

So here are a few "mask rules:'

1) Wash your hands before and after applying the mask and scarf, since you will be toughing your face a nose, which is where the virus enters the body.

2) Don't touch the mask or scarf once it's on and don't take it on and off or adjust it frequently.  If you do, you are defeating the purpose of wearing it.  A scarf, unlike a surgical mask, will get wet with your secretions from talking.  If you touch the scarf with your hand, and then rest your hand on a counter, you've just put your mouth germs on the said table.  And if you are wearing the mask to protect yourself from Covid, then if someone did spit or cough near you and the virus landed on your protecting scarf or mask,you're touching the Covid by touching the mask/scarf.  Wearing scarves and masks can feel very claustrophobic.  Trust me, I know.  So if you can't keep your hands away from the mask and toughing your face, don't wear one, and focus your energies on social distancing and sheltering in place.  

3) Disinfecting the mask and or scarf at the end of the day is imperative.  If it's a scarf, just wash it.  Heaven forbid you take the scarf and reverse it the next time its worn, possibly placing the Covid exposed side against your mouth! Ewww!  If it's a mask, just spray it with some Lysol, but wait a day or so to let it dry so the Lysol doesn't irritate your lungs.

If anyone has any questions about this email or any of my previous ones, do not hesitate to call the office or email me. 

As some parting thoughts, I just wanted to emphasize again the importance of handwashing.  I actually promote good ole fashioned handwashing over the sanitizer.  I also wonder about the long term effects on the skin from all of the alcohol and bleach we are using these days. 

Lastly, I once again wanted to send out my support to "hang in there."  I realize the stress that many of you are feeling right now, whether it's from fear of the virus, fear of the economy, or just fear of the unknown.  I have it, too.  We will prevail, and like you, I want this Crisis over sooner rather than later. 

I'm really hoping that we move fast on an effective and inexpensive antibody test that can prove who has developed immunity so those who are immune can get back to work and life.  One such test is being launched today. 

I have always joked that that the reason we use the term the "practice of medicine," is that doctors are always practicing... always working to learn and get better.  That is how advancements in medicine happen.  Covid is no different, just the stakes are a lot higher.

 I will continue to update you as more information and knowledge is gained, and try to give you my interpretation of the data being reported.  As of now, I hope the data is wrong that the peak in South Carolina is in May; I hope it's this week. 

So sending prayers this Easter week!

Heidi Williams MD

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