Jeff Su -

How to protect yourself from airborne transmission? A Nurse's recommendation

How to protect against airborne transmission? Which face masks to use? 

The CDC has finally confirmed the suspicions of many in the medical community that the COVID-19 virus can be transmitted in the air.  Similarly, colds, flu, tuberculosis, chickenpox, mumps, measles, and the more dangerous SARS & MERS have airborne transmissions.  

Many of these diseases have vaccines to protect the public from large outbreaks though the problem with COVID-19 is that the public has not received any proven vaccines yet as this is a new virus. Interestingly, the virus that causes the flu mutates and has many different strains, hence the need to receive flu shots yearly.

A vaccine may prevent you from acquiring the disease and in cases where you still obtain the disease, your symptoms may be milder and you can recover faster. One of the main issues with COVID-19 is that this virus is new and until the public can receive an effective vaccine, we must take appropriate precautions to protect ourselves and those around us.

Protesting & Partying

Because COVID-19 can be spread by air, it means it can be spread when talking, sneezing, and even just breathing. This makes it especially important to wear a mask or face covering in public. Indeed, social distancing will prevent the larger droplets of the virus from coming on you. However, in closed spaces such as inside buildings or buses or airplanes, the limited ventilation of air and the smaller aerosolized particles of the virus allows it to spread much farther than 6 feet and remain in the air for hours. Those who do not wear face coverings or social distance are putting their families and workmates at risk. Likewise, crowded areas where people yell and refuse to social distance as in the case of protesting or partying in a bar also increases the likelihood of spreading the COVID-19 both by close contact and airborne transmission.

Who are more difficult to treat - patients from earthquakes, bombings, or COVID19?

One experienced physician, Dr. Jospeh Varon (Chief Medical Officer in Houston), who has treated patients after various disasters lamented,

"Fighting against the Covid19 virus is easier than fighting against people's stupidity! I have been in the middle of earthquakes, in the middle of bombings, in the middle of tsunamis. I've been involved in every possible catastrophe that you can imagine. And by far, this (COVID19 Crisis) is the worst.” 

He laments that many in the public are ignoring physicians and health authorities during a global pandemic. A CNN article provided a great photographic view of the exhaustion of some medical staff in his COVID-19 unit and a story of nurses on the unit becoming patients. 

"I'm pretty much fighting two wars: a war against COVID and a war against stupidity. And the problem is that the first one I have some hope about winning. But the second one is becoming more and more difficult to treat."

Dr. Jospeh Varon (Chief Medical Officer, Houston)

The evidence supporting the use of face coverings:

Face coverings act as a barrier for preventing the larger droplets expelled from our mouth and nose from escaping and evaporating into smaller aerosolized droplets that can travel far in the air.

To add to the urgency of the situation, it has been confirmed that asymptomatic carriers can pass the COVID-19 to others without realizing it. In fact, the CDC estimates that 50% of COVID-19 cases are transmitted by pre-symptomatic or asymptomatic individuals. This makes it especially important for everyone to wear face coverings. 

Experiments have confirmed that masks decrease the viral load of COVID-19 - the amount of virus inhaled. The less virus inhaled, the less sick you get. For ethical reasons, humans can not be subjected to experiments of how well surgical masks protect them from a virus causing a pandemic compared with those without masks. Though from experiments with mice and surgical masks, scientists found that surgical masks significantly reduced the likelihood of obtaining COVID-19 and had milder symptoms than those without the masks.

With mounting evidence from scientists across the world, CDC and WHO finally changed its policy on wearing face coverings. Some retrospective studies showed that even in high-risk cases, where people wore masks and had the coronavirus (but did not know it yet as they were asymptomatic) prevented those around them from obtaining it. One person with Coronavirus, who wore a mask on a flight and later the people nearest to him on the airplane were tested and did not get the virus. In another case, after some hairstylists, who wore masks, found out they had the Coronavirus informed authorities and they subsequently had all their clients tested and none of them tested positive for the coronavirus. 

Initially, the CDC discouraged the use of face masks by the general public as there was a severe shortage in the country and medical staff was forced to reuse what they had. Now that the country has been receiving more supplies and ramped up domestic production, this gives more options to the public. Since we are all in a fight against an unseen enemy and with the CDC, the WHO, and even President Trump adjusting their stance and supporting the value of face coverings, we should discuss the various options available.

A Nurse’s Conclusion:

Ideally, an effective vaccine is developed and distributed to everyone. Realistically, it will take a long time to distribute the vaccine to the general public. Additionally, a vaccine is not a cure. Viruses like the coronavirus mutate. Just like the annual flu vaccine does not protect everyone. Perhaps more vaccines will need to be developed for the various strains of COVID-19 that mutate for the foreseeable future. Additionally, one of the world’s experts on infectious diseases and White House Coronavirus adviser Dr. Anthony Fauci indicated that they are hoping that a COVID-19 vaccine will be 75% effective but that the FDA will accept 50% effectiveness.  This figure is on par with a normal flu vaccine. In hospitals, we can isolate patients who have contagious diseases. However, it is not possible to quarantine an entire country. The next best option is to make testing available for everyone as asymptomatic individuals can still pass the virus while those who test positive, can be isolated for a couple of weeks.

Since the US is based on the freedom of expression, perhaps these who feel the need to uniquely express themselves can try wearing fashionable face coverings. Now they come in many different colors and designs. Some companies will allow you to customize or use your own design for cloth face masks and neck gaiters. Face shields can be used as an added layer of protection as they do not restrict breathing or vision. The CDC does not recommend children under 2 years of age or people with difficulty breathing and those unconscious to wear masks. For those with trouble breathing, perhaps they can consider wearing cloth masks or neck gaiters and/or face shields as these options are less restrictive and provide some protection for others while in public. This article explores the various face coverings that can provide a measure of protection when out in public.

Although the US missed the opportunity to contain the outbreak early, we can all do our part to decrease the risk of transmission by wearing face coverings. The best thing we can do now is put on our face coverings, continue to social distance, hand hygiene, and also avoid crowds. Unfortunately, this may be the new normal until an effective vaccine is distributed to the public. Regardless if there is a mandate for face coverings or not, for the sheer sake of compassion for others, wearing a face covering will help protect those you love, your neighbors, and your community.