Why wouldn't you want surgery from a surgeon without gloves or mask? Why you should wear a mask to reduce the impact of Covid-19.
There has been a popular movement of businesses requiring masks for customers and staff. States as well are finally coming around to issuing mask-wearing mandates. This after a casual approach to compliance has clearly failed to control spread of the virus. So, is there a good reason why you should wear a mask?
Recommending mask-use has evolved since March of 2020. Initially, there was concern that there would not be enough masks to support the healthcare workers who would be treating the sick. There was a rationing mentality – save the masks for frontline workers. But that has since changed. Likewise, before Covid-19 was well understood, recommendations were ‘best guesses’ based on past respiratory viruses.
The Centers for Disease Control have evolved their recommendations as information and evidence have become available. Their guidelines and arguments for why you should wear a mask are built around sound precautionary principles.
Once the World Health Organization (WHO) concluded that 80% of infections were mild or asymptomatic, that 15% of infections were severe and 5% were critical, recommendations changed. It meant that voluntary use of masks only by individuals who were experiencing symptoms (the original recommendation) would not be an effective approach at all. In the absence of the ability to test for the virus or its antibodies in real time there is no way to know who is Covid-19 positive yet asymptomatic.
Universal precautions is an approach to infection control that, in the absence of evidence to the contrary, assumes bodily fluids are infected with bloodborne pathogens. Communicable diseases like HIV and hepatitis are examples of why Universal Precautions are so important. It is why all blood draws, for instance, are performed using personal protective equipment like gloves.
Standard precautions extend beyond blood to all bodily excretions (except sweat) and, like Universal precautions, are applied regardless of a patient’s diagnosis or presumed infectious status. Standard precautions include handwashing, personal protective equipment (gloves, gowns, masks, etc.) to reduce the risk of transmission from unrecognized sources of infection.
Transmission-based precautions focus on airborne, droplet and contact contamination. It is why masks are used in surgical settings for instance, since the presence of infectious air droplets must be assumed either from or to the patient or the clinician. Transmission based precautions are implemented along with Standard Precautions when an individual’s airborne, droplet or contact-contamination status is unknown.
All of these levels of precaution protect the wearers of the personal protective equipment as well as those they interact with.
If there was an ability to test for the presence of the Coronavirus in real-time, it would change the way we approach precautions. If we test everyone at the same time then quarantine them until the results came back we could then say with confidence who has it right now and who doesn’t. But of course, we can’t.
The problem with that lies in the current turnaround time for testing. As of right now, the need and interest in Covid-19 testing has overwhelmed laboratories’ ability to meet any reasonable timeline. As reported in The Hill on 7/14/20 “A seven-day wait for test results…magnifies the risks that an infected person has already spread Covid-19, making it too late to effectively implement contact tracing”. Likewise, long turnaround times between testing and results nullify test results unless the individual tested remained in quarantine 100% of the time after being tested.
In other words, trickled testing can tell if you are positive or negative right now, but does nothing to prevent you from becoming infected as soon as you leave the testing site or any time after. An individual could be tested, be negative in that moment, but not learn that they are negative until days later, during which time they may have become positive. Because it is not possible (yet) to profess any certainty in any given moment about infection, the persistent practice of precautions is needed.
A natural study out of the University of Iowa evidenced that the implementation of mask usage between April 8 th to May 15th in 15 different States plus DC suggest that between 230,000 – 450,000 cases of Covid-19 were possibly averted. Another international study concluded that government policies supporting the wearing of masks by the public, as well as international travel controls, are independently associated with lower per-capita mortality from COVID-19.
Empirical data of this kind, the nation’s current inability to test and report quickly, combined with the absence of a vaccine leaves very little room for other solutions for the time being. That is why you should wear a mask.
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