Where required…./Craig Medred photo

If you live in Alaska, there are situations in which a firearm just might save you from being mauled or killed by a grizzly bear.

With the SARS-CoV-2 virus on the loose, the same might be said of a face mask as regards those around you.

The comparison is being made here because these two pieces of equipment – for lack of a better word – share something in common.

Whether they help you and others, or endanger you and others, is contingent on your knowing how to use the equipment.

Consider for a moment the results of one of the few actual tests done on masks and SARS-CoV-2. Among other things, the study reported in the Annals of Internal Medicine in early April found this:

“Neither surgical nor cotton masks effectively filtered SARS–CoV-2 during coughs by infected patients.”

But that wasn’t the most important finding. The most important finding was arguably this:

“Of note, we found greater contamination on the outer than the inner mask surfaces…. The consistent finding of virus on the outer mask surface is unlikely to have been caused by experimental error or artifact. The mask’s aerodynamic features may explain this finding. A turbulent jet due to air leakage around the mask edge could contaminate the outer surface. Alternatively, the small aerosols of SARS–CoV-2 generated during a high-velocity cough might penetrate the masks.”

Dirty laundry

The outsides of the masks ended up carrying significant viral loads. In possibly the most understated sentence in the entire study, the South Korean researchers wrote that “these observations support the importance of hand hygiene after touching the outer surface of masks.”

How many people do you see in Alaska thoroughly washing their hands after any touching of the outer surface of a mask versus those pulling the mask up and pulling the mask down with no thought to the germs on the surface, or just pulling their bandana off their face and stuffing it in their pocket?

What are they doing when they do this? They’re coating their hands with those spiky, sticky, but invisible SARS-CoV-2 pathogen of which everyone has now seen hugely blown-up photos. When those hands touch things, they create what are called “fomites,” virus-coated inanimate objects just waiting to spread disease. 

There is still debate as to how exactly SARS-CoV-2 is most easily transmitted, but fomites were years ago identified as playing a big role in the transmission of viral diseases long thought to be spread by aerial transmission or direct contact with the infected.

“Over the years, studies have changed the perspective on viral transmission to include a more complex multifactorial model of disease spread. There is now growing evidence that contaminated fomites or surfaces play a key role in the spread of viral infections,” University of Arizona researchers reported in a peer-reviewed examination published in the journal of Applied and Environmental Biology in 2007.

Fomite spread would help explain how a 57-year-old woman in San Jose, Calif., ended up dead from COVID-19 before SARS-CoV-2, the virus that causes the disease, was known to be spreading in the U.S.

Patricia Dowd died on Feb. 6 of a ruptured heart. Her husband requested an autopsy to try to determine why. It was not until after the local medical examiner sent tissue samples to the Centers for Disease Control (CDC) in mid-March that it was discovered she had been infected with SARS-CoV-2.

Dowd was not known to have any contact with anyone infected with the virus, but as forensic pathologist Dr. Judy Melinek reported at MedPage Today, “she worked in a Silicon Valley company where people went back and forth from China regularly. The Chinese government claims that the Wuhan virus was first discovered there in November, but this timeline has been undermined by reporting that Beijing also tried to suppress early reports of a novel atypical pneumonia.

Dowd is among the scientists who suspect the pandemic that now has the world in a panic was brewing long before November in China and might even have reached the U.S. by then.

As of this writing, no scientist has proven fomite transmission of SARS-CoV-2, but it has been accepted as a means of transportation.

“This virus is spread through respiratory droplets produced when an infected person coughs or sneezes. It can also be transmitted on fomites, surfaces infected by a person with the disease,” the American College of Rheumatology declares. “Convincing evidence
of airborne transmission (which is distinct from droplet transmission) has not yet emerged with SARS-CoV-2.”

Masks are intended to stop the spread caused by respiratory droplets. If the real-world use of masks is simply concentrating coronaviruses so people can transfer it to their hands and spread it all over everything, the value of wearing masks becomes debatable.

To go back to the grizzly bear analogy, it would be like someone shooting and wounding a bear that then runs off after the attack. The shooting has protected the person being attacked, but does a wounded bear in the neighborhood make it less dangerous or more dangerous for others?

Operator’s manual

As with bears and firearms, again, it depends on how the equipment is used.

National Jewish Health, a globally recognized leader in lung treatments and research, offers detailed directions on how to properly use a mask:

• Wash your hands thoroughly before putting it on.
•  Avoid touching the inside or outside of the mask.
• Pick up by the ties and tie the upper ties and fasten them behind your head so the mask covers both your nose and mouth with the bottom edge under your chin.
• Wash your hands.
• While wearing the mask, do not pull it down like a scarf.
• Avoid touching the mask.
• If you do touch the mask, wash your hands.
• Wash your hands before removing the mask.
• Remove the mask by the straps to avoid touching it.
• Wash your hands.
• Throw the mask away if it is disposable or if it is to be reused, place it in a laundry bag or pillowcase to avoid it infecting anything else before it can be washed.

How many Alaskans running around with masks on are following these instructions? Nobody knows.

How many Alaskans are wearing masks in places where they’d be just as well off without them? Nobody knows although it is known that it’s not a good idea to wear a mask unless you need to wear a mask.

Before wearing a mask became the thing to do, it was the thing not to do.

“Folks who don’t know how to wear them properly tend to touch their faces a lot and actually can increase the spread of coronavirus,” U.S. Surgeon General Dr. Jerome Adams said at the start of March. 

The CDC shared that view at the time, but later changed its mind to recommend people wear masks. There is no real data on which to form a solid conclusion as to which position is best.

After a meta-examination of 84, mask-related studies, the Centre for Evidence-Based Medicine at Oxford University concluded that “taking into account the observational evidence from the previous coronaviridae outbreaks we should certainly use all the precautions for exposed people, especially our healthcare workers.

“But what of the folk walking down the road, going to the supermarket or watching the ducks in the pond?

“The answer is simple: we do not know. That being the case, and since there is a pandemic underway we are in an ideal situation to carefully record ‘natural experiments’ on a global scale, comparing rates of infection and transmission between states at different stages of lockdown and with different masking and distancing policies.”

Suffice to say, the data is so contradictory that it’s not worth fighting over.

Mask battles

That did not deter an off-duty Alabama cop from body slamming and handcuffing a woman who got in an argument with a Walmart employee who wanted her to wear a mask.

Masking has clearly become a highly contentious subject. Two California emergency room doctors who publicly offered their opinions that demanding everyone wear masks in public was nonsense got roasted.

The American Academy of Emergency Medicine and the American College of Emergency Physicians went so far as to issue a joint statement saying “Dr. Daniel Erickson and Dr. Artin Massihi (voided) reckless and untested musings….inconsistent with current science and epidemiology regarding COVID-19. As owners of local urgent care clinics, it appears these two individuals are releasing biased, non-peer reviewed data to advance their personal financial interests without regard for the public’s health.”

Fearing fake news, YouTube took down a videotape of the press conference involving the two doctors and Bakersfield, Calif. media. A defiant Erickson two weeks later told a San Diego television station that the collateral damage of shutting down the economy was worse than COVID-19, and that organizations dominated by “academic institutions who sit in their offices and fire of emails” should be ignored.

The ability of an invisible, microscopic virus to divide an already divided nation has proven amazing. In a Facebook post picked up by MedPage Today, a Texas doctor lashed out at “conspiracy theories” about how COVID-19 is no worse than the flu.

“I have had to listen to folks, some even friends of mine, carry on with an extra dose of ‘hoax talk.’ Conspiracy theories. Fanciful tales of the deep state, socialism, and tyranny,” wrote Dr. J. Michael Wilson. “I can tolerate most of it. But if I have to listen to one more person tell me about how COVID has been no worse than the flu, I may just lose my ever-lovin’ mind.”

Data isn’t a conspiracy. Data is data.

And for many in these times, SARS-CoV-2 is the flu. These people are asymptomatic or mildly symptomatic and progress through the disease much as if it with flu or at least the “common flu” as we know influenza now.

For others – largely the elderly and/or those already fighting serious diseases – this pandemic is for them, their families and friends a nightmare of Spanish flu proportions on an individual level.

Overall, however – on a population level – we remain blessed to live in the days of modern medicine. The Spanish flu killed an estimated 50 million people in a world home to 1.8 billion. That was about 2.8 percent of the global population at the time.

There are now 7.8 billion people on the planet. Similar mortality would mean about 217 million dead. The COVID-19 death count as of today stands at 297,000. It seems sure to hit 500,000, and it might reach 1 million.

But looked at in any objective way, 1 million hardly compares to 217 million. The survival rate for those hospitalized with COVID-19 is at this time 85 percent. If a doctor tomorrow diagnosed you with lung cancer and told you you had an 85 percent chance of living another year, that would be a big improvement.

At this time, the one-year survival rate for lung cancer is less than 50 percent. The five-year survival rate is 18.6 percent. And yet people continue to smoke knowing it increases their chance of death by 13 percent (women) to 23 percent (men.)

SARS-CoV-2 has made life more difficult, but it’s not the end of the human race as is sometimes portrayed. It’s simply another pathogen with which we must deal. It’s scary because it is new. We will eventually accept that, adapt and go on.

If this is a “normal” year, about 17.3 million people will die of heart disease, and we will not batt an eye because heart disease is now viewed as one of our “normal” causes of death.

It is impossible not to feel for doctors like Wilson who have to watch people pass. None of us like to watch people die, be they young, old or in-between. But it is important for those trained as scientists to look at the world rationally, not emotionally, no matter how bad things get.

Wilson might not like people telling him what the stats say about SARS-CoV-2, but those stats matter. They are the very foundation of science.

Unfortunately, all they say about masks is that nobody knows. In that regard, masks might be even more like guns for bears. Used properly, they may offer some help. I know; I once shot a grizzly bear off my leg.

But then again, the odds of having a grizzly bear with your leg in its mouth are right up there with getting hit by lightning.

So wear a mask if it makes you feel better, or if you think it makes others feel better because they believe you are protecting them. Or ignore a mask if you feel you must for whatever reason.

Just don’t deceive yourself into believing it will make a big difference one way or the other. If you really want to save lives, there are a lot of things you can do that are more effective. You can stop texting while driving. You can convince your friends and family to eat better and exercise more.

Or you can contribute to any of the organizations trying to bring clean water and better sanitation to Africa and other parts of the Third World. Our World in Data calculates that “unsafe sanitation is responsible for 775,000 deaths each year.”

Given the connections between COVID-19 and sanitation, that number can probably only be expected to go up in 2020.