As the political leaders in the Municipality of Anchorage were deciding to once more mandate face coverings as the be-all to end-all to stem the latest wave of the Covid-19 pandemic, the Center for Infectious Disease Research and Policy (CIDRAP) weighed in heavily on this subject.
Based at the University of Minnesota, internationally recognized in the scientific community and backed with a two-decade-long history of investigating infectious diseases of all sorts, it had this to say on Thursday:
“The data are clear that most cloth face coverings and surgical masks offer very limited source control (protection of others from pathogens by limiting emissions from an infected person) and personal protection against small inhalable infectious particles and should not be considered a replacement for other, more effective methods of reducing one’s exposure to SARS-CoV-2, such as vaccination and good ventilation.”
CIDRAP scientists made a point of emphasizing that “we are not ‘anti-mask.’ Rather, we are in favor of wearing the most protective facepiece for the setting – such as a non-fit tested respirator when spending more than a few minutes in a crowded indoor space – and in combination with other interventions.”
The issues here focus on the difference between meaningful actions and those done for show in an environment colored by fear and politics.
As the collective of doctors who authored the CIDRAP statement noted, there are some masks which when used properly – used properly being a big caveat – do appear to provide some protective value.
“We strongly support people wearing more effective facepieces, including respirators,” they said. “Even if not fit-tested, an N95 filtering facepiece respirator (FFR) – or any other respirator – will offer better protection from Covid-19, if sized and worn correctly. As there is now ample supply, it is no longer important to reserve respirators for healthcare workers only.”
If sized and worn correctly and if handled properly and if….
The problem with masks is what the problem has been since the beginning of the pandemic.
Many people want a magic safety net because the best means of controlling the spread of the Covid-19 causing SARS-CoV-2 virus is the solution most people – conservative, liberal, progressive, libertarian and nearly all others -dislike: staying away from each other as much as possible.
Humans are just not good at this. They’re social animals, like cows. They like to herd up. Sometimes this is necessary in order to produce or manufacture the products that keep the modern, industrial world functioning, but often it is not.
Journalism is a shining example of the history of where it is not. For decades, most journalists spent most of their time hanging out in newsrooms instead of out in the world where the news is being made because they enjoyed the socializing.
Or editors wanted them there because, as with middle managers in most businesses, what would editors do if no one was around for them to supervise?
Mainly, though, it was about hanging out with coworkers who tend to become a sort of extended family. Journalists were and are not alone in this.
Morning Consult, a website that has been “Tracking the Return to Normal” almost since the beginning of the pandemic has consistently found about two-thirds of office workers want to get back to the office “as soon as it is safe.”
Meanwhile, other indicators of the need for socialization have simply skyrocketed since the beginning of the pandemic.
The less than 20 percent of Americans comfortable with a visit to a shopping mall in May of last year increased steadily in the months that followed even as Covid-19 infection rates in many states climbed.
By mid-July of this year, about two-thirds of people said they were comfortable with going to the mall. The number has dropped slightly since but remains near 60 percent.
Other group events lag only slightly. Near 60 percent are reported to be comfortable socializing in public places, but the comfort level drops for wedding attendance, now at 52 percent, and church or party attendance, now both at 46 percent.
Still, National Football League stadiums are packed, and the Consult report says 60 percent of sports fans are comfortable going to an outdoor sporting event, though the number drops to 42 percent for indoor events.
The results do indicate some number of sports fans at least understand the nature of the disease. You are a lot more likely to catch Covid-19 by spending time in an enclosed box with strangers than in the open air or an open-air stadium or, for that matter, a wire cage.
CIDRAP specifically took both the U.S. Centers for Disease Control (CDC) and the World Health Organization (WHO) to task for their failures to recognize this and make it clear long ago that COVID-19 infections have a lot to do with how much SARS-CoV-2 there is in the air around you.
“Despite early overwhelming evidence that SARS-CoV-2 is transmitted primarily by inhalation of infectious particles in the air (aerosols), it took the WHO and CDC many months to recognize this mode of transmission in their scientific briefs,” the group said. “Neither agency, however, has adequately directed its guidance away from droplet and contact transmission toward interventions that focus primarily on preventing aerosol inhalation.
“The interventions that prevent aerosol inhalation are those that reduce the concentration of small particles in a shared space and the time someone spends in that space inhaling those small particles. Particle concentration can be reduced by having fewer people in the space, sharing space for shorter periods, using ventilation that removes particles quickly near the source, and using source controls (masks and respirators) with good filters and fit.”
The ventilation factor is little different for SARS-CoV-2 than it was for secondhand smoke. A peer-reviewed study of the smoke in Chinese bars and restaurants published in 2014 concluded that servers working “five days a week for 45 years in smoking restaurants” were at more than 15 times greater risk from a smoking-related death than patrons who went there “on average of 13 minutes a day for 60 years.”
As for COVID-19 specifically, a peer-reviewed study of more than 120,000 residents of the United Kingdom published in The BMJ in 2020 found that “transport workers” faced more than twice the risk of contracting Covid-19 as their countrymen employed in non-essential jobs that allowed them to work from home.
“These essential worker groups have increased exposure to the SARS-CoV-2 virus through their work which may bring them into close proximity with members of the public or infected patients, particularly since carriers may be infectious without, or before, showing significant symptoms,” the study said then.
The evidence accumulating since would indicate there was more to it than just close proximity. As CIDRAP pointed out, Covid-19-infected individuals passing through an enclosed space can leave behind SARS-CoV-2.
“Ventilation can…be an effective intervention because it dilutes and removes inhalable particles from a shared space,” they said. “It may not be effective, however, if many sources share a space for a prolonged period.”
Simple translation: If you’re a bus driver, your risks of catching Covid-19 go down when the windows are open and the ridership low, and go up when the windows are shut and the bus is packed.
The same dynamics apply to everyone in bars and restaurants or, for that matter, the local supermarket. The worse the ventilation in the space and the greater the number of people, the higher the risk.
“Cloth and surgical masks offer a very limited degree of source control, because, while they limit the number of larger respiratory particles in a space, they do not prevent the emission of most small particles (aerosols) exhaled during breathing, talking, singing, coughing, or other respiratory actions,” the experts at CIDRAP wrote. “Because masks offer limited source control and much more limited personal protection, their effectiveness can be improved only by combining them with other interventions.
“As discussed above, anyone wearing a mask should be aware that the longer they spend in a shared space with other people, the greater the risk of being infected.”
If Anchorage, or any other city, wanted to do something truly effective, it could discuss improving ventilation standards for buildings or return to the occupancy limits for closed spaces as was the case early in the pandemic or set limits on the working hours for people whose job force them to spend lots of time in enclosed spaces around other people.
But it’s so much easier to order people to wear masks and never mind the social consequences (Anchorage is now at war over masks once again) or even the possible medical consequences.
The Vermont researchers concluded that when masks went on, close contacts went up, and as close contacts increased, so did the number of Covid-19 cases.
But the situation could be even more complicated than this.
The verdict is still out on fomites – microscopic particles to which the SARS-CoV-2 virus can cling to then be deposited anywhere. Fomites were behind the early Covid-19 advice to wash your hands, wash your hands, wash your hands.
That advice has now fallen almost totally off the radar. Nobody is fretting about washing or sanitizing their hands these days. The sanitary hand wipes still supplied by some stores go little used.
A medical journal, The Lancet, in July of last year published a commentary by microbiologist Emanuel Goldman arguing the danger of fomite-driven infections was being exaggerated, and many seem to have taken that conclusion to heart.
But the jury is still out on fomites, and it’s hard to overlook the fact that aerosols were also once dismissed as SARS-CoV-2 carriers before they weren’t.
Against this backdrop, French scientists in a research letter published in the Emerging Infectious Diseases journal last month reported finding evidence that fomites might indeed be a problem.
“…We showed that a moderate protein concentration in droplets markedly increased the infectivity of SARS-CoV-2, suggesting that a protein-rich medium like airway secretions could protect the virus when it is expelled and may enhance its persistence and transmission by contaminated fomites,” they wrote.
“Accordingly, it is plausible that fomites infected with SARS-CoV-2 play a key role in the indirect transmission of coronavirus disease Covid-19. This finding supports surface cleaning as a necessary action that should be enforced and repeated because it may play a key role in halting SARS-CoV-2 transmission and mitigating the Covid-19 pandemic.”
And if you watch how people now so nonchalantly handle face coverings – with their hands all over them to collect any SARS-CoV-2 that might have been blocked by the mask and transport it to anything their hands touch – you have to remains just a wee bit concerned about fomite risks.
All this said, one thing hasn’t changed since the start of the pandemic:
Most individuals have the ability to significantly increase or decrease their risks of catching Covid-19 by modifying their behaviors.
CIDRAP referred to a “hierarchy” of safety protocols.
“At the bottom of the hierarchy of controls is personal protection, such as respirators like N95 FFRs, which can be effective at protecting the wearer, but rely on appropriate fit and consistent wear,” it reports.
At the very top is isolation. To catch Covid-19, you have to get the SARS-CoV-2 virus from someone – or a mink or maybe a deer.
Isolation is hard for most to do although not impossible. Almost anything can be ordered delivered to your home these days, including food. Or you can order online and go pick up the orders at the store while safely in your car.
Still, most are inclined to want to dash into a supermarket or a liquor store now and then to get something. And dashing would be a good idea.
The less time you spend in there, the farther away from people you stay while there, the lower your risks. Add an N95 filtering facepiece respirator, and you can even push your risks a little lower.
But don’t be fooled into thinking you can hang around in enclosed places for long with no risks of catching Covid-19. Anchorage Dr. Benjamin Westley might want to believe he caught the disease in an Anchorage restaurant because the people there weren’t wearing masks.
He might even choose to write a commentary in the state’s largest newspaper blaming the maskless for his infection. But he has no evidence – none – to support that conclusion. It is nothing but shameless finger-pointing in an environment charged with anger over people being ordered to wear face coverings.
Westley can’t even know for sure that he caught the disease in a restaurant, though that is at least a logical conclusion if he can be believed in his claims to having no other close contacts with strangers.
It still doesn’t rule out the possibility someone in his inner circle could have been asymptotic – an all too common occurrence – and infected him with SARS-CoV-2 without knowing he or she was even sick. But the odds are better for his restaurant theory.
Bars and restaurants are risky environments when infection rates are high in any community. People visiting restaurants more than double their risks of catching Covid-19, the CDC reported more than a year ago.
A mask doesn’t really change this. A Danish study concluded, face-coverings don’t make any difference, though that study was conducted in Denmark at a time when infection rates in Denmark were low. A later study in Bangladesh claimed a 9.3 percent reduction in infections.
Do the math: You double your risks by going to a restaurant and then reduce the risk by 9.3 percent by wearing a mask.
You don’t win; you lose. Despite the mask, you’ve still greatly increased your risks of catching Covid-19.
One can only wish staying safe from Covid-19 was as simple as putting on a mask as Anchorage Assemblyman Chris Constant would have one believe.
Constant, who did not respond to a request for comment, might want to believe this, but it’s simply not true. The 14-day moving average number of cases in Clark County is 324 per day, though it is now trending downward, with an average of eight deaths per day, according to the Las Vegas Review-Journal.
The seven-day moving average for deaths in the state peaked at three at the end of September. That would put it about equal with Clark County which is home to close three times as many people as the entire state of Alaska.
But Alaska’s seven-day moving average for deaths is now down to zero.
Furthermore, it needs to be noted Alaska is testing for Covid-19 at the rate of 4.4 million tests for every million people. This is 2.75 times the Nevada test rate of 1.6 million per million people.
If Alaska’s daily infection rate is corrected to reflect this so as to gain a more accurate comparison with that of Las Vegas, the rate drops to a comparative 320 cases per day.
Though this might look the same as Clark County, it is still three times higher on a per capita basis because of the differences in population size.
About half of the Alaska cases have been occurring in Anchorage, but the lack of an Alaska Health and Social Service’s Department breakdown on testing rates for the city makes it difficult to directly compare the number of infections with Clark County.
It is, however, possible to compare deaths. The municipality reported 43 deaths to the state of Alaska in September.
The website USA Facts records about 440 deaths in Clark County in September, but the county, population 2.27 million, is home to about eight times as many people as Anchorage, population 283,000.
When deaths are calculated on a per capita basis, previously unmasked Anchorage (the one before the Anchorage Assembly overrode the mayor’s mandatory mask mandate) and masked Las Vegas were not far apart with an Anchorage death rate of 15.2 per 100,000 versus a Clark County death rate of 19.4 per 100,000.
Looking at those numbers, it’s hard to conclude masks do much if anything.
Anyone who believed Constant was clearly misled, but in fairness to the assemblyman, one can see from looking at the USA Facts website that Clark County does not report Covid-19 infections or deaths on weekends, and the dates cited by Constant with zero infections were weekends.
His statements might have been a simple mistake, although in these times when the question of how to respond to the pandemic is often more about politics than science (even when some of the players are scientists), it is impossible to know.
There are a lot of people who want to believe masks are salvation, and Constant is clearly among those people. Unfortunately, the scientists say they are not nearly as protective as people would like to believe.
But maybe then the Assembly’s masking mandate will work. Maybe people who don’t like it will avoid bars, restaurants and other enclosed spaces because of the new mask requirement and in that way truly protect themselves.
As for the rest – those who think they can put on a mask, ignore the volume of SARS-CoV-2 now circulating in the city, and act like the pandemic is over – the CIDRAP summary of mask effectiveness should encourage everyone to wish them good luck.