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Ode to the Mask... A Message from our CMO

By editor
June 4, 2020

Ode to the Mask (with apologies to any other “Ode to the Mask” ever written)
 
Oh my wondrous mask!
You protect me from viruses unknown
You are the mightiest defense I own
 
Oh my magnificent mask!
Some accuse that you are a sham
Others say you are worse than spam
 
Oh my beautiful mask!
Sometimes you hide a smile
Or show an image of teeth quite vile
 
Oh my noble mask!
My fear of the virus conquers me
So I hide behind your veil pretending to be free
 
Oh my misunderstood mask!
Where does this contempt of you derive?
When your only goal is to keep me alive?
 
Every day, I receive dozens of emails asking our guidance on wearing face masks during the pandemic and recent reopening of our cities. Many make it clear how they want the question answered. Some feel it is a case of government overreach and unnecessary. Others feel it is an important part of the slow road back to normalcy.
 
Since I feel the answer is obvious, I try to research the literature to convert an opinion into a fact. Big mistake.
 
Our government experts first encouraged mask wearing.  Now Dr. Fauci says it’s unnecessary.  The WHO and CDC both reversed policies mid-stream based on little actual evidence.
 
What about peer reviewed medical journals, ostensibly relying on hard data and having no political agenda? Think again.
 
The respected NEJM has a new "article" from Harvard concluding masks are not necessary outside of health care facilities, calling mask wearing "a reflexive reaction to anxiety.” However, no numbers were offered, nothing prospective or retrospective. So it is an opinion. From Harvard nonetheless…but still an opinion.
 
Enter Sarah Arrowsmith, a scientist at Arizona State University. She published her data on using CLOTH masks. As a matter of fact, ones she made personally.  Acknowledging only N95 masks will block the virus and that there are insufficient N95’s to supply all medical facilities, let alone the country, she studied the efficacy of a cloth, homemade mask. 
 
Arrowsmith’s mask caught roughly 95-99% of particles that ranged in size between 0.07 and 0.209 microns—about the size of a coronavirus particle.  (The average Covid particle is 0.125 microns)  The results were reproducible.
 
Turns out how many viral particles are "caught" by the mask is an industry metric well studied. Doing nothing is a rate of 0. A cotton hanky loosely held over the nose/mouth actually blocks 28% of Covid particles. A normal surgical mask from the local OR? 80%. And one guess the percent of the N95 mask? Bingo! Yes that’s how they got the name---a 95% blockage rate.
 
Ms. Arrowsmith’s homemade cloth masks rivaled a surgical mask and even the revered N95’s. In fairness, Ms. Arrowsmith found the best results with double ply cotton, and found the mask had to be well sealed ABOVE the nose to work that well.
 
I know what you are saying: "Dream On.  Do you really expect me to ‘Walk That Way?’ You're letting ‘Sweet Emotion’ get in the way of your opinion." 
(Sorry couldn't help that.)
 
When there is conflicting data, I've always resorted to a wacky tactic.  I ask what I would do if I were the patient. (Or my family.) If I knew I had Covid19, I’d wear a mask EVERYWHERE. Well in fact, I wouldn't get within 50 feet of anyone, but that’s me. If a family member was bringing me my meds, I’d wear a mask, whether I was in a health care facility or not.
If I didn't have Covid-19, but had to interact with someone who was known to be Covid19 infected, I’d wear a mask. Absolutely.  Sorry Dr. Fauci, WHO, CDC, and the NEJM. 
 
But what about a normal Joe going to the grocery store, restaurant, or dry cleaners? The odds are high there is no Covid around. No need for a mask then right? I’m going with the mask. We have no idea where the virus floats. And a mask helps. Even homemade ones.
 
They work in the OR, ER, and whenever doctors need to be safe. The mask in the hospital keeps the physician from infecting YOU if they have any bug unknowingly. It also protects the provider if YOU have any bug unknowingly.
When you cough or sneeze, you are told to cover your mouth/nose with your hands. It’s common sense and courtesy. Is a mask that much worse than covering yourself, except you’re doing it for normal breathing? It is as much of the equation as hand washing and social distancing.
 
On social media, I’ve read posts saying “I HAVE A MEDICAL CONDITION THAT PROHIBITS ME FROM WEARING A MASK--YOU CANT ASK ME WHAT IT IS DUE TO HIPAA AND IM NOT GOING TO WEAR ONE.”
 
Good Grief. There are no medical conditions in my career where I ever told someone NOT to wear a mask. If they have COPD or asthma, you WANT them to wear a mask so as not to get an infection. A mask does not reduce your oxygen levels. 
 
Another post I read said “I WILL NOT ALLOW A GOVERNMENT TO FORCE ME TO WEAR A MASK.”
 
Seriously? I don't think there is a law requiring you to wash your hands, cover your mouth with  a sneeze, or take an occasional shower. You do it as a sign of respect and it’s the right thing to do. 
 
Most recent studies on Covid show the particle can travel with normal air currents quite far; one study said 50 feet and it doesn't need to be via a cough. Just breathing it out is enough. 
 
We diagnosed someone with Covid-19 last week. She had no idea where she got it. We had to go back 14 days and have her recall ALL her contacts during that 14 days. Since she went to stores etc there are hundreds of people  exposed who do not know it. Were they all more protected if she was wearing a mask? (She was.) I say yes. NEJM says no. You can choose for yourself.
 
So when do you wear a mask? We don’t have that data. We ask you to be patient as we collect it. We need to see how many never-maskers get the virus vs. always-maskers. As we reopen our cities, we plead for the safer course, wearing masks--even if future data shows it was unnecessary. 
 
So our advice?

Wear a mask while waiting in lines, when shopping, and riding in cars with people on buses or trains. Wear a mask at the doctor’s office and depending on the type of work you do, on the job. At least for now.
 
It’s the right thing to do.
 
Gregg DeNicola MD
Chief Medical Officer
Caduceus Medical Group

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