There is no doubt that the situation concerning coronavirus has worsened. I certainly felt more encouraged when the overwhelming majority of cases were confined to China. The spread of cases (but, keep in mind, we are talking very low numbers of cases) to 58 countries is disappointing and suggests early efforts to restrict travel were not entirely successful. But, many of these countries have only 1, 2 or 3 confirmed cases, and, in some cases, these persons were known to be at risk because of travel and therefore were kept under quarantine in their home country during which time the infection was identified, so in fact, public health measures have helped constrain the spread of this virus.
It is important to maintain perspective. Although things can change over time, thus far, the magnitude of infections has not eclipsed that of influenza (the “flu”). Further, there are reasons to believe that while certainly there is person-to-person spread, the effectiveness of spread of this virus from person-to-person is less than some of the other viruses we have dealt with. Why do I say that? First, lets keep in mind that this infection became recognized in early December. Here we are at the end of February. There are close to 83,000 cases world-wide. The infection began in Wuhan, China, so it is the geographic area where the virus has had the most time and opportunity to spread. Yet, we have less than 80,000 identified cases in all of China, but the population of just Wuhan is 11 million people.
Further reassuring is the fact that while we now know that this virus can be spread from an infected person even when they have not yet developed symptoms (which this fact would raise the risks for community spread of the virus), in the US, we have only just now identified the second case in which this community spread of the virus appears to have occurred. To be clear, I am expecting many more cases in the coming weeks and months, my point is this is not spreading like wildfire.
I certainly do not mean to convey that we should be dismissive of the threat or not take our preparedness and response seriously, I am just calling for us to keep things in perspective, at least until such time as we know the situation has changed.
So, let me address the most common question I get – “should I be wearing a mask?” Last night I heard a reporter on television indicate we should. This is NOT correct. There are two groups of people who should be wearing masks – people infected with the virus and those caring for them.
Let me explain why. The coronavirus is incredibly small. You cannot see it without advanced microscopic imaging techniques. It is so small that it can easily penetrate the porous material that masks that you can buy at the drug store or on the internet are made of. The reason we put masks on patients is that though the virus is extremely small, when it is projected form the lungs, throat and mouth of an infected person, it is surrounded in a mix of secretions that make it a bigger droplet. The size of that droplet is largest when it leaves the patient’s mouth or nose and at this size, it can often be trapped in the mask, but when the person is not wearing a mask, the surrounding secretions rapidly are dispersed into the air and evaporate or land on surfaces as they travel through the air, and the further it travels, the smaller it becomes, to the point that by the time it reaches another person standing several feet or more away, it has decreased to this ultra-microscopic size again, that can relatively easily penetrate a mask, or probably more often, be breathed in by the person wearing the mask as the virus enters the person’s nose that is not covered by the mask, or if it is, around the sides of the mask which are not air-tight and often have significant gaps, or even through the mask material itself.
That is why in the hospital, when we are caring for patients such as these, our health care workers do not wear these kinds of masks. They wear a special kind of mask that can filter out 95 percent of particles the size of these viruses and for which our personnel are specially fitted to ensure that there are not even tiny gaps, let alone the kinds of gaps that are quite common with commercially available masks.
You might say, well, even if the mask will not offer me good protection, it might offer me some protection, and I feel better wearing it. That is the problem. I am very concerned that people wearing masks will actually be at more risk because they may be complacent and not take much more effective measures, such as washing their hands.
Although we are still learning about this particular virus, it is often the case with viruses that people become infected with the virus through contact with the infected person’s secretions through direct contact or contact with a surface nearby in close proximity in time and space to the person that has coughed or sneezed and then put their own hand up to their eyes, nose or mouth. People would be far better off just to wash their hands with soap and water for at least 20 seconds, or use a hand sanitizer, frequently, and certainly before eating or after having close contact with other people or touching surfaces often being used by large numbers of the public – handrails, doorknobs, etc. So, if you are really determined to wear something, wear gloves instead of a mask!
The best advice for coronavirus and other colds and flus – stay home if you are ill. Do not expose your colleagues to whatever you have. Don’t send children to school or daycare when they are sick, especially, if they have fever. Wash your hands frequently. Cover your mouth when you cough or sneeze and then wash your hands. If you do believe that you might have coronavirus – you have had travel outside of the US in the past 2 weeks or you have been in contact with someone who is believed to have coronavirus, call your physician or the emergency room before showing up. This way they can meet you before you come in the office or emergency room, put a mask on you and take you to a special isolation room where we can minimize your exposure to others and our healthcare workers can be protected until we have a chance to determine whether you likely do or don’t have coronavirus. Remember, if you have cold or flu symptoms and have not had recent international travel or exposure to someone known or suspected to have coronavirus, it is extremely likely you just have a cold or the flu, and very unlikely that you have coronavirus.