As the Medical Director of the Kansas Business Group on Health I’m sometimes asked to weigh in on topics that might affect employers or employees. This is a reprint of a blog post from KBGH:
From February to October of 2002 father and son John Allen Muhammad and Lee Boyd Malvo killed more than a dozen people and injured several more on a crime spree that started in Tacoma, Washington and ended in an orgy of indiscriminate violence in and around Washington, D.C. The media devoted enormous time and resources to the shootings. Once it was clear the attacks were the work of a serial killer, on-air coverage often lasted for hours after each attack.
The attacks naturally caused a huge amount of public apprehension in the D.C. area. People at gas stations began walking rapidly around their cars in order to make themselves harder targets. Many gas stations hung tarps around fuel pumps to block the view of potential snipers. People attempted to buy gas at the National Naval Medical Center, as they felt safer inside the guarded fence of a military installation. Senate pages got a police escort to and from the United States Capitol every day and were confined to their residence hall except for work activities. Schools cancelled field trips and outdoor sports, and some schools hired additional security officers and changed after-school pick-up procedures in order to minimize the amount of time children spent in the open.
People began wearing bulletproof vests.
Imagine the public reaction if the scale of the D.C. sniper attacks were much, much larger. What if, instead of a dozen or so deaths over nine months, one to two thousand Americans were dying daily in the crosshairs of snipers. Imagine that elders, especially those with medical conditions, were the primary target of the snipers simply because they were easier to kill.
What would be our response to this internal threat? Would we hole up for a month, wait for the death rate from terrorist attacks to plateau, and then largely go about our business? No. I suspect we would devote billions or even trillions of dollars to identifying members of the group, arresting them, and prosecuting them. We would use sophisticated methods to track their movement.
And we would wear bulletproof vests.
You may have figured out where I’m going with this. My analogy is pretty transparent. After the sacrifice of ten weeks of social distancing (which may have prevented 60 million infections and many thousands of deaths), we’re all naturally tired. But a rogue agent known as SARS-CoV-2 is on the move in America and still killing thousands of people per day through not gunshot wounds, but from a disease called COVID-19. We’re not in a second wave of infection; we’re not even out of the first wave yet:
The virus doesn’t kill by gunshot. It kills by airborne transmission and infection of people’s lungs.
Our bulletproof vests are masks. And we should be wearing them.
I know it’s hard to keep up with changing advice. Under the assumption that all masks worn would be medical grade the CDC originally advised against wearing them to avoid shortages. So did I. But the evidence has become very convincing that even cloth masks--our “bulletproof vests”--don’t just protect us. They protect those around us, too. One study showed that if even 60-70 percent of Americans consistently wore masks, and those masks were at least 60-70 percent effective at preventing disease transmission, we would crush the reproductive rate of the virus. The goal of any strategy in infection prevention is to get the number of people infected in turn by each infected person, the “Re,” down to less than 1.0:
Proceedings of the Royal Society A
Watch the rate of infection fall as the rate of mask wearing increases and the rate of effectiveness of the masks increases! The bidirectional effect of masking shines light on a more important point: protecting against coronavirus, whether by being careful with social distancing, by handwashing, or by mask wearing, is an act of service, just like getting vaccinated for other infectious diseases. We can only do so much to protect ourselves; most of our work should be in protecting one another. Two hairstylists in Missouri, who saw hundreds of clients after being unknowingly infected themselves, appear to have infected zero clients because of their faithful facemask use.
So in that regard, COVID-19 is not like a serial killer. COVID-19 is like HIV. Where sex is the dangerous activity (along with shared needles), being indoors with other people is the dangerous activity with COVID-19. Ninety-seven percent of “superspreading events” are indoors. I like Linsey Marr’s analogy about how COVID-19 is like cigarette smoking. Imagine everyone smokes but you. She said, “The denser the smoke, the more likely it is to affect you. It’s the same with this virus: The more of it you inhale, the more likely you are to get sick.” So if everyone around you smoked, you would stay out of crowded spaces that would be quickly filled with smoke. You would try to stand as far from the smokers as you could. If you could open a window to clear some of the smoke, you would. And if you were forced to be in a crowded space you would wear a mask to filter the smoke.
I’ve had a chance now to see several workplaces’ policies around COVID-19 safety. And they’re pretty good! But we need to encourage our employees to follow those same safety rules outside the office. Ninety percent of Americans report frequently wearing masks. I cannot help but believe that there is a flaw in that data. My recent masked trips to the grocery store in which a small minority of people were wearing them tells me the true number is much smaller than that.
I know it can seem like a performance to wear a mask in public when you may not even know a person who’s been affected by COVID-19. But this shouldn’t be about virtue signaling. Defeating a global disease requires global effort. Protect the people around you. If you’re outdoors alone, you don’t need to mask up. But if you’re in a crowd where you can’t stay six feet from other people, or if you’re indoors with people you don’t live with, for heaven’s sake, wear a mask.