Cases Are Up, Mask Use Is Down -- Let's Reverse That

Paul G. Auwaerter, MD


June 15, 2020

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This transcript has been edited for clarity.

Hello. This is Paul Auwaerter with Medscape Infectious Diseases, speaking from home, though normally at the Johns Hopkins University School of Medicine.

It's nearly mid-June, and many have breathed a sigh of relief as states have relaxed. Many of the social distancing and economic maneuvers have led to significantly decreased rates of COVID-19 infection and hospitalizations. Here in the state of Maryland, hospitalizations are reaching lows that haven't been seen since early April, so these are quite hopeful signs.

But at the same time, COVID-19 is affecting many parts of the world and our own country differently. Rates in many parts of Latin America, South America, and India are thought to be escalating, and it's unclear what kind of maneuvers governments might be employing to try to help staunch the rises.

Here in the United States, on June 11, 12 states now have increased rates of hospitalization and 21 states have increasing rates of COVID-19. So, although many believe that the worst is over, we still must be very cautious with this virus. And as physicians, it is incumbent on us to try to get out messages that are highly important to patients. I recently traveled to help my son move, and unfortunately, I saw many people — even in fairly closed public settings — not wearing masks, which is certainly encouraged if social distancing cannot be maintained indoors, as well as in retail outlets and so on.

There are a lot of misunderstandings that cloth or surgical masks are not protective. They might slightly reduce your risk of acquiring COVID-19, but the main aspect is to help prevent you — if unknowingly infected — from spreading virus through just simple speech or other actions when you're in closer quarters and potentially infecting other people.

Clearing Misconceptions

In fact, what I like to do with patients is emphasize that although there will never be an ethical randomized study, significant numbers of observational reports, as well as comparative studies numbering over 25,000 patients, were evaluated by Chu and colleagues recently in The Lancet. Some common-sense things were at least verified, things on which I think people may be losing perspective.

The first of the three top interventions that proved to be effective for preventing COVID-19, based on a review not only of COVID-19 but the other coronaviruses as well, is maintaining a physical distance of at least 1 m if not further, which is better. The second is wearing a facemask, which is helpful for preventing acquiring disease, as is eye protection, the third intervention. These, of course, are routinely employed as much as possible in healthcare environments, where the N95 mask is preferred. But even in home environments or in day-to day-activities, maintaining social distancing and using face masks are going to be very important in trying to keep the number of infections down.

I also ask my patients where they get information. The Shorenstein Center at Harvard recently published some surveys that suggest people get their information mainly from television, family and friends, social media such as Facebook, some of the network news, and YouTube. Yet, at the same time, the sources they trust are doctors, hospitals, scientists, researchers, and the Centers for Disease Control and Prevention. Whether these are being reported properly and respectively in a way that conveys the importance of these messages vs other aspects, such as individual liberties and so on, is why I think there's such a divide.

Wearing a mask has especially become an unfortunately divisive and polarized issue, and I try to just preach that it's best to wear a mask not only for yourself, but to protect all your fellow members in your community, your family, and friends.

I think a strong recommendation from a person's physician is very important. We know from influenza vaccinations that it's the most important thing that can be done to try to influence behavior and perhaps correct some misconceptions.

These are issues that will remain very important as we move ahead. People are getting a needed sense of relaxation and letting down their guard. This is quite understandable. I think people feel it's difficult keeping this up. But success, I think, bears witness in places such as Japan, Hong Kong, and Singapore, where wearing masks universally has kept the number of cases and fatalities at lows compared with European countries or our own.

Thanks for listening. Remember — please try to convince your patients to make wearing masks out in public a routine if they can't keep social distancing, and try to correct any misconceptions. I am asking patients what they think of wearing masks whenever I meet them. Thanks so much for listening.

Paul G. Auwaerter, MD, is a professor of medicine at the Johns Hopkins University School of Medicine and clinical director of the Division of Infectious Diseases. His areas of clinical expertise include Lyme disease, Epstein-Barr virus, and fever of unknown origin. He has been a Medscape contributor since 2008.

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