A growing body of evidence suggests that masks for everyone might be a beneficial strategy. In the US that strategy has been rejected in order to encourage conserving PPE for health care providers.  In Czech Republic, where national leaders have successfully waged a masks4all campaign (in combination with quarantine), COVID19 GROWTH seems to have stabilized. I previously discussed droplet vs. aerosol spread. The WHO and CDC have officially labeled COVID19 as droplet spread.

Droplets fall to the floor and surfaces, they do not linger in the air. Disease transmission can occur by touching a contaminated surface and then touching your face. Droplets coughed or sneezed into your face (even from a distance) will transmit disease. Singing, yelling, or loud talking can probably do the same. Face to face conversation without cough or sneeze can transmit COVID19.

Aerosol represents smaller particles that linger in air for hours making a confined space infectious for hours and allowing for disease transmission just by breathing the air, a more contagious situation.

Certain medical procedures such as intubation produce aerosol, increasing risk for health care providers.

On March 10, 60 members of a choir rehearsed in the state of Washington. None were symptomatic. They did not share music and distanced themselves. 45 members became ill, 28 tested + for COVID19, 2 died. It is likely all 45 who are symptomatic have COVID19 (there is a 37% false negative rate for nasal swab PCR test, 28/45=62%, very close to expected # of positives if all 45 have the virus.)

Those without symptoms should be tested, they are likely carriers.

If they all had been wearing masks transmission rates would probably have been lower.

As described in a previous post, an advisory letter from Stanford ENT Surgery Dept., warned about highly contagious circumstances in the OR during ENT surgery. In one case all 14 personnel who entered and left the OR contracted COVID19 despite wearing PPE including N95 Masks. Multiple reports of deaths among ENT and eye surgeons who work close to the nose have been reported from other countries.

These examples and many more suggest that there is a continuum between droplet and aerosolization and both may be present. Although not completely protective, masks would decrease the viral load associated with an exposure. A lower load of virus would be less likely to overwhelm the immune system. COVID 19 is also called SARS-COV-2.

The virus enters human cells by attaching to a specific protein on the cell surface. These proteins (ACE2) are in high concentrations in the NOSE.

There is no discrete safety with a distance of 6 feet. That degree of separation is just a guideline. A forceful cough or sneeze might project droplets much further.

B

Based on these considerations MASKS4ALL might help contain this virus AND flatten the curve with greater efficiency.

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Eat clean, drink filtered water, love, laugh, exercise outdoors in a greenspace, get some morning sunlight, block the blue light before bed, engage in meaningful work, find a sense of purpose, spend time with those you love, AND sleep well tonight.

Doctor Bob