“We still have a lot to learn about this virus.”
Andrew Cuomo, May 9, 2020
The governor’s comment was a perfect summary of the experience of not only New York but the nation and the world since the SARS-CoV2 virus and its associated disease was first identified in December 2019. Even the date of its emergence in this county is being revised, as medical forensics are reconsidering mystery illnesses that had been attributed to pneumonia or flu but turned out to have been what later became known as Covid-19.
Nothing about this disease has remained sure or static, as new information challenging what we thought we knew is learned nearly every day. Cuomo was commenting in his daily briefing on the emergence of a strange new manifestation of covid in a population once thought essentially immune: children. Not only was the target group unexpected, so was the new target organ system: coronary arteries and other blood vessels. It should not have been a complete surprise, though. The virus had also been attacking young and middle-aged adults, causing sudden, often fatal, strokes. And in the older population, it did not restrict itself to respiratory distress: kidney failure was also often a separate outcome, thought to be caused by the peculiar clotting syndrome that produced “covid toes.” The novel coronavirus may have entered the body through the eyes, nose, or mouth, but once inside, it could seemingly do damage anywhere.
As New York takes its first measured steps toward reopening, we must all be mindful of how best to accomplish that goal without provoking a resurgence in infections and deaths. Cuomo wisely mandated the use of masks soon after the CDC’s belated advice that the general public wear face coverings. And masks will be key in making our way forward, as interactions resume and social distancing becomes more difficult.
Like so much else in this pandemic, the early thinking on how the virus is transmitted was wrong. The World Health Organization initially recommended keeping a distance of three feet, believing that unlike other respiratory pathogens, the novel coronavirus traveled only in larger droplets and fell quickly to surfaces. Hence the emphasis on handwashing as the primary means of prevention. It was advice that propagated through public health systems and in the public consciousness all over the world. Even after the U.S. Centers for Disease Control doubled that distancing standard to six feet, handwashing persisted with almost ritualistic appeal as the prevention of choice, with few questioning the reason for the distancing revision.
The reason was that new information has shown that the coronavirus is, in fact, airborne. The six feet (“at least”) advisory was probably the most that the CDC felt it could recommend and still obtain reasonable compliance (until it didn’t, and the country shut down altogether). The reality is that the virus is transmitted in aerosolized sprays much farther than six feet, small enough and light enough to be suspended in the air for at least 30 minutes, even after an infected person has left the area. A sneeze was shown in simulations to travel as far as 26 feet, but it does not even take a sneeze to expel virus particles far into the air: singing, talking, even breathing alone will do it. Especially the kind of heavy breathing produced by joggers; aerodynamics studies have shown that even people walking leave a wake of “breathcloud” 15 feet behind them; for joggers, it’s easily 30 feet. Something to keep in mind next time you’re out for a healthful stroll.
Which brings us back to masks. “I wear a mask for you, you wear a mask for me” is only half right. Masks prevent an infected person’s droplets from spewing into the air. But they also protect the healthy wearer from those droplets, should an infected person not be wearing a mask. The virus-laden droplets and aerosol land on your mask, not in your nose. Think about it: health care workers wear masks to protect themselves from infected patients, not to protect the patients from them. In fact, as Cuomo noted in a recent briefing, doctors and nurses treating covid patients have had a lower infection rate than the general public. Why? Masks. The Surgeon General’s early famous, disastrous, exhortation, “Seriously, people, stop buying masks!” was motivated out of his awareness of the nation’s limited supply of N95 and surgical masks, and the need to conserve them for those medical personnel – not from any factual basis that they don’t work to prevent infection.
As a substitute for masks, the federal government heavily promoted social distancing. The CDC had to reverse course after the death count exploded, but the damage was done: it was hard to erase in the public mind the initial implication that masks were useless. To be sure, cloth masks are not as effective as N95s or surgical masks, but as long as those remain out of reach to the public, cloth masks will provide enough of a barrier to stop viral-laden droplets from reaching your respiratory tract.
So the messaging on masks has been wrong from the outset. Wrong on the facts – if it helps prevent health care workers from contracting the virus, it helps prevent infection for anyone wearing it – and, most importantly, wrong on the psychology. First, it depends on altruism, which, despite all the gestures of generosity featured on the nightly news, is really an unreliable motivator in a society as divided as ours. With GenZ/millennials flouting distancing guidelines at spring break, calling covid the “boomer remover”; with the cultural, economic, racial, and political divisions made even more pronounced by this crisis, “We’re all in this together” is a dangerous fantasy.
But the most problematic aspect of the current advice about masks is denial. The message that you wear a mask to prevent others from catching your deadly disease requires a willingness to admit that you might, in fact, right now, have a deadly disease – an almost insurmountable mental hurdle.
So the mask message needs a serious rethink, but it can be done. It must be done, if we are to get within business distance of each other and resume life without risking dying, until there is an effective drug treatment or vaccine. Testing is not prevention, and relentless surface disinfection will not remove virus from the air. Wearing a mask whenever you’re around other people is one of the few things you can do to control your own safety in this very uncertain environment. Republicans would call it personal responsibility. Cuomo calls it smart.
Yes, a mask is uncomfortable, but it is less uncomfortable than a tube down your throat. There are encouraging signs that masks are becoming socially normalized, popularized like any other accessory, with fashion-forward companies already producing them to match their bags. But adoption is still not where it needs to be, I believe, because the message has not been made clearly enough that you wear a mask for your own good.
Thousands of undergraduates are likely returning to Ithaca in the fall, many from the state’s covid epicenter. Can the community expect them to keep a distance of at least six feet? Will they feel that infection poses no great threat to their health, even as cases in Tompkins County have disproportionately occurred in people of their age group? We'd better get into the habit of wearing masks, now.
It’s not just a good idea, as they used to say about seatbelts, it’s also the law -- the governor's executive order has the force of law. Again to quote Cuomo, "Do not underestimate this virus. The more we learn about the virus, the more the facts change, and the worse it gets. ...You know who's going to protect you? You are. It's about you protecting you."
The virus is still out there, more infectious and devastating than any we’ve experienced, and the life you save may be your own. Ask not for whom you wear the mask; you wear it for thee.
Pat Leary is a member of the Town Board of the Town of Ithaca