In case allyuh think I spewing spittle again:
Should We All Be Wearing Masks In Public? Health Experts Revisit The QuestionMarch 31, 20205:00 PM ET
Huo Jingnan-Allison Aubrey - Carmel Wroth
Even without symptoms, you might have the virus and be able to spread it when out in public, say researchers who now are reconsidering the use of surgical masks.
Elijah Nouvelage/Bloomberg via Getty Images
Updated March 31, 8:25 p.m. ET
A few months ago, it may have seemed silly to wear a face mask during a trip to the grocery store. And in fact, the mainline public health message in the U.S. from the Centers for Disease Control and Prevention has been that most people don't need to wear masks.
But as cases of the coronavirus have skyrocketed, there's new thinking about the benefits that masks could offer in slowing the spread. The CDC says it is now reviewing its policy and may be considering a recommendation to encourage broader use.
At the moment, the CDC website says the only people who need to wear a face mask are those who are sick or are caring for someone who is sick and unable to wear a mask.
But in an interview with NPR on Monday, CDC Director Robert Redfield said that the agency is taking another look at the data around mask use by the general public.
"I can tell you that the data and this issue of whether it's going to contribute [to prevention] is being aggressively reviewed as we speak," Redfield told NPR.
And Tuesday, President Trump weighed in suggesting people may want to wear scarves. "I would say do it," he said, noting that masks are needed for health care works. "You can use scarves, you can use something else," he said.
On Tuesday Dr. Deborah Birx, who serves as the White House's coronavirus response coordinator, said the task force is still discussing whether to change to the recommendation on masks.
Other prominent public health experts have been raising this issue in recent days. Wearing a mask is "an additional layer of protection for those who have to go out," former FDA Commissioner Scott Gottlieb told NPR in an interview. It's a step you can take — on top of washing your hands and avoiding gatherings.
In a paper outlining a road map to reopen the country, Gottlieb argues that the public should be encouraged to wear masks during this current period of social distancing, for the common good.
"Face masks will be most effective at slowing the spread of SARS-CoV-2 if they are widely used, because they may help prevent people who are asymptomatically infected from transmitting the disease unknowingly," Gottlieb wrote. Gottlieb points to South Korea and Hong Kong — two places that were shown to manage their outbreaks successfully and where face masks are used widely.
A prominent public health leader in China also argues for widespread use of masks in public. The director general of the Chinese Center for Disease Control and Prevention, George Gao, told Science that the U.S. and Europe are making a "big mistake" with people not wearing masks during this pandemic. Specifically, he said, mask use helps tamp down the risk presented by people who may be infected but aren't yet showing symptoms.
If those people wear masks, "it can prevent droplets that carry the virus from escaping and infecting others," Gao told Science.
The argument for broadening the use of face masks is based on what scientists have learned about asymptomatic spread during this pandemic.
It turns out that many people who are infected with the virus have no symptoms — or only mild symptoms.
What this means is that there's no good way to know who's infected. If you're trying to be responsible when you go out in public, you may not even know that you're sick and may be inadvertently shedding the virus every time you talk with someone, such as a grocery store clerk.
"If these asymptomatic people could wear face masks, then it could be helpful to reduce the transmission in the community," says Elaine Shuo Feng, an infectious disease epidemiology researcher at the Oxford Vaccine Group at the University of Oxford.
Given the reality of asymptomatic spread, masks may be a good socially responsible insurance policy, Gottlieb argues. "[Wearing masks] protects other people from getting sick from you," he says.
But there is still a big concern about mask shortages in the United States. A survey released Friday from the U.S. Conference of Mayors finds that about 92% of 213 cities did not have an adequate supply of face masks for first responders and medical personnel.
At this point, experts emphasize that the general public needs to leave the supply of N95 medical masks to health care workers who are at risk every day when they go to work.
And supplies are also tight for surgical masks, the masks used everywhere from dentists' offices to nail salons and that are even handcrafted.
"We need to be very mindful that the supply chain for masks is extremely limited right now," Gottlieb says. "So you really don't want to pull any kind of medical masks out of the system."
Given current shortages, it may be too soon to tell the general public to start wearing surgical masks right now. "We certainly don't have enough masks in health care," says William Schaffner, an infectious disease expert at Vanderbilt University. "I wouldn't want people to go out and buy them now, because we don't want to siphon them off from health care."
Where does that leave us? Some research has shown that cotton T-shirt material and tea towels might help block respiratory droplets emitting from sick people, even if the effect is minimal.
"Homemade masks, shawls, scarves and anything that you can conjure up at home might well be a good idea," says Schaffner. "It's not clear that it's going to give a lot of protection, but every little bit of protection would help."
But experts say homemade masks may not be effective if not constructed and handled properly.
That's why Gottlieb says the CDC should issue guidelines advising people on how to construct their own cotton masks. "Cotton masks constructed in a proper way should provide a reasonable degree of protection from people being able to transmit the virus," he told NPR.
There's no definitive evidence from published research that wearing masks in public will protect the person wearing the mask from contracting diseases. In fact, randomized controlled trials — considered the gold standard for testing the effectiveness of an intervention — are limited, and the results from those trials were inconclusive, says Feng.
But Feng points out that randomized clinical trials have not shown significant effects for hand hygiene either. "But for mechanistic reasons, we believe hygiene can be a good way to kill pathogens, and WHO still recommends hand hygiene," she says.
And those randomized studies were looking at how the face mask could protect the wearer, but what experts are arguing is that face masks may prevent infected but asymptomatic people from transmitting the virus to others. It's hard to come by data on this point. One meta-analysis reviewing mask use during the SARS epidemic found that wearing masks — in addition to other efforts to block transmission, including hand-washing — was beneficial. Another meta-analysis of mask use to prevent influenza transmission was not conclusive but showed masks possibly help.
The research may not be conclusive, but researchers we interviewed agreed that mask use is better than nothing. "There are some modest data that it will provide some modest protection," Schaffner says. "And we can use all the protection we can get."
Concern over presymptomatic spread in the community has also led some hospitals to change their policies and extend the use of masks to nonclinical employees and visitors. Last week, Massachusetts General Hospital in Boston took the unusual step of giving surgical or procedural face masks to all employees who go into the hospital to work, even if they don't provide care to patients, the hospital's Infection Control Unit associate chief, Erica Shenoy, told NPR.
"This runs very contrary to what we normally do in infection control," she says. "But we felt that with the unprecedented nature of the pandemic, this is the right decision at this time." She says if an employee were to get sick while at work, "the face masks would serve to contain the virus particles and reduce the risk of patients and others working at our facilities."
On March 29, the University of California, San Francisco, also started giving surgical masks to all staff, faculty, trainees and visitors before they enter any clinical care building within the UCSF system.
Feng cautions that if people do start wearing face masks regularly in public, it is important to wear them properly. She notes that the World Health Organization has a video on how to practice correct hygiene when putting on or taking off a mask.
Saskia Popescu, an infectious disease researcher and biodefense consultant, is skeptical that healthy members of the public need to start wearing masks regularly — she says people should follow current CDC guidelines. But she emphasizes that if you are going to wear a mask, "you have to wear it appropriately." That means, she says, "you have to discard it when it gets damp or moist. You want to stop touching the front of it. Don't reach under to scratch your nose or mouth."
Otherwise, she warns, wearing masks could give "a false sense of security."
https://www.npr.org/sections/health-sho ... e-questionNot wearing masks to protect against coronavirus is a ‘big mistake,’ top Chinese scientist saysBy Jon CohenMar. 27, 2020 , 6:15 PM
Chinese scientists at the front of that country’s outbreak of coronavirus disease 2019 (COVID-19) have not been particularly accessible to foreign media. Many have been overwhelmed trying to understand their epidemic and combat it, and responding to media requests, especially from journalists outside of China, has not been a top priority.
Science has tried to interview George Gao, director-general of the Chinese Center for Disease Control and Prevention (CDC), for 2 months. Last week he responded.
George Gao, head of the Chinese Center for Disease Control and Prevention
Stephane AUDRAS/REA/Redux
Gao oversees 2000 employees—one-fifth the staff size of the U.S. Centers for Disease Control and Prevention—and he remains an active researcher himself. In January, he was part of a team that did the first isolation and sequencing of severe acute respiratory syndrome 2 (SARS-CoV-2), the virus that causes COVID-19. He co-authored two widely read papers published in The New England Journal of Medicine (NEJM) that provided some of the first detailed epidemiology and clinical features of the disease, and has published three more papers on COVID-19 in The Lancet.
His team also provided important data to a joint commission between Chinese researchers and a team of international scientists, organized by the World Health Organization (WHO), that wrote a landmark report after touring the country to understand the response to the epidemic.
First trained as a veterinarian, Gao later earned a Ph.D. in biochemistry at the University of Oxford and did postdocs there and at Harvard University, specializing in immunology and virology. His research specializes in viruses that have fragile lipid membranes called envelopes—a group that includes SARS-CoV-2—and how they enter cells and also move between species.
Gao answered Science’s questions over several days via text, voicemails, and phone conversations. This interview has been edited for brevity and clarity.
Q: What can other countries learn from the way China has approached COVID-19?
A:
Social distancing is the essential strategy for the control of any infectious diseases, especially if they are respiratory infections. First, we used “nonpharmaceutical strategies,” because you don’t have any specific inhibitors or drugs and you don’t have any vaccines. Second, you have to make sure you isolate any cases. Third, close contacts should be in quarantine: We spend a lot of time trying to find all these close contacts, and to make sure they are quarantined and isolated. Fourth, suspend public gatherings. Fifth, restrict movement, which is why you have a lockdown, the cordon sanitaire in French.
Q: The lockdown in China began on 23 January in Wuhan and was expanded to neighboring cities in Hubei province. Other provinces in China had less restrictive shutdowns. How was all of this coordinated, and how important were the “supervisors” overseeing the efforts in neighborhoods?
A: You have to have understanding and consensus. For that you need very strong leadership, at the local and national level. You need a supervisor and coordinator working with the public very closely. Supervisors need to know who the close contacts are, who the suspected cases are. The supervisors in the community must be very alert. They are key.
Q: What mistakes are other countries making?
A:
The big mistake in the U.S. and Europe, in my opinion, is that people aren’t wearing masks. This virus is transmitted by droplets and close contact. Droplets play a very important role—you’ve got to wear a mask, because when you speak, there are always droplets coming out of your mouth. Many people have asymptomatic or presymptomatic infections. If they are wearing face masks, it can prevent droplets that carry the virus from escaping and infecting others.Q: What about other control measures? China has made aggressive use of thermometers at the entrances to stores, buildings, and public transportation stations, for instance.
A: Yes. Anywhere you go inside in China, there are thermometers. You have to try to take people’s temperatures as often as you can to make sure that whoever has a high fever stays out.
And a really important outstanding question is how stable this virus is in the environment. Because it’s an enveloped virus, people think it’s fragile and particularly sensitive to surface temperature or humidity. But from both U.S. results and Chinese studies, it looks like it’s very resistant to destruction on some surfaces. It may be able to survive in many environments. We need to have science-based answers here.
Q: People who tested positive in Wuhan but only had mild disease were sent into isolation in large facilities and were not allowed to have visits from family. Is this something other countries should consider?
A: Infected people must be isolated. That should happen everywhere. You can only control COVID-19 if you can remove the source of the infection. This is why we built module hospitals and transformed stadiums into hospitals.
Q: There are many questions about the origin of the outbreak in China. Chinese researchers have reported that the earliest case dates back to 1 December 2019. What do you think of the report in the South China Morning Post that says data from the Chinese government show there were cases in November 2019, with the first one on 17 November?
A: There is no solid evidence to say we already had clusters in November. We are trying to better understand the origin.
Q: Wuhan health officials linked a large cluster of cases to the Huanan seafood market and closed it on 1 January. The assumption was that a virus had jumped to humans from an animal sold and possibly butchered at the market. But in your paper in NEJM, which included a retrospective look for cases, you reported that four of the five earliest infected people had no links to the seafood market. Do you think the seafood market was a likely place of origin, or is it a distraction—an amplifying factor but not the original source?
A: That’s a very good question. You are working like a detective. From the very beginning, everybody thought the origin was the market. Now, I think the market could be the initial place, or it could be a place where the virus was amplified. So that’s a scientific question. There are two possibilities.
Q: China was also criticized for not sharing the viral sequence immediately. The story about a new coronavirus came out in The Wall Street Journal on 8 January; it didn’t come from Chinese government scientists. Why not?
A: That was a very good guess from The Wall Street Journal. WHO was informed about the sequence, and I think the time between the article appearing and the official sharing of the sequence was maybe a few hours. I don’t think it’s more than a day.
Q: But a public database of viral sequences later showed that the first one was submitted by Chinese researchers on 5 January. So there were at least 3 days that you must have known that there was a new coronavirus. It’s not going to change the course of the epidemic now, but to be honest, something happened about reporting the sequence publicly.
A: I don’t think so. We shared the information with scientific colleagues promptly, but this involved public health and we had to wait for policymakers to announce it publicly. You don’t want the public to panic, right? And no one in any country could have predicted that the virus would cause a pandemic. This is the first noninfluenza pandemic ever.
" Infected people must be isolated. That should happen everywhere."
George Gao, Chinese Center for Disease Control and Prevention
Q: It wasn’t until 20 January that Chinese scientists officially said there was clear evidence of human-to-human transmission. Why do you think epidemiologists in China had so much difficulty seeing that it was occurring?
A: Detailed epidemiological data were not available yet. And we were facing a very crazy and concealed virus from the very beginning. The same is true in Italy, elsewhere in Europe, and the United States: From the very beginning scientists, everybody thought: “Well, it’s just a virus.”
Q: Spread in China has dwindled to a crawl, and the new confirmed cases are mainly people entering the country, correct?
A: Yes. At the moment, we don’t have any local transmission, but the problem for China now is the imported cases. So many infected travelers are coming into China.
Q: But what will happen when China returns to normal? Do you think enough people have become infected so that herd immunity will keep the virus at bay?
A: We definitely don’t have herd immunity yet. But we are waiting for more definitive results from antibody tests that can tell us how many people really have been infected.
Q: So what is the strategy now? Buying time to find effective medicines?
A: Yes—our scientists are working on both vaccines and drugs.
Q: Many scientists consider remdesivir to be the most promising drug now being tested. When do you think clinical trials in China of the drug will have data?
A: In April.
Q: Have Chinese scientists developed animal models that you think are robust enough to study pathogenesis and test drugs and vaccines?
A: At the moment, we are using both monkeys and transgenic mice that have ACE2, the human receptor for the virus. The mouse model is widely used in China for drug and vaccine assessment, and I think there are at least a couple papers coming out about the monkey models soon. I can tell you that our monkey model works.
Q: What do you think of President Donald Trump referring to the new coronavirus as the “China virus” or the “Chinese virus”?
A: It’s definitely not good to call it the Chinese virus. The virus belongs to the Earth. The virus is our common enemy—not the enemy of any person or country.
Posted in:
Asia/PacificHealthCoronavirus
doi:10.1126/science.abb9368
https://www.sciencemag.org/news/2020/03 ... tist-says#bluefete wrote:Right now big disagreement by the "experts" on whether people should or should not wear masks.
Western doctors saying it is not necessary or only when you get the virus.
Eastern (China) doctors saying it is mandatory because that also helped slow the virus in China.
Who are we supposed to believe?
