This Week: Masks

Hi, I’m back as Robin-Schoenthaler-the-Boston-cancer-doctor-who-writes-about-Covid.

(And it’s okay with me if you want to share.)

Today I’m talking about how Masks May Be Magic.

Massachusetts is still okay, trending up a bit in terms of numbers of cases but hospitas are fine, deaths are low. 

The rest of the US outside of the Northeast:  it’s just unspeakable.  The numbers are unfathomable. 

How bad is it?

Here’s an analogy: 

More or less, the US is having one Wuhan a day.  Remember how terrible Wuhan was and ended up being?  That many cases are happening every day in the US. 

Here’s some statistics:

How fast are cases exploding?

0 cases to 1 million cases: 98 days

1 million to 2 million cases: 44 days

2 million to 3 million cases: 27 days 

3 million to 4 million cases: 14 days

Here’s a story:

Every Thursday night I listen to this whiz kid Infectious Disease doc from Texas talk about Covid.  She talks non-stop for an hour and whips through about 55 papers, summarizing study after study after study.  She’s like the kid in high school who was absolutely the smartest person in the room and made it look easy; she’s amazing. 

At a recent broadcast she was quoting a paper and all of a sudden she started crying.  I couldn’t even figure out what was happening (I was doing dishes in my Eternal Multitasking Fashion) but when I stopped loading the dishwasher and looked at my computer screen, there she was, wiping her eyes and weeping.  That’s what life is like in Texas. 

In the midst of this misery, let’s talk about something positive.  Let’s talk about masks. 

I love masks.  Right now they feel like are like our magic protectors, like holding garlic up in front of Dracula, or wearing a special amulet that keeps the evil eye away. 

Or maybe like wearing a condom and not getting syphilis.

Why are masks particularly important with Covid? 

Well, as with Everything Covid, “we are building the plane while we fly it.”  We are accumulating data as fast as we can and some trends look promising. While some of this may change over time, for now this is what we know. 

First off, it appears, unbelievably, that the rate of people who are infected but have no symptoms is around forty percent.  (These are people who had positive nose swabs but stay completely asymptomatic.)

FORTY PERCENT!  It’s awesome that four out of ten people don’t suffer from the disease at all, don’t have long-term sequelae, etc. 

But it also means four out of ten people who have Covid have absolutely no idea they are infected, don’t know they’re contagious, don’t realize that every time they speak/yell/cough/sneeze they may be spewing tons of infected confetti all over the place, don’t know they may be an actual danger to family and friends.

But if they’re wearing a mask, they’re not so dangerous. 

There is now a good amount of research, old and new, showing masks filter out the majority of viral particles.  All masks matter, to varying degrees.  Without getting into a song and dance about the exact numbers, here’s the basics:

    • N95s are better than surgical masks
    • cloth masks are way better than nothing
    • two masks (one on me, one on you) are better than one
    • having it on your chin doesn’t work

Masks can work to protect other people from your infection.


Masks can work to protect you from other people’s infection.

and furthermore

    • Masks can work to protect you from getting ANY virus inside you.
    • Masks can protect you from getting LOTS of virus inside of you. 

You always need a certain amount of viruses spewed at you like the above mentioned confetti to get sick. It can’t be just one solo virus — it has to be thousands.  Masks have been shown to cut those numbers down. 

Even better, there is evidence that the volume of virus that gets into your mouth or nose is related to how sick you get.  So when you wear a mask and hang out with people wearing masks, early studies seem to indicate you are increasing your chances of having milder disease.

It even appears that masking increases the rates of being asymptomatic!  In some very interesting early studies, we are seeing this happen. It’s happened on cruise ships, it’s happened in food processing plants — even in the midst of big outbreaks, infected people who use masks are more likely to be completely without symptoms.

When we don’t wear masks, we have more deaths. We saw this so tragically in Italy and New York among health care workers.

When you do have places mostly masking (eg >80%) you may well see fewer deaths.  San Francisco (a great masking place, like Boston) has had ONE death since July 16 despite 1500 new cases.  And deaths have stayed low post-surge in the Far East countries where masking is part of the cultural norm and most countries where masking had been mandatory.

This is not to say that masking is a miracle cure-all; we still need physical distancing and hand washing and staying home when sick.

Still, what a lot of reasons to wear a mask:

— you don’t have to walk around with the guilt of being Patient Zero

— you have less chance of getting it

— you probably have a higher chance of being asymptomatic

— you may well have less chance of getting super sick

— you may have less chance of dying of it

And you won’t make your doctor burst into tears in the middle of a presentation.