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Local experts, medical professionals agree: Mask up

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A crowd member wears a mask designed with the American flag during the Mount Rushmore Fireworks Celebration on Friday, July 3 in Keystone. (Matt Gade / Republic)

Want to get back to normal life? Masks are the best way to get there, according to health care professionals.

While 31 states around the country are experiencing a rise in COVID-19 cases, South Dakota has remained steady. Davison County has accumulated 71 cases of COVID-19 during the pandemic and no deaths, according to the South Dakota Department of Health. But there are 15 active cases, and wearing a mask is the best way to prevent an increase of cases, according to Avera emergency physician Hilary Rockwell.

“The recommendation (by the Centers for Disease Control and Prevention) stays the same no matter how big of an area you’re in or small,” Rockwell said. “We do still have community spread, so if you’re in a public place, you should wear (a mask). … We don’t have a lot of cases, that’s great, but it doesn’t mean we should drop our guard or think that it’s not around. The scary thing about this virus is that you can spread it without knowing you have it.”

Areas such as Sanborn County -- which has no active cases and 12 recorded overall -- may seem safe from the spread of the virus, it is hard to gauge actual numbers due to revelations of asymptomatic carriers.

Initially, experts believed that COVID-19 would act in the same manner as its cousin, SARS, which spread after the onset of symptoms. Instead, it is now believed that the virus can be spread by carriers that express no symptoms, according to Wendell Hoffman, an infectious disease physician at Sanford Health.

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Hoffman compared battling COVID-19 to a football team using good blocking and tackling as cornerstones of winning games. The two blockers are social distancing and face masks and the two tacklers are hand hygiene and environmental cleaning, which all must be used in unison until a vaccine becomes the ultimate blocker and an antiviral agent becomes the ultimate tackler.

“The long-term pursuit should be that the community acts as the immune system,” Hoffman said. “We are the ones that block and tackle until we get a vaccine and good antiviral therapy. It’s up to the community to become the immune system to protect the most vulnerable in our midst. Masks are an important part of that whole science.”

The effectiveness of wearing a mask

The CDC states that COVID-19 spreads person-to-person through respiratory droplets when speaking, coughing, sneezing or singing in close proximity.

Several studies have shown that masks greatly reduce the spread of those droplets. A study by the New England Journal of Medicine used a high-speed video to show a person saying a simple phrase generated hundreds of droplets, but when the same phrase was uttered from a mouth covered by a damp washcloth, nearly all of the droplets disappeared.

The World Health Organization has found N99 and N95 masks to be the best quality for reduction of droplets. Both ends of the mask sealing tightly around the nose and mouth, the N99 mask was found to reduce infection from 94 to 99 percent after 20 minutes of exposure, while N95 masks have a 95 percent efficiency in reducing aerosol droplets from being inhaled or exhaled through the mask, according to the Journal of Hospital Infection.

Disposable surgical masks -- which have filtering to keep out small mychrons -- are next on the list, followed by masks made of multiple layers of cotton or silk. Scarves, cotton T-shirts or bandanas were proven to be largely ineffective in the study.

Rockwell compares the process to seeing your breath while outside in freezing temperatures. The cloud emitted when the cold air causes the warm moisture breathed to turn into droplets of water. Wearing a mask would cause that cloud to disappear.

“Surgical and N95 masks work both ways as far as protecting you and others around you,” Rockwell said. “Cloth masks protect those droplets from going all over and protects people around you from getting sick. In theory, if we all wear a mask, we will all protect each other.”

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Hoffman pointed to a pair of hairdressers at a Great Clips in Springfield, Missouri, who saw nearly 140 clients in June while asymptomatic. Both stylists wore face masks, while the salon had implemented social distancing measures, and among the 140 clients and seven co-workers exposed, 46 took tests and all came back negative. After a 14-day quarantine, no COVID-19 cases have been linked to the salon, aside from the two stylists.

There is also mounting evidence among researchers that the number of COVID-19 cases have been undercounted significantly, so much so that the University of California, Irvine and Orange County Health Care Agency partnered for a large study to find the actual prevalence of COVID-19.

Hoffman, meanwhile, says studies show up to 40 percent of the population is asymptomatic and COVID-19 is two to three times more infectious than influenza. He also says herd immunity -- which is the idea that 80 or 90 percent of people in a population are immune can shut down a virus -- can be applied to masks.

“Even if we have 80 to 90 percent of people wearing masks, we block the virus and it has nowhere to go,” Hoffman said. “It will die on its own in that particular context. Mask use, social distancing, good hand hygiene and environmental cleaning -- we can become that immune system and protect those most vulnerable.”

Living with the virus

As politicians at the national, state and local levels are calling for a return to normalcy in our society, many medical professionals agree.

It is just going to be a different type of normal.

Hoffman was adamant about being aware of a second pandemic in conjunction with COVID-19, which is the amount of people not taking care of typical medical procedures to alleviate non-COVID medical issues such as heart or mental health problems. He also supports schools reopening, but reopening involves wearing masks and practicing the now ingrained social distancing and hand-washing.

He says the virus is not going to disappear on its own and the idea of herd immunity is not proven, citing evidence in which those who have been infected lose antibody levels after two or three months and are not immune to the virus.

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“Most of the scientists who write profoundly about this, estimate that SARS-CoV-2 will become the fifth seasonal coronavirus,” Hoffman said. “It will take several years, but populations will increasingly come down with this until some sense of herd immunity through natural infection or a vaccine. … Whether it’s school or church or small businesses -- we have to learn how to live alongside this virus.”

Hoffman also points to a needed understanding that science and truth about COVID-19 may evolve as the pandemic continues, just as it has from the beginning when national medical experts did not believe masks were necessary based on information during the early stages. New information has changed that thinking and there may be more changes as more studies are completed in the coming months.

"We have to continue to have the attitude that this is an emerging situation," Hoffman said. "No one foresaw a coronavirus pandemic, so we need to be a little kinder to each other when we come out with information where seemingly contradict (previous information). We're not contradicting it, we're building on prior knowledge. ... We really didn't have the knowledge base that this was being spread asymptomatically in such a dramatic way."

As the urge to return to normal lifestyle situations increases, some of what is deemed to be normal may change in the coming year. Wearing a mask is likely to become a new normal until an effective vaccine is created and being aware that COVID is lurking at a large-scale event, so preventative measures are necessary.

“Living with it means that we know that it’s there,” Rockwell said. “It’s not going to go away if we ignore it. Do the things that have been proven to work to help stop the spread and get back to being somewhat normal. It is not going to be what it was last summer or in February. Things are not going to be back to that for a long time. This is a new normal, but it can be a very good normal.”

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