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DOUG TERRY'S COMMENTARY
Doug Terry is a veteran Washington, DC, based reporter, writer, photographer and documentary producer who has covered major news beats in Washington for NPR, more than 80 local television stations across the nation and been heard around the world on the PBS, CBC, Armed Forces Radio and other news outlets.
are masks enough to defeat the virus?
Less concern about surfaces like cardboard, metal, plastic
Doug TerryMay 22
This commentary contains specific steps you and others can take to avoid the virus and help bring the crisis to an end as well as links to the CDC. Note: this is a revised version of an earlier post.
Masks. Masks. Masks. Can they really save us from getting infected with the demon of this virus?
The answer is maybe, maybe not. There are other steps that need to be taken.
Epidemiologists have pointed out that the masks most of us wear are not good enough to really filter out the airborne particles set loose by talking, breathing and, in the worst case, sneezing or coughing. So, the mask is to protect other people from us and to discourage touching the face when out and about and before we get a chance to thoroughly wash our hands.
A mask is a communal decision and action, which might be one reason that the “freedom first” crowd doesn’t like them: communal action is frowned up unless there is an agreed upon exchange, a benefit for ME. The rather extreme concept of freedom for some people, especially in the far western states, seems to contain an intention to be apart from the influence of others as a cause, a life purpose. How can you be a “rugged individualist” if you are cooperating with others? Cooperation, in this case however, is a way to pursue broader freedom by ridding ourselves of this virus and disease. The dead have no constitutional rights.
When NY state got information from hospitals about infections that occurred during the partial shutdown, they found that 66% of the new infections occurred in the home. This finding should have set off alarm bells because it was a major indication that the shutdowns, while helping, were not getting the job done.
Mitigation of the disease impacts is one thing; stopping it in its tracks should be the goal, however. The fact that infections, and deaths, declined was important, that they continued was a warning of insufficiency.
As of Friday, 5.15, the CDC issued new guidelines in regard to the reopening. They included ventilation of indoor areas as a recommendation. No, this does not mean air condition, which is merely, in most cases, merely air circulation. Ventilation, in the context of Covid-19, means air passing through and out of confined spaces, something that is difficult to achieve in buildings that have been designed as closed systems to save money on heating and cooling.
Here’s my suggestion: if you go out to a restaurant to eat and there is no air passage in and out of the seating area, leave. In some cities, the need to be in the open air is being recognized and streets are being closed to allow the establishments to create outside dinning zones. Good. (more recommendations for restaurants coming up)
The same could apply if you go back to work in an office setting. Social distancing? How does that really help if you are sitting in a closed area where the air conditioning will simply recirculate the tiny droplets in the air? The system could actually act to spread the virus, as a study in China of people sitting in a cafe showed.
While we have concentrated on masks, the need for fresh air circulation has been largely overlooked. This needs to change. Being outside is one of the safest places you can be because, even with a modest breeze of a few miles per hour, aerosols and larger droplets will disperse rather quickly. No, you don’t want to be around anyone, even at 10 to 20 ft. away, who is actively sneezing, but otherwise the chances of infection outdoors are small.
SURFACES A MAJOR POINT OF INFECTION?
On 5.21.20, the CDC issued new guidance saying that the virus on surfaces is not nearly so important as a means of transmission compared to viral droplets and aerosols in the air. What does this mean? The new guidelines say the disease does not spread easily by the virus on surfaces but that doesn't mean that surfaces are entirely safe. It puts the emphasis back on person to person transmission through the air and, presumably, direct contact, touching. (More on this as facts become available.)
The newest advice from the CDC is confusing because the agency is not abandoning the idea of disinfecting and general cleaning of surfaces. This is especially true for the advice on reopening schools where it recommends regular cleaning and disinfecting and covering with plastic areas that are commonly touched, like computer keyboards. In the main, it seems to mean we can be less concerned with infections spread from surfaces but not entirely assured. How does that help?
PUBLIC TRANSIT AND INFECTIONS OCCURRING IN HOUSES AND APARTMENTS
The governor of New York, Andrew Cuomo, made a big deal at his daily news conferences about the fact that, for the first time in history, the transit authority in New York undertook to disinfect every subway car and bus every night. So? Clearly, the above information indicates that is not enough. You can’t safely ride a subway car in a city with widespread infection and then touch virtually anything. Latex gloves might help but they would need to be disposed of upon leaving and carefully thrown away, followed by hand washing as soon as possible.
RESTAURANTS WILL NEED TO CHANGE THEIR WAYS
In the best of times, eating out involves a trade off on safety versus good tasting food and fine service. The meal might look wonderful by the time it reaches you but there have been many encounters with germs along its trip to the table. The late Anthony Bourdain said if you don’t want to eat food that has been played with a lot, don’t eat in a restaurant. Now? Major adjustments in the way restaurants operate are required.
Not being a restaurant expert, here are a few starting suggestions:
Every table has to be disinfected after every diner, as well as high touch areas like arms on chairs, etc.
The front and back doors should be open if at all possible (air flow). Otherwise, the door handles should be constantly disinfected or, at the very least, the front door left open.
Every diner should sanitize their hands before eating.
Plates and knives/forks can no longer be left out waiting for customers. They should be placed upon arrival or covered with a cloth napkin or something similar.
Plates cannot be handled with bare hands by any staff.
Payment by card and as close to touch free should be practiced.
The way air flows in and out of the dinning area should be carefully considered. Rotating air condition air that flows up, down and around isn’t acceptable any more.
(There are other specific recommendations available, I have tried to highlight ones that might not have gotten great attention elsewhere.)
Here's a link to the CDC guidelines for opening restaurants and bars:
The CDC is still recommending cleaning and disinfecting on its website:
Disinfection using EPA-approved disinfectants against COVID-19 external iconcan also help reduce the risk. Frequent disinfection of surfaces and objects touched by multiple people is important.
https://www.cdc.gov/coronavirus/2019-ncov/community/reopen-guidance.html
The black hole of this disease is the period in which people have it, and can infect others, but have not yet developed symptoms.
This is where contact tracing becomes useful because people who have come into contact with the virus can be notified to avoid contact with others. The efforts to ramp up contact tracing have been robust, and various governors have made strong efforts to increase tracing, but most experts say we are nowhere near we need to be at this point. Even if we were, many people who have the virus test negative the first time they are tested.
The governor of Maryland, Larry Hogan, pulled off something of a medical coup by, with the help of his wife of Asian descent, getting 500,000 tracing kits delivered from South Korea to Maryland. Additionally, he directed the special flight carrying the kits to land at Baltimore/Washington International to avoid any possibility that the federal government would try to seize the kits if the plane were to land at Dulles Airport in Virginia, outside DC.
What we have not had is a true mobilization, an all-hands-on-deck effort across the nation. Instead, the governors do what they can and the federal government, by all indications, brings up the rear. Tracing inside a specific state is all well and good for that state but that does not give us a national picture of what is happening and what response might be called for as a result.
CONCLUSIONS
We are fighting a virus with enormous potential for killing people for many months to come. The goal ahead should be to devise a plan to stop the virus in its tracks, if at all possible, in advance of the development of a vaccine, which might, in fact, never come along. What seems more likely is that a cocktail of various existing medicines will be uncovered that can lessen the impact of the illness and, perhaps, reduce the danger by a great deal so that far fewer people are threatened with death.
Social distancing and wearing masks certainly appear to be very important but we don't why the disease continued to spread during the near total shutdown in places like New York and Washington, DC. Disinfecting surfaces frequently, washing hands often and avoiding placing unwashed hands on the face are most likely just as important, especially at a time when person to person contact has been greatly limited.
We need a complete reassessment of how this disease is being spread with particular attention to what to do about asymptomatic people who can spread the disease that they don’t even know they have. A crack team of investigators needs to be sent into hot zones to do an intense study and come up with new recommendations.
In all the hours of listening to governors, medical experts and reading news and direct information from the CDC and elsewhere, I have not seen nor heard anyone addressing the asymptomatic issue in a comprehensive way. Masks and social distancing appear to be the two main weapons against that situation but getting infections down to zero appears to be far out of reach, in which case the virus could be with us for years.
ZERO must be the goal. If a drastic reduction in infections and death are reached while seeking zero, so much the better. In an emergency you can never do enough until you reach victory, release from the torment. The experts advised America on a particular course but those decisions were based on limited knowledge of the virus and fell within the scope of what they imagined they could get people to do. Now that we know the full potential for death and destruction, we can clearly see the need for a better course. We have to keep looking, rethinking what is being done until we find the right direction.
Remember this: the protocols with are using to fight Covid-19 were not developed to fight this particular pandemic. They were developed during the administration of G.W. Bush, with much resistance from the bureaucracy, to fight a pandemic. Those protocols need to be reviewed top to bottom and new recommendations provided.
Additionally, the education of the public has been woefully inadequate.
Government, public minded businesses, non-profits and the media have to step in and do a better job, much better, in fact. (My website, http://covidnews1.com, is an effort to provide better, more comprehensive information on which people can act to save lives.)
THE NEED FOR A MORE COMPREHENSIVE APPROACH
There are some serious problems with the state and national response to the virus emergency.
We have gone into a national panic about the virus…well, most people in most states have while those who see it as some weird plot or just something “far away” that doesn’t concern them insist it is all being overplayed. The latter attitude works nicely and easily, until someone close to you gets the virus or dies. Then, everything changes.
It is the panic aspect that concerns me here. Panic is a state of mind that blocks thought. It is part of the “flee or fight” response of all humans to danger and it is quite useful as an emotional driver if a bear is chasing you through the woods, provided you don’t panic too much and just freeze in place. As it became all too clear that the novel coronavirus was real and a deadly threat, many people just locked themselves in their houses and refused to come out for anything, except a resupply of food or medications. This flee response was an exaggeration of the dangers facing everyone but, you know, why take chances?
People are wearing masks in cars as they drive by themselves. Masks on city streets when there is no one else around for a block or more. Masks while walking on a wooded trail with no one else around. The purpose of masks is obviously misunderstood and was made worse by the early advice (lies) that told people not to wear them, that they needed to be saved for hospital workers. Then, the advice changed and, in urban settings on the east and west coasts, masks became a mandatory part of daily living and spread across much of the nation.
Remember this: the purpose of the mask is NOT to protect yourself, it is to protect others by keeping your sneezes or moist emissions from talking or shouting away from other people. The mask isn’t for you, it is to protect everyone around you. It is a social act of concern expressed through inconvenience, a necessary collective bow to weirdness until the virus is defeated.
Unless you are very close to someone outdoors, you are very unlikely to get the virus anywhere outside. Being outdoors, in fact, is probably one of the safest places you can be. Yes, wear the mask if you think you might get close to someone, or if it makes you just feel better, but realize it is not a protective device, in the main, for yourself.
GOING BACK TO WORK IN OFFICES
Is “social distancing” going to save you in the office? Most modern buildings, including houses, are essentially sealed air environments. This was done to save money on heating and air conditioning. The air you breath in your office is recirculated air, not necessarily fresh air brought in from outside. Even if there is a component of fresh air, the air in an office complex is going to be blown around and there is a strong possibility it could carry enough virus molecules to make you sick. In addition, air conditioning circulates the air around in the office setting.
The same thing applies inside restaurants where, if you go for a meal, you could be seated in one location for half an hour to an hour or more. Round and round the air goes and there you sit. One study that was done in China showed that people at nearby tables got sick as the air conditioning system pushed air from sick people toward other patrons. I have not seen any evidence that social distancing would ensure that you won’t get sick.
In both of these cases, air coming in from outside the restaurant or office, or circulating through it, might make a critical difference. In a restaurant, just leaving a front and back door open to the outside could make a big difference, especially if there are favorable breezes. Flowing outside air disperses the particles that carry the virus from a sneeze or when someone talks. Stagnant air, in contrast, tends to hold the virus for a longer time where you might encounter it and get sick.
Offices are a bigger problem. I would suggest what many would consider a radical solution: when possible, consider cutting a decent size round hole in that expensive glass that covers the outside, perhaps a hole on each floor or even in each suite of offices on a given floor. Building engineers, perhaps those who designed the building, would have to say whether this is possible and, on the very highest floors of tall buildings, the winds might be too strong to allow this, but just because it would be difficult or not work in every case does not mean it shouldn’t be considered. Of course, it would be expensive to fix or replace the glass when the crisis is over but how expensive is it to have another four to six months of being closed? Millions to billions.
Air circulation inside otherwise enclosed spaces could be a critical way to limit exposure to the coronavirus. It could be a critical tool in saving thousands of lives and being able to work and play in a more ordinary, normal way.
TAKING TEMPERATURES BEFORE YOU CAN ENTER BUILDINGS
Really? Does this make any sense? The biggest problem with this virus is the period of 5 to 14 days when people don’t have any symptoms but might, according to the CDC, be able to infect other people. Once you have a temperature, the horse has left the barn: you’ve probably infected people around you.
Taking temps outside buildings is a last line of defense, something you do if you can’t come up with something better. It’s a bit like taking away a gun from a terrorist after he’s on the plane: yeah, it helps but why didn’t you catch him earlier? The temperature checks show that you lost the battle much earlier but you are ready to fight a rearguard action before giving up.
TESTING
No one knows for certain what level of testing we truly need. All testing, including survey oriented testing, provides helpful information but how much testing, followed by contact tracing, is enough? Since a high percentage of cases have no symptoms, and many more involve milder cases where the person does not need hospitalization, even the most massive testing program probably is missing most of the people who get and carry the virus. Strategic testing, used to coral outbreaks and confine them, is something that, as far as I know, has not been clearly defined by health and science experts. We need to know more about this possibility.
A MAJOR, BROADER QUESTION
Depending on where you live, we have now undergone almost two months of work and social isolation. Is it working? If you listen to various briefings, especially those of Gov. Cuomo of New York, the answer is yes. The rate of new infections and the number of daily deaths have gone down steadily, if modestly, in the hot zone of the New York metropolitan area. Is anyone asking why the numbers have gone down so slowly?
If we assume, as reported, the maximum of a 14 day incubation period from exposure to symptoms, why wouldn’t the numbers decrease much more rapidly? Obviously, something is missing. People are still being exposed on a steady basis, just not as many as previously. There could be a hundred different reasons for continuing infections but we need to find out of there are a few key reasons that could change future outcomes.
In addition, New York State found that recent admissions to hospitals for the virus consisted 66% of people who had been staying home. So, there are two factors to consider: 1. The fact that the rate of infections was not falling dramatically during the period of isolation and, 2. The fact that new admissions were coming from people who reported themselves isolated.
Here are some possible explanations:
- People, especially the poor and near poor, live too closely together and, perhaps, were not paying enough attention to warnings.
- Some people are ignoring the advice to not approach others and are spreading the disease by ignoring the advice.
- “Essential workers” are getting and spreading the disease in large numbers.
- Mask wearing only became close to universal in the last couple of weeks, prior to that, few wore masks.
- There could be unknown, internal building means of spreading the disease. On cruise ships, it was believed that some passengers got the virus as sewage from flushed toilets passed through rooms on the way down to holding tanks because the pipes were not properly insulated. In New York’s poorly regulated environment for housing, particularly among poorer residents, something like this could spread the virus to hundreds and then thousands.
- The virus might have aspects which are still unknown which are defeating the isolation methods.
- Sufficient virus molecules could be entering houses and apartments on boxes and other surfaces through direct deliveries and through take out meals. New York, in particular, is where few apartment dwellers cook for themselves, preferring take out or delivered meals.
- Door handles and other high touch areas in buildings are not being continually and sufficiently disinfected.
WHAT IS PHASE TWO IF THE CURRENT PHASE FAILS COMPLETELY TO CONTAIN THE VIRUS?
With widespread belief that the virus is not as serious as experts say, and Trump campaign rallies being perverted into “open up now” events, it seems highly likely that we will see a great resurgence of cases around the nation. It could be less than what hit New York over the last two months, but massive just the same. Since many states don’t have great population density (even big ol’Texas, however, is an urban state), it is entirely possible that the outbreaks could be smaller. Plus, there is the hope that warmer weather and sunny skies might suppress the virus to a degree. Nonetheless, what do we do if the long period of isolation doesn’t hold?
I have some ideas and will endeavor to outline them in my next post. If those ideas have validity, they would have to be studied and approved by experts on the novel coronavirus before being implemented.
Coda: The above views reflect a long period of examination of these problems but not any specific scientific or expert views, other than that which can be gained from a careful reading of what has been going on in our country since February, 2020. During the ten plus years I published terryreport.com/ I had extensive experience in explanatory journalism, also drawing on by long background in reporting daily news developments. As Bobby Dylan said, “You don’t need a weatherman to know which was the wind blows”. You don’t have to be a credentialed expert to see and understand gaps in our knowledge and actions. These gaps can be seen by anyone who takes the time and makes the effort to see them. Additionally, I did some projections (not predictions) early in March that fully indicated the potential for more than 2 million Americans to die. Those projections have informed my thoughts and these comments.