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These infections put into question how effective infection control policies are at preventing
transmission.
Face masks have become ubiquitous in China, sold on the street, and worn by almost everyone in
public. A new survey, the Premise Coronavirus Awareness Survey, showed that in Taiwan 79.9%
of people questioned said they were wearing masks in an effort to protect themselves from
COVID-19. A similar percentage was noted in the Philippines.
Bruce Ribner, MD, medical director of the Serious Communicable Diseases Unit at Emory
University Hospital, said the two masks serve very different functions. A surgical mask, or
procedural mask, is meant to protect the environment from the wearer.
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"It's meant to keep the surgeon's respiratory issues away from a patient," Ribner explained. A
surgical mask does a good job of trapping large droplets, and some aerosol transmission, he said.
Many of the masks being worn in China, though, are not designed for medical use or to any
standards and so their effectiveness in trapping droplets is unknown.
A respirator, such as an N95, fits tighter to the face and is meant to help protect the wearer from
inhaling infectious droplets in the environment.
"We don't really know how the coronavirus is being transmitted from person to person, because
no one has done the NIOSH studies that simulate the cough big droplets that land 3 to 6 feet
away from a person or the little droplets that can travel long distances and in air handling
system," Ribner said. "So we have to use what we know about other coronaviruses and influenza
when it comes to this disease."
What we know, Ribner said, is that multiple modes of transmission are likely at play, including
large droplets, small droplets (or aerosols), and contaminated hands.
At Emory, Ribner is responsible for the care of patients treated for Ebola, Lassa fever, and other
serious pathogen diseases.
Michael Osterholm, PhD, MPH, director of the University of Minnesota's Center for Infectious
Disease Research and Policy, which publishes CIDRAP News, says, "The very unsettling data
regarding the number of infected healthcare workers in the Wuhan area and the infection of a
Japanese doctor working with those quarantined on the cruise ship and who used standard PPE
[personal protective equipment]—except for a surgical mask instead of an N95 respirator—
should be a real wake-up call to all of us about how do we really protect against this critical
occupational risk."
Though Chinese officials said earlier this week that they believe the coronavirus is transmitted
only via droplets, implying they do not believe airborne or contact transmission plays a role,
Milton said that statement is likely rooted in fear, not science.
"To me this sounds like someone trying to deal with panic, because people panic when they hear
airborne transmission and long-distance transmission," he said. He said there has been scientific
evidence of aerosol transmission of MERS-CoV (Middle East respiratory syndrome coronavirus),
so it is likely possible for this novel coronavirus, as well.
Milton cautions that the difference between aerosol and droplet transmission is largely in name
only. Respiratory droplets, emitted with a sneeze or a cough, are commonly thought to land
within 6 feet of patients and are too large to be buoyant on air currents. Respiratory aerosols are
droplets too, Milton said, but smaller and light enough to travel farther.
"You cannot tell the difference epidemiologically between something aerosol transmitted by weak
sources and large droplet spray," said Milton. "They behave so similar, it's very hard to pick up
the difference."
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"If we have a person who is shedding nCoV in the environment, the best way to stop transmission
is to stick a surgical procedure mask on them," Ribner said. "In the best of all worlds, anyone
coming into the room with an nCoV patient would wear a respirator."
But if a respirator is not available, because of cost or manufacturing, the next best option is a
surgical mask, Ribner said. He said that likely contributes to the WHO's surgical mask
recommendation.
"The WHO is sensitive to the fact that not every part of the world has the resources of the US and
Western Europe," he said.
In an op-ed today in the Washington Post, Osterholm and coauthor Mark Olshaker stressed, "In
a very real sense, what happens to our health-care workers will be the metric of how we respond
to this unfolding crisis. If we don't do all we can to protect them, they will quickly transition from
providers to patients, further stressing already overburdened facilities."
They add, "Governments must support private-sector manufacturers in providing N95s and other
equipment to front-line health-care providers and other essential workers. In terms of
minimizing illness and death, this will be more important than any border closing, airport
screening, or quarantine."
See also:
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