Want to avoid another shutdown? Wear a mask, experts advise

Monday, June 22, 2020
By ERIC FERRERI
Duke Drs. Sallie Permar and Cameron Wolfe

Sallie Permar, PhD and Cameron Wolfe, MD

Duke doctors brief media on how best to move forward in the pandemic

If you’re in public and see someone wearing a mask, that person is doing it for your benefit.

So return the favor.

That was one of several themes to emerge Thursday from a media briefing featuring two Duke medical scholars with vast expertise in vaccines, immunology and the spread of infectious diseases like COVID-19.

Drs. Sallie Permar and Cameron Wolfe took questions for an hour on myriad issues. Here are excerpts:

On Wearing Masks in Public

Dr. Cameron Wolfe, infectious disease specialist

“The scientific consensus is actually quite clear. The consensus exists on both the types of masks and their protective efficacy of the individual wearing it, and also the collective benefit for the community.”

“That second part has really not been emphasized sufficiently. People have sort of viewed a mask … as something designed to protect them. While that may be true in a hospital ward … in the community the drive is very clearly to protect everyone else.”

“We understand now very clearly this virus has a pre-symptomatic phase of shedding. Even though I may not be symptomatic today, even though I may have no idea of the fact I may become sick in a day or two … I can pass it to other people unwittingly. So my wearing a mask fundamentally protects you when I don’t know I’m sick or infectious. That part of the science is actually pretty clear.”

“The wearing of any mask, including cloth masks that folks will now see for sale widely, is very satisfactory at me preventing you getting sick. That’s the public health part of this. When I walk down the street wearing a mask, I’m doing that for other folk around me, not fundamentally for me.”

Dr. Sallie Permar, pediatric infectious disease specialist

“The data has really shown that wearing a mask and preventing those respiratory droplets from spreading on other people is really effective.”

“The masks are super useful in protecting those that you are around. You wear a mask to prevent infecting others. It does play some role in protecting yourself as well. When we think about requiring masks … I think it’s something that the benefit versus the inconvenience weighs towards the benefit.”

On Convincing People to Use Masks

Permar

“It’s hard to remember to wear a mask, and it’s uncomfortable, so the more you see other people doing it, the more you’ll be reminded to do it.”

“I went out and bought some designer masks. I think everyone can show their personality in what masks they choose. The more we require masks, the more it will become normal in our everyday lives.”

Wolfe

“A lot of it is about good leadership … and good example-setting. That is something I wish we could do better on as a community. We have almost politicized mask-wearing. That is some sort of dystopian reality where the wearing of a mask has become something that can be judged.”

“It comes from political leaders buying into this, it also comes from state and federal politics, with leaders visibly taking this to heart. That has not yet happened, and that needs to change if we want people to buy into this.”

On Wether States with Rising COVID Cases Should Shut Back Down

Wolfe

“Being prepared to put a pause on things should be the first step. I’m heartened that our state health departments are finally talking about the implications of what a pause to phase 3 for us would look like. If we consider ourselves to be data-driven and we see the data heading in the wrong way, it’s nonsense to think we can continue doing the same thing and expect that trajectory to change.”

“Re-crunching down can still be avoided if you put your efforts into the right mitigation strategies.”

“If you want to keep opening and if we want to allow businesses to function, an individual choice on behalf of our collective, for me to wear a mask, seems like a smaller move than closing down again.”

On School Re-opening

Permar

“School reopening is a really difficult decision that we’re facing. We will dig into the data that shows that children have a very different course of the infection. They are mostly asymptomatic. What’s really important to understand is how much do they transmit the virus? How much do they transmit virus to their peers? How much do they transmit virus to the staff and teachers? What about when we wear masks? Can we reduce that risk?”

“What I hope will transpire over the next couple months is the development of child-specific metrics. How many children who are presenting with routine health care test positive? How many children are testing positive in our community? Another example might be absenteeism for influenza-like illness.”

“What I hope is that the education leaders and the public health leaders can think about schools differently than how we treat bars and restaurants. The appropriate metrics for opening up the community in many places where adults are going to congregate -- the number that are hospitalized, the percent testing positive every day -- I don’t know (if) we should apply those same metrics to children and schools.”

“We know that as much as teachers try and as much as parents try, the virtual learning will not be the same, especially (for) the youngest children who really need the face-to-face interaction.”

On the Dangers of Quarantine Fatigue in the Citizenry

Wolfe

“Many of us, frankly, are starting to see some fatigue in the community. I think that fatigue expands to many things. It extends to mask-wearing, it extends to social-distancing fatigue. Those things have played into disease transmission. Unfortunately, the phased reopening has, I suspect, encouraged a little bit of a letdown of folks’ guard. You really are seeing that steady march of increasing cases, increasing hospitalizations. We’ve got to figure out a way to turn that around.”

On the Short-and-Long-term Effects of the Pandemic on Children

Permar

“I often think about what are going to be the impacts on children now and for the future. They are the ones who will be living with the impacts of this virus the longest.”

“It’s a respiratory virus where children are not often severely affected during the acute infection. However, one thing that has been very new and still developing is seeing this post-infectious syndrome that happens almost exclusively in children. There’s an inflammatory syndrome that can be very severe.”

“It can land children in the hospital. We’re still really understanding what that post-infectious syndrome is. But it has reminded us that children are not completely unaffected by this pandemic.”

“We know that despite them being a minority of the hospitalizations, they have been impacted majorly when it comes to their development, their education and even their routine health care that has fallen behind in this time.”

“As we look towards a vaccine, the vaccine is being developed at a most amazing speed. As a vaccinologist, I never thought I’d see a vaccine developed within a year. That’s being solely focused on adults, and I think we need to consider adding children to that vaccine development as well. We know children are the targets of most vaccines.”

“They, of course, are often routes to adults becoming infected as well. Adding children into vaccine development is very important for us to think about now rather than waiting until all adults are vaccinated.”

On What Happens if People Refuse the COVID Vaccine

Wolfe

“I’d be naïve not to be concerned. I think it is going to be really incumbent upon public health leaders and federal government leaders to demonstrate a clarity of message here that needs to be uniquely available and visible to the public. Yes, I am worried about skepticism. We have to continue to reiterate active demonstrations of safety.”

Permar

“If we roll out a vaccine to a large percent of the population and then have a safety concern, that will diminish the faith in vaccines. While we’re going at this with the most rapid speed because the pandemic is not ending until we have a vaccine, we are also facing the challenge of making sure it’s the safest vaccine we can put out in a rapid fashion.”

 

This article was originally published in Duke Today