We must acknowledge that COVID-19 is a brand new disease that really didn't spread much before December 2019. Interestingly it is turning out to be very similar to its close cousin, SARS, that caused an outbreak in 2003. The CDC in 2011 presented the following summary on their page as retrospective on the 2003 outbreak https://wwwnc.cdc.gov/eid/article/10/11/04-0729_article and it has a few applications to today. One application comes from the fact that mask use combined with other public health efforts was responsible for a significant decline of new cases. The CDC report states
"A case-control study in Beijing found that wearing a mask more frequently in public places may have been associated with increasing protection (15). Another case-control study in Hong Kong found that using a mask “frequently” in public places, washing one’s hands >10 times per day, and “disinfecting living quarters thoroughly” appeared to be protective (16). The types of masks used were not specified. With the exception of the Amoy Gardens cluster in which SARS-CoV was apparently transmitted through accidentally produced aerosols of sewage (17), SARS transmission in the community from aerosols or in social settings appeared to be rare."Importantly, many research studies from that time found that the first SARS and are now finding that the current SARS-Cov2 virus are not usually present and transmissible as aerosols. Why does this matter? The recognition of aerosols creates a decision pathway different from viruses spread by large droplets. If we in the medical community identify the major transmission mode as aerosol then we focus on the smallest particle size and how to filter it out of the environment when transmission is likely. With large droplet transmitted viruses the efforts focus on reducing the presence of the droplets and maintaining physical distance from the infected patient.
More on Droplets and Particles
To better understand the situation with which we are faced as we tackle this disease we need to understand how the disease moves in our social spaces. Many of us can easily recall the vision of the fog of breath on a cold winter’s day. As kids we told each other it was smoke, but as adults we know that it is water vapor being expelled from the airway of a warm body on a cold day. Where does this warm water vapor originate? The way the human airway works to create this situation is that it is lined with mucus membrane that stays mo--t, or wet for those sensitive folks, all up and down from the nose, mouth, and throat to deep in the lungs where the mucus membrane lined tubes give up space to the thin lining of tiny sacs called alveoli. Some of the cells lining alveoli produce fluids that keep the lung sacs mo--t and open (look up surfactant, it's cool), and all these fluids increase the humidity of the air that moves into the nose and mouth down into the lungs, and keep it moist (there I said it. I couldn't help myself). Your airway creates a fog of sorts in your body and blows it out every time you breathe. Now here's the thing- the fog carries things with it, like bad odors (I bet you've had this experience).
Once again we need to use or imagination so that we can consider what happens if a virus has invaded the airway cells of a human body. Viruses use a port of sorts to inject a bit of RNA into a cell and force that cell to make a bunch more of that viral code. The cell basically stops what it was designed to do and makes enough copies of the virus that the cell "pops" and spews the virus copies in the surrounding tissue to invade more cells and make more virus. Suppose the same vapor traveling out of the lungs through the throat to the nose and mouth into the space surrounding the sick individual now has, in addition to the bad breath odor, virus copies looking for new cells to invade. The virus copies hitch rides on the little droplets in the vapor and can be sucked into a healthy airway to wreak havoc there. For some viruses, such as the one that causes measles, the droplet lets the virus hitch a ride, but once the droplet dries out the virus particle stays viable floating by itself and is considered an aerosolized particle. Other viruses need to stay moist to stay intact and need that droplet to stay together so they are considered large droplet dependent viruses. Larger droplets don't go too far and tend to hit the ground or another surface where they spread out, and if the surface is not conducive to keeping the viral structure moist, the moisture dependent virus dries out and can't get anyone sick.
Masks and Filters
The good news is that the SARS-CoV2 virus that causes COVID-19 struggles to stay intact when it is dry, and so it tends to only get people sick if they breathe in the droplets that are keeping the virus alive. Yes, that is gross. Most flu viruses and many cold viruses, however, tend to be much more hardy so they can float into your nose as happy little particles.. These facts explain why masks work so much better with preventing the spread of COVID-19 than they do in preventing the spread of flu or the common cold. In fact, both forms of SARS have another barrier in their spread in that they really "like" the cells deep in the lungs alveoli much more than the nose and throat and so it is hard to find SARS virus particles in the nose or throat, which is why we bury the culturette so deep in your brain when testing for the COVID virus. Contrast that to the flu and cold viruses which tend to have an affinity for cells in the nose and throat so they have an easier time finding droplets to hitch a ride with on the way out to destroy the world. So SARS viruses usually only escape when deep breathing like loud talking, singing, or coughing pop them out while flu and cold viruses are right there to be breathed out when normal breaths occur.
Knowing that large droplets carry and keep SARS viruses "alive" while flu and cold viruses don't necessarily need the large droplets, and that SARS viruses tend to hide deep in the lungs while
the others like the nose and throat it would make sense to see that cold and flu viruses are harder to contain with a mask. In fact most studies that have looked into containing flu and cold viruses transmission, unsurprisingly, find that masks of any kind have minimal benefit, but like covering your mouth when you sneeze, they aren't useless. Staying six or more feet away from someone with cold or flu viruses tend to reduce transmission because the particles fall down due to gravity, unless blowing air keeps them aloft. On the other hand, studies of the SARS outbreak in 2003 and the current SARS-CoV2 behavior find that masks do trap the larger droplets, and only in very specific situations are the viral particles of the SARS viruses "shot out" fast enough from the airway to spread to other healthy airways. These situations of spread tend to be intubations, where a tube is stuck down the throat close to the lungs, and the turbulent movement of sewage containing the virus. YUCK.
Really Smart People Disagree
The Association of American Physicians and Surgeons posted an article that uses studies on the transmission of flu and the common cold viruses to explain why masks are essentially useless in preventing the spread of SARS-CoV2. A few other researchers and professionals in health care have chimed in to point out that since masks don't effectively reduce transmission of flu or cold viruses they are useless against SARS-CoV2, and one writer being reposted on my Facebook feed by several friends even went so far to state that the higher the environmental humidity the lower the chance that any virus will make it into the tissue of a healthy patient. Interestingly the facts posted above contradict all this.
The WHO acknowledges that masks are not 100% effective in preventing spread of COVID-19, but recommends that mask use be part of a strategy to reduce the transmission of SARS-CoV2. Keeping distance from the infected individual to allow the virus containing droplets to hit the floor, wearing a mask, keeping groups of people to a minimum to reduce the chance that a sick person is in the group, being in large spaces to keep the droplets from getting concentrated, and staying home if you are sick all work together to reduce the chances of spreading SARS-CoV2. We learned most of this in 2003 and it makes sense to put it to work.
Now if we could get the contact tracing to work in the United States...
Really Smart People Disagree
The Association of American Physicians and Surgeons posted an article that uses studies on the transmission of flu and the common cold viruses to explain why masks are essentially useless in preventing the spread of SARS-CoV2. A few other researchers and professionals in health care have chimed in to point out that since masks don't effectively reduce transmission of flu or cold viruses they are useless against SARS-CoV2, and one writer being reposted on my Facebook feed by several friends even went so far to state that the higher the environmental humidity the lower the chance that any virus will make it into the tissue of a healthy patient. Interestingly the facts posted above contradict all this.
The WHO acknowledges that masks are not 100% effective in preventing spread of COVID-19, but recommends that mask use be part of a strategy to reduce the transmission of SARS-CoV2. Keeping distance from the infected individual to allow the virus containing droplets to hit the floor, wearing a mask, keeping groups of people to a minimum to reduce the chance that a sick person is in the group, being in large spaces to keep the droplets from getting concentrated, and staying home if you are sick all work together to reduce the chances of spreading SARS-CoV2. We learned most of this in 2003 and it makes sense to put it to work.
Now if we could get the contact tracing to work in the United States...