The Citizens Handbook
Better ways to control the pandemic

Charles Dobson

Australian doctors closely packed at a convention during the COVID-19 pandemic

Evidence suggests the pandemic can be held in check if people wear well-fitted surgical masks when near others. Masking will be effective in all but a few places, such as gyms, bars and restaurants. Mandatory masking would eliminate destructive lock-downs, permitting the normal operation of schools, businesses and the other elements of everyday life.

The COVID-19 virus is transmitted in tiny droplets sent into the air when people talk, and exhale. Loud talking and heavy breathing through the mouth emit more droplets. Joggers and puffing people in gyms emit even more. Because the smallest droplets may float in the air for hours, social distancing by itself may be ineffective in enclosed spaces with poor ventilation. For more info see this video report on research from Japan and a report in the journal Science. Masks are necessary indoors, when near others. They are usually unnecessary outdoors, where transmission is 18 times less likely, except for large close-packed gatherings. Still, there remain some questions about masks because they don't seem to work in the community even though they work in the lab. Masks alone may not be sufficient. The addition of face shields that protect the eyes has been shown to provide much improved protection for front-line health workers

Infected people with no symptoms can shed large amounts of virus. In fact, as reported in Nature, infected persons may be most capable of spreading the virus 1-2 days before showing any symptoms.

The graph below comes from a study on face masks reported in the June 10, 2020 edition of the Proceedings of the Royal Society.


The study concludes: In summary, our modeling analyses provide support for the immediate, universal adoption of face masks by the public . . .
A September 2020 report in Nature estimates that 40% of transmissions are from people who are asymptomatic. A case study of a Utah childcare center found twelve children with mild symptoms or no symptoms had spread coronavirus to their families.

Even more disturbing is the D614G spike mutation of the virus. The COVID-19 virus, like all RNA viruses, often mutates when making copies of itself. The 614 mutation has made the virus more infectious, making the D614G variant the dominant stain in most countries. In October 2020, researchers reported another variant, 20A.EU1, has now become the dominant variant in Europe. Still, a study reported in November, 2020, concludes that the virus is not becoming more infectious despite thousands of mutations. For a creepy animation of the rise of coronavirus variants play the map on nextstrain.org. Mutations may arise that will enable the virus to circumvent new vaccines. Researchers have identified three characteristics that vaccines need to address virus mutation and evolution.

Surgical masks (typically blue, 3-layer, non-woven, pleated) prevent transmission. An international research group led by a team at the University of Hong Kong studied 246 people sick with viral infections. The researchers randomly assigned half of the people to wear surgical masks. Then the team measured viruses present in each person’s exhaled breaths. Between 30 and 40 percent of the people with coronavirus infections exhaled viruses if they wore no mask. But no virus was detected in breath exhaled through a surgical mask. For details see the April 3 report in Nature Medicine. Unfortunately blue surgical masks with ear loops leak through gaps at the nose and puckers at the sides. To reduce leaks by about 50%, the loops need to be knotted near the mask itself and excess material tucked inside. This video shows how. TV news stories show almost every citizen, doctor and public health official wearing a sieve-like cloth mask or a cheap surgical mask that does not fit properly.

Health authorities should make surgical masks or N95 masks mandatory for all indoor public spaces and all large outdoor gatherings. Epidemiologists say that masks should not be worn continuously but only when necessary; some are far more breathable than others. Surgical masks can be disinfected and reused by allowing them to dry 48 hours. Sunshine also kills the virus. Washing, and spraying with alcohol or bleach degrade the mask.

Taiwan, a country of 23 million, has performed better than any other country with only 7 Covid-19 deaths as of June 22, 2020. It did not shut down its economy, like less-prepared countries. Instead, according to president Tsai Ing-Wen:
“Upon the discovery of the first infected person in Taiwan on January 21, we undertook rigorous investigative efforts to track travel and contact history for every patient, helping to isolate and contain the contagion before a mass community outbreak was possible. In addition, government . . . took over the production and distribution of medical-grade masks. and devised a system for distributing rationed masks to everyone.” On October 29, 2020, Taiwan reported having no domestic COVID-19 infections in 200 days.

The Centre for Global Development has questioned why policymakers rely on lock-downs and physical-distancing to control a viral epidemic. Physical-distancing is not an option for lower income people, who cannot stay at home because they need to go to work. It may be impossible in many places, in densely populated cities, slums, prisons, churches, schools, public transit, meat packing plants, and elder care facilities. Government insistence on physical distancing has created an immense socioeconomic crisis in many counties. In India, where the government has asked 1.3 billion people to stay home for three weeks, literally millions have been left stranded, homeless, without work, and potentially going hungry. Physical-distancing is undoing years of progress in curbing global poverty.

A full-blown pandemic can easily out-pace the hesitant measures put into place by governments. Policymakers need to figure out how to sideline cautious bureaucrats in favor of creative problem solvers who can quickly assess and respond to a constant flow of new research. No reason beyond the behaviour of bureaucrats can account for governments ignoring simple DIY testing, a cheap and easy way to screen people for infection by making ordinary citizens active participants in controlling the pandemic.

COVID-19 news in the mainstream media is weak, repetitive and out-of-date. If you want to know what is really going on, visit MedicalXpress.


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