A simple life-saving act of humanity

by Dr. Rey D. Pagtakhan

	Former US President Jimmy Carter and first lady Rosalynn Carter encourage the use of facemasks in a Twitter photo from the Carter Center.

Former US President Jimmy Carter – a Nobel Peace Prize recipient – and first lady Rosalynn Carter, released a photo on Twitter recently from The Carter Center. They have added their voices and called on the American people to “please wear a mask to save lives” as their country continues its struggle against the onslaught of COVID-19. Always filled with a deep sense of humility and humanity, the couple’s call is an appeal, not a mandated order. It makes their posted message with the photo of them wearing masks even more inspiring – and timely for all. The world needs such leadership at this critical time in our common battle against the deadly viral pathogen.

Indeed, wearing a face mask or cloth face covering when out in public as recommended or ordered by public health authorities is one vital yet simple measure to prevent or slow the continuing community transmission of this catastrophic contagion and, thereby, helps reduce the enormous human toll.

While Canada’s case fatality ratio is double than that of the USA and worldwide, more than two-thirds of the total caseload of patients have now recovered.

Mindful of the community eager for “the great outdoors” and travel, Canada’s Chief Public Health Officer, Dr. Theresa Tam, underscored several pointers in a series of recent statements. (See the PHAC website for details). One key message says, “wearing non-medical masks or face coverings is a must when it is not possible to maintain a two-metre distance from others as on board buses, trains or planes.”

Rationale for changing the guidance on the use of facemasks

This message is a clear change from what had been conventional wisdom to say “No” to facemasks during the early part of the pandemic. Few justifications had been advanced then, including: 1. may give a false sense of protection; 2. may lead to neglect hand hygiene and cough etiquette; 3. mode of transmission was only via close contact with the infected droplets and not airborne; 4. might do more harm if touched with unwashed hands; 5. no definitive study regarding its effectiveness; and 6. the scarce supply had to be reserved for frontline health care workers. The last two justifications ostensibly were difficult to reconcile unless the two environments – the outdoor public and the indoor hospital settings – created a difference in effectiveness for the same medical mask. Note that these justifications were advanced back then by the World Health Organization, the Centers for Disease Control and Prevention (USA and Europe), and by the Public Health Agency of Canada.

Meanwhile, use of face mask was nearly universal in Asian countries since Day 1 of the pandemic. Was it merely a cultural difference?

What the medical-scientific community now knows

The last three to four months of this seven-month pandemic journey have been a great learning experience for both the medical and the research-scientific communities – not only about the development of vaccines and the demonstration of useful or non-useful drugs, but also more about this new disease and the behaviour of the pathogenic virus. Much has been learned about the spectrum of the clinical severity of the illness (mild, moderate, severe, and critical), the clinical manifestations (respiratory and non-respiratory signs and symptoms), droplet and aerosolized transmission of virus particles, human-to-human community transmission, the shedding of the virus and incubation period, carriers of virus with or without symptoms of the disease, the availability of rapid diagnostic tests, the changing age-group vulnerability, and the duration of clinical recovery and immunity following infection.

The new body of knowledge that has been gained has informed frontline health care workers and public health authorities to update their approach to managing individual patients and their advisories to the public, respectively. Specifically, the following provide for the rational use of facemasks or cloth face coverings to help prevent to any degree achievable the further spread of COVID-19:

1. The COVID-19 virus easily spreads between infected people even before symptoms appear or without ever developing any;
2. The virus can spread through talking or even just breathing in addition to sneeze or cough-induced droplets;
3. Heavy breathing and singing can propel aerosolized viral particles farther than two metres and thereby increase the risk of transmission;
4. Infectious viral particles could linger in the air for hours and later be inhaled;
5. The incubation period is long – up to 14 days – and thereby gives a wide window of opportunity for people, even before they know they are infected, to infect others; and
6. Carriers may be most contagious in the 48 hours before they show symptoms, making transmission even more blind.

Thus, people who look well can have and can spread the virus. When they shout, cheer and sing loudly, they produce a lot of droplets and aerosolization and enhance their infectivity. The fact that a person with the COVID-19 virus, on average, can spread it to two or three other people makes it twice as contagious as the common flu. Anyone in this type of situation – and that can include anyone of us – is a potential spreader. It is the medical consensus that the main benefit of using a non-medical mask or a cloth face covering when out in public is more to protect others. Thus, wearing a mask in public becomes a simple life-saving act of humanity.

Information from the John Hopkins University Coronavirus Dashboard, July 13, 2020

Dr. Rey D. Pagtakhan, P.C, O.M., LL.D., Sc.D., M.D., M.Sc. is a retired lung specialist, former professor of pediatrics and member of Canada’s parliament and government. He served on the Winnipeg Police Commission and chaired the House of Commons Human Right Committee. He presented on “The Global Threat of Infectious Diseases” at the G-8 Science Ministers and Advisors Meeting held in June 2003 in Berlin, Germany. Contact: reypagtakhan@mail.com

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