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You Have a ‘Moral Obligation’ to Wear a Facemask: Fresno County’s Top Doc



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California health officials are bracing for a second COVID-19 wave as soon as July.

Photo of Dr. Rais Vohra, Fresno County interim public health officer

If someone comes into contact with someone infected by COVID-19, if they were wearing a facemask they’ll be cleared to go back to work right away. If not, “then you are going to be ordered to stay home and isolate and quarantine.” — Dr. Rais Vohra, interim health officer, Fresno County 

The Fresno County Department of Health is also bracing for that possibility. It has seen cases and hospitalizations rise as more people are going outside and becoming more mobile. The county’s rate of doubling cases has gone from three weeks to two.

Many doctors and researchers say facemasks are the best chance to stop a second or even third COVID wave.

Vorha: Wearing a Facemask Is ‘a Moral Obligation’

Interim Fresno County health officer Dr. Rais Vohra says wearing a facemask is, “a moral obligation.”

In a Friday morning Zoom call, GV Wire asked Vohra whether facemasks would stop a second wave of COVID-19.

“There’s no doubt in my mind that they help slow the spread of illness,” says Vohra. “Even though there hasn’t been that absolute gold standard randomized control trial about the use of masks in coronavirus. If you’re waiting for that, then it’s really going to be too late.”

Vohra also said that facemask wearing will be a litmus test during contact tracing in the county. If someone comes into contact with someone infected by COVID-19, if they were wearing a facemask they’ll be cleared to go back to work right away. If not, “then you are going to be ordered to stay home and isolate and quarantine,” said Vohra.

Fresno County made facemasks mandatory for less than a day before it was pulled back by Vohra. The order now reads, “all residents should (replaced shall) use cloth masks or equivalent face covering while indoors at work, while visiting a business, or while coming into close contact with someone who is not a family member, in accordance with CDC guidelines to prevent spread of respiratory droplets when physical distancing cannot be maintained.”

Listen to Vohra’s full answer and reasoning for wearing a facemask here.

Cambridge University and Greenwich University Study

A study published Wednesday by scientists in the U.K. finds that widespread adoption of face masks, in addition to lockdowns, could prevent further waves of the coronavirus and allow for less strict lockdown measures.

Both of the study’s models show that, under a wide range of conditions, facemask use by the public could “significantly reduce the rate of COVID-19 spread, prevent further disease waves and allow less stringent lock-down regimes. The effect is greatest when 100% of the public wear facemasks.”

Another part of the research says, “Under certain conditions, when lock-down periods are implemented in combination with 100% facemask use, there is vastly less disease spread, secondary and tertiary waves are flattened and the epidemic is brought under control. The effect occurs even when it is assumed that facemasks are only 50% effective at capturing exhaled virus inoculum with an equal or lower efficiency on inhalation.”

The authors say facemasks appear to help so much, that, “even when implemented at 120 days after the initiation of the epidemic, 100% adoption of facemasks by the public stops the occurrence of further COVID-19 epidemic waves.”

A key message from the study’s analyses is: ‘my mask protects you, your mask protects me’.

Other key parts of the study include:

  • If lock-down periods are combined with 100% adoption of facemask use by the public, the initial disease progress peak is dramatically flattened and delayed and subsequent waves are prevented.
  • Facemasks reduce the amount of droplet inoculum escaping from infectious individuals by capturing a proportion of droplets within the mask. Facemasks also reduce the amount of droplet inoculum inhaled by susceptible individuals by capturing a proportion of droplets in the inhaled air and hence reducing the uptake transmission rate.
  • Other recent evidence on facemasks for reducing SARS-CoV-2 transmission is provided by an epidemiological investigation where a patient transmitted COVID-19 to five people in one vehicle when he did not wear a facemask. In a later journey, no one was infected in the second vehicle when he wore a facemask.

UK Study: A patient in China transmitted COVID-19 to five people in one vehicle when he did not wear a facemask. In a later journey, no one was infected in the second vehicle when he wore a facemask (GV Wire/Alexis DeSha)

  • The larger the droplets, the more important it is to capture them, and even a home-made mask will do this very well. There are also experimental data, for instance, that show that home-made facemasks consisting of one facial tissue (inner layer on the face) and two kitchen paper towels as the outer layers achieved over 90% of the function of surgical mask in filtering droplets.

The National Institutes of Health studied how well a facemask did at preventing air droplets. At left, droplets without a mask. At right, droplets with a mask. (NIH)

California Counties

According to the LA Times, of California’s 15 most populous counties, Los Angeles, San Diego, Santa Clara, Alameda, Sacramento, Contra Costa, San Francisco, and San Mateo require mask-wearing in public, while Orange, Riverside, San Bernardino, Fresno, Kern, Ventura, and San Joaquin do not.

Other Countries

The Japan Times reports over 50 countries now require people to cover their faces when they leave home, especially on public transport and in shops.

The UK study says this may explain why some countries, where adoption of facemask use by the public is around 100%, have experienced significantly lower rates of COVID-19 spread and associated deaths.

According to Fortune, many Asian nations saw mass adoption of masks early in the COVID-19 crisis, and the practice is credited with slowing the disease’s spread. Researchers at the University of Hong Kong (HKU) wrote a separate paper assessing the influence of different public health measures on virus suppression in Hong Kong, which flattened its first wave and squashed a second.

“It is likely that the widespread use of face masks in the community has played a role in reducing transmission,” the HKU researchers wrote, noting that the largest infection clusters in Hong Kong occurred in bars and at a wedding dinner, “both locations in which face masks were not worn.”

World Health Organization

At the start of the pandemic, the World Health Organization (WHO) did not advocate facemask wearing by the public owing to concerns over the efficacy and the shortage of masks and other personal protective equipment (PPE) for health workers.

But, on June 5, WHO changed its mask advice, recommending that people wear fabric masks if they could not maintain social distancing, if they were over age 60, or had underlying medical conditions. Part of the reasoning, WHO officials said, was to account for the possibility that transmission could occur from people who had the disease but weren’t yet symptomatic.

Mask Use Graphic

The Institute for Health Metrics and Evaluation ran a meta-analysis on more than 20 studies. They’re results show masks reduce the risk of respiratory illnesses like #COVID19 by 40-50%. 

The Institute produced a graphic showing mask use around the world. You can see from the infographic below the United States shows very low percentages of the population wear facemasks. California fares a little better.

COVID19 Mask Usage 2020 (Text)

(The Associated Press contributed to this story.)