This is not the seasonal flu

I guess it was inevitable, but COVID-19 has finally showed up in our corner of paradise. Boundary County saw its first cases in July and has seen a steady increase since then.

When we first started hearing about this virus, I was skeptical. I suspected that this would be similar to the Ebola outbreak of 2014; all media hype and political posturing, and honestly until July, I continued to wonder if COVID was being overblown.

Now that I’ve witnessed the virus first hand as a physician in the emergency department at Boundary Community Hospital, I can confirm that this is bad bug.

Current estimates indicate that about one-percent of COVID patients will die and a staggering 20-percent will require hospitalization. This is not just the seasonal flu.

As with many viruses, our options for treatment remain limited. Given this, the focus has been mainly on preventive measures. Simply maintaining distance from others is an obvious strategy. More controversial has been the use of face masks.

Early in the pandemic, the CDC recommended against mask use by the general public as it appeared unnecessary and unhelpful. However, in time it became evident that asymptomatic COVID patients could also transmit the virus through breathing and speaking.

Therefore, the recommendation was changed.

This about-face by the CDC, made some people question their motives, but it’s important to understand that as our understanding of the virus evolves, so do the recommendations.

Understandably, some have questioned the scientific evidence for mask use.

Ideally, we would be able to rely on medicine’s gold standard of evidence, the randomized double-blind placebo controlled study. Unfortunately, such a study is not feasible or ethical in the midst of a pandemic.

Given these difficulties, we have to rely on lesser forms of evidence. Thankfully, we have multiple other lines of evidence that support the efficacy of face masks.

One study using high speed video showed the ability of a mask to block tiny respiratory droplets created while speaking. Another recent study demonstrated that in individuals with influenza and the common cold, masks reduced the amount of virus emitted in droplets and aerosols.

Multiple case studies also support the use of masks. A man with a dry cough, later diagnosed with COVID-19, flew from China to Canada. He wore a mask on the flight and all 25 people closest to him during the flight later tested negative. Two hair stylists with COVID-19 had close contact with 140 clients. Both wore masks as did their clients, and none of the clients tested positive.

A review, published in the Lancet in June, of over 172 observational studies in 16 different countries, concluded that face masks were protective for both health care workers and people in the general community.

Others have expressed concern about a 2015 study of Vietnamese health care workers with high exposure to respiratory viruses. This study demonstrated that cloth masks are inferior to medical masks at reducing viral infection because of moisture retention, poor filtration, and frequent reuse.

Unfortunately, some have misinterpreted this study to mean that a cloth mask places one at higher risk of infection than no mask at all. Additionally, it’s important to remember that this study applies to front-line health care workers with frequent, close contact with infected patients.

As such, it is a mistake to extrapolate this result to the general public. Finally, let us remember that the primary purpose of the cloth mask is to protect others, not one’s self.

Given the current weight of the evidence, I strongly encourage the citizens of Boundary County to wear a face mask in public and to continue to maintain physical distancing.

Let’s show the politicians that we don’t need a mask mandate in Boundary County because we’re simply willing to do it voluntarily.

Let’s wear the mask for the benefit of our businesses, schools, and neighbors, not because we have to, but because we care.