Mask Q&A Live

Great. So we're live on both Instagram and Facebook. The purpose of tonight's live, a lot of these have arisen last week as here in Virginia, we're now phasing back in. Some restaurants are starting to open, some public places are starting to open back up, and a lot of people having questions about safety, about the utility of masks. There's a lot of confusion, especially with the CDC last week talking about COVID 19 only being spread person to person. And outdoor venues like parks, recreation areas are most likely safe, which is just reiteration of past data from about two months ago. This has just caused a lot of confusion. So before I go through the question and answers, we have a list of multiple questions. I want to talk about a couple large topics, and large topics are as follows. First of all, there's the scientific response to masking. Is it good? Is it safe? How do we do this? There's the legal answer legally, as far as being sued if someone gets ill coming to your place of business or someplace like that. And then there's the. On the medical side, there's the medical malpractice on my end. So you have people wanting to know practical safety information, but then you have businesses, government organizations being worried about suits. So we have these general recommendations. And then you have. On the medical side, people are a little cautious to make recommendations because of the potential malpractice. And I think that's partly why we're seeing such a disparity, similar data being interpreted different ways. So I'm going to say up front, the opinions I'm going to state right now are my opinions. I am a medical doctor. I am a clinical researcher. I've been following this since January. I've been researching this deeply. But ultimately these are my opinions based on the data. I have to say that because I have to worry about malpractice and things of those natures, even though this is just me answering people's questions. So that's what I'm going to put out there. Another couple of basic topics I want to talk about before I answer the questions have to do with age and risk. So if you're less than 25 and you get exposed to COVID 19, your risk for COVID 19, we now know for dying from it is less than the usual flu. Let me say that again. If you're less than 25 and you get this, your risk for dying is less than typical flu. If you're older, this is way more worse than the typical flu. If you have comorbidities this is way worse than the typical flu. If you have 1.7% of people who die from this have no comorbidities. So that means the vast majority have something else going on. And that's the other thing you have to realize is this idea of relative risk. Is it safe to go outside? Absolutely. Is there a potential risk for exposure? Well, of course, there's a potential that you might be in a car accident, driving from point A to point B. So. So yeah, so that's the idea of relative exposure. Possible to get this in public? Absolutely, it's possible. Is it probable? Absolutely not. There's been to date two recorded cases, less than 10 recorded cases of this spread person to person for prolonged contact, which basically means. And this was in China, which. And these are super close contact with, which basically means this is. It's really hard to spread in public. So a lot of questions were around kids and schools, which is, again, it's kind of a difficult topic because it's no longer a medical question. It's a legal question. It's not a question of safety, it's a question of legalities. If someone potentially gets sick, because the literature is clear that kids. This is less dangerous in kids than the flu. So they have to keep that in mind. So as I kind of go through these questions, I just want to try to reiterate some of those. Those ideas. What's medically appropriate is not necessarily what's going to be some recommendations. The other thing about it as well is that if you're young and you're healthy, you don't have any major issues. The reason you wear a mask is twofold. One. Facebook, there's twofold. One is so that you don't spread infection. Also to release other people's anxiety if people are anxious, if they see you unmasked, that's part of the issue you're doing is just relieving their anxiety. So I'm going to go through the questions now. The first one, I'm going to read these and then kind of go through them. Our mask. And this is actually a long kind of question that revolves around what we talked about. Are masks safe for children to wear for an entire school day? Do masks need to be changed periodically due to moisture from breathing and bacteria breathing on the inside? Can kids faint while playing and running wearing a mask? What about during naps? Can kids really be expected to wear masks to handle them, etc. Given the mildness of COVID in children, Is it excessive and your mask pose more harm than good? Are There children who should not wear masks. Is this going to cause trauma for children if they have to wear them all day in school? So, you know, that was a bit a lot of questions around kids and masks. But I think the point is how many three long. And how many teachers is it going to take to actually enforce that? That's a different topic. That's not a medical question, that's a practical question. That's a legal question. But the reality we talked about, if your child without any major and serious illness is less than the regular flu, there's an interesting factory that I should say. I was reading about the Hong Kong flu of 1968. 100,000Americans died in that flu. And that was when the population of the United States was 100 million people. That would be equivalent of about 360,000 people dying from this right now, which we're nowhere close to that. And yet there's no major issue. Nothing was stopped down with that flu. What does that mean? I'm not quite sure what that means, but I do think we are majoring on the minors and making kids try to wear masks might be traumatic to them. I mean, who's going to enforce that? If you have 20 kids in a room, how many teachers is it going to take to enforce that? There are some issues the questions the masks as far as do they breed bacteria. Bacteria spread on masks. And those are all valid concerns. At artwork where we are mask, we actually have an ozone generator that sterilizes the masks. But the reality is they are cloth and if you use them for a while, you know, they do start to smell after about to go on and do an ozone generator to clean it up for a couple days. Should children older than 2 be wearing masks in public? So this define public. If public is a park, the public is outdoors. Again, the literature is clear. There's either literature show it's really hard. There's no literature to show that it actually spreads in public like that. So if you're in public, if you're social distancing that is six feet away from other people, you know, you might wearing a mask at that point in time is more for other people's anxiety levels. And there's a lot of anxiety out there. But I can't really scientifically tell you that if you're in public in an open space and people are distant from you that there's any risk. UV light kills the virus, heat kills it, humidity kills it. And we're in summertime, so outdoors again, it's pretty safe. And the CDC as much as such changed some recommendations saying that outdoor things are relatively safe. So I think that's instructive. How do kids. Kids don't social distance. Well, how does that work? I have no idea how kids social distancing is supposed to work. I know that my son, as soon as he sees other kids, he runs up and wants to play with them. Are we going to teach our kids to not like other kids? I mean, there are a lot of social implications to some of these policies. I'm not sure they've been thought out. We already have record high numbers of suicides in certain counties, certain states in the country already. Actually there's some states in the country that had more suicides so far from COVID 19 suicides during this time than actual deaths from COVID 19. They're obviously smaller states with less population, but we're not really thinking about a lot of the social implications of forcing kids to not hang out with their friends. I'm talking about young children. I think high school students can kind of sort of get it. But I don't think a five year old, a six year old, my nine year old son, I don't think he would quite understand why he shouldn't talk with his friends. And, and this is all in light of the fact that if you're less than 25, the risk of dying for this is less than the typical flu. So I've read that wearing a mask can cause you to breathe in your own CO2 for extended periods of time. That can cause your blood to become acidic. Is that the case? So there's a thing called the diffusion coefficient. What that is, it's how well CO2 diffuses across a membrane. It's actually quite high for CO2, which means it's going to fuse across the mask quite rapidly. Oxygen, on the other hand, has a lower CO2, has a lower diffusion coefficient, which means it won't diffuse across a barrier quite as easily as CO2. So if anything, you'd be worried more about oxygen not going through the mask than CO2, which we're not obviously worried about. So I think I'm not sure where the information about CO2 not going across it comes from. That's patently false. If that was true, then oxygen would even more so not go across and everybody would just pass out and die from hypoxia wearing the masks. So that's patently false. Are there dangers in wearing masks for extended periods in time? You know, and a couple of questions around that. I, as a physician wear my mask pretty Much all day at work. If you're in the ER, you're wearing it for 12 hour shifts. If you're in the ICU, not only are you wearing masks, you're wearing these garbs. You're suited down, almost like hazmat. Excuse me. So a lot of healthcare people have been this whole time wearing masks for extended periods of time, and we've been okay. So I don't think there's any serious harms for wearing masks. The best concern is, you know, the chemicals in the mask. Some people react with them, some people develop a contact dermatitis. I think that's the bigger issue than the actual safety of the mask per se. Some people might be prone to hyperventilate. Some people might feel claustrophobic from the masks. Those are totally different issues than safety of the mask per se. Next question. Patient says they have a KN95 mask. Is it a good idea to insert them with a cloth to extend their life rather than wear an N95, etc. So actually, in the ER, what physicians are doing is wearing their N95 mask with a surgical mask on top of it and using that and just replacing those out. But that's again in the ER where you're seeing lots of patients and being close up in front people listening to their hearts, listening to their lungs, which I'm assuming most people aren't gonna be that close in public. One thing I want to talk about real quick, the masks with surgical masks versus N95 masks. Surgical masks were developed so that when you're doing, when you have someone open on the operating table, then when you're talking to your surgical techs, your other staff, anesthesia, you're not spinning particles into people's wounds. That's the main purpose of a surgical mask is certainly talk. You speak, you cough, you're not spreading particles. Yes, you do diminish some of the inhaled particles, but the main purpose is for not spreading particles. Difference with the N95 mask is that's mainly for on inhalation, not breathing particles in. So construction workers, if you're doing woodwork, you'll wear that so you don't inhale fine dust particles. So when you refer to mask, also, you have to determine if you're talking about N95 mask or a regular surgical mask. And most of the cloth masks I see people wearing are just basically surgical masks. What's the best type of mask to purchase? And should you wear a mask once and throw it away if it's not washable again, I've had three masks I've been wearing for this whole time and just rotating them through and cleaning with ozone. So our office actually got a medical grade from Henry Schein, a medical grade ozone generator special for this kind of purpose. So it's kind of funny how ozone that was kind of considered faux pas and kind of not real science. You know, six months ago. Now you can actually buy these generators to clean your medical equipment. I would probably recommend something like that. I don't. Yeah. Versus wearing them once and tossing them. They're good for multiple uses and long periods of time. All the healthcare workers that I know are using masks for whole shifts. ER people are using for a whole shift and tossing them. And of course, it depends on where you're at in ER and which system. So I shouldn't. That's not really generalizable. But for the average person, using your mask for longer periods of time is absolutely reasonable. Most construction workers do that. I have N5 masks I use around here for crawling in my house and doing insulation work and woodwork and other things like that. And I just reuse those. Just heard on some station that wearing N95 mask with a vent is bad. So the vent, you know, when you. The main purpose of N95 mask is so that when you breathe in, you are not breathing in particles. So when you breathe out, the little vent will pop and air will come out. But that's not really any different than the sides of a surgical mask. The main purpose of the N95 is that when you inhale in, there's no particles coming around the outside like a surgical mask. So I would say that the vent doesn't really have a whole lot to do with the safety of the person wearing the mask. I have asthma. I have a hard time breathing with a mask when walking my dog. So that wasn't really a question, it was a statement. If you're walking your dog, you're outside walking your dog by yourself. In the city, in Richmond or any other city, you don't really need a mask because there's no one around you. And if someone's coming down. When I've been in public, most people actually, when I walk with my kids, we bike. Literally, people on bikes will like sway away from us 10 to 15ft. So there's really not concern. Again, if you're out in public outdoors, I should say if you're outdoors and you're social distancing, the risk for getting this is super, super low. Has it happened before? Yes, but it's ridiculously rare. Next question. Is there a mask or type of material better for asthmatic patients? Again, the biggest thing is just people reacting to the chemicals in the masks, basically. So that's a place where, if you're sensitive, maybe a cotton mask, maybe a homemade homespun type mask made out of cotton. Although most cotton actually is highly sprayed with the pesticides, it's actually one of the most highly sprayed. So you want to make sure you're getting organic cotton mask. That's a little tidbit there. So you might actually react worse with a standard cotton mask if it's not organic cotton.

So just do the best you can.

Do the best you can. Yes, yes. See how, See how. Yeah. Yes, yes. There's tons of rabbit holes to go down. Sorry, I just.

You have so many private messages.

I just gave. I just gave a reason. My wife has been telling me not to. To watch what I say because it creates rabbit holes. I say things like organic cotton and I unleash the hounds. Anyway. Does the reduced level of oxygen exposure. Okay, so does the reduced amount of oxygen and reduced biodiversity negatively impact you wearing a mask for long periods of time? Your oxygen levels are not low from wearing the mask. I've talked about that already. The biodiversity. I think people are referring to inhaling viral particles, yeast particles, bacterial particles, which are in the air all the time. Most of the stuff you inhale, you actually eventually swallow. There is no literature I've seen referring to the masks affecting overall biodiversity, especially since your gut Microbiome has about 100 trillion bacteria and your skin microbiome is maybe a million, and your respiratory microbiome is in about that million zone. So it's very small, relatively speaking, to your gut microbiome. Can you wear the same cloth all day? Okay. And wash. Can you wash it? Absolutely, yeah. This is something else that's come up a lot as well. I've noticed that some people wearing masks are constantly touching them to adjust them, to fiddle with them. This totally defeats the purpose of wearing a mask. Not totally, but partially. Would those people who seem to be touching their faces more frequently be safer without one? I don't wear one as it makes me feel claustrophobic. I feel I can't breathe. I just use hand sanitizer. So I think the general idea, if you use. You know, I mentioned using gloves before when going out in public in a mask, and that caused some consternation, I guess, is the way if you do, if you use any kind of personal protective equipment, a seat belt, you know, if you use a seat belt the wrong way. If you don't put it on the right way, it's not going to work. You know, if the child protective locks in your car, if you don't engage them the right way, they don't work a surgical mask. If not put on the right way, it won't work as well. The same thing with gloves. You know, if you're. I heard that someone said, you know, someone had gloves on, then they bit the tip of their thing, took it off and then started king on their phone. You're kind of defeating the purpose. You know, would it be better not to wear gloves and just wash your hands? Well, if you cannot touch your face, your eyes or anything else, I think gloves just keeping people more aware that they have something on their hands and less likely to touch their faces. But ultimately, if you wash your hands very well, you kind of obviate the need for gloves. But the purpose of the gloves is to make that physical barrier. As with anything, if you don't use personal protection equipment the right way, it's not going to work as well. Does it still help? Sure. I've seen people wearing their face masks just over their mask and not their nose is exposed. I've even seen some people with it on their necks, not covering in their mouth or their nose. You know, I don't think that works very well. So I'm not sure what else to say besides that if it's not used the right way, it's not going to work very well.

Can you go back into like when you're talking about masks, gloves, that if you're young and healthy, you're protecting.

Yeah, yeah. So good, good point. Good point. If you're young and healthy, if you're less than 25 and if you're less than 50, this is if I'm 40, turning 47 this year, this for me in my risk zone is about the same as a typical flu. If my risk chance for dying from this. So it's, it's, you know, I wear the mask public mainly because I can't get exposed. Because I see patients, I would get them exposed. So I'm wearing it. Not necessarily for me, I'm wearing for other people. And if you're young and healthy, it's the exact same thing. You're wearing it for other people. So you help their ease their anxiety and so that you don't. If you do. If you are 50% of people who get this probably are asymptomatic and so you could be young and healthy have no idea. You have it and be spreading it. So if you're in that zone, you're wearing the mask for other people. That's something to keep in mind as well. And the mortality, even if you're older, the mortality still most people over 80 who get this will still survive. 15% mortality is terrible. But that means 85% of people over 80 still survive. So what are the odds of the average citizen over 16 years old catching this and dying from COVID in a phase one mass community? I think I've already answered that question. Again, I'm not sure the age 16 came from. I'm using 25 to 30 because that's where the data is. Can you explain viral load? What do you see as the pre existing conditions that carry the greatest risk? Okay, viral load. I'm not sure which viral load this person's referring to. There's two that I think of. One is the exposure load. So if someone coughs in the air and I walk through that dust cloud and 10 minutes later, okay, the amount of viral particles in the air are so low that my risk for getting that are super, super low. So low in fact that the CDC says going out in public is actually low risk in open air and outdoor situations. If that is up in someone's face and they cough and cough in your face and you get a massive load, then you have a big viral exposure and you can get quite sick. We've actually seen this with healthcare workers wearing nebulizing patients and some of the personal care protection devices that actually got massive exposures of aerosolized viral particles and got quite sick. So basically, if you get exposed to small, small, small loads, which is the whole thing of someone touching a packet, a cardboard package and you touching it an hour, two hours later, that's a minuscule viral load that's most likely not going to result in an infection versus someone coughing in your face. Then there's the idea of viral load in your blood and that's a little more complicated because it's not just the viral load, it's also your body's response. Because ultimately what's killing people is not the initial viral load. It's does your body have an appropriate inflammatory response and suppress that or does your body have a delayed response, the viral load goes even higher and then you basically just get sicker and sicker and sicker or does your body knock out the viral load but then have the inflammation doesn't stop and you have this cytokine storm. So hopefully that helps the viral load question. I feel like I Might have complicated it a little bit. But anyway, as far as the greatest pre existing conditions, the single greatest is age. Age over 85. 80 to 85. Then there are the secondary ones which are your obesity, diabetes, hypertension, metabolic syndrome type stuff. Those are your next category of things. There's a lot of secondary things in that, like renal disease, but these are all categorized in mailbox syndrome, which would be again, obesity, diabetes, hypertension, since the risk for getting Covid outside is lower. Again, yeah. This question is, should they wear a mask out? If you're outside at the park, in a public space where people are social distancing, you're wearing the mask to ease other people's anxiety. And you know, when I was out this past weekend during Memorial Day, I was seeing people literally going down the aisle way in the grocery store. You have a mask on, someone sees you, they turn around and go the different way. So I think just being cognizant of that, respecting other people, realizing that everybody's anxious and not asserting your own volition, your own will, but realizing that you're interacting with other people and some are quite anxious and the things you do are helping allay that anxiety. One thing I've not seen a lot of people talking about, which is actually data popping up now, is just the mental health effects from this. Whether it's young kids committing suicide, whether it's anxiety, whether it's domestic abuse, there's tons of things going crazy right now and no one's really talking about that. So I think us doing our part to ease other people's anxiety is a reasonable ask and maybe look at it like that. So I think that's it for the questions that were posted before.

There are a couple quick things to. I'm not 100% if everybody's still here, but I thought there was one on here. Okay. There's not one on there.

Okay.

Kind of a follow up on just general information. If you become exposed, or I guess like if you're symptomatic or whatever, are they still recommending 14 days of quarantine?

The 14 day quarantine was basically if you're here, exposed.

Yeah, you're like exposed. I guess if you like have a known exposure, are you supposed to take yourself out of the. I'm assuming it means if you're exposed, not necessarily sick.

Yeah, I think, I think that's kind of. I'm gonna. Official public policy change on that. Initially it was the 14 days, but now that we know that this is pretty prevalent, that the percentage of people having this is much higher, you know, cats out of the bag, so to speak. I think that that was, that was stepped back, but never. I'm not sure if it's actually removed from the public policy recommendations. So I'm going to just say from a public policy standpoint, sure, but pragmatically, there's so many people that have been exposed, I have no idea. I mean 50% of people. And actually that initial public policy recommendation was made when we had no idea that half the people who get this have no symptoms whatsoever. So, you know, it's not really practical. You might, if you were exposed to someone, you should be wearing a mask. So if you're exposed and you're wearing a mask, you'll be less likely to spray symptomatically. If you get a fever, then obviously pull yourself out. That's where I think the mask thing comes into play. Because if you are exposed, you decrease your risk for getting a high enough viral exposure to get this. And then if you do get infected, you're less likely to spread it. But the 14 day things, it's pretty much fallen out of favor and people aren't doing that anymore. But as far as an official thing, I'm not sure that actually was retracted yet.

And then one person asked about swimming outdoors in a chlorine treated pool, which I don't think we've seen anything on.

Yeah, I mean, I don't think there's.

Any official word on that.

Yeah, I mean, a chlorine treated pool. What I'm gonna tell you is chlorine is one of the things that kills COVID 19, the sodium hypochlorite. So you're literally in the, you're literally bathing yourself in the thing that actually kills it. So I think a chlorine pool is absolutely fine. I wouldn't necessarily be worried about it per se.

That's going to go back to the whole liability thing. I think if you're talking about like.

A community pool, well, that's a different question. Whether community pools are open versus people's personal pools. You know, we're not even sure if those can be open quite yet.

If you're having in your personal pool with your family that you're already quarantined with, it's probably fine, right?

Yeah, yes. That's where it's gonna be hard because the reality is a public clone a pool is pretty safe, you know. Will the local places open up pools in the summer? We don't know. Will the beaches in Virginia open up besides Virginia beach this year? Don't know, we're waiting to hear. So these are things that'd be great to know the answers to. That's where knowing the data, being comfortable with it. Hopefully we'll get. Get some public policy changes that can be enacted based on where the data is, not where we thought it was, which is what's kind of happening right now anyway. Hopefully that was helpful. If this is another thing, it's actually if those are still hanging around. There's been a lot of issues on social media with anything related to COVID 19 being censored and dropped. One of the. I follow a professor at UCLA and some of the stuff he does and literally he's like, you know, super well respected, does a lot of education, he's getting his stuff dropped. And so if you feel like this is helpful, share with friends. That's the way we're going to get good information out there. Unfortunately, a lot of this stuff is just being dropped because it's considered controversial and so it's being censored out. So hopefully, if you like this, share it, let people know about it and stay safe, be well and I'll continue to do updates as. As I feel like things. New changes come out.

Sorry, I'm gonna throw a quick one in. There was a hypothesis going around that maybe children like that it doesn't transmit very well between children and adults. And someone is just asking if you've seen any like, confirmation or.

There is literature published that actually that's not being transmitted from children to adults, but it has been. We do have recorded cases of being transmitted from adults to children, but not vice versa. So. And we're not quite sure what to make of that. But again, I don't know if it matters as much. Where that makes a difference is it lowers the likelihood of a grandchild passing their grandparent. Okay. That's where that's important. Kids are still. Their mortality risk is still super, super low. They can get it from other kids, they can get it from adults, but their likelihood spreading back to adults is low. We're not quite sure why or what the biological plausibility for that is. But that is actually a phenomenon we have seen. And I think where that makes sense is more from kids passing it to grandparents. But then the question is, you want to risk that. And I don't know anybody who's like, yes, now I can, you know, hang out with my grandkids, which I think is a big issue. I have some patients that are in their 80s and they, you know, the idea of not seeing, not hugging their grandkids for a year. When they have maybe, you know, they're 80, they don't have a ton of years left. Some of them are like, you know, I'd rather just hug and kiss my grandkids, and if I die, then it's a living death not being around my grandkids. When you're 80 and 85 and that's, like, the most important thing to you, it's literally, you know, it's pretty bad. So, anyway, y' all take care. Be safe. Sorry to end on that note. Yeah, exactly. Right. Take care.