No Mask? I'm Outta There

We all understand the concept of the tipping point—as Malcolm Gladwell wrote about so powerfully in his book by the same name. The tipping point is that magic moment when an idea, a trend, or social behavior crosses an imaginary barrier to spread. A point in time when the landscape becomes completely different.


The computer chip, for example, completely transformed our world. The iPad, the iPhone, the evolution of robotic surgery. In the medical community, the introduction of the electronic health record was a tipping point after which the medical world was dramatically transformed.


These were not life-and-death crises, but today we are dealing with a tipping point threatening our very survival.


No, concern about the COVID-19 pandemic is not hyperbole. This is not science fiction. This is a grim reality barreling down the track like an out-of-control locomotive. From an obscure virus in an outdoor market about a year ago (thus the 19 as a designation for coronavirus), a deadly virus traveled across the globe, and our lives will never be the same.


With the onset of what I am calling the “nuclear winter” with more indoor gatherings and major holidays on the horizon, we are faced with the grim expectation of Armageddon. To date, more than a quarter million people have died in the United States and an additional 110,000 may succumb before the end of 2020 to this killer virus, and millions more have been infected. And there is no reasonable likelihood that these ominous numbers will improve from an elusive vaccine, which is not yet ready for prime time.


We have been bludgeoned and battered with recommendations from public health and political policy experts about what we can do to flatten yet another, a third, curve and somehow reverse this nightmare. The evidence is compelling and consistent. Masks not only protect others should we be infected (and not know it), but we now know that masks also protect us from others who may be infected.


We also know or should know the importance of regular and conscientious handwashing and maintaining social distancing from other individuals. But there is another important dimension that is sometimes overlooked—the concept of “staying in our bubble,” our small group of family members.


Now for COVID biology 101.


Until recently there was a consensus among health experts that the virus, which could be shed by coughing or sneezing, would lose its infectiousness within approximately 6 feet of the infected individual. But we now know that aerosol particles much like a room deodorizer can extend well beyond that 6-foot distance, especially in an enclosed area such as a restaurant, a bar, or coffee shop.


Data have been distilled from cell phone users, so we know that in some major cities restaurants, bars, and cafes account for approximately 10% of the physical locations where the virus starts but account for at least 85% of cases. In other words, a very small percentage of hot spots account for a very large percentage of new cases and deaths.

This kind of information is not lost on policy makers, and there are now clear restrictions on the hours of service for these businesses.


What does this mean to you and me? We better pay attention. Our lives depend on it.


But know that the casual encounter with person X, Y, or Z who was infected with COVID but who had no symptoms could have shed the virus and could have changed our lives forever. We need to be alert and vigilant with these casual encounters that can make all the difference. Let me explain.


A nearby faith community met for a religious service. The church was meticulous, methodical, and maniacal about disinfecting the venue, about social distancing, and about having stations for hand sanitizers. Every attendee wore a mask. And everyone knew the correct way of wearing the mask and how to sit apart from others.


The congregation had a sense of comfort during this time of uncertainty and gathered for a rare, seemingly safe respite.


But then the unthinkable happened.


A speaker who stood on a stage and who was approximately 20 feet from the closest congregate removed his mask to speak. However, his support staff on the stage was clearly within 6 feet of him.


There was a quiet gasp from some members of the congregation at this gesture, which may have imperiled the life and the well-being of individuals at the service. This was a person of visibility, and I can only surmise that he may not have realized the danger and the infectivity of COVID-19.


Out of respect for his prominence, no one left the program. But they should have.


Upon careful reflection, we need to take ownership of our own health and well-being. For example, upon entering a retail space where individuals are not wearing masks, we have the right to leave. Or cancel attendance at any function where masking and social distancing are not assured. Or quickly leave any venue (restaurant, store, post office, gas station, library, coffee shop, grocery, fast-food window, office—and religious service) where masks are not evident on everyone, no exceptions.


Bottom line: We are responsible for our own behavior. We are responsible for our health and well-being. We need to understand the life-and-death consequences of shrinking that bubble so that close contacts are members of our original household.


Most of us do not have the luxury of isolating ourselves on some remote island. Mundane tasks have to be attended to such as grocery shopping, and throughout the day we will undoubtedly have contact with other individuals. But we need to prioritize our actions and minimize any contact, however brief, with individuals who may harbor the virus and not be as respectful as we are about masking and distancing.


This is a big deal. Our life and lives of our family depend on our decisions.


We all deserve a moment to stop and smell the roses. Here's yours. A photo from Tom Liggett, author of Mozart in the Garden, a memoir of Silicon Valley, where he cultivates prize roses and is a world-famous expert rosarian.

© 2020  Edward T. Creagan, MD, and Write On Ink Publishing