Masks, Handwashing, and Social Distancing: The Science

The following is basic medical knowledge backed by science, and I’ve linked the science for you.  Very little of this is new; the concepts have been around for quite a while now, and we’ve spent decades refining our knowledge.  Most is not a matter for discussion; it is factual rather than opinion, and should be treated as such.

Handwashing

When Ignaz Semmelweis began practicing the first sanitary measures during childbirth, his contemporaries mocked him.  Even after he demonstrated his results conclusively, the weight of medical authority was against him, and he died after a breakdown of the very sepsis he’d fought his whole professional career.

Students would come into the surgery directly from the dissection room.  They wouldn’t engage in procedures; their chief purpose was observation.  On occasion one would assist, handling instruments or sponging away blood.  And yet, infection spread from them, in sharp contrast to the far healthier ward next door where midwives trained — without dissection.  Semmelweis instituted mandatory handwashing in a chemical solution, and infections dropped to nearly zero.

That was over a hundred and fifty years ago.  Since then, hundreds of studies have been performed.  And they tell us that handwashing works — especially if one does so religiously every time one handles soiled objects outside a safe space.

Unlike Semmelweis, you don’t need caustic agents; hot soapy water for twenty seconds will work just fine against SARS-CoV-2, which is nowhere near as durable as some bacteria.  (Soap dissolves its protective lipid coating.)

Simple, no?  And yet:
“Did you wash your hands?”
“Yes.”
“Did you use soap?”
*sigh* [running water]

The main difference between children and some adults is that the adults are better liars.  Studies in food prep environments bear this out.

Social Distancing

This concept predates Semmelweis by quite a bit.  The earliest mention of medical isolation is of leper colonies in the Bible, and isolation wards existed under the early Sultans thirteen centuries ago.  Italian merchant ports began enforcing quarantine during the Black Death of the fifteenth century, and international conventions aimed at controlling cholera and scarlet fever became a standard response over a hundred years ago.  They’ve been demonstrated effective for centuries.

Of course, a cordon sanitaire around a house, a neighborhood, a ship, a town, or even an entire country may be more than is required for any given infectious event, particularly if a person shows no signs of illness.  And yet, even for influenza, a person can transmit the virus for a day or more before becoming symptomatic and then for up to a week after.  So there’s something to be said for encouraging isolation even during a bad flu season, and even more when the virus is as nasty as the present one.

The practice of individual distancing has been studied in recent years as an alternative to cordoning off whole towns and cities, and it’s been shown to be relatively successful.  A 2018 literature review of fifteen studies concluded that it’s effective alone as a way to slow or even stop the spread of some infectious diseases.  However, depending on virulence, it is more useful in combination with other primary measures, such as handwashing and the wearing of masks and/or gloves.

Masks

Every flu season, almost the entire population of Japan dons masks, a practice that has been demonstrated effective at reducing its spread for some years.  This form of cultural prophylaxis is most common in east Asia, but in the present illness it’s becoming standard around the world.

One of the first publications about the effectiveness of wearing masks to prevent disease transmission in a medical environment was composed in 1905 by Alice Hamilton, M.D., later destined for world renown as an expert in occupational hazards.  Her initial studies were inspired by Flugge’s earlier revelation that even normal conversation could spread infection through vector-laded moisture droplets expelled into the air.  Hamilton’s efforts paralleled those of other physicians, but hers is notable for demonstrating correlation with secondary transmission prevention around typhoid epidemic wards.

In the century since, masks have developed a great deal as their use has expanded.  Some of our present materials are truly wondrous, capable of actually blocking items as small as a virus.  However, the primary utility of a face mask remains interference with moisture expulsion from coughing, sneezing, talking — or even simple breathing.  As such, even homemade cotton masks are highly effective for common use — in many instances, even more so than storebought filter masks.

It’s true that a face mask is only moderately useful for keeping yourself safe from infection, particularly in a confined space.  Studies of co-habitants show that transmission remains likely — in part through mis- or under-use — though it’s certainly a recommended step when infection would be dangerous.  (This is one of the few instances when fitted medical N95 respirator use would be recommended for at-home use.)

But individual effectiveness is not as important as that of the impact of a large percentage of the population employing them.  Transmission models show that with the participation of from 30-50% of a given population, influenza outbreaks can be slowed or stopped with minimal effort or inconvenience.  Early data from Spain indicates COVID-19 can be controlled the same way — and there’s no reason it shouldn’t be.

There are people who should not wear masks, and times and places inappropriate for them.  If you suffer from congestive heart failure and have trouble breathing, you might want to check with a doctor first, for example.  Runners may sweat so much they soak a fabric mask and start to suffocate themselves.  But that’s about it for exceptions.

The Bottom Line

It works.  We know it works.  Any argument to the contrary is absurd.

COVID-19 is debilitating and potentially deadly.  It’s at least ten times worse than a bad flu, and we should be doing most of this every flu season.

So:  Wash your hands, keep your distance if you can, and wear a damn mask.

‘Nuff said.


No, I’m not a doctor.  For medical advice, talk to a doctor.

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