Doctors and nurses around the country are already facing terrifying shortages of N95 filtration masks, and the U.S. is likely not even near the peak of the COVID-19 pandemic. But a pair of ER doctors on the front lines in Boston have been answering questions on Reddit and they say that while healthcare workers certainly need the masks more, regular people who want to protect themselves from the aerosolized virus may do so fairly effectively with homemade masks and even bandanas — and true social distancing.
Two emergency physicians at Mass General Hospital and Harvard Medical School, Dr. Ali Raja and Dr. Shuhan He, answered questions Friday in a Reddit AMA (Ask Me Anything) on the r/Coronavirus subreddit. And they had some fairly terrifying revelations to share that have come out of the limited data, studies, and evidence that doctors have so far as they begin the battle against it here in the United States.
The first bit of advice, and the one that got the most upvotes, is to leave the N95 masks for the healthcare workers who are going to need them most. "Try to consider the population as a whole and help us healthcare workers by leaving the disposable N95 masks on the shelves," they write — making the point that if the masks run out, the healthcare workers will be getting sick and be unable to care for everyone else. (One university hospital in Nebraska has started trying to sterilize disposable masks with ultraviolet light so that they can be reused for up to a week, to address the shortage.) Also: "You really don’t want us wearing homemade ones at work and then taking them from room to room. However, homemade masks (made from teacloth or regular cloth) may still confer a significant degree of protection, and you are likely fine to wear one to the grocery store."
That being said, Drs. Raja and He want everyone to understand how highly, insanely contagious the coronavirus appears to be — beyond the often repeated facts about virus cells from coughs and sneezes being able to get into one's nose and eyes from hands that have touched infected surfaces.
Keep in mind, some of this is the educated opinion of two physicians, and some is based on newly released, small-scale studies. Let the terror begin:
- Whether one is on the mild trajectory or the severe/critical trajectory, patients experience a fever first and often a dry, persistent cough. By Day 7, one should know if they they are on the severe trajectory because they will be unable to speak without severe shortness of breath. In both trajectories, patients still had symptoms after 17 days.
- The very first cohort of data on critically ill patients with COVID-19 in Washington was just released in a paper on Thursday, March 19.
- "There is some evidence that shows that the virus can be found on surfaces for up to 7 days... if you put droplets of the virus on it. If you cough (aerosolized it) well up to a few hours to days too. A recent study in NEJM showed it can last in the air up to an hour after a sneeze or cough. That is dangerous."
- A study published in the New England Journal of Medicine on Tuesday looked specifically at the aerosolized virus from coughing and sneezing, and basically you should think of all public spaces as minefields where the virus could be floating for hours after an infected person coughs. "Unfortunately, the fact that it is airborne means that yes, it looks like it just stays in the air like a cloud," say the docs on Reddit. "We think this means that it probably stays infectious too." This would better explain the cruise ship outbreaks, particularly the large one on the Diamond Princess.
- "A person simply handling a doorknob is not an issue, as much as someone coughing and sneezing onto their hand and then handling the doorknob."
- Produce from the grocery store should preferably be washed with gentle soap and water and then rinsed. But rinse well! "We really don't want to be seeing patients in the ER coming because of soap and hand sanitizer poisoning."
- Young people in their 20s and 30s are absolutely susceptible to the virus. "I just admitted a patient to the hospital yesterday who was not old enough to drink alcohol legally in the US. This patient had gone on spring break and come back with a cough and shortness of breath so bad he could barely walk across a room."
And the worst bit of realness:
- "So here’s what I think the future will look like. We’ll get this novel coronavirus under control, if, and only if, we do things like self-quarantine aggressively. We’ll develop a vaccine, and the symptoms will be milder, but it won’t entirely prevent it (much like the flu shot, which decreases the symptoms and duration of — but doesn’t entirely prevent — influenza). But every so often, maybe once or twice a year, there will be flare-ups, and we likely haven’t seen the last of things like occasional city-wide lockdowns and travel restrictions. This might be a new reality for us for a long time."