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Research shows masks may be the key to containing COVID-19

ARIZONA — Masks have become a cultural flashpoint, in the long shadow of the pandemic.

Masks – or the lack of masks – have spurred bitter arguments in the checkout lines, attacks on store clerks, defiance by small-town mayors, fashion statements and political rants.

Nonetheless, doctors, governors and the federal Centers for Disease Control now urge everyone wear masks in public – especially if they can’t stay six feet apart.

So how did advice from doctors become so controversial?

Why did the US Surgeon General initially warn people not to wear masks?

Most importantly — will widespread mask-wearing blunt the frightening second wave of infections now plaguing Arizona and much of the West and South?

Short answer to that last crucial question?


A growing body of research suggests that widespread mask wearing by the healthy and the sick alike can slow down the spread of the virus as effectively as closing businesses and rarely leaving the house.

In fact, one recent study concluded that mandatory face mask orders issued in 15 states may have already reduced the total number of infections by 300,000 or 400,000. Studies show that widespread mask wearing could have just as big an impact on slowing the spread of COVID-19 as the shutdown of schools and businesses and the stay-at-home orders that have caused such economic carnage.

So why has the message changed from the early days of the pandemic when the US Surgeon General said people shouldn’t rush out and buy masks already in short supply for doctors and nurses?

Mostly, this is because doctors have discovered that people who aren’t coughing, sneezing, feverish or in any way symptomatic can still spread the virus. In fact, perhaps as many as 40 percent of those infected never develop noticeable symptoms, but still spread the virus when they breathe or talk. The other 60 percent may be most infections a day or two before symptoms develop.

That conclusion has emerged from a growing body of research, both in the real world and in the laboratory. As a result, near-universal mask wearing in public remains one of the best ways to slow the spread of the virus and buy time, while doctors continue to search feverishly both for effective treatments and vaccines.

That doesn’t mean people in masks can safely gather in big crowds or ignore social distancing rules. But the combination of social distancing and wearing a mask provides the best protection from a virus that spreads mostly through the air, according to the research.

Masks work because the virus spreads mostly in microscopic, airborne droplets. People who are infected breath out these droplets constantly, with the viral load and range increasing when we talk, cough, sing or shout. Fortunately, cloth masks made of a finely woven fabric stops most of those droplets, even if the mesh of the cloth is larger than the virus itself. To spread efficiently, the virus must be protected and wafted aloft while riding cocooned in the droplet of moisture. Such droplets can travel 30 feet and linger in an enclosed space for hours.

Some anecdotal evidence suggests wearing a mask can make a dramatic difference in the rate of spread. Of instance, a man infected with COVID-19 flew from China to Toronto. He had a dry cough, but wore a mask on the flight. The 25 people sitting closest to him were all subsequently tested for the virus and none were infected, in CMAJ, a Canadian medical journal.

In another case, two hair stylists in Missouri had close contacts with 140 clients while sick with COVID-19. Everyone wore a mask and none of the clients tested positive, according to the case report published in a medical journal.

Many researchers now argue that the widespread use of masks to cope with air pollution in many Asian cities may account for the much greater success of countries like China, South Korea, Singapore and Japan in containing the virus. China managed to contain the initial outbreak to Wuhan, even as the virus spread to every state in the US. China also contained a second outbreak in Bejing. Many people in urban areas of China already wore surgical masks daily due to the dangerous level of air pollution in China’s major cities.

So here’s a summary of some of the latest research on how COVID-19 spreads and how wearing a mask will make a difference.

“Stay Healthy”: One lab-based study found quietly saying “stay healthy” generates hundreds of droplets ranging from 20 to 500 micrometers, but nearly all those droplets were blocked by covering the mouth with a damp washcloth, according to the study published in the New England Journal of Medicine.

Masks work: Wearing a surgical mask significantly reduced the viral particles emitted in droplets and aerosols by 246 people with the flu or the common cold, according to a study published in NatureMedicine. People wearing masks released about 1,000 particles in 30 minutes while people without masks released about 100,000,000,000 particles.

States compared: A study in Health Affairs found mask mandates in 15 states slowed the spread of the virus, compared to 15 states without such a statewide mandate. The mandate slowed growth by 1 percent immediately and 2 percent over the first three weeks. That doesn’t sound like much, but it was likely enough to reduce the total number of infections by as much as 450,000 in the 15 states.

Countries compared: Countries in which most people wore masks in public had a much lower rate of spread of COVID-19, according to a study of 198 countries published in ResearchGate. In countries with “government policies” or “cultural norms” supporting widespread mask wearing practices deaths increased by 8 percent per week, compared to 54 percent in similar countries where people generally didn’t wear masks. The average of the population, obesity rates and curtailment of international travel also affected the mortality rate. Lockdowns, testing rates and contact tracing also had an impact on mortality rates, but much less than mask-wearing.

80 percent: If 80 percent of people wore masks in public it would slow the spread of the disease more than a strict lockdown according the results of a computer modeling program based on research on the effectiveness of various interventions, according to an international study by researchers from UC Berkeley, Cambridge and elsewhere. The study suggested that if 80 percent of people reliably wear masks in public it slows the spread of the virus by 60 percent. However, if fewer than 50 percent of people wear masks, it has little impact on the overall spread. The computer projection concluded effective social distancing after lockdowns end would eventually produce 1.1 million deaths in the US. An indefinite lockdown would produce 180,000 deaths. Masking levels of 50 percent after lockdowns end would produce 240,000 deaths. Masking levels of 80 percent after lockdowns end would produce 60,000 deaths.

Saving lives: Another projection by Health Metrics and Evaluation concluded that if 95 percent of people wear masks in public it would save 33,000 lives by Oct. 1.

Cloth masks work: Surgical masks and cloth masks with a triple-layer, fine woven cloth work almost as well as custom fitted, N95 surgical masks for non-medical personnel outside the hospital, according to a study by engineers from Northeastern University. The homemade cloth masks tested removed 38 to 96 percent as many viral particles as surgical maps. However, more crude masks like simply wearing a bandana or even a face shield that doesn’t make contact with the face around the mouth and nose were ineffective.

Masks slash infections: A Texas A&M study concluded that face mask use in New York from April 17 to May 9 reduced cases by 66,000. In Italy from April 6 to May 9, masks reduced infections by 78,000. The authors – including Nobel prizewinning atmospheric chemist Mario Molina from US San Diego, concluded mask-wearing can do more to stop the spread of the virus than hand washing or social distancing – although they still urged the public to practice those measures. The research has come under fire after publication in the scientific journal PNAS for statistical methods that potentially.

Thousands enjoy Round Valley 4th of July Parade

WHITE MOUNTAINS—Americans of all colors, faiths, ages, and politics, came together for a few hours to celebrate what this country was built on: freedom. There was no social distancing, no masks, and no fear. There were lots and lots of American flags, candy, small water balloons and fun.

Karen Warnick/The Independent  

Almost every inch of sidewalk from Eagar to Springerville was packed with thousands of happy people celebrating the 4th of July.

With all other communities in the White Mountains cancelling 4th of July events, except a few fireworks shows, thousands descended on Springerville-Eagar to celebrate the birth of our nation.

There was no protesting, no rioting, and lots of smiles and cheering. There were classic cars and trucks of all kinds, ATVs, motorcycles, floats, dancing and music.

Karen Warnick/The Independent  

This group of parade goers lives in Greer and were excited to come to the parade. They brought small water balloons and had a lot of fun tossing them around. They agreed this was the best parade ever.

It’s too bad other communities didn’t let their citizens celebrate such an important day and enjoy a respite from the fear that has held this country hostage. It was a welcome coming together of people enjoying a sense of normalcy.

Karen Warnick/The Independent  

Every parade entry tossed tons of candy to the spectators.

Thank you to the towns of Springerville and Eagar for not canceling.

Karen Warnick/The Independent  

The theme of the 2020 4th of July parade was ‘United We Stand.’

State delays school opening

ARIZONA — Gov. Doug Doug Ducey this week pushed back any in-person school re-openings until August 17, giving school officials another two weeks to prepare for their plunge into the unknown.

Metro Creative  

... research has also demonstrated that the abrupt shift to online learning last semester cost many students half a year of academic progress, with the worst effects on minority and low-income students. That includes many rural areas like the White Mountains ...

The order came as confirmed cases of COVID-19 exploded and the state re-imposed an order to close non-essential businesses, lifted on May 15.

The stutter-step on reopening schools comes amid intriguing research showing that children are not only much less likely to get infected with COVID-19, but once infected they’re much less likely to develop symptoms.

On the other hand, research has also demonstrated that the abrupt shift to online learning last semester cost many students half a year of academic progress, with the worst effects on minority and low-income students. That includes many rural areas like Rim Country and the White Mountains, where half of the families qualify as low-income.

An earlier executive order gave school districts broad flexibility in reopening. Districts could return to near-normal, in-person learning, continue mostly online learning or embrace a blend of in-person and online approaches. Districts would still have to offer a place for students to study in the event of a blended approach. However, the order would insulate schools financially from a big drop in enrollment if parents kept their children home. It also eased standards for the amount of time students had to spend in class to get state funding.

The latest order spawned new uncertainty just as school districts were scrambling to lay plans for an August 3 reopening, while grappling with the suddenly overwhelming list of scheduling options.

Arizona Superintendent of Education Kathie Hoffman this week told the Arizona Republic “we were hopeful that schools could reopen and that with mitigation strategies that our schools could still offer in-person instruction. But more recently, it’s become more clear that’s not advised. We’re going to see a lot more online learning than we saw before,” she said.

The decision comes as confirmed cases of COVID-19 have risen from about 500 per day when the stay-at-home order expired on May 15 to about 3,500 per day in the past week. The rate of infection has increased eight-fold among younger people, but only doubled among high risk groups like those over 65. Only 11 percent of the confirmed cases have been among those under 20.

Even before the most recent surge, studies suggested 18 or 20 percent of parents have doubts about sending their children back into in-person classes. On the other hand, many parents support a return to in-person classes, especially those struggling to provide online learning tools at home or facing big problems providing care for children at home due to their own work demands.

Interestingly, recent studies suggest COVID-19 doesn’t pose a grave risk to children. Some doctors have documented a strange, potentially dangerous inflammatory response in children who have been infected, but the condition remains rare.

One international study found children are only half as likely to get infected when exposed to the virus as adults, according to the results published in Nature. Moreover, once infected only 21 percent of children show any symptoms at all. By contrast, 70 percent of people over 70 develop symptoms.

Much of the initial alarm about the impact of COVID-19 on children was based on the experience with the flu – a different respiratory virus. The flu hits the very young and the very old the hardest and spreads readily in school settings. However, COVID-19 has shows a very different pattern, with the odds of infection and the development of serious symptoms increasing with age.

The researchers concluded, “In countries with younger population structures — such as many low-income countries — the expected per capita incidence of clinical cases would be lower than in countries with older population structures, although it is likely that comorbidities in low-income countries will also influence disease severity. Without effective control measures, regions with relatively older populations could see disproportionally more cases of COVID-19, particularly in the later stages of an unmitigated epidemic.”

That’s bad news for rural counties in Arizona with generally older populations than urban counties like Maricopa. It also means that even if children don’t face a high risk of serious complications, they could get end up with a “silent” infection they pass along to parents. That’s especially alarming in places like Payson, where many grandparents are caring for their grandchildren.

The researchers said something in the immune systems of children apparently lowers their risk of first getting infected and then developing serious symptoms.

The human immune system has both an immediate response to an invader and an additional system based on an immune system memory of previously encountered viruses and bacteria. Children have a quicker immediate immune response, but less of an immune system memory of previous challenges that orchestrates a secondary immune response. Doctors speculate this difference in the immune system response might help explain the difference in reaction to COVID-19. The SARS-CoV-2 virus that causes COVID-19 first evolved in bats – which have a much faster-acting immune system and far less inflammatory response. The immune system’s inflammatory response in humans is behind many of the most dangerous complications of COVID-19.

The researchers in the Nature paper noted, “Understanding the role of age in transmission and disease severity is critical for determining the likely impact of social-distancing interventions on SARS-CoV-2 transmission, especially those aimed at schools, and for estimating the expected global disease burden.”

Other research has provided mixed results. Most studies have shown few infections and little serious illness among children. Some have shown children can get infected as easily as adults and spread the virus, even if they have few or no symptoms.

In Arizona, children account for 11 percent of infections and less than 1 percent of the deaths. By contrast, people older than 65 account for 12 percent of the infections but 74 percent of the deaths.

The enormous disparity suggests the greatest health risk in going back to school involves children with risk factors like diabetes and children likely to take the infection home to parents with risk factors or family members older than 55.

Some researchers have suggested this opens the door to a more nuanced approach when it comes to reopening schools. Mask wearing, temperature checks, spreading out children in classrooms, limiting the mixing of children during the school day and enhanced cleaning efforts could slow the spread of the virus on campus. In the meantime, improved distance learning for children with risk factors and family members at home with risk factors could limit the consequences of infections that do take place.

The latest governor’s order gives hard-pressed districts another two weeks to hash out a response.

Arizona percentage of infections and death by age

Age;Infections;Percentage of deaths

Under 20:;11 %;0 (6 deaths)

20-44:;49 %;6 (91 deaths)

45-54:;15 %;7 (107 deaths)

55-64; 12 % ;13 (219 deaths)

Over 65;12 %;74 (1,209 deaths)