*Note: I no longer practice clinically but leave these pages up to show how I practiced*
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Covid Advice #25 (08/31/2022):
Why Still Mask-Social Distance?
Why Still Mask-Social Distance?
- from Dr. Dennis Fong -
Covid is here to stay for years, but we need to live happy, social lives, we need to have our masks off and see each other's smiles when we socialize with friends and family and when we meet with people for business and work. The problem is that we catch Covid like any other respiratory disease from asymptomatic people, people who never get sick from it but just carry it for a day or two, or people who will get ill but this is the day or two before they do but they are already infectious.
So what's there to worry about with catching Covid? The media has stopped reporting on it. The CDC has stopped tracking it. And far fewer people are dying from it.
Well, quite besides death or long Covid, both of which by the way I still see in my patients even with Omicron, it's the silent long term complications of Covid that worry me. It is established by a large population study (1.25 million U.S. persons, Taquet et al, Lancet Aug 2022) that with the original Covid, an excess of 1.2% of people over 65 get dementia after 2 years. Rush Universitity's studies suggest that heart disease and diabetes are also silent consequences of Covid. An autopsy study of people who have had Covid (Stein et al, Nature Dec 2022) found that the virus goes into all body organs, some organs more often and others less, but almost all brains have had Covid virus in them.
Of course, unlike long Covid, these longer trem consequences are all silent. Therefore they can only be discovered by large population studies comparing those who haven't had Covid with those who have. Now that almost everyone has had Covid, such consequences may only be discoverable by historical comparison studies of large populations. Very expensive and will take some years for enough data to become available.
The optimistic (or reckless depending on your point of view) argument is that Omicron is milder and therefore may not cause those things. The pessimistic (or prudent) argument is that Omicron is only milder and less lethal because it doesn't go as much into the heart and lung, but stays in the head, and therefore there may be a lot more virus that attack the brain.
At any rate, Covid is here to stay, and for some years to come we won't know if we get silent long term problems from it, so here are some measures. Also the following measures are effective for all respiratory disease.
- When ooutdoors the air circulation is good, and so no need to mask unless close to the other person quite a lot of the time, like 2 feet, or you are in a crowd.
- When with people indoors and we can't have our masks on, like drinking or eating, or in business or work meetings where
we need to see each other's facial expressions:
- I keep a distance of 4 feet from mouth to mouth if the air circulation is good, see below.
- I carry a pocket air quality meter (I use the Aranet brand) and if index is >800 I keep a distance of 6 feet from mouth to mouth, more if >1,000.
- When I don't have a pocket air quality meter on me, I guesstimate the air circulation by how high the ceilings are, whether the windows are open, how many people are in the room, how far apart people are, and so forth.
- I try to have a HEPA filter turned on nearby.
- When eating -- this is the setting when most infections take place:
- For restaurants I try to do outdoor seating.
- I favor the restaurants where I can have a server who wears a mask.
- When inoors in a restaurant and the air circulation is good, I keep a distance of 2 empty chairs or about 4 feet away from the next person sitting on the same side of the table, and if sitting across from the table, it's again 4 feet, so a 3 feet wide table serves the purpose very well.
- When I can't or I don't want to social distance at an indoor restaurant or at a home eating dinner, or if the air circulation is not so good according to the air quality meter, I do "airplane eating and drinking" (see section below) where I pull up my mask to take a mouthfull, then pull it back down to chew or swallow.
- When I cannot social distance with people, I keep a mask on.
- In stores I keep a mask on.
- On airplanes I keep a mask on.
- To eat or drink on the airplane I pull up my mask to take a mouthfull, then pull it back down to chew or swallow.
By the way, in hindsight, I think that all the lockdowns from 2020 on in this country were wrong, did nothing to stop the pandemic, caused lots of needless bankruptcies, social isolation and misery, and created widespread anger at the very mention of preventing Covid. Masks and social distancing should have been stressed to the public, not lockdowns instituted. I think we will get another Covid-like pandemic in the future, and this can be a lesson to apply then.
At any rate, I think I will be resisting social pressure and doing masking and social distancing for years to come, until large population, probably historical, studies prove that Covid never had or longer has those silent long term consequences.
By the way, the new Covid vaccine is coming out soon, I think everyone should get his/hers.
This is especially so for Asians, since Asian Americans who get Covid die 3.1 times as much as white Americans from Covid (Yan et al, Journal Genl Int Med Nov 2021). Why? ACE2 receptors are the doorways through which Covid enters cells, and studies show that Asians have a lot more ACE2 receptors on their cells.
I wish you happiness and health!
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