• Wed. Oct 5th, 2022

A message from The Center for Closing the Health Gap

By Clyde E. Henderson, MD

Cincinnati Medical Association

Our country continues in the throes of COVID-19 tragically two years since this virus came to our shores. We are within the peak of the omicron variant surge which now accounts for over 99% of the cases in the USA. Cases reached a record high of 1,364,418 ten days ago (Jan. 10, 2022).  Even though most cases are less severe, the sheer number results in the delayed emergence of hospitalizations and deaths. On Jan. 23 we recorded a single day number of 3,810 American dead. Although this is a high in this season, the number is less that the record 4,442 deaths recorded exactly a year ago, January 20, 2021. Although it is not clear from the statistics, we are in a better place than last winter. This is the case because we have vaccines, more and better masks, effective medications to treat Covid-19, more clinical experience in treating those who are sick, finally more testing, and hundreds of billions of taxpayer dollars to address the ramifications of this virus.

We thought that we were out of the woods once there was a sufficient supply of vaccines for every age group except those under five. Universal vaccination, thus prevention, is the rational approach to this disease. Approximately 64% of the American population is fully vaccinated. It is still the case that the unvaccinated compose 90% of the hospitalized and those dying from COVID-19. In that there is such a high level of community infection, the vaccinated are also exposed to the virus and some are contracting breakthrough infections.  These infections result in proportionately far fewer hospitalizations and even rarer deaths. Nonetheless, those with breakthrough infections are still contagious.  In order to dramatically reduce the spread and thereby reduce the tendency for mutation we need to have the unvaccinated get their shots. Additionally, until the level of community spread lessens, appropriate masking for everyone is our best tool.

Just last week the CDC upgraded its guidelines regarding masking.  Although “any mask is better than no mask at all”, it is clear that cloth masks are not adequate. They are potentially fashionable, but they are not optimally functional. Early in the pandemic there was a strong push and recommendation for cloth masks or face coverings. This alternative was recommended because of a shortage of multiple ply protective masks. Those masks were to be reserved for health care workers. The multiple ply surgical masks with the elastic ear loops are better than the cloth masks or face coverings. Nevertheless, they lose some of their effectiveness because of the air that more easily enters or escapes, unfiltered on the open sides of the masks. Double masking helps lessen the ingress and egress but makes it much more difficult to breath.

The science has evolved, and the shortages have been eliminated as production and supply chain obstacles have been overcome. It is now known that there is a 75% leakage with cloth face coverings, in and out. On the other hand, N95 masks filter 95% of the particles and are much better at filtering small particles and aerosols.  Note that the presence of a valve in a mask eliminates its effectiveness and they should not be used.   

The new guidelines indicate that one should wear the most protective mask that can be physically tolerated and of course afforded. The most effective masks are N95, KN95, and KF94s. Legitimate N95s are tested, certified, and regulated by the US agency National Institute for Occupational Safety and Health (NIOSH). Those masks have a properly spelled “NIOSH” marking. The KN95s are tested by manufacturers in China, but in CDC testing 60% of those did not meet the intended Chinese standard, which by the way matches CDC standards. Lastly, there is the KF94 mask which are Korean manufactured and tested by the Korean Ministry of Food and Drug Safety. The Ministry of Korea maintains an online database detailing approved KF94 manufacturers.

Affordability of effective masks has been at issue until now. The Biden administration announced it would be taking 400 million non-surgical N95 masks from the Strategic National Stockpile. These will be made available to everyone through pharmacies and federal community health centers.  Get yours FREE next week!