Wearing face masks is the new America's pastime

In my 4/7/2020 letter-to-the-editor (to Observer-Reporter) I began with “It is regrettable that President Trump said he chose not to wear face mask. . .” Trump made wearing face mask a political statement, whereas the House majority leader, Nancy Pelosi, made it a fashion statement.

Nancy Pelosi has a formidable rival:  This is Slovakian President Zuzana Caputuva on her swearing-in ceremony.  How many face coverings you ladies may need?  It all depend on how many dresses you have.  I am sure pretty soon the face coverings will also match or contrast your hair colors, too.

It was reported that Nancy Pelosi's large stockpile of face coverings comes from Donna Lewis.  I was told that Victoria Secret also makes face coverings, I do not know what is their sale slogan, but "Less (covering) is more" will not do.  The followings are products from Donna Lewis.

As we all know wearing face covering is mainly to protect others, and to a lesser extent, protect oneself.  Not wearing face covering when the occasions call for is an irresponsible behavior, not courteous, inconsiderate, ignorant and reckless.  The photo is President Trump with Governor Jared Polis of Colorado.

The scientific basis of wearing face mask

The evidences of benefit of wearing face masks in curbing the spread of coronavirus in Asian countries may not be able to convince some Americans. I'll present a collection of reports in various credible scientific and medical journals showing the merit of wearing face masks. On the 6/2/2020 Scientific American issue, there was a comprehensive article of “How to use masks during coronavirus pandemic”.

It is not my intent to tell the technical aspect of the scientific basis of wearing face mask, although it is available if one is interested in this kind of “dry” stuff. There is an article on 9/21/2011 the Proceedings of Royal Society A with a title of “Effectiveness of facemasks to reduce exposure hazards for airborne infections among general populations”. https://royalsocietypublishing.org/doi/10.1098/rsif.2011.0537

Comparison of paper surgical masks with fabric/cloth ones

Researchers examined the materials under a microscope and noted fabric has a more open structure with bigger holes (see the photo). Ideally a cloth coverings should have at least two layers, which can trap more particles than a single layer. I personally tend to wear a cloth covering on top of a surgical mask inside.

Droplets evaporate and become smaller and smaller as they flow through the air, so they are the largest when they are first coughed or sneezed out, this is why cloth mask with relatively “large” holes (under microscope) still can do the job well, trapping the droplets, preventing them airborne.

Wearing face covering can reduce the wearer's risk of catching the virus by 65%

There was a report on Medscape on July 10, 2020, in which Dr. Dean Blumberg, chief of pediatric infectious disease at UC Davis Children's Hospital, said that a “standard rectangular surgical mask . . . will decrease the risk of infection to the person wearing the mask by about 65%.”

Dr. Blumberg likened those who don't believe masks work to not believe in gravity. He also said not wearing face mask is an irresponsible behavior, “it is like double-dipping in the guacamole. You are not being nice to others.” President Trump encouraged his supporters not to wear face masks, it is like sending his people into the battle field without helmets.

To be realistic, a surgical mask may not be able to trap aerosols, that is why we also need to avoid the crowd and practice social distancing.

The surgical masks can reduce influenza virus RNA and coronavirus RNA in aerosols

A 6/2/2020 Nature Medicine article shows that the surgical masks can reduce influenza virus RNA and coronavirus RNA in aerosols, thus preventing transmission of coronavirus and influenza viruses. The study was done on the exhaled breath and coughs of children and adults with acute respiratory illness due to seasonal human coronaviruses (not SARS-CoV-2) and influenza viruses.

Hamsters with masks are protected from coronavirus infection

A study reported on May 2020 Clinical Infectious Disease showing hamsters wearing masks reduced coronavirus infections by more than half comparing with those hamsters without using masks when exposed to coronavirus.

The studies showing benefits of wearing face masks abound

A systemic review and beta analysis of 172 studies found that “face mask use could result in a large reduction in risk of infection.” This was published on 6/27/2020 Lancet. An article in Health Affairs revealed that state mask mandates may have prevented more than 230,000 coronavirus infections.

The microscopic aerosols can infect people, coronavirus is airborne, lingering in the air indoors, WHO finally agrees

There is an article on 4/2/2020 Science “You may be able to spread coronavirus just by breathing”, on the same day Nature also has a similar article, “Is the coronavirus airborne? Experts cannot agree”, in which it says that “gathering unequivocal evidence for airborne transmission could take years and cost lives”.

Also on the same day Dr. Harvey Fineberg of the National Academy of Science (former dean of the Harvard School of Public Health) wrote a letter to the White House, alerting them to this finding.

Since then I have been convinced that this, along with asymptomatic transmission, is what drives this horrendous pandemic. The evolutionary instinct of this coronavirus is to jump from one person to another to survive, replicate and propagate. They must have an ingenious way to do it, and this is it.

However, WHO has always resisted the ever increasing evidences that not only droplets (from coughing and sneezing), but also aerosols (from breathing, talking, shouting and singing), can infect people. And that viruses can float and linger in the air indoors, especially in a poorly ventilated closed areas.

On July 4th, 239 scientists from 32 countries wrote an open letter (which will be published in a scientific journal next week) to WHO, outlining evidences that aerosols can infect people and that coronavirus is airborne, calling for WHO to revise its recommendations, to which WHO said the evidence for the virus being airborne is still lacking and inconclusive.

WHO must have a change of heart, announcing today (7/7/2020) that in a few days it will add aerosol transmission indoors to the likely modes of transmission and that the virus particles may float and linger in the air indoors, infecting people nearby.

I recall WHO declared this pandemic one week after Germany did. WHO's advice often lags behind science and rapidly evolving research. WHO did not endorse wearing face masks to deter the spread of the virus until June 5, 2020. In early June it also said the asymptomatic transmission is “very rare”, leading the nononsense Dr. Anthony Fauci to say “WHO is incorrect”. WHO did retract or at least revise its statement.

Church worship is essential: How to do it safely (Part 3)

Details of the service in the Baptist church in Frankfurt, Germany remained unknown as it is being investigated, but the deputy head of the Health Department called it a “very dynamic event” (“sehr dynamisches Geschehen”).

The Deputy Head of Office at church said there was no violation of a legal regulation (Es gab keine Verletzug einer Rechtsverordnug) as initially reported in a May 23 article on Der Tagesspiegel. But subsequent reports said otherwise.

The report also said although the said church is not small, but a much larger cathedral in Frankfurt can only allow up to 70 parishioners to worship together according to the new legal guidelines (die Regeln). There were 170 faithfuls packed in the church, singing without wearing face masks, according a May 28 report on Farnkfurter Allgemeine, in which it said the total infected cases have reached 200. Transmission to the people that didn't attend the May 10 service apparently has occurred. The social distancing was set at 1.50 meter apart in Germany.

The guidelines for re-opening governing the faith-based organizations in Germany are essentially the same as that of CDC: Social distancing, wearing face coverings, providing soap and hand sanitizers, not to use the shared hymnals or prayer books (the congregants are encouraged to bring in their own items), not to pass around the collection basket or tray, considering a stationary collection box or even regular financial contributions electronically.

Many of the physical contacts that are practiced among the faith community may have to be curtailed such as hugging, shaking or holding hands in a chain. A safer and acceptable way to do Communion has to be devised. Outdoors service, if feasible, should be encouraged.

Symptom-free transmission is what drives this pandemic. Not only do the droplets from coughing and sneezing contain viruses, but also the aerosols from breathing, talking and especially singing. The initial much detailed CDC guidelines discouraged choir in the service, this was apparently deleted by White House.

The same guidelines though they may be in the U.S. and Germany, they are implemented quite differently. The Frankfurt Health Department said the Baptist community has to be held accountable if they are careless in handling corona-hygiene rules. Each congregation has to follow the state ordinance even for divine services or religious gatherings.

Church worship is essential: How to do it safely (Part 2)

112 out of 180 church goers got Covid-19 after attending a “very dynamic worship” in a Baptist Church in Frankfurt, Germany. It may come from a nursery school teacher. It is facing a criminal investigation since it violates the reopen laws, which are simply guidelines in America (CDC calls it suggestion).

“CDC offers these suggestions for faith communities to consider and accept, reject, or modify, consistent with their own faith traditions, in the course of preparing to reconvene for in-person gatherings while still working to prevent the spread of COVID-19.”

I myself may not be in favor of a criminal prosecution for such a violation by a church having a divine service, a reprimand at most. But this clearly shows the Germans are serious, not half-hearted in fighting to contain the spread of coronavirus. This will never happen in the U.S. under Trump's watch. This may also reflect the cultural difference. Although we need to keep in mind that Germany is exemplary as the global leader in fighting this pandemic.

The case is facing criminal investigation

The church may have forgotten another set of “holy trinity” (social distancing, wearing face mask and wash the hands) according to NJ governor.

Church worship is essential: How to do it safely (Part 1)

(I'll have serial posts on the Covid-19 spread linked to a worship in a Frankfurt church, Germany. Church worship is indeed essential. With the wisdom God grants us, we need to learn how to do it safely.)

the case is facing criminal investigation

The worship at a Baptist Church in Frankfurt Germany took place on May 10, the first news of the Covid-19 broke out on May 23, at which time more than 40 cases were reported in a Der Tagesspiegel article, next day the articles in the Wall Street Journal and the New York Times reported as many as 107 cases (180 parishioners attended the service). A Frankfurter Allgemeine article on May 26, reporting the case was under criminal investigation (Baptisten-Gemeinde drohen strafrechtliche Ermittlungen). Another article on the same newspaper on May 28 reported 200 cases have been linked to this incident.

In response to the huge pool party in Missouri on Memorial Day weekend, Dr. Anthony Fauci said, “One of the things that the people who are out there frolicking need to realize is that when you do that and you see no negative effect in one week please don’t be overconfident. The effect if spreading is not going to be seen for may be two, three or even more weeks.”

The timeline of the case involving the Frankfurt church worship is obviously in line with what Dr. Fauci said.

Comparison of USA and Germany: Revisited

When it comes to the handling of the pandemic President Trump likes to compare the USA to Germany, so do I. He claimed Germany and the United States were “leading the world in lives saved per 100,000.” But according to data from Johns Hopkins University, Germany has one of the lowest mortality rates in the world, at 9.13 deaths per 100,000 people, the United States 24.31 deaths per 100,000.

The venerable Robert Koch Institute

Robert Koch Institute (RKI) in Berlin is equivalent to our CDC. Robert Koch was the first director of the institute that now bears his name back in 1882 when he discovered Tubercle bacillus that causes tuberculosis, for which he received the Nobel Prize for Medicine in 1905. His Koch Postulates (in 1884) practically began the field of the infectious disease.

There is hardly a day goes by without the RKI making an official statement during the corona-crisis: One would read the following headlines in the press all the time.

• „RKI zum aktuellen Stand“ (“RKI on the current situation”),
• „RKI fordert…“ (“RKI calls for…”),
• „RKI warnt…“ (“RKI warns…”),

When RKI speaks, everyone listens: the chancellor, government officials, public pundits and general public. The RKI website is most sought after and consulted by experts and general public alike.

Different story here in America

Upon request by the White House, CDC came up with a 17-page detailed documents of how to reopen America safely, only to be rejected by White House, labeling it “overly prescriptive”. One may suspect that the White House perceives the too cautious and conservative approach may damage the economy which is the top priority of the Twitter King, who just twitted against Pennsylvania governor for the same concern.

To quarantine or not to quarantine, the two leaders in contrast

Around March 22, 2020 German chancellor Angela Merkel went into self quarantine after learning that her physician gave her a pneumonia vaccine injection and was then tested positive for coronavirus. This is a standard recommendation according to the public health officials.

Coronavirus is in the West Wing of the White House. A military valet of President Trump and the press secretary of the Vice President Pence have tested positive. Three high-ranking health officials ( CDC director Dr. Robert Redfield, FDA commissioner Dr. Stephen Hahn, and NIAID director Dr. Anthony Fauci) all went into self quarantine for two weeks, but not President Trump or Vice President Pence.

Chancellor Merkel is a physical chemist (quantum chemistry) who listens to the health scientist whereas President Trump has no knowledge of evidence based medicine and whose reckless recommendation of injection of disinfectant as a potential treatment of coronavirus drew worldwide uproar, condemnation and ridicule.

Merkel and Trump: A comparison in the age of the pandemic

I follow Dr. Christian Drosten (a German virologist, German answer to our Dr. Anthony Fauci) closely. When asked about his assessment of Chancellor Angel Merkel, he responded,

“She’s extremely well-informed. It helps that she’s a scientist and can handle numbers. But I think it mainly comes down to her character – her thoughtfulness and ability to reassure. Maybe one of the distinguishing features of a good leader is that they are not using this present situation as a political opportunity. They know how counterproductive that would be.”

That stirred my interest in reading an article (Warum in den USA die Merkel-Mania floriert?) in Der Tagesspiegel (a German newspaper) that appeared on May 6, 2020. The following is my English translation, which is verified by using various dictionaries and translators.

Angela Merkel and Donald Trump at the White House 2017

Why does the Merkel-mania flourish in America?

The rivalry between Merkel and Trump revived in the coronavirus crisis. Many see the chancellor in the leadership role in the whole world. An analysis.

When the American media put on their pink glasses they see in Angela Merkel as a learned physicist who listens to the advice of the scientists.  With 15 years in the position as the chancellor, crisis-proof, stable and experienced.

Angela Merkel turned sixty: July 17, 2014

She quickly and decisively reacts to the danger of the coronavirus pandemic. The number of the new cases and the Covid-related death have been sharply declining.

In addition: Angela Merkel is calm, moderate and is willing to compromise. Her government also recognizes the global dimension of the crisis.

More than 200 coronavirus victims from Europe—particularly from France, Holland and Italy—have been brought to Germany and have been intensively treated. Germany also provides more than one billion euros to the developing countries to support their struggle against the coronavirus.

Change to the glasses with dark-tinted lenses one draws (portrays) a different picture. There is an ex-real estate entrepreneur and big-mouthed Twitter-King who calls himself the US-president, who knows nothing about science and pandemic-fighting strategy, who first claims he has more authority than the governors of the states, but then take this responsibility alone. [the last sentence doesn't make much sense to me, but that is the best I can translate.]

Trump and Merkel at the White House in 2017

An old rivalry lives on

In addition: The contradiction of his statements does not seem to bother Donald Trump in the slightest. At one time the virus is no worse than the flu, at another time he expects the death toll would be 100,000. At one time he strongly recommends following the rules of social distancing, at another time he would praise the heavily armed opponents/protesters against the shutdown.

Trump rejected the accusation that he instructed the CDC and NIH way too late.

Merkel versus Trump

The old rivalry lives on during the coronavirus crisis. That Trump's severe criticism of Merkel's refuge policy during the American election cannot be forgotten, and that Trump refused the hand-shake when they first met [that is German perception, Trump said he didn't refuse shaking hands with Merkel], as well as Merkel's dry statement:

“The world situation must be sorted according to the US election.”

Between the two, not only is there no chemistry, but also much more than that.

Forget about Washington und Peking

But now in the face of the coronavirus tragedy in the USA, the Merkel-mania flourished. There are several recent headlines in the American media: “Forget about Washington and Peking. The global leadership comes from Berlin in these days” (from Foreign Policy). “Local, practical, unpolitical—but successful German coronavirus-strategy” (from Wall Street Journal). “in a crisis the leadership stands out” (from New York Times).

The TV CNN comments the difference of the transatlantic federal governments: While Trump was having a tough time (“biting the teeth”) over the US-Constitution, the other decentralized country that is more than 6,000 miles away is “getting a completely different leadership lesson”.

The healthcare system is stable, the death toll low, whereas in US by contrast the new cases and death toll numbers soar, and the healthcare system on the verge of collapse.

Also the usually restrained Microsoft founder, Bill Gates criticized Trump and praised Merkel's administration.

In the United States the tests for the would be suspected cases were not necessary priorities. There are no clear instructions as to the restriction of public life activities. Gates said that stop funding to WHO is wrong. Merkel, by contrast, is “a leadership and clear voice” in Germany.

A “Darwinian Situation” is emerged

The New York Times ranked Merkel in the league of those politicians that react in a crisis, “determined, courageous, with respect for the science and with empathy for the basic decency”.

Merkel is for sure not a charismatic and eloquent European leadership figure, but no one can ever doubt her decency/honesty. When she turned to her nation, there is no “pompous or bombastic” in her speech.

In Foreign Policy, the German politics will as the result fill the global leadership vacuum. Normally the United States would take the lead in a global crisis.

But those days has passed for Trump. A “Darwinian Situation” has been established, the states have been fighting one another about the medical protective equipments, medicines and compete for the access of vaccines.

The testing, and the testing only, is the thing

To paraphrase Oscar Wilde’s “The play, and the play only, is the thing” may not be entirely appropriate, but diagnostic testing is the most important thing in fighting this most infectious and vicious coronavirus plague, no doubt about it.

We are learning as we are fighting a novel virus, the learning curve is steep, the price paid is high. This is why I constantly look for exemplary “models” among the countries fighting along with us, or better yet, took the fight before we did.

Widespreading testing is the common denominator of the success
If the low death rate is selected as a measure of success, then Germany, South Korea, New Zealand and Taiwan emerge as the models. There is a common denominator for the success of these countries：wide spread testing.

Mortality rate as of 4/17/2020 according to Johns Hopkins University coronavirus resource center:

United Kingdom    15,498/115,314 (13.4%）
Italy                       23,227/175,925 (13.2%)
USA                       38,664/732,197 (5.28%)

Germany               4,459/143,342 (3.1%)

South Korea          232/10,653 (2.17%)
Taiwan                  6/398 (1.5%)
New Zealand        11/1,422 (0.7%)

Across the globe the success of the curb of coronavirus spread and the relatively low mortality rate are corresponding to the level of widespread testing.

The initial flawed test developed by CDC cost US several precious weeks
WHO delivered 250,000 diagnostic tests (designed and manufactured by German Lab, later proved to be dependable) to 70 laboratories around the world, US health officials decided to go on their own way. Unfortunately the initial test developed was flawed due to contamination; it took several weeks to correct it. CDC also didn’t send virus samples to private labs and university research centers to develop the tests until late February.

U.S. lost several precious weeks in rolling out testing at the crucial moment—at the beginning of this scourge, even Dr. Anthony Fauci so admitted in yesterday’s (4/17/2020) White House press conference.

Without testing capability the U.S. can only play mitigation, not containment

This led to all the “hot spots” to lose the chances of containment, viruses are ahead every step of the way. All they can do is chasing the viruses through mitigation. America is now poised to gradually enter the three-phased economy re-opening, containment is all the more important. Widespread testing capacity is the prerequisite of entering the Phase 1.

Whether we have testing capacity to enter Phase 1 to “open America”, it is all depends on what you read or watch. CDC messed up early on, no doubt. But it has since been ramped up tremendously and the capacity is growing everyday.

Dr Anthony Fauci

Dr. Fauci is hopeful that we have testing capacity to fight the next stage of containment

Dr. Anthony Fauci seemed to be confident that we do have testing capacity to enter Phase I, although he also admitted that his colleagues on the front lines telling him otherwise. He explained that it is most likely due to the logistics, the gap or disruption between the supply and demand. Testing can be more complicated than you thought, supply of swabs and testing reagents can be the issue.

Nobody knows what is considered the adequate testings per capita, but one thing for sure is the more the better, as testing is the only way to “see” this invisible enemy.

Wide spread testing capacity is the indispensable tool for containment, which is achieved by quickly identifying the infected, followed by isolation and contact tracing and this cannot be done without testing in a timely fashion.

The level of testing separates the countries with success and otherwise
The U.S. is not alone running into testing problems. The countries shared the mishap of testing with the U.S. are also the countries most ravaged in this horrendous pandemic, such as Italy, Spain, France and United Kingdom.

Countries (Germany, South Korea and Taiwan) are in stark contrast with the U.S. United Kingdom has medical technology know-how, but lack the scale to mass produce. The healthcare system reform over the past 10-20 years enables Germany to have nearly100 private laboratories that can be mobilized quickly. I read “drive through” test in German newspaper almost one week before I first heard in the U.S. Being a role model though Germany may be, a recent study commissioned by the government said Germany has to speed up the testing capacity in order to gain an upper hand on virus. Lothar Wieler, the head of the Robert Koch Institute (RKI)—equivalent to our CDC—shared the same view.

Dr. Christian Drosten, Jens Spahn, Dr Lothar Wieler

German Minister of Health declared worldwide pandemic on March 4, a week before WHO did on March 11.  Dr. Christian Droston (a noted virologist) is German's answer to our Dr. Fauci, but not his experience.

There was an article on March 3, 2020 the Journal of American Medical Association (JAMA), chronicling the success story of fighting coronavirus in Taiwan: proactive testing is one of the most important tools.

President Tsai of Taiwan on Time

The article in Time President Tsai of Taiwan reporting the success story.

https://time.com/collection/finding-hope-coronavirus-pandemic/5820596/taiwan-coronavirus-lessons/

Some technology issues and concern on testing

Many pharmaceutical giants and biotech companies (Roche, Abbott, Hologic, Labcorp, Cepheid, etc.) rose to the occasions in developing various testing kits. Abbott's NOW COVID-19 takes 5 minutes for positive results, 13 minutes for negative results.  Abbott has had three testing kits so far and is working on the fourth.

This New England Journal of Medicine showing how to do a nasopharyngeal swab, which is more complicated than you thought, one may have false negative result if the specimen is not obtained deep enough into the nose.

https://www.nejm.org/doi/full/10.1056/NEJMvcm2010260?query=featured_coronavirus

The standard way is doing throat and nose swab, it can be labor-intensive and the healthcare worker needs PPE. Germans are trying to do it on sputum, but it requires good sputum coughing up from deep chest and that is not an easy task.

FDA approves a test done on saliva, but a negative saliva test has to be double checked by standard throat or nose swab.

A Q-tip type test kit is being developed and it is funded by Gates Foundation and UnitedHealth. Gates Foundation is also funding 8 of the vaccines being developed, thank you, Bill and Melinda.

All of these diagnostic tests are “approved” through FDA Emergency Use Authorization (EUA), the approval process was expedited at the expense of stringent evaluation. Two days ago a UPMC pathologist reported the Abbott's rapid test can have false negative result when the virus load is low.