The city of Idaho Falls and the Eastern Idaho Public Health District are to be commended for their measured approach to public masking with the COVID-19 Regional Response Plan. Because of simple, clear metrics that the public can understand, the decision by EIPHD to mandate public masking is perceived to be science-based rather than as arbitrary and political.
Any decision they make on public safety policy must be defensible. The most defensible decisions will be based on best available science and a risk/benefit analysis. Unfortunately, both of these institutions are being pressed to make decisions based on incomplete and often, in this case, obsolete information and guidance by public institutions like the Centers for Disease Control and Prevention (CDC).
For example, the World Health Organization and the CDC are overly cautious regarding the role of airborne transmission of the COVID-19 virus. Neither organization has provided guidance. This reticence presents the state, city and our regional health districts with the dilemma of possibly acting on plausible scientific information that has not been vetted by our scientific, medical, or political institutions.
The scientific evidence for airborne transmission is compelling and needs to be addressed according to 239 scientific and health experts. For example, one person, without symptoms during lunch, caused the infection of nine other people in a Guangzhou, China restaurant. Droplet and contact transmission within the restaurant were easily ruled out for five of those infected. The unique airflow pattern within the restaurant, carrying infective aerosols, is the only plausible explanation for their source of infection.
The W.H.O. has not changed its stance that droplet and contact transmission are the predominant means of spread but did note: “[S]ome outbreak reports related to indoor crowded spaces have suggested the possibility of aerosol transmission, combined with droplet transmission, for example during choir practice, in restaurants or in fitness classes. In these events, short-range aerosol transmission, particularly in specific indoor locations such as crowded and inadequately ventilated spaces over a prolonged period of time with infected persons cannot be ruled out.” The CDC has not provided guidance on the role of airborne transmission other than to admit it may be possible.
Nevertheless, the city and EIPHD should seriously consider this evidence for future public policy actions or recommendations. This is especially important with respect to opening our schools. Three teachers in Arizona became infected with the virus. They reportedly shared a single classroom for about two hours to provide on-line instruction for their students, wore masks, socially distanced and followed recommended hygiene practices. One of the teachers died and the other two have been slow to recover. The details are not available. Airborne transmission within the classroom may not be responsible. But the incident should give us pause to closely examine the heating and ventilation systems in our school buildings.
Clearly mask mandates can stop COVID-19 spread. But only with a high compliance rate. The lower the compliance rate, the lower the effectiveness. But a blanket mask mandate ignores growing evidence that roughly 80 percent of infections are caused by 10 to 20 percent of those who are infected. If true, this translates into one individual infecting 4 to 8 people rather than the population average of about 2.5 infections. On June 18 at Harpers Restaurant and Brew Pub in East Lansing Michigan, there were 225 people on two floors. The number of infected people at the start of the night is unknown, but 144 of the 225 patrons became infected that night. They went home and now 187 infections have been traced back to that one incident.
One unmasked infectious individual outdoors on a packed sidewalk may infect one or two others within six feet. Whereas one unmasked infectious individual in a crowded, poorly ventilated bar, nursing home or school might infect 4 or more persons. One or two new infections a day will not overwhelm our health care systems. Four or more new infections will.
Hopefully, the current mask mandate will give us time to fully understand and control this virus.