Narrator:
0:01
Welcome to MedEvidence, where we help you navigate the truth behind medical research with unbiased evidence, proven facts powered by ENCORE Research Group and hosted by cardiologist and top medical researcher, Dr. M ichael Koren.
Dr. Michael Koren:
0:16
Hello, I'm Dr. Michael Koren and I'm your host for this session of MedEvidence. In particular, we have a wonderful guest here, Dr. John Rowda, and he's joining me for this program called Two Docs Talk about how to look up things. The conversation is always organic when we have these sessions and we really got into a neat discussion about the use of masks, particularly masking during the COVID-19 crisis. I'd like to pick up from where we left off in our last session and talk about actual data. People have these very strong opinions one way or another about wearing masks or not wearing a mask. We both told anecdotes about it, but how to get to the truth? What do we do to actually learn how to advise our patients and how to advise the public? So what are your thoughts on that, John?
Dr. John Rowda:
1:04
Well, we have great problems with people understanding research and looking for quality research, reliable information. One of the simplest things we were talking about is that there are videos of people wearing a mask, not wearing a mask or wearing an N95 and coughing in front of a black screen and seeing the difference of your cough you're transmitting through the air and that picture, the video is worth a thousand research studies.
Dr. John Rowda:
1:36
It works. It works. It stops stuff from blowing out of your mouth. But in the COVID specifically, the virus mostly comes and goes, comes out of you and comes into you to get infected. It's through your nose and there is a huge problem of getting people to wear it over their nose. I don't know if they didn't know, or is there a way of protesting having to wear a mask that I'm not sure.
Dr. Michael Koren:
2:02
It may not be that comfortable for people not used to it, but you bring up some good points. So that video evidence that you describe is something that is fascinating to me because it brings up the point that masks for viruses in particular probably work better for sick people to prevent them from spreading it, rather than healthy people who may be exposed to a sick person. So to be clear, if somebody is sick in a room and has COVID and is sneezing and coughing and filling up the room with virus and you're wearing a mask, it may not be that protective because you're going to get it on your skin, you get it on your hands and at some point you're going to touch your nose and mouth, et cetera, and so you're still not terribly well protected. But that same person, if that we were wearing a mask, particularly an N95 mask, it would prevent that person from transmitting the virus into the room.
Dr. Michael Koren:
2:53
So this concept of healthy people protecting themselves versus sick people protecting others is one of the elements of mask wearing that I think sometimes gets lost. So that's one element of it. Then the other element that we alluded to this, but I think it's important you can weigh in, is that some people are using cloth masks and some people are using paper masks and some people are using surgical N95 masks. So explain to people a little bit more about those concepts so people can have a better understanding of what that means.
Dr. John Rowda:
3:22
Well, the N95 is the best because it has the smallest pores. The cloth masks, the surgical masks, those are three layers and we've heard people say that each layer they'll say that the openings are too big to stop the virus. Well, the virus doesn't know where the holes are. So some of the viruses are going to hit the mask and most of the virus comes out on some sort of a mucus droplet. So you don't even have to stop the virus, you stop the nucleus droplet and you stop the virus. So they are effective, but different degrees of effectiveness. And then to add onto what Mike said, is people oftentimes are contagious, say a day or two before they have symptoms. So that's another reason to wear a mask during a pandemic. Is that not just when you're sick? If you want to try to stop a highly contagious and virulent organism, you have to go with the program.
Dr. Michael Koren:
4:25
Yeah, yeah, sure. And the other thing that I like to remind my patients of is that we're in a COVID time, so everybody's thinking about COVID, but there are other illnesses out there and one of the very interesting parts of the epidemiology of COVID is we found that during the stages of COVID where people were more compliant with social distancing and wearing masks, that flu rates went down, that other viral rates went down, other illnesses went down. So again, masks aren't specific just for COVID-19 virus coronaviruses, but for others. The other thing, the other point I would make, is that masks should be used properly and there were some studies that show that maybe masks didn't work as well as it anticipated and that could be related to using them improperly. So when we use surgical mask paper masks they're meant to be thrown away. You know where they're meant to be worn for a day or for a few hours and then thrown away.
Dr. Michael Koren:
5:22
And I had this issue with a few patients. They'd be wearing cloth masks and I just asked them when was the last time you washed that mask? And inevitability they would tell me three weeks ago. And you know that's obviously defeating the purpose of it to a large degree, in that they have these bacteria laid in pieces of cloth over their face. That can't be a good thing over a long period of time. So not only is it about wearing a mask or not wearing a mask, but actually following a protocol where you understand what the mask is trying to accomplish and then use it properly. Use it properly, and then that makes a huge difference. So we'd like to make those points.
Dr. John Rowda:
6:00
Well, as you're talking, I was thinking about, when you compare, that we see people in the United States, a lot of politicians, comparing how one state versus another did well, the United States did the worst and every state is bad. What do you want to do is compare. How did America do with, say, similar cultures, Canada, New Zealand, Australia? New Zealand stopped it in its tracks. Australia did great, Canada did the closest culture to ours. They did far, far better than we did, and the best was Japan, which had the worst circumstances, the most tightly packed society to transmit a disease. And yet their numbers are the best and they're reliable numbers in those three, those four countries.
Dr. Michael Koren:
6:46
Yeah, all the Asian countries did well, better than the US, including countries that are incredibly densely populated like. Hong Kong is a good example. Singapore is a good example. These are incredibly densely populated places, much more so than any place in the US, and they tend to do well Now. They had the advantage of being exposed to this issue through SARS, and so there was more preparation, more awareness going into it at the beginning, but, to your point, they had much lower infection rates and much lower death rates.
Dr. John Rowda:
7:19
And I think they have a history of that. If you're sick, they have a tradition of wearing a mask in their densely populated areas. So that was not a foreign concept and they knew to cover their nose.
Dr. Michael Koren:
7:31
Yeah, I actually visited Hong Kong in I think it was like 2015, after the SARS scare, and a lot of people in Hong Kong were wearing masks at that point. So, to your point, it was something that was generally socially accepted and you go in the subway there and have the people wearing masks even before the COVID-19 pandemic. So that I think that is insightful. But you know, the other point of that is it wasn't just the mask. So I always like to give both sides of the story. It was also contact tracing. So when somebody got sick, they did a much better job at isolating the person who was sick and then informing all the contacts that they could be at risk and they should separate themselves from people. And I know one of the first countries to be hit by COVID-19 with South Korea, but they did such a good job with contact tracing that they kind of isolated really, really quickly. They had an incident early on where there was a church in South Korea where a lot of people spread the virus and they were able to take all the contacts of those people and separate them from the rest of the population and fortunately, South Korea did extremely well throughout the pandemic because of this concept of contact tracing. That probably would not be accepted in the US for cultural and other reasons, but it does work. You know, these things are proven public health measures that, in fact, can be extraordinarily effective.
Dr. Michael Koren:
8:50
So getting into another element of this discussion has to do with what we do here at Encore Research, which is clinical trials, and I always like to say that clinical trials are our answer box, and in a clinical trial you ask a question and then you just change one variable and you see the change of that one variable makes a difference in the world's results down the road. So for masks, there's different ways of asking the question, but basically what we're asking is under certain circumstances, does wearing a mask protect people compared to not wearing a mask? Or does an N95 mask do better than a paper mask? Or do people in the health care industry wear a mask all the time, or just certain amounts of time? Whatever the question may be, you just change that one variable and everything else stays the same, and we actually have a fair amount of clinical research results from masking and COVID-19 and their mixed results, quite frankly.
Dr. Michael Koren:
9:52
So one of the papers that came out in the New England Journal I believe it was probably late 2020, was a Dutch study that looked at people at home wearing masks versus not wearing masks, and they showed a little bit of a difference between infection rates in a household of people wearing a mask, but not that much, and that was jumped on by people who didn't believe in masks to suggest that masks weren't necessary. But again, that's a tough situation. Where actually living with somebody and who knows what your compliance is and and doing other elements of social distancing and hand-washing and cleaning of surfaces is very difficult on those circumstances. But then there was another study that was done in Bangladesh that looked at randomizing communities. So Bangladesh is a densely populated country in in Asia. There's about 165 million people that live there and a lot of people live in densely populated villages, and the researchers gave everybody in a village randomly masks and compared though that group with people who did not have access to masks in another village, and they clearly show that the villages that had access to masks did better than the villages without it, although it wasn't a huge difference.
Dr. Michael Koren:
11:02
But when the villages got N 95 masks, you saw the biggest difference, and it's always reassuring to see when clinical trial results mirror what your expectations are, and the reason for that is because if you get a result that makes sense, you know it's not only doing a clinical trial, but it's taking that clinical trial result and then matching it up with common sense.
Dr. John Rowda:
11:27
I agree.
Dr. Michael Koren:
11:27
Yeah, so to me, I found that interesting. So, in our next section, I want to explore more about other areas and particularly John has done a lot of study about how people should use the internet and how people should use different resources to come up with best solutions and really this very, very important concept that Mark Twain introduced in the beginning of our program, which is that there's a lot of stuff there that just ain't so.
Narrator:
11:58
Thanks for joining the med evidence podcast. To learn more, head over to medevidence. com or subscribe to our podcast on your favorite podcast platform.
