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. Michael Koren.
Dr. Michael Koren:
0:16
Hello, I'm Dr. Michael Koren and our host today for this MedEvidence presentation called Two Docs Talk About How to Look Up Things.
Dr. Michael Koren:
0:26
I'm very pleased to have Dr. John Rowda, an ophthalmologist and a long-standing colleague of mine, who I've worked with on many clinical trials in the past, to talk about this issue.
Dr. Michael Koren:
0:34
In our first session, we talked about the fact that there's so many biases, there's so much information that people can become overloaded, and we have this tendency in our society, given all this information, to look up things and to find things and to read things that confirm what we already believe, rather than becoming objective about evaluating an issue. And what I'm going to do in this session is bring up one of the most controversial things that we've talked about as clinicians and as people who live in our community and as Americans. T he concept of whether or not to wear a mask and in what circumstances to wear a mask through the COVID-19 crisis. And I know John's very passionate about this and he and I have actually done a fair amount of our own research and have some views that we'd like to share with people. So, John, once you get everybody up to speed in terms of the controversy and, where it's been irrational and rational ways of understanding things.
Dr. John Rowda:
1:31
Well, I'll try to be inflammatory right away. We'll talk about Dr. Fauci, and I follow this stuff and try to research it, and in the early days, when COVID was just coming out, there would be people who discredit Dr. Fauci, saying, well, look at this video and he's saying that we don't need a mask. At that time that was about January, maybe 2020, when the vaccine was just coming out and there weren't. Well, it was not out, and he was talking to the press that we didn't need a mask because all the numbers and information coming from China was that is not a big problem. That's the only information he had. And that's what he was relying to the public.
Dr. John Rowda:
2:13
Well, just a month or two or three later, it was a huge problem. And he still did not recommend that the public wear a mask. Well, the problem was they realized how bad COVID was. There were not enough masks for the ICU workers and the emergency room workers, let alone the rest of the hospital, to wear 24-7, and so he wanted these masks saved for those at highest risk. And later, when the mass production came up, then he started reporting that the public would be safest if they wore a mask. So if you play those three videos with not knowing the background, you think, well, this guy changes his mind all the time. This is awful. Not only that he had a reason for it, but that's, that's a good scientist. When he gets new information, they change their mind. You get new information, good research level one research. You change your opinion, that's a normal scientist.
Dr. Michael Koren:
3:06
Yeah, and great point. And Tony Fauci has certainly been villainized. I've met him on a couple of occasions. He's actually a very nice person. And I think, a sincere person, and unfortunately, he's been at the center of a media storm. But quite frankly, I think he really spent his entire career looking after the public health of US citizens. And I hate it when he's villainized. It's unnecessary because he has no evil intentions. But you know, having said that, maybe he could have done a better job of articulating uncertainty at times and perhaps done a better job of explaining the pros and cons of masks, in particular in some of the other controversial issues with regards to COVID-19.
Dr. John Rowda:
3:51
I looked up more on Fauci and what I saw that during COVID there's 16 national and international medical societies and research societies named him their man of the year. In America he's vilified. Italy and Israel named him their man of the year, for his work on COVID in their country. And here he's a villain. I think it's grossly unfair.
Dr. Michael Koren:
4:17
Yeah, yeah, well, any event, so, we'll go to more, less controversial.
Dr. Michael Koren:
4:22
Well, I am a fan, actually, of Tony Fauci. And he actually did some of his training at Cornell, where I did my training. In fact, I was a chief resident at Cornell and had the same job that he did 20 years after him, so I have that connection with him. But, having said that, I do think he probably could have done a better job in certain circumstances, of explaining the pros and cons, and he was in a tough situation because, you know, he spanned different presidents and different political agendas and you know different media cycles. I t's a very challenging job to do all that. But let's dig in a little bit more. So, even to this day, we don't know if we should be wearing a mask or what the pros and cons are. I want to dig into that a little bit with you, John. I'm going to start with an anecdote of my own. So, sort of during the teeth of the crisis it was probably maybe June or July of 2020, the gyms had just gotten permission to reopen, as your call? It's probably a little bit later, actually, now that I'm thinking about, it was actually September 2020. So let me be precise It was September 2020.
Dr. Michael Koren:
5:28
The gyms had recently been given permission to reopen but there was social distancing. And I went to the gym that I usually go to that was closed literally for three or four months. And I was doing my work on the bicycle, the stationary bicycle, and I was, you know, probably 20 feet away from everybody else. But I was told gently by one of the folks who was a monitor at the gym that this was a mask mandatory session. And I had typically gone to sessions that didn't require masks, even though we were socially distant. So I said, oh, okay, I didn't know that. So I went to my car I actually, you know, obviously I work in a hospital and I had a bunch of different masks. So I brought my paper mask and I brought my N95 mask. And I was interested to see how it would affect my ability to use the bike. So I get there and I put the paper mask on and I'm doing my exercise and I'm saying, okay, that's not too bad. I said, let me take that off and put the N95 mask on and see how I do with that. So I'm taking the mask off and as I'm fiddling with it, the monitor comes by and says please, you need to wear your mask at all times during this mask mandatory session. And I said, yeah, I have no problem with that, I'm just doing a little experiment here. So I put the N95 mask on.
Dr. Michael Koren:
6:42
I have to say it was more difficult to exercise with the N95 mask that has the smaller pores than it was with the paper mask, and probably easier to exercise without a mask at all for a number of reasons. So I'm doing this back and forth and it so happens that I was also very, very involved in the COVID-19 vaccine studies at that exact time. So I was starting to explain to people that these are different masks. And the paper mask has bigger pores. It's really designed to protect people against bacteria and I know you have some interesting historical insights about that. Whereas an N95 mask has a much smaller pore size and maybe works better for viruses, and I was just trying to understand that from a personal standpoint. So it was really interesting.
Dr. Michael Koren:
7:28
A woman came by about five minutes later and she says to me well, I'm glad you brought up a fuss about the mask. She says all this is going to go away after the election is over. She came to me and I said well, no, this is a serious question. We don't know all the answers, but masks have some efficacy. Quite frankly, we're 20 feet away from each other so I'm not that worried. But whatever, I'll wear the mask for now. But I can sort of calm her down and also identify myself as a scientist that's working in this area.
Dr. Michael Koren:
8:00
And then, literally five minutes later, somebody came up to me and he looks at me with derision and he says the problem with this world and this epidemic is because of people like you that won't wear their masks. And I said you know this is what I do for a living. And I started giving him a lecture about masks and pointing these things out. And he turns away and says it's best that you and I just don't talk and he goes off. So it just sort of highlighted the fact that people had their set opinions about masks and really didn't care that much about the data. And you know we're all about the data, so let's get into the data. So give us a little bit of a historical perspective. First of all about the fact that masks in general are a very effective means of preventing the spread of infectious disease.
Dr. John Rowda:
8:47
I read a book about pandemics written before the current pandemic. And the history goes back to about the 1870s. A German surgeon started wearing a mask for all his surgeries and his infection rate went down considerably. And that was starting to spread, which back then spread very, very slowly around the world. Something like 15 years later, the Mayo brothers in Rochester, Minnesota, saw that information and they did that, then they tried to take it up a step and they made everybody in the operating room wear a mask.
Dr. Michael Koren:
9:24
So the Mayo brothers first started by doing their surgeries wearing a mask, which wasn't routine at that time. Notice the dip in their infection levels and then sort of spread the word in the US.
Dr. John Rowda:
9:33
Yeah, and they had the lowest reported infection rates in the nation. People started coming from around the world to have surgery before the age of antibiotics And they had the reputation that people didn't die after having general surgery.
Dr. Michael Koren:
9:47
Yeah, and this was probably the late 1800s, during the time that Louis Pasteur was helping people understand about germ theory, and probably at the same time hand washing became a bigger deal and other measures to reduce infection rates. Just to be fair, there may have been other factors involved, but certainly masking and spreading bacteria through your respiratory cycle was one of them.
Dr. John Rowda:
10:10
And the author of this book compares, t he only pandemic that compares is actually worse than our current one was the pandemic of 1917 in San Francisco. And San Francisco was interesting in the author' s statistics is San Francisco did the best of any city in the United States, partly because it started mostly in Philadelphia, traveled slowly no planes back then across the country, and interestingly to me was that he felt it was the earthquake in San Francisco 10 years before that set the stage. He said the infrastructure was destroyed water, sewer, everything, everything for public health had been destroyed and the public health officials and the politicians created a plan and the citizens followed that plan to recover. So when the pandemic came you had the trifecta the public officials worked with the public health people, the politicians and the citizens believed them. A nd the three of them worked together and they had the best statistics of any city in the nation in 1917 pandemic.
Dr. Michael Koren:
11:18
Interesting. Yeah, it's a lot of interesting things about that. And just for the audience, you're talking about the Spanish flu epidemic that lasted for about a year and a half between probably 1917 and 1919. And you know they call the Spanish flu, but it probably started in the US, Kansas. Although there's still a little bit of debate about that. But it became more known and widespread due to World War I. W here literally, you know, thousands of soldiers were getting sick from the flu, and a particular characteristic of that virus is that it affected young people much more than older people, which is really interesting. So probably older people had some immunity from a previous viral infection that the younger people didn't have. And you know, amongst healthy troops in the US Army there was like a 5% mortality rate or 7% mortality rate.
Dr. John Rowda:
12:10
So they're packed together in barracks. That's exactly true. They think that, yeah, like 30 or 50 years before, there had been a pandemic that wasn't very virulent but, it was the same type of virus, and so old people had protection and the young did not.
Dr. Michael Koren:
12:24
Yeah, and obviously in the COVID crisis it was completely the opposite young people tended to do well and older people can be devastated by it. So every pandemic is a little bit different. And you have to look at the science of numbers and data to your initial point, you have to make adjustments as you learn more. So we're going to end this particular session with that, but I want to bring it back in our next session and then talk about more of the details and different ways of understanding masks and mask mandates in terms of actual data.
