“Good fences make good neighbors” is a memorable and salient line from Robert Frost’s poem, “Mending Walls.” While the context of its meaning is a plea for the importance of privacy, it is a useful phrase for the COVID-19 pandemic as we all try social distancing as our physical defense and protective barrier from the Coronavirus. Six feet away from one another and swathed with a nose and face-covering mask seems to be the barrier du jour. It has been that throughout life we must deal with barriers that represent either obstacles, as in the poetic verse of Robert Frost, or provide succor to our existence. In our current COVID-19 world, our imposed barrier, a protective mask, will be critical to manage our new normal prior to a transformative drug or vaccine. In essence, we need a science-driven mask that is effective, comfortable, and re-wearable.
Biologic barriers are present from conception. Surrounded by the amniotic membrane, we are protected from most pathogens. Upon its rupture and our ride down the birth canal, we start the self versus society struggle. Hepatitis B, polio, rotavirus, diphtheria, tetanus, and pneumococcal vaccinations are our initial immune barrier. Childproofing mechanical barriers (plug locks, stair locks, edge protectors) are present during our formative years. Car seats and later seat belts protect us from motor vehicle morbidity. Science has driven these medical protections, and public health measures have orchestrated their distribution to the public and their acceptances as standards of care.
Societal barriers have protected humans for eons from human aggression, accidents, and microbes. The Caves of Lascaux protected Paleolithic man, The Great Wall of China retarded invasion by the Mongols. The Roman emperor Hadrian built his namesake wall in Northern England to keep out the barbarians. Ramparts and moats around European castles in the Middle Ages slowed the devastation wrought by the Vikings. In our lifetime, we put up with anti-terrorist barriers at TSA checkpoints at all U.S. airports. Physical barriers and screening techniques have been shown over time to decrease disease and death from outside threats to our well-being.
Our protection from COVID-19 now demands a barrier to our nasopharynx. We are now safely surrounded by our homes” four walls, and limited world contact through our UPS and Amazon delivery services. In order to integrate into society we need extra protection from the virus. A mask or “facial condom” could provide us with the protection and turn human interaction into an acceptable risk. We are now familiar with the N95, surgical, and home-made masks. We have YouTube videos of media celebrities constructing masks. Now, mask science is the next logical step to assure that our efforts are working to prevent COVID-19 transmission. What we really need is some evidence-based guidelines developed from a controlled study.
The geometry is well known: N95 keeps out 95 percent of particles that are as small as 0.3 microns; droplets containing COVID-19 are 50 microns or less. Droplet spread is 6 feet, more if sneezing or aerosol transmission is involved from the contact. What we don’t know is what materials and layering are most effective against virus spread when used in a real-world scenario.
Compliance and comfort are inextricably linked. When I donned a mask in the OR, my face felt like I was in the microclimate of Miami during the summer, and my eyeglasses fogged up like winter in London. We have designers and aerosol engineers that can overcome wearability issues that could lead to improved compliance. We have industry and universities that have the capability of testing combinations of fabric under simulated and actual environmental conditions. Distribution capabilities are available to send masks to every household in the United States utilizing the postal service.
Americans have internalized the use of seatbelts and TSA screenings in my lifetime. Introducing and complying with a new fence is easier when the alternative may be a painful respiratory death. Wearing a fashionable, comfortable, and effective face mask should become the new normal. The design, efficacy, and distribution is simply just one more barrier for science to overcome.
Lawrence Hurwitz is a gastroenterologist.
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