Dean Hashimoto - The Case for Masks

Copyright 2020 by Dean Hashimoto

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Library of Congress Cataloging-in-Publication Data is available on file.

Cover design by Daniel Brount

Cover image courtesy of Shutterstock

Print ISBN: 978-1-5107-6523-8

Ebook ISBN: 978-1-5107-6556-6

Printed in the United States of America

Contents

Introduction

This book explains why masks are the most important public health tool for controlling the coronavirus pandemic. It describes the scientific research that supports universal masking, including observational studies, population-based analysis, and biosafety studies. It provides practical, science-based guidance for living in the pandemic. This guidance will be invaluable in the short and longer term as the coronavirus is likely to persist for more than the short term and may become endemic, similar to influenza epidemics.

I write this book from the perspective of a physician specializing in workplace health in a large health-care system with more than 75,000 employees. After medical school, I sought specialized medical training in Boston including at the Brigham and Womens Hospital and the Harvard School of Public Health. I began my medical career as a staff physician in the Pulmonary and Critical Care Department at the Massachusetts General Hospital and later specialized in care for the health-care workforce at the Mass General Brigham hospital system, where I am the chief medical officer overseeing the Workplace Health and Wellness division. This division provides clinical services for health-care workers, supports injury and illness prevention programs, and conducts research in association with the Harvard Center for Work, Health, and Wellbeing.

I base this book on the experience of serving in clinical and physician executive roles in protecting the health-care workforce during the coronavirus pandemic. Our hospital systems strategy was highly focused on implementing key CDC guidelines. The danger of trying to reduce all potential health risks to zero is the failure to prioritize the safety interventions that will have the most substantial impact. We took the practical approach of emphasizing key CDC recommendations and implementing them extremely well. Our published study in the Journal of the American Medical Association describes the unexpected high success of the universal masking of health-care workers and patients in our hospital system.

Contrary to the beliefs expressed in the popular media and by some medical experts, I do not think we should entirely rely on the development of a silver bullet that will instantly and magically make the coronavirus pandemic disappear. As I explain in the last chapter, we should not expect vaccinations or drug treatments to necessarily immediately halt this pandemic and its continuing danger and risks. Rather, our best available tool to control the pandemic over the next several years may be based on universal masking. We can diminish this pandemic and normalize our activities if we mask appropriately and regularly wash our hands.

While masks are a key public health tool, this book provides practical science-based advice about related helpful behaviors including social distancing, avoiding high-risk environmental situations, flu shots, and self-isolation if you develop symptoms. This practical how-to advice includes guidance about what types of masks are effective, the best way to wear and fit a mask to your face, special precautions that should be taken for children and in households, as well as safety concerns about masking. These are issues familiar to me, as I have answered literally hundreds of emails from concerned employees and patients.

It is important that science provide the primary guidance for how to live and thrive in the coronavirus pandemic. Scientific knowledge related to the pandemic has developed at a breathtaking rate. Since Chinese researchers published the RNA structure of the coronavirus in January 2020, the scientific knowledge base has expanded rapidly, providing invaluable data for practical application.

Unfortunately, the public has not sufficiently benefited from this scientific and medical knowledge. Instead, theyve become overwhelmed by the constant drumbeat of daily reporting by the public media over the internet. Public leaders have provided conflicting information driven by political considerations. This inconsistency in messaging, along with the evolving nature of scientific research and discovery, has confused the public, as has the preponderance of fake scientific news online.

A problem with modern scientific news is that it is impossible for the public to understand the medical or public health context of particular issues. It is difficult to know what science is important and how much scientific evidence is sufficient to provide guidance on how to live in the coronavirus era. This book provides guidance about a strategy for daily living based on scientific data. It not only provides the science behind the guidance for universal masking, but also more specific information about the types of masks and the environmental context for wearing them. It provides a fundamental understanding of the science so that you can make decisions based on your own individual assessment of your risks and medical vulnerability.

Universal mask wearing is necessary to reduce substantial risks of infection within our communities and borne by individuals. We need to create a new culture of community safety that successfully defines individual boundaries, rights, and responsibilities based on shared scientific understandings. We should develop community standards so we can move forward after reopening our communities and establish a new normality in our social relationships and work practices.

In the first chapter, I describe three striking examples from the pandemic spread that are based on scientific reports of observational studies. Observational studies are fundamental to epidemiological research, particularly in studying the impact of environments on health. In an observational study, the scientific researcher observes individuals to measure associations between exposures in the environment and health outcomes. Such studies may be especially important in studying rare eventssuch as the current coronavirus pandemicwhere collected data can reveal likely associations and their real-world implications.

CHAPTER 1

Stopping the Coronavirus Pandemic: Three Case Studies of Failure and Success

A Choir Practice, March 10, 2020