In my last two emails, I sounded the alarm about the second spike of spread of the coronavirus in the southern and western United States. Apparently, someone heard me.

With the exception of Mississippi, over the last 4 weeks most measures of infection in the United States have improved, in some cases substantially, across the country. This is not to say that things are great, but they are better. We were in a sinking boat, but we just found a bucket to start bailing. And that bucket may be the fact that every state with high levels of infection began to require wearing masks.

The scientific evidence on masks is thin. The efficacy of masks likely varies depending on the properties of the particular virus that the mask is designed to protect against. The size of the viral particle, its ability to spread by respiratory droplets vs hand to mouth contamination both play a role. One compelling study specifically looking at the coronavirus compares the spread in where masks were compulsory vs countries in Europe, where mask wearing ramped up over time, shows the following: Between December 31, 2019 and April 8, 2020, incidence of infection in Hong Kong  was  129/ per million population; in Spain 2983/million, Germany 1241/million, and France 1151/million.  There are of course other factors that influence these numbers.  (Which is why it makes it hard to study masks.)

My thoughts about masks have evolved, but what convinces me they are working is that we have not seen more than a handful of upper respiratory infections in our practice in the last two months, and we usually see a handful every day.  After being in practice for 20+ years it is extremely rare not to see at least a few patients with a cold, sinusitis, bronchitis or a sore throat on a daily basis. Now we essentially see none. On a statewide basis, despite huge increases in human activity in Maryland, evidenced by the return of traffic and cell phone data showing increased mobility, the coronavirus infection rate has slowly declined to under 4%. ICU bed utilization for Covid patients is at its lowest point in Maryland since the beginning of the outbreak in March. Compliance with masks in indoor environments in Maryland, based on my observations is nearly 100%, and it is now the law.

And contrary to what you have heard from many experts, the terrifying combination Influenza/Covid season predicted to begin this fall in the United State may never materialize. Evidence from the southern hemisphere, where winter and the flu season are coming to an end, shows that cases of influenza have been a small fraction of the cases from the previous winter. The drastically lower-case load of flu in South Africa, Australia, Argentina, and Brazil are attributed to social distancing and masks, which have not let the virus spread.  Check out this data

The possible reduction in cases in the US could be wrecked by foolish communities opening schools prematurely, by large gatherings over the holidays, by explosive outbreaks in colleges (already happening in Alabama and North Carolina), or an earlier than expected winter which forces people inside. But there are now indications here and around the country that people are adhering to methods to prevent spread, masks, distancing etc.

In the United States, cases of Covid -19 have declined from about a 60,000 daily average 2 weeks ago to about 42,000 now.  Deaths, which peaked again in late July at about 1500 per day have hovered under 1000 per day for the past few days. Mississippi has the highest rate of test positivity, (28.5%) and the highest number of new cases per day/ population (25.9 per 100,000). Vermont has the lowest rate of test positivity (0.4%) and the lowest rate of new cases per day/ population (0.9 per 100,000. In Mississippi, despite evidence of the state swarming in virus, Governor Tate Reeves did not institute mandatory wearing of face masks in indoor spaces until August 5, 2020, and he remains committed to opening schools in high-risk areas. (Another case of you can’t fix stupid). States that are showing precipitous declines in cases and viral load since peaking in July, including Florida and Arizona, did so after instituting statewide mask laws, closing indoor bars, and banning large gatherings.

So, I think that we have the recipe to get through the next few months until a vaccine, or multiple vaccines become available, likely in the December to January timeframe. Masks are one of the ingredients. With them we can maintain low viral loads while still engaging in multiple activities, without shutting the economy down.

Two quick therapeutic updates: 1) An August 18^th article in the Annals of Internal Medicine reports that autopsy studies from 12 severely ill Covid patients showed that 58% of them had evidence of abnormal blood clotting including large pulmonary emboli (clots in the lungs). It has now become standard practice to anticoagulate severely ill patients who blood test suggest a propensity to form clots. 2) “Pooled convalescent plasma” that is serum from patients who have recovered from Covid-19 which contains antibodies to the virus, has been approved for emergency use by the FDA in severely ill patients. This was standard practice in most hospitals but will expand the availability of the therapy.

The https://severnaparkdoc.com (https://severnaparkdoc.com/) website has been updated and relaunched. On the “patient forms page”, you can see a new photo of Cowboy and Blaze, two of the best, but not brightest, dogs in the world.  Stay safe, this could be over sooner than you think.