September 27, 2020 – Maskless States

Talking with patients and friends over the last few weeks, I was struck by the agreement on the importance of wearing masks when we are out and about, especially indoors, from people of all political persuasions. This got me thinking about how mask laws differ from state to state, and how that correlates with infection rates from the coronavirus. Fortunately, there is Google to answer that very question.

Currently, thirteen states do not have mandatory mask laws, though some do encourage wearing masks. Other states do require masks, and all of the states in the Northeast and Mid-Atlantic regions have had this requirement for several months, without exception. Here are the rates of infection per 100,000 population for the group of states without the law, and for the states of the northeast corridor.

No Mask LawNortheast /Mid-Atlantic States
Florida 81Virginia67
Missouri180New York29
North Dakota         364Delaware73
South Carolina156Rhode Island65
South Dakota304Vermont5
Tennessee135New Hampshire15
Utah          208Maine16
Georgia     89

I will leave you to draw your own conclusions from this data. But remember, these numbers are per 100,000 population, which is probably the most useful way to compare caseloads between states. Also, you will notice that the rates are highest in the maskless states that have low population densities, like North and South Dakota which early on thought the virus would never get there. Vermont and New Hampshire have low population densities as well, but with masks their rate of infection is at least 90% lower than that of the Dakotas.

Wearing masks is a pain in the derriere, but the more data I see, and the more observations I make, I am more convinced that this is what can keep this infection at bay until the spring, when a vaccine becomes available. Mask wearing also allows us to keep the economy going – there are very few things you cannot do with a mask on. Flying on a plane with a good mask is safe, as evidenced by the lack of infections in airline crews. We can likely attend sporting events with a mask, especially outdoors, without fear of transmitting the virus.

So, armed with this useful information on how we can conduct our lives safely for a few months, why are infection rates going up in some parts of the country? Here’s a clue:

Yes, the gentleman at the podium is the President of the United States, hosting an indoor campaign event for over 2000 people in Nevada earlier this month. The people are in close proximity, not wearing masks, with many shouting accolades to the leader of the free world. Regardless of your political leanings, most polite people might say to themselves “I don’t think this a very good idea” and the rest of us might say “WTF?” Not only is the President exposing this room full of supporters to a potentially lethal infection, he is: a) exposing himself, to aerosolized infection in an indoor venue, without a mask, b) sending a message to the country that that it is ok to gather in large crowds, shout and not wear a mask, and c) exposing everyone who attended the rally, to the rest of the population.

Not wearing a mask in public is not like refusing to wear a motorcycle helmet. That act increases your risk of splattering your brains across the asphalt, but you do not put anyone else at risk. Maskless people are more like drunk drivers, who threaten not only themselves, but everyone else in their path.

Infection rates, after coming down a bit in the United States over the last few weeks are now going back up in 30 out of 50 states. In the northeast, despite having the highest population density in the country, rates are low and going down. Governor Ron DeSantis of Florida instituted mandatory mask wearing and closing of indoor bars in late July, when the state was about to go up in a viral inferno. Rates of infection rapidly came down. This weekend he opened everything back up, before the viral load was in a safe range, and withdrew the mask restriction. That, as literally millions of snowbirds are about to return to the state for the winter. He will be responsible for the sickness and death of hundreds of people. He should not be in charge of the county dump, let alone one of the most populous states in the country. And finally, according to Dr. Scott Gottlieb, who appeared on a news program this morning, Quest and Lab Corp have been conducting anonymous sampling for antibodies to coronavirus on samples sent in for other routine blood work. He reports that the infection rate in these random samples in around 10% on average for the United States. This would mean that about 33 million people in the U.S. have been infected. Current positive cases in the United States have tallied at 7 million as of today, which means that about 80% of people that have had the disease have not been tested.  With current deaths in the U.S. at about 200,000, the real death rate for Covid is 200,000/33 million or about 0.7%, which would make it about 7 times as deadly as the flu. At a 0.7% death rate, without a vaccine, assuming 60% of the population in the U.S. would have to become infected to achieve herd immunity, about 1.4 million people would die in that process. This is more yearly deaths than occur from heart disease and cancer combined in this country. So, let’s all hope that at least one of the vaccines will work.

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