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  • Writer's pictureDr. Bow Tie

COVID-19: Three Years Later (Pt. 4: MASKS AND MITIGATIONS)

TW: Suicide

The public health emergency (PHE) has been officially declared over. Great - problem solved, right? Well, not quite. The pandemic has not ended - just the PHE. In the wake of that, though, people have started to try and rewrite the history of the last three years. A great many people, including physicians, have found a platform in contrarianism. The truth about COVID is that it's hard, and it DID change things, and it IS still around and making people sick (and dead). There is a path to instant fame in using your platform to peddle pseudoscience and "easy" cures that have no evidence basis, and to question the actual science (which is fine if you're willing to listen to the answers) while touting their own "research" with complete confidence (when even just a little scrutiny shows glaring flaws, but if you call that out they pivot to myths and grift - that's the difference. Scientific communicators like me who actually follow evidence also acknowledge the research's flaws). Let's set the record straight. And don't forget to order your free COVID tests!

Okay, first off, let's dispel two myths up front because these two drive me crazy:

1) Lockdowns were terrible and devastating to our country, and responsible for so much harm.

2) Lockdowns are returning.

We never actually had real lockdowns in the United States. Yes, people were encouraged to stay home, work from home, school from home, and that was difficult. I don't deny that. Still, people could come and go as they pleased and those deemed "essential" saw no break in their work lives. And still we saw hundreds of thousands of people admitted to hospitals with COVID-19, many of whom struggled to survive and many who didn't. Imagine how many would have died if we had not bothered with even pseudo-lockdowns. Or imagine the lives we could have saved if we had done it better.

Lockdowns, masking, home schooling - these things did not directly cause harm. COVID-19 created the situation, and we had to respond to the disease and its deadly nature.

In fact, many folks tried to claim that there was an increase in suicide or suicidal thoughts in children due to school closures. A paper published in JAMA looked at pediatric ED visits and hospitalizations after suicide attempts and found a decrease during school closures, which is consistent with the fact that suicide in school-aged children is actually more tied to the stress of the school year. This is not to comment on the stress of homework and school because that is a whole other article and Tyler Black (See linked papers below) has done incredible work in that arena to acknowledge and address the problem, but only to say that claims that lockdowns caused suicides are false.

The mental health issues, the effects on kids' learning - those stem from the global pandemic and its effect on people. Not from mitigation measures trying to combat said pandemic.

That said, times have changed. We have other tools, even if we choose not to use them, such as vaccines, higher-quality masks, frequent testing, and increased ventilation and air purifier use, to combat COVID spread, and the variants are different, too. So there is not enough evidence to support doing lockdowns again for COVID-19 (though I worry if/when something ever comes along that actually does require lockdowns, that no one will actually do it).

My hospital recently resumed putting masks at the entrances and more widely available at nurse stations. As COVID-19 cases rise in the country, we have seen more admissions in the hospital, and some hospitals are starting to see in-hospital transmission. We are nowhere near the numbers we saw in 2020 or 2021, for sure, but it's still enough to make me glad I never stopped masking at work. I don't just do it to protect me - I do it to protect my patients, and the people I'll see outside of work.

I will not lie to you. Even I have become more lax with masking outside of work. I still wear an N95 from the moment I enter an airport, through the flight, and until I exit the airport at my destination (or maybe get to my hotel). But if you have hung out with me at an outdoor concert recently, or at a restaurant that's not too crowded, you may see my bearded smile. I still mask in indoor crowds, or if the outdoor concert crowd gets thicker. I finally caught a sale on carbon dioxide meters and bought one for myself, which can be a helpful indicator of the ventilation/exposure in an area to help make masking decisions.

Funnily enough, the week AFTER the public health emergency was declared over, the CDC decided that was a good time to finally talk about masking for the first time since the mandates went down, and to talk about the importance of improving ventilation. They waited until after the PHE so that no funding would need to be directed that way - "it's just a recommendation." These are still important, though, and will be key to suppressing COVID-19 spread going into the future. Masks are an individual measure, but ventilation and reducing crowding in work/school spaces is a systemic measure and funding is needed...if our government could see fit to invest in safety.

Myth: I can't breathe in a mask. It makes my carbon dioxide level rise.

This is incorrect, and there are plenty of studies to show that. The studies that do claim to show this do not measure carbon dioxide in any kind of accurate way. Further, the CO2 molecule is significantly smaller than the virus SARS-CoV-2, and the droplets on which the virus is transported (which are blocked by masks). In 2020, before we knew as much about COVID-19, I ran six miles a day in a mask and I am not a pinnacle of athleticism by any means. You may feel anxious or that it is harder to breathe, but that can be overcome with practice and getting used to the mask.


Sure, Martin. I mean, a woman asked me what to do now that her husband had died in the next bed. Many of my colleagues and I held patients' hands as family said goodby to them over the phone. Those kids you mentioned - many of them were orphaned and many died. But sure...a partial face covering was most disturbing.

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