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Scott Webb: This Healthy Hero COVID-19 podcast was recorded on September 17th, 2020. Though COVID-19 has caused many of us to feel helpless over the past seven months or so there are some proven measures that we can take to help slow the spread of the virus. Joining me today to help emphasize the importance and effectiveness of mask wearing and social distancing is Dr. Leo Girio-Herrera. He's an Infectious Disease Specialist at UMUCH. This is the Healthy Hero Podcast from UM Upper Chesapeake Health. I'm Scott Webb. Doctor, thanks so much for joining me. Let's jump right in. You know, there was a lot of confusion at the beginning of the pandemic about cotton masks and whether we should wear them or not. Do they help, do they not? I'm assuming that your take on this is that any mask is better than no mask at all, right?

Dr. Girio-Herrara: Yes. Absolutely. Wearing masks is the right choice as we try to fight COVID-19 and essentially try to decrease the number of cases in our country. In fact, a recent study came out that compared cloth masks with regular surgical masks, and there are a variety of cloth masks or homemade masks. And when you combine them all allowing for the certain level of diversity, they're half as good as a surgical mask, which obviously is a good choice because half protection is there the no protection at all. So I do recommend that people whether symptomatic or not, when they're out in public, be wearing a mask.

Host: And just so we know for sure, you know, because we've heard different things about this, but my understanding anyway with masks is that they not only protect others from you, right? Let's just say that whether you're asymptomatic or not, whether you have COVID or not wearing a mask protects others, but it can also in a way protect ourselves. And I'm trying to understand why is it? Is it because then we're not as inclined to touch our faces?

Dr. Girio-Herrara: Yeah. So it does provide two benefits. The first benefit, which I think most people think of, is that they are protecting themselves from the virus being transmitted to them. And that is true. As we know the Coronavirus COVID-19, it's spread through what we call respiratory droplets. So when somebody has the infection, whether they're symptomatic, pre-symptomatic or asymptomatic, they have what we call viral shedding, which means that the virus is in their airways and the virus is going to come out, either the nose or the mouth when we sneeze, cough. And sometimes when we with regular speech, either loud speech or singing. So when a person has the virus and they wear a mask that viral shedding or that sprinting of the virus essentially is contained to the mask where, which means that everyone around them or near them are not going to have exposure to the virus to a certain degree. Now, the mask doesn't protect all of the virus from coming out. Some small amounts of virus may come out. And the person that's wearing a mask, but they are not sick when they are exposed to this respiratory droplet or when the virus is in the air phone to the ground, the mask actually provides protection because the mask filters the air to certain extent.

It's not a hundred percent filtering device, but it does filter enough that perhaps the amount of virus that the noninfected patient breathes in, maybe a lower amount of virus, we call this an inoculum size. So I'm just picking round numbers right now, instead of maybe receiving or inhaling a hundred viral droplets while wearing a mask, you're only inhaling five viral droplets. It's been shown that the severity of the illness is proportional to the number of viral droplets or inoculum, viral inoculum that you breathe in. So maybe instead of getting a really bad illness with fever that may perhaps puts you in the hospital, when you wear a mask and you breathe in perhaps the virus or you touch the surface. And obviously you're not going to be touching your nose or mouth. That just means that your illness may be much milder and perhaps even asymptomatic. So again, a mask provides protection to the person wearing it when they are not sick, but if they do become sick, they contain the virus to protect those around them. So it is really important to wear a mask during this pandemic situation.

Host: Yeah, definitely. And I haven't heard that, that that's really fascinating that the amount of, pardon the expression, but the amount of virus let's say that you inhale for lack of a more scientific way of putting it, the amount is commensurate with perhaps the severity of your symptoms. That's really interesting.

Dr. Girio-Herrara: Yes, that is interesting. You know, there were, there have been many case studies, you know, over the last seven months, essentially each area that deals with COVID-19 the scientists and researchers essentially look at the factors of each environment and the patients that get COVID and see what we can glean from this. And an interesting recent study was comparing an outbreak in the cruise ship. So cruise ships at the beginning of the pandemic, had only maybe 20 to 40% of patients who get COVID, who were asymptomatic. That means that the majority of them had symptoms and a more recent outbreak in a cruise ship where the majority of people in the ship had masks, the asymptomatic rate was much higher, close to 80 or 90%. What does that mean? That they were infected with a virus, but perhaps because of wearing the masks, their illness was so mild that they were even asymptomatic. So, so the severity of the virus outbreak on an was impacted by whether the people who got infected were wearing a mask or not. And that's very important.

Host: That is really amazing and great information that you're sharing today. When we talk about wearing a mask, it seems to be that not everybody quite, really totally understands how to wear a mask. When we're talking about the homemade or the cotton masks. But oftentimes I see people with the mass covering their mouth, but not their noses. And it's really important, right. That people understand that the mouth and the nose must be covered in order for the masks to be effective. Right?

Dr. Girio-Herrara: Yeah, that's absolutely right. Like I mentioned earlier, a viral shedding or spreading of the virus when somebody is sick, comes through the mouth and the nose, if you're breathing out of your nose or maybe even just sneezing those viral droplets or those respiratory droplets with the virus on them will come out of your nose. And if you don't have the mask over the nose, then it's going to be in your surrounding area. And the respiratory droplets, which are these microscopic droplets of fluid that have virus in it, they can fall on surfaces. And then the next person that comes and maybe touches a door knob, then that viral droplet will be in their hands. And if that person touches their face and that's how the transmission may occur. So it is important to know that if you're wearing a mask and that it should be covering the nose and the mouth.

Host: So, let's shift gears a little bit here and talk about clinical people like yourself, the, the types of PPE that, that you all wear. So maybe you could talk a little bit about the experience of wearing N95s or using pappers or even face shields for long periods of time. What's that experience like? It's probably a bit different than for all of us. Like the worst thing that happens to me is that my glasses get fogged up when I wear my mask. You know, when, especially if I go from the car into a store or something like that, but what's it like for clinical people to wear the really serious PPE stuff?

Dr. Girio-Herrara: I'm going to sugar coat it. It is difficult. You know, when you have a N95 mask, which has to be specifically fitted and it has to fit tightly around your nose and the surrounding of your face. And especially if you are a physician or many and nurses and nursing techs, ancillary staff in the hospital who have 12 hour shifts, you know, they're wearing this N95 masks for you know, let's say four hours on. Maybe they take a 15, 30 minute lunch break and then four hours back on, and then finishing their shift. So these are very long periods of time wearing a tight fitting mask. Now we do it because we know it's the right thing to do and it's keeping us safe. So even though there are many evidences that I'm sure your listeners have seen online on Twitter or anywhere that the mask can leave marks on the Bridge of the nose, that's what we do, because we want to keep ourselves safe in order to be able to provide good care for the patients that come to the hospital. Face shields are the same thing.

You know, they usually wrap around your forehead to the back. And if you're wearing them for a long time, maybe will give you a headache. They'll give you some pain on the sides of your head. And they also leave marks there, although it is uncomfortable, what will be more uncomfortable, which is the sentence that some people say is, you know, the more uncomfortable thing will be to either not wear appropriate PPE or misuse it, and then end up with COVID. And then you ended up in the hospital requiring supplemental oxygen, being intubated. And those are things that are much greater level of discomfort and obviously things that we want to avoid. So, we do what we need to, the science has shown us that N95 masks, their face shields and even the cloth masks that we just talked about, they're effective. So we hopefully are taking the steps to keep ourselves safe, to provide good care for the patients who need it.

Host: Definitely. And all of you on the front lines, the sacrifices that you've made. And I know that none of you go to work feeling like, well, today I'm a hero again, but you know, a lot of sacrifices made and, and what you're describing. I mean, I know just wearing one of my cotton masks, you know, in the store for 20 minutes can start to get a little bit annoying, especially when my glasses get fogged up. I can't imagine, you know, wearing that serious PPE, you know, for the amount of hours that you all do. A really thank you for that. I appreciate it. We all do. Is there any relief coming in terms of more comfortable PPE? Is there anything we don't know, that's on the horizon?

Dr. Girio-Herrara: The work horse in the hospitals N95, there are some N95s that are being developed for longer use and more comfortable use, but I don't see those being a widespread implemented just because of the cost. And, you know, the fact that resources are limited at this point, even just with regular and any five masking. So I am not seeing any large scale change to the type of PP that we're using. Plus we've seen that what we using at this point is very effective. Again, there are some discomforts and some mild bruising, but overall safe and overall tolerable. You know, it is remarkable how adaptable we are. I have a two and a half year old who at first didn't want to wear a cloth mask, but when we go out, he may wear for, you know, two and a half, three hours and he keeps it on. And so I think that if my two year old can do it. I think we can all get used to it. And even though, again, I do understand it it's uncomfortable. You know, I wear glasses sometimes, like you mentioned, they get fogged up. And it is just kind of the, the times that we're living in. So hopefully in several months or a year, we won't have to depend on them as much.

Host: Yeah, I hope so. And as you say, you know, when we sort of weigh these things out, if you way contracting the virus versus the inconvenience or, you know, bruising or whatever it might be, it seems, you know, like kind of an obvious choice, but maybe not for everybody. And these are interesting times we're living in. And I don't know that you know, when we talk about a vaccine, I think many of us would like it sooner than later, you know, today would be great if they could work that out for us. But I don't know how optimistic, how realistic that is. So as we enter the seventh month of the pandemic, what's your level of optimism that we'll see an end to this soon. Is it, and if you are optimistic, is it because of the vaccine or that more and more people are going to embrace wearing masks and wearing them properly and letting them be an effective means of limiting the spread? What's your take on this?

Dr. Girio-Herrara: Yeah, that's a tough question. It's layered. I think my level of optimism depends on really the level of compliance by all of us in the nation to do the things that we know work. So, you know, if we were all wearing masks, I think we'll be in a better spot now, you know, if we all had social distance before we would be in a better spot now. So with regards to the vaccine, I think the vaccine will come out. It's not going to be in the next couple of months, because even if it comes out in the next couple of months, it'll take anywhere from three to nine or 12 months to really distribute nationwide to where it will make a big impact. Just like, you know, the CDC director mentioned yesterday again, the third quarter of 2021. And that's what I've been telling colleagues and family and friends. So that's still many months away. I think what will have the biggest impact at this point is uniformity in mask wearing and social distancing. Those are the things that have been proven to work. And so my hope really is that from a leadership standpoint, that our leaders lead us to right habits, right choices. So we can all come out of this together sooner rather then later.

Host: So great having you on today, Doctor, as we wrap up as an infectious disease specialist, what's your best advice for helping people avoid contracting COVID-19 for helping not to spread COVID-19 what would be your message?

Dr. Girio-Herrara: Yeah, so, I mean, I think it is important to keep in mind that we do still have to live our lives. We have to go to work, we have to go grocery shopping, you know, hopefully we give ourselves a different environments. So we take care of our mental health. So we're going to the park, you know, prison is going to get colder. So, so those choices will be limited, but whatever we do, just like I said, just a minute ago and how we have talked throughout this podcast is if you go out, wear a face mask. And if you do go out and make sure that you are mindful enough to have some physical distancing, some social distancing, and I will certainly at this point, avoid any closed, indoor large crowd gatherings, because it will be difficult to maintain social distance and maintain the benefits of the mask and the distancing. So I think my bottom line message will be, try to live life as fully as we can right now, even though there are many limitations and then just make sure we stick to the basics where mask do hand washing and maintain feet with people that are not in your household. And I think that, that will be a recipe for at least a way to getting through the next few months until we see the light at the end of the tunnel.

Host: Yeah. That's great advice and so great to have a passionate expert like yourself on today. So thank you so much for your time and you stay well. That's infectious disease specialist, Dr. Leo Girio-Herrara for more information visit UMUCH.org/hero. And if you've found this podcast helpful, please share it on your social channels and check out the full podcast library for topics of interest to you. This is the Healthy Hero Podcast from US, Upper Chesapeake health stay well.