Sunday May 24, 2020 

INTRODUCTION 

Dear Patients, 

This is now our 6th COVID-19 email update for our patients. The 5th one last weekend was really short. Thus, this is the first sizeable update since April 11th. My staff tells me it is hard to read on a phone, so consider a larger device. For a while there was not much new to inform you of. For the past one week however, we have moved into Stage 1, a new COVID-19 mitigation stage in Ontario, yet reopening much more slowly than in Quebec. I’ve heard and witnessed that some people believe and behave as if the COVID-19 threat is over – NOT TRUE.


Just biking down Main Street Unionville, I can see that lots of people are not physically distancing and not wearing masks – in particular, beside a coffee place which has just opened for takeout after being closed for several weeks. One of our former staff members just posted this to Facebook today: "Case count is up there again and many people out without masks and not distancing. (Unionville Main Street looks like the good ole days!) I have a feeling he's going to roll this back, and I hope he does. Maybe then people will realize we need to take this seriously."


My daughter told me that some of her friends equate opening parks and dog grooming to the threat being over – SERIOUSLY??? That’s not what I heard from Premier Ford! What is true is that info can change from day to day and from week to week, so some content in this email may no longer apply in a few weeks' time. Sure, uncertainty is uncomfortable but being careless can be deadly. In addition, many people are at much greater risk due to housing, income and food insecurity. One quote this week resonated with me strongly. “We are not all in the same boat, but we are all in the same storm.” This email will feature a bit of a different format than our previous updates. Lots of your questions will be answered about WHAT’S NEXT for your health care, for our office and for coping with re-opening after the shutdown from COVID-19. There will be lots of reading material, ideas and resources for all ages. 

For starters, one way to cope better is to adopt an “attitude of gratitude”. I am very thankful to have the opportunity to be a resource to my community. We can assist many people to cope better and to stay healthy. I am grateful for the support I have received here in Unionville since 1983. Thus, I will aim to provide a primary health care service level above the average doctor’s practice in this time of uncertainty. With the weather getting nicer, it is getting harder to adhere to all the rules, and with this being said, it is important that you have the information necessary to make the decisions that will keep you and your loved ones safe. These emails can also be found on our website: sportmednorth.com  

To all our patients who fasted during Ramadan, we wish you an Eid Mubarak!  

ANSWERS TO OUR PATIENTS’ QUESTIONS 

In our 5th email update last weekend, we asked you to send us any questions you had about coping with COVID-19 and “what’s next”. We have compiled an anonymous list of the questions, grouped by themes, and we provide the answers below. 

Q: 

There's been conflicting reports about who should wear masks. Should I be wearing a mask at all times while out in public? 

A: 

The short answer: 

Yes and NO.
Yes, wear a face covering, preferably double layered, if you are unable to maintain 2 metres physical distancing. i.e. at the grocery store, on crowded streets or on the Subway. Along with hand washing, these are the absolute necessities to prevent COVID-19.  No regarding mask usage “at all times”. If you can maintain 2 metres physical distancing, then it is not necessary.  

The longer answer: 

It is important that your mask fits well and is worn correctly. However, if you keep taking a mask on and off, you are touching your face too often, potentially with virus on your hands. Your mask protects others from your droplet spread, rather than protecting you from their droplet spread. “My mask protects you; your mask protects me.” I know that it seemed like a big flip flop. I was not a mask proponent back in March. The World Health Organization and the Government of Canada’s health advisers were so wishy washy on this. However, this past week both the Prime Minister and the Premier were both wearing masks. As the newspaper ads and the Ontario.ca/coronavirus website tell us…”We’re making a difference to keep each other safe from COVID-19. As businesses begin to reopen, we all need to continue our efforts to protect each other.” 

• Practice physical distancing. Stay two metres away from others. 

• Wear a face covering when physical distancing is a challenge. 

• Wash hands thoroughly and often. 


“Inside or out, stay safe. Save lives.” 

The much longer answer: 

Should I wear a mask??      

Read this excellent article in the section further below, by James Larson an Orthopaedic Surgeon from Virginia and then decide. 

KEY POINT:Yes, wear a mask or face covering if you are unable to maintain 2 metres physical distancing. 

Q: 

I have heard recently that serological testing is becoming available in Canada. Are you aware of any plans for if / when this will accessible to your patients? For example, I was very ill for several weeks with pneumonia, caused by what was assumed to be influenza, starting at the end of January... I would really like to know if I have antibodies (if it was in fact COVID-19 that I had). Thank you, hope you are all well! 

Q:  

How can I be tested to see if I have acquired antibodies to covid-19? 

A (for the 2 questions above): 

The short answer:  

Serological tests are not yet available in Canada and may give very limited reassurance when we do have them. These tests will not say you are 100% immune or that you will not contract the virus for certain. 

The longer answer:  

No serological tests have yet been approved for use in Canada, but there are three types in development and/or available in other jurisdictions. Some of these tests can indicate if antibodies are present. However, these cannot conclude whether a person is really immune or how long someone may be immune. It is currently unknown how long a patient with antibodies is protected from future infection. Further, serological tests — even with high sensitivity — will include error. 

KEY POINT: these tests are not yet available and may give very limited reassurance when we do have them. 

Q:  

When will it be safe to come in for routine check-ups, booster shots, bloodwork, etc.? 

Q:  

Will there be general testing going forward and if so, how will it happen? 

Q:  

I have a physical in June. How? In the office, or video conference and what about bloodwork? 

Q:  

Hello - I was wondering about blood tests /physicals/mammograms/etc. I'm scheduled to retire in August and at that point I will lose my benefits coverage. Will these types of procedures be able to be done due to my timing or will I need to postpone retirement? Thanks for time - we know you're very busy and Thank You for all for the incredible dedication to your field of choice. 

A (for the 4 questions above): 

The short answer: 


We are aggressively working on alternatives until it is safe for doctors to see many patients in the office again. 

The longer answer:  

We know whose “physicals” have been / will be postponed from March until July.  You will be our priority, yet all patients can expect excellent preventative care. The majority of time spent during those “physical” or wellness visits encompass a preventative approach and coordinate a series of tests or shots as needed, dictated by your age group. We have hired MORE staff to seamlessly collect this info for a virtual visit, which will accomplish many of the same objectives as your prior “physical”. Missing will be blood pressure, weight measurement and listening to your heart, poking your belly, etc. If we can accomplish much of the original visit virtually then your time in the office for the “physical” part is greatly shortened. Family doctors across Canada will be evaluating newer models for preventative care. Quality improvements are the goal across Canada and some virtual care will replace what we have done for decades in our offices. So you will get your blood tests + more, just not here in June.  We can email you the requisitions at any time. You will not need to postpone your retirement. Call us and we will make decisions together. 

KEY POINT: We know that preventative care is a priority and we are planning to create a newer and better delivery model for this aspect of your health care. 

Q:  

Do you expect back to at least 90% within 2 months? 

A: 

“Back to at least 90% within 2 months”…No way! At least not for me. I like going inside restaurants, drinking coffee inside Timmy’s, and watching pro sports with fans in the stands. Laws in several provinces requiring no more than 50 people gathering are still requiring physical distancing; that has not been eased. We will be wearing masks until at least next year when a proven vaccine becomes available. Doctors’ offices will never be the same since we started providing so much virtual care. The public likes it too much! What no 30-60 minute wait in the waiting room??? Most people would say: “Sign me up”. 

Q:  

My wife and I are in our mid to late 60s, almost in the redline/deadline 70s group but in good physical health). We are really torn between starting to see and meet with close family and friends (trying to follow the new reality distance and disinfection rules as much as possible). I think it’s vital for our mental health but is it worth the risk? 

A: 

Don’t be torn about starting to see and meet with close family and friends (trying to follow physical distancing and hand washing rules as much as possible). I agree it’s vital for your mental health and it is worth the risk if you are very careful.  

Q:  

Even if I wear a mask, is it appropriate to visit children and grandchildren yet? 

A: 

The short answer:  


You should visit and maintain 2 metres physical distancing, but sad to say, you should not hug or kiss your grandkids yet. This could change soon. 

The longer answer:  

You may have heard of the double bubble – two families getting together without the same physical distancing recommendations. This revised recommendation may happen soon, however kids may be spreading the virus without symptoms and that is a hazard for grandparents who have a much higher COVID-19 mortality risk. 

Q:  

I'm wondering how to best keep our kids safe when returning to school. Also, as a teacher, what are best practices when I return to the classroom? 

A: 

School in Ontario will be very different when live, in school teaching resumes in September. Older kids will likely need masks or facial covering.  Did you see the South Korea school cafeteria photo this week? They had plexiglass separating each child while eating lunch. Sports teams will be a huge issue. I am sure that the Education Ministry, the school boards and the Public Health experts will have lots of advice for teachers and for schools. 

Q:  

We are no safer today than we were a month ago. Do you believe it is short sighted and dangerous for our governments to be yielding to the pressure to open up? 

A: 

It is hard for me and for other health professionals to find that correct balance between caution, warning, hope and optimism. “No safer than we were a month ago” is correct. “Flattening the curve” has been a success in Canada, except for the absolute tragedy in our nursing homes. If you lived in Italy or Spain it would be safer than one month ago, but many of your neighbours would be dead. With our strategies, our hospitals have not been overwhelmed and we did not run out of ventilators in ICUs, however the first wave was expected to be prolonged. Thus, we are no safer than one month ago, by design. We succeeded in lessening our death rate by staying at home. Now Ontario has moved into Stage 1, the next step, understanding that the first wave was more prolonged than in harder hit regions and countries. Ontario is taking a more cautious approach in order to prevent a large second wave and not all experts agree. Quebec is really gambling with a much quicker reopening strategy. They risk a larger second wave than in Ontario. Yielding to pressure to open up is understandable although risky. However, our economy, deficit and debt have taken a huge beating and there are good arguments either way. 

https://www.theglobeandmail.com/opinion/article-we-must-speed-up-the-recovery-to-avoid-a-depression/ 

https://www.theglobeandmail.com/opinion/article-reducing-covid-19-cases-cant-be-our-only-public-health-goal/ 

KEY POINT: Thanks for all your questions. The weather is so much nicer. Adapt your social gathering and fun with friends and family. Follow the rules (2 metres / no hug or kiss yet) and meet them outside. Go for walks in a park. Do this often but stay safe. 

VIRTUAL CARE 

Our office is able to provide medical care for our patients for almost all of our usual office visit reasons. We have used several methods including OTN, Doxy.me, Zoom, FaceTime and the good old telephone. We aim for the most secure video conference platform, however if the video or audio is failing us then we will switch to another method. Our staff will give you an “appointment” (usually in the afternoon) and then they will call you just prior to the video conference with the doctor. Starting May 20th, our calls will be booked as appointments with 15-minute or 30-minute time slots. We ask that you are ready and waiting for your appointment the same as if you were waiting in the waiting room in our office. We also ask that you be in a location with the strongest WIFI to limit any connection quality issues. Please note, we endeavour to alert you prior to each video conference or phone call. Here is what we will enter into each chart:  

Informed verbal consent was obtained from this patient to communicate and provide care using virtual and other telecommunications tools. This patient has been explained the risks related to unauthorized disclosure or interception of personal health information and steps they can take to help protect their information. We have discussed that care provided through video or audio communication cannot replace the need for physical examination or an in person visit for some disorders or urgent problems and patient understands the need to seek urgent care in an Emergency Department as necessary.  

You may ask, what are these risks and what are the steps? Here is how the OMA suggests doctors explain this...  

We do our best to make sure that any information you give to us during virtual care visits is private and secure, but no video or audio tools are ever completely secure. There is an increased security risk that your health information may be intercepted or disclosed to third parties when using video or audio communications tools. To help us keep your information safe and secure, you can:  

• Understand that this method of communication is not secure in the same way as a private appointment in an exam room.  

• Use a private computer/device (i.e., not an employer’s or third party’s computer/device) and a secure internet connection. For example, using a personal computer or tablet is more secure than at a library, and your access to the Internet on your home network will generally be more secure than an open guest Wi-Fi connection.  

You should also understand that virtual care is not a substitute for in-person communication or clinical examinations, where appropriate, or for attending the Emergency Department when needed (including for any urgent care that may be required).  

By providing your information, you agree to let us collect, use, or disclose your personal health information through video or audio communications (while following applicable privacy laws) in order to provide you with care. 

WHAT’S NEXT/ HOW TO ADAPT TO NEW INFORMATION BEING RELEASED 

 The Ontario government does have a plan on what to do next in order to mitigate COVID-19, and a plan how they will move forward based on results however, the timing is uncertain. The re-open will happen in stages and progression will depend on the success of the previous stage. We entered Stage 1 one week ago. 

https://files.ontario.ca/mof-framework-for-reopening-our-province-en-2020-04-27.pdf 

The Ontario Medical Association (OMA) has created a 5-pillar plan as Ontario reopens. 

https://www.healthing.ca/diseases-and-conditions/coronavirus/omas-five-pillars-are-a-safety-plan-for-ontarios-reopening 

The OMA president describes the 5 pillars and how we must remain vigilant. 

https://www.cp24.com/video?clipId=1962379 


This is a toolkit for coping with kids at home during COVID-19. 

https://www.covidwithkids.org/ 

Kids need active play, every day. 

https://activeforlife.com/ 

But don’t forget SAFE RECREATION: 

Dr. Carson has noticed many children in Unionville and Markham riding their bikes with NO HELMET on. Let’s not focus everything upon COVID-19 and ignore 25 years of safety advice. Parents: STEP UP and keep your child out of the hospital with a head injury! Enforce wearing a helmet for bikes, scooters and skateboards. 

A British Columbia colleague of mine has put together some tip sheets that are very useful and informative: 

1. Tips for Shopping During COVID-19 

2. Practical Tips for People Living in Apartments and Condominiums 

3. Practical, Evidence-Informed Tips About Food 

4. Keeping Your Home Safe When None of You are Sick 

5. Practical Tips for Ride Sharing 

6. and more like these 

A helpful article from ‘The Globe and Mail’ on how to minimize the harms of coronavirus. 

https://www.theglobeandmail.com/canada/article-life-with-coronavirus-cant-be-risk-free-but-we-can-minimize-harms/ 

An interesting article from ‘The New Yorker’ on the safest way to return after a lockdown. 

https://www.newyorker.com/science/medical-dispatch/amid-the-coronavirus-crisis-a-regimen-for-reentry 

SENIOR’S HELP 

This is a great link for those who are isolated and vulnerable in the Eastern York Region and North Durham area (this includes Markham, Stouffville, Uxbridge and Brock). This link can be used to request services online or by phone. Services include grocery delivery, meals on wheels, transportation, personal support and homemaking, telephone safety check, counselling, care coordination, and other services. 

https://eyrndoht.covidresponse.ca/ 

DOWNSIZED SPORTMED                      UPSIZED FAMILY MEDICINE 


Most of our patients are aware of my special interest in sport and exercise medicine. It was hard to miss with our website called sportmednorth.com. For the past 25 years we have welcomed the community into our office even if they were not our family medicine patients. We also welcomed medical learners who were especially keen to assess these sport related cases. Much of my teaching young doctors focused upon the management of sport injury.  

I want to inform you that I am altering my focused practice of sport and exercise medicine, reducing that aspect hugely and increasing our focus upon YOU, our family medicine patients. Please know that this is not as a result of COVID-19 but has been in process for several months. I plan to vigorously continue my family medicine practice. I plan on continuing my role with Seneca College and being involved with the medical care of their varsity athletes.   

WHAT’S GOING ON AT OUR OFFICE 

Linda and Cathy (on most Tuesdays) are working with Dr. Carson in our office. Most of our visits are virtual – video conferencing or by phone. Tanya is working remotely due to physical distancing concerns. We have purchased an additional phone line that can be used as an app from her phone, and it identifies as “Dr. J. Carson Markham”. Despite this ID, Tanya tells me that of 18 calls she made the other day, only 6 were answered! Please note, our staff will be calling you during a pandemic to check up on you and see how you are coping. Please answer your phone, or if you miss our call, arrange by email when you will be available.  

Our family medicine resident, Dr. Julianne Falconi has been working on the front line (emergency department and internal medicine ward) for the past 3 months. I am immensely grateful to her and to all her colleagues who are taking care of the sickest patients. Dr. Falconi will be our resident until her graduation in June of 2021. Because she cannot come here on Tuesday afternoons to see patients in the office, she is working remotely, calling our diabetic patients to check in and to give exercise advice.  

Emma is our new summer intern and she has joined Tanya by working remotely and making these check-in calls. You may be asked about your health card and email address, but you will not be asked for any other personal information such as credit card number or banking information.  This is not a call from the doctor, but it’s from our office and it will address your current concerns, condition and possible needs. 

Many of you have met Carolyn who started working with us on Thursday evenings about 6 months ago. Carolyn is a well-known and highly respected fitness professional in Unionville. Because of her health and wellness expertise, she has been redeployed by Dr. Carson to coordinate our proactive preventive care project. Coming soon, we will be reminding you when you are due for tests or shots by email or by phone. A virtual or real “physical” visit can be booked. Some patients make this a very low priority. Instead of waiting for you to come in and discuss preventive care with the doctor at your “physical”, we will make this process way more effective for our patients.  

WHO’S COMING TO OUR OFFICE 

You may feel frustrated that information for the public seems to change each week. However, Dr. Carson agrees that the latest credible and evidence-informed strategies are wise and prudent to follow. It is important to note that we are not re-opening our office fully yet, as it is still the law in Ontario that only essential medical care is allowed. If you or your baby need a needle or vaccine you will likely need to come in. However, you will be screened on the phone by our staff and will have your visit deferred if you have any respiratory or other suspicious symptoms for COVID-19. We do not have adequate PPE (Personal Protective Equipment) to see any more patients in the office for the next several weeks at least.   

We are carefully following our medical leaders. Family doctors are planning to reopen services in several stages, and we do not know when this will start. When we do start allowing more patients to come back into the office, you will be asked a series of screening questions and if you have any of the symptoms listed below you will not be assessed in our office for the safety of our office staff and doctors. 

Please be honest with the screening questions. One case of COVID-19 could shut us down for a minimum of 2 weeks! 

New Screening Questions as of May 15th:

Michael Ungar heads the Resilience Research Centre in Nova Scotia. https://www.psychologytoday.com/ca/blog/nurturing-resilience/202004/homeschooling-driving-you-crazy-turn-chores-lessons 

https://www.theglobeandmail.com/opinion/article-will-pandemic-babies-live-with-the-effects-of-their-mothers-stress/ 

Mental Health Commission of Canada - Self-care and resilience guide
https://www.mhfa.ca/sites/default/files/mhfa_self-care-resilience-guide.pdf 
 


I started with gratitude and I will end with hope. This esteemed colleague is from Women’s College Hospital and he is the scientific editor of Canadian Family Physician.  

https://www.cfp.ca/content/66/5/312 


I hope that in reading this, you can envision why I want to utilize this difficult time to look for opportunities for improvements. Let’s adopt an attitude of gratitude and care for others, including by heeding good public health advice. Let’s be optimistic, look to improve and move forward carefully. 

=====================================================


 

However, please do not fret, as many people are calling with symptoms on this list which are actually allergy symptoms, and not everyone with pink eye has COVID-19.  

MENTAL HEALTH & WELLNESS RESOURCES 

On April 11th, in our 4th COVID-19 email, we put out a long list of coping resources. You can find that at sportmednorth.com. Two weeks ago, Dr. Carson did a webinar for the student athletes at Seneca College. This resource list, compiled by our summer intern Emma, was made available to those students.  A portion is more focused upon young athletes, but the list contains valuable information for all. 

WEBSITES 

OCFP- The Ontario College of Family Physicians (OCFP) put together a poster to assure you that doctors are still here for you. Many people have been avoiding care since this pandemic started but it’s important to know that doctors are still available to help you. 

https://www.ontariofamilyphysicians.ca/ocfp-getcare-infographic.pdf 

Anxiety Canada - self-help information and this website offers the Mindshift CBT app. THIS SITE IS FREE! 

http://www.anxietycanada.ca  

Mental Health Resources- Premier Doug Ford recently announced FREE programs that are accessible by phone or online to help with mental health and addiction needs. You can find different programs at: 

https://www.ontario.ca/page/covid-19-support-people#section-4 

Mind Beacon – a digital program available to all Canadians for FREE where lift-you-up guidance is offered from mental health experts 

https://www.mindbeacon.com/strongerminds?gclid=CjwKCAjwwMn1BRAUEiwAZ_jnEpyfkQzk2Ya-fSShHw1cbmMdIOdZ2GPiArJc68qVlS6GjrNWa4xsqBoC6I4QAvD_BwE 

CCHMS – the Canadian Centre for Mental Health and Sport offer mental health services as well as a Canadian sport helpline, and many other resources. 

https://www.ccmhs-ccsms.ca/ 

Athlete Self Care- a self-care worksheet developed by Game Plan and the Canadian Centre for Mental Health in sport to help with positive coping strategies and self-care needs 

https://static1.squarespace.com/static/5a31bc2dd7bdce9ea2f21342/t/5e7cc47a470b79446264db05/1585235067134/AthleteSelfCare_Workbook_EN.pdf 

Adapt Worksheet- an additional worksheet on how to adapt to training in a new way. Gives suggestions of ways to change physical, technical and tactical, as well as mental and emotional training. 

https://static1.squarespace.com/static/5a31bc2dd7bdce9ea2f21342/t/5e77966082f4153fcc96b7f3/1584895584354/Adapt+worksheet+%28EN%29.pdf 

Virus facts- The following is a link from the Ontario Medical Association providing information about COVID-19. There is information about how to protect yourself as well as your loved ones, what to do in the event you need help, and tips and tricks to limit the spread of the virus. 

https://www.virusfacts.ca/ 

CSI Ontario-This next link is from the Sport Medicine Advisory Committee directed to and intended for elite or professional athletes. It is updated every Wednesday with news about COVID-19 as well as how, as an athlete, to deal in various aspects of your life. 

https://www.csiontario.ca/news/update-14-advisory-covid-19 

CASEM - The Canadian Academy of Sport and Exercise Medicine (CASEM) has provided an extensive list of helpful resources on ways to cope and adapt to life during this trying time. 

https://casem-acmse.org/resources/covid-19/ 

Stay Active, Stay Safe – a statement from CASEM on access to activity during COVID-19. This is a great source for student athletes as well as family members! 

https://casem-acmse.org/wp-content/uploads/2020/04/CASEM-Statement4PreFinal-Access-to-Physical-Activity-during-Covid-19.pdf

Headspace - offers free meditation for COVID-19 

 http://www.headspace.com 

 CAMH has a resource for coping with stress and anxiety during COVID-19 outbreak  

http://www.camh.ca/covid19?fbclid=IwAR2yWpPt8FDcaLyrtrLe5p3OQ18-xfzZmP3p2je6ZNRVLDhLh8ZJNQ3LPhs  

The American Psychological Association has excellent resources…  

In this podcast, the expert explains why we worry about new risks more than familiar ones, how to calm our anxiety and what are the psychological effects of being quarantined.  

https://www.apa.org/research/action/speaking-of-psychology/coronavirus-anxiety  

also...  

https://www.apa.org/helpcenter/pandemics 

APPS 

Calm App - Now offering free meditations.  

http://www.calm.com 

Nike Training App- fitness app that leads workouts and yoga sessions 

https://www.nike.com/ca/ntc-app 

Strava- fitness app that allows you to track your walk, run, hike, ride, canoe, swim, and more! 

https://www.strava.com/mobile 

Balance - (iOS App store) - Balance meditation app is offering a free one-year subscription. Email access@balanceapp.com for instructions  

http://www.balanceapp.com  

Prana Breath App for Android - Calm & meditate. Free app for guided breathing  

Available on Google Play  

https://play.google.com/store/apps/details?id=com.abdula.pranabreath&hl=en_CA  

Healthy Minds App - Training your mind is the key to your emotional well-being, also free 

http://www.healthymindsapp.ca  

MORE ON MASKS 

Read this excellent article written article, by James Larson an Orthopaedic Surgeon from Virginia and then decide. 

---------------------------------------------------------------------------------------------

Should I wear a mask??  

There has been plenty of debate about wearing masks to help prevent the spread of coronavirus. And with good reason. At the start of this pandemic, we didn’t really have much scientific evidence. And what little evidence we had involved other diseases, like the flu, which can’t be applied to the COVID-19 virus, SARS-CoV-2 or Coronavirus. 

When this all got really bad, I was in Peru, desperately trying to get home the day before that country shut its airports. I was traveling with a handful of other doctors, and none of us wore masks. We were sure that anything other than an N95 was pointless. 

But I was wrong. We were wrong. The WHO is STILL thinking wrong. Because we were thinking backward. We were thinking of how to avoid getting it. But we should have been thinking about how to avoid spreading it.  

Because yes, if an infected person coughs in your face, you are likely to get infected unless wearing an N95 and face shield. But a simple cloth face mask turns out to be remarkably effective at keeping someone’s germs to themselves, especially during the presymptomatic phase of the disease.  

I’m not here to force you to wear a mask, or to call you stupid for not wearing one. I’m just here to show you the evidence that changed my mind. I hope you come to the same conclusion as I did: We don’t have to choose between killing the economy or killing people. With simple face masks in addition to hand washing we can eliminate the virus, reopen the economy, and save thousands of lives all at the same time. 

THE TRUTH ABOUT MASKS 

The truth is that coronavirus is largely spread by respiratory droplets. And homemade masks can block the majority of those droplets. “Healthy” people infect just as many people as sick ones. And places like Austria saw a 90% drop in COVID infection within two weeks of mandating masks. So all of us should be wearing masks. But please don’t take my word for it. I’ve been wrong before, I’ll be wrong again. Instead, look at all the evidence below. 

CLOTH MASKS BLOCK THE PRIMARY MODE OF CORONAVIRUS TRANSMISSION 

First of all, we needed to realize exactly how coronavirus spreads. This is primarily through respiratory droplets which are about 5-10 microns in diameter. Studies tracing the outbreaks in China show that the transmission mode was primarily through these larger droplets. https://www.who.int/news-room/commentaries/detail/modes-of-transmission-of-virus-causing-covid-19-implications-for-ipc-precaution-recommendations 

Still we can’t rule out transmission through aerosols (droplets smaller than 5 microns). But, fortunately cloth masks can block both droplets and aerosols. 

A study from Wake Forest (in publication) shows that home-made masks can block almost all droplets, including aerosols. The better the material, the more droplets they block. The best masks are made with two layers of batik quilting fabric, or else cotton backed with flannel. These block even more droplets than a standard surgical mask, like the one I’m wearing in the photo on this post. https://newsroom.wakehealth.edu/News-Releases/2020/04/Testing-Shows-Type-of-Cloth-Used-in-Homemade-Masks-Makes-a-Difference 

Other studies have shown that unfitted surgical masks can drastically reduce the spread of the seasonal human coronavirus, a much less virulent cousin that causes mild colds. This study shows that even if aerosols and droplets emerge through the mask, they seem to have been filtered of all coronavirus RNA. https://www.nature.com/articles/s41591-020-0843-2#Tab1 

The following video demonstrates the effect on a scale we can see. These droplets are bigger than the ones we’ve talked about so far. I use it only to help visualize what the other studies show on the microscopic scale.  

https://m.youtube.com/watch?v=UNHgQq0BGLI&time_continue=19&feature=emb_title 


And its important to remember, that you have to inhale a certain number of live viruses to actually catch the disease. That exact number isn’t known for COVID. But 1000 is the best guess of virologists. You may think “who cares if the mask blocks most virus? All it takes is one and I get sick.” But that’s not correct.  

https://www.sciencemediacentre.org/expert-reaction-to-questions-about-covid-19-and-viral-load/ 

Blocking most of the virus droplets means the people around you are unlikely to inhale enough to get infected. This is also why being outside is safer than in an enclosed area; the wind spreads your droplets around and people nearby are less likely to get hit with enough live virus to cause an infection https://www.vox.com/future-perfect/2020/4/24/21233226/coronavirus-runners-cyclists-airborne-infectious-dose 

WHY HEALTHY PEOPLE SHOULD WEAR A MASK 


This is a frequent topic of debate. Why should healthy people be made to wear a mask? Well there is one major problem: up to half of those infected with COVID don’t know it, but can still spread it. So you can’t really know whether you are truly healthy. It’s an assumption of health, and it’s often incorrect. 

In fact numerous studies have found that roughly half of COVID infections are transmitted between people before they know they are sick. (These are in process but so is the pandemic.) https://www.nature.com/articles/s41591-020-0869-5 

https://www.medrxiv.org/content/10.1101/2020.03.05.20031815v1 

This asymptomatic transmission is what accounts for people developing infections after lockdowns and quarantines are instituted. 

https://www.medrxiv.org/content/10.1101/2020.04.17.20053157v1 

MASKS WILL STOP THE SPREAD OF THE VIRUS 

Using all of these numbers, new models predict a vast drop in COVID cases with the universal use of face masks. (I know models have been wildly inaccurate, but stick with me just a bit more.) Some actually show it to be far more effective than the economic shutdown we have been going through. In fact they give us hope that with only 70% of the population wearing masks we could extinguish this disease before a vaccine is ever developed. That’s something we can all be happy about. 

https://arxiv.org/abs/2003.07353 

https://news.cgtn.com/news/2020-05-09/AI-modeling-shows-mask-effective-in-COVID-19-prevention-QmaVnIJYaI/index.html 


https://www.medrxiv.org/content/medrxiv/early/2020/05/15/2020.05.09.20096644.full.pdf 

BUT DOES IT WORK IN REAL LIFE? 


Like I said, the last few months have been full of models and predictions whipsawing from one extreme to another. And there are valid concerns that average people don’t know how to use masks or that masks might give us too much confidence, leading to unsafe behavior. But we can look to real-life examples to provide evidence of the effectiveness of masks. And that shows us that masks can be incredibly effective.  

Let’s talk about Japan (we’ve had 10 times their number of cases despite only being 2.5 times as large.) They’ve had no lockdown and closed no stores, but everyone wears masks. And they’ve had days with no new cases reported. But there could certainly be other reasons for their low case levels, such as total testing and differences in reporting. Besides, you could argue that their culture is used to wearing masks and would use them more effectively.  

So instead let's look at Austria, a country with no previous culture of face mask wearing. They made masks mandatory in public starting April 6. Two weeks later, infections had dropped by 90%. https://www.sciencetimes.com/articles/25410/20200421/austria-90-drop-coronavirus-cases-requiring-people-wear-face-masks.htm 

Let’s look at the Czech Republic. They required facemasks in mid March. Within three days, the people produced enough masks at home for every man, woman and child, all 10 million. Coupled with their social distancing, this has kept the total cases in Czech Republic to one of the lowest in Europe, with only 50 deaths. https://www.usatoday.com/story/opinion/2020/04/04/czech-government-implemented-face-mask-requirement-help-combat-coronavirus-column/2940393001/ 

Similarly, Slovakia, the second country in Europe to implement facemask use has had some of the lowest cases and deaths in Europe. https://www.euractiv.com/section/coronavirus/opinion/facemasks-against-covid-19-why-slovakia-became-the-trailblazer/ 

And finally let's look to America. What happens when a hot zone institutes face mask policies? Well Brigham and Women’s Hospital in Boston instituted universal masking of patients and staff, the rate of staff COVID infections dropped by 50%. https://www.wbur.org/commonhealth/2020/04/23/brigham-and-womens-masks-infections 

Other than that, it’s hard to say. Our testing rates are low, case reporting and compiling vary significantly from state to state, and most states only require employees to wear masks when in contact with customers. We really don’t have reliable data from which to draw conclusions. 

WHY NOT JUST MASK THOSE AT HIGH RISK? 

While this seems like a reasonable and simpler solution at first, it is logistically impossible. Most elderly people here live in multigenerational homes and can't afford to live on their own. Even if they stay home, their families will bring COVID home to roost. 

And if we were to round them all up and put them in some sort of protective housing, well that too would be an enormous violation of civil rights. Plus putting many high risk individuals together just means that when a care worker at this facility eventually infects somebody, we will have just set up a slaughterhouse and made the disease that much more likely to kill them all. 

Plus you have the final piece in this puzzle. Unfortunately it's another one that puts egg on the face of the medical community and our assumptions. It turns out that wearing an N95 mask is maybe not the best way to keep yourself from getting sick. Having the infected person wear the mask is. In a study published (and largely overlooked) in 2013 in the Journal of Aerosol Medicine and Pulmonary Drug Delivery, it was shown that even a simple surgical mask on a source of aerosol was better at preventing exposure than an N95 on the “healthy subject.” https://www.liebertpub.com/doi/10.1089/jamp.2012.0998 

This is why the motto in Czech Republic is “My mask protects you, your mask protects me.” 

WHY WE SHOULD ALL BE WEARING MASKS 


Putting it all together, we should definitely all be wearing masks as much as possible in public. Especially situations with high risk of transmission (office buildings, restaurants, parties, bars, nightclubs, public transit, gyms, and religious services). For more info on that, please read this incredibly informative article by Dr. Erin Bromage at Dartmouth. https://www.erinbromage.com/post/the-risks-know-them-avoid-them 

I’ll be the first to admit that the medical profession is playing catch up here. And the inconsistent, conflicting messages have been very confusing. Hell, I’m contradicting the WHO! But I think the evidence is solid. And so do others: 

Face Masks Against COVID-19: An Evidence Based Review 

https://www.researchgate.net/publication/340603522_Face_Masks_Against_COVID-19_An_Evidence_Review

CAN’T WE JUST GET IT OVER WITH? 


I know I sometimes think “I’d rather just catch this virus, get it over with and get back to normal life.” I’m sure many of you do too. Some think that risking infection is their duty to return the country to normal. But that’s letting the virus win.  

Patriots make sacrifices, sure. But not senseless ones. And risking infection is an unnecessary sacrifice because wearing a mask, washing your hands, and keeping 6 feet away is the only sacrifice you have to make. (Well, that and getting your brain tickled by the COVID nasal swab if you have symptoms.) 

I hope you come to the same conclusion I did. I hope we can all agree to make these accommodations. For so long, it has seemed like we would have to choose between our people and our economy. But with this new information, for the first time in a long time, I’m hopeful we can save both. 

Stay safe my friends 

BUILD RESILIENCE 

This TED talk by a New York emergency physician really resonated with me. This was done several months before the COVID-19 crisis. I especially like her green, yellow, red and black analogies. 

https://www.ted.com/talks/darria_long_an_er_doctor_on_triaging_your_crazy_busy_life 

Here are some screen shots from an excellent webinar from CAMH on April 30th:

EXPERT SPORT MEDICINE CARE

Dr. CARSON’S 6th COVID-19 UPDATE

“WHAT’S NEXT?”

​​​ ↑​ SPORT MED NORTH