Aug. 26, 2020 -- In 1910, 10,000 hunters rushed into a region in northeast China that sits on the border with Russia. They were searching for an animal called a tarbagan marmot that made its home in underground burrows there and was valued for its pelts.

Fur was high fashion in Europe. German tradesmen had recently devised a way to dye cheaper marmot pelts to look like more expensive mink and sable.  Prices for marmot quadrupled, sending throngs of foreigners to scour the forests of Manchuria for the shrieking, toaster-sized rodents, which are relatives of squirrels.

These hunters are the reason we are all wearing face masks today.

Instead of following traditional methods used by skilled marmot hunters, the inexperienced newcomers dug the animals out of their underground burrows. This method, historians believe, brought them into contact with sick animals infected with Yersinia pestis, the bacteria that causes the plague -- one of the deadliest human pathogens.

Soon the hunters began dying in droves, vomiting blood and turning purple. The illness was quick and almost universally fatal. Its victims typically died within 2 days. Records show only a single person survived their infection. It was also spreading quickly. No one knew how to stop it.

When bodies began piling up in the streets of town of Harbin, the Chinese emperor sent a 32-year-old doctor named Wu Lien Teh to intervene. Wu had recently graduated from The University of Cambridge England. He was the first Chinese man to attend its prestigious school of medicine. He brought western medicine and its methods to the frontier town, one of the last stops on the newly built trans-Siberian railway, which had greatly expanded trade between Asia and Europe.  The railroad also meant the disease could travel.

Wu arrived on Christmas Eve, 1910. He quickly performed an autopsy on one of the recent victims. The autopsy itself was a radical act because it violated traditional beliefs about how to care for the dead.  To pull it off, he had to convince a local man to let him examine the body of his dead wife, who was Japanese. The autopsy revealed that the disease had eaten holes patient’s lungs. He also found the plague bacteria in the lungs. It was the first time anyone had seen pneumonic plague, or plague of the lungs.

Unlike previous plague epidemics, which had been transmitted to humans by the bites of infected fleas, this disease was spreading from person to person. Wu realized it was being carried through the air, in respiratory droplets from breath. He wrapped the faces of health workers and grave diggers in layers of cotton and gauze to filter out the bacteria, creating the ancestor of the modern n95 respirator mask. He urged people to cover their faces.

Not everyone believed his theories. A well-known French doctor and experienced plague fighter who had arrived in Harbin shortly after Wu ignored his young colleague’s warnings to cover his face when treating patients. His death, a few days later, grabbed international attention.

“That kind of took the world by storm. Everybody sat up and noticed. From then on, for years, masks were globally important in dealing with respiratory pandemics,” says Jeremy Howard, a data scientist and researcher in residence at the University of San Francisco. Howard stumbled across Wu’s story as he led an effort to compile research on face masks earlier this year.

Soon, everyone was wearing Wu’s cloth face coverings. There was even an international design competition for face masks. Wu’s design won.

“It’s interesting how effective his designs were. Stuff we’re now discovering or rediscovering are what he and his team discovered in the decades from 1911 onwards. He basically dedicated his life to fighting respiratory plague,” says Howard.

The outbreak killed more than 60,000 people in 4 months. By March of 1911, it was over, and Wu was widely praised for his efforts that used masks, quarantines, contact tracing, and other actions to control it. In 1935, he became the first Chinese physician to be nominated for a Nobel Prize. Universities around the world -- including Johns Hopkins in Baltimore -- awarded Wu honorary degrees.

Face masks again played a central role in efforts to control the 1918 flu pandemic. But decades later in the West, at least, face masks were forgotten.

History Repeating

Asian countries never forgot the lessons of the Manchurian Plague. In Asia, wearing masks in public is considered a part of good hygiene. Many people keep them at home and wear them in public if they feel ill, especially during cold and flu season. People seen coughing or sneezing uncovered in public are shunned for shirking their civic duty to protect the health of other people.

It’s no surprise, then, that soon after seeing their first cases of COVID-19, in cities like Hong Kong, which was heavily impacted by the first SARS virus in 2003, and in countries like Taiwan, nearly everyone began wearing masks in public.

The Truth About Face MasksSince the COVID-19 pandemic began, there’s been lots of buzz about covering your face. Here’s the truth about face masks.120

SPEAKER: Since the COVID-19

pandemic began,

there's been lots of buzz

about covering your face.

Here's the truth about face

masks.

I'm not sick.

Should I have to wear a face

mask?

Yes.

COVID-19 can be spread by people

with no symptoms, who don't even

know they're sick.

And as many as 35%

of COVID-19 cases

are asymptomatic.

Wearing a mask goes a long way

to protect people around you.



Doesn't wearing a mask cause

carbon dioxide poisoning?

No.

Wearing a mask

won't cause carbon dioxide

poisoning.

Although an airtight mask might

make it a little harder

to breathe, that doesn't include

cloth masks or N95 respirators.



Do masks actually help protect

the person who wears them?

Yes.

Masks can help block

infectious particles in the air

and reduce the amount you

breathe in.

One study found that wearing

a mask

can reduce the risk of infection

by 79%.



Does wearing a mask cause a drop

in blood oxygen levels?

No.

Doctors wear masks for very long

periods of time, even all day,

in lots of cases.

Masks are designed to be

breathable, and there's

no evidence that suggest wearing

masks will cause

a drop in oxygen levels.



Will wearing a mask weaken

your immune system?

No.

There's zero evidence that

wearing a face mask will lower

or weaken your immune system.



Do you still need

to social distance with a mask

on?

Yes.

You still need to practice

social distancing when you're

wearing a mask.

Every step you take,

like distancing

and good handwashing,

lowers your risk further.

The CDC recommends wearing

a face mask and staying at least

six feet apart from others

to best stop the spread

of COVID-19.



The bottom line?

Face masks are most

likely to reduce the spread

of COVID

when you wear them in public.

Researchers have predicted

that if 80% of us wear masks,

we could do more to suppress

the spread of coronavirus

than a strict lockdown.

So do your part and mask up.

Hartford Healthcare: “Killer COVID-19 Masks? The Truth About Trapped Carbon Dioxide.” University of California San Francisco: “Still Confused About Masks? Here’s the Science Behind How Face Masks Prevent Coronavirus.” American Lung Association: “From the Frontlines: The Truth About Masks and COVID-19.” CDC: “Considerations for Wearing Cloth Face Coverings.” Poynter: “Can the government legally force you to wear a mask?”/delivery/aws/2a/da/2ada2b02-95ef-3bf7-8875-300d91503992/091e9c5e81f8ad71_truth-about-face-masks_,4500k,2500k,1000k,750k,400k,.mp408/10/2020 10:04:0018001200black girl putting on mask/webmd/consumer_assets/site_images/article_thumbnails/video/truth-about-face-masks-1800x1200.jpg091e9c5e81f8ad71

Those places have logged some of the lowest numbers of COVID-19 cases and deaths in the world. Taiwan, which has a population of nearly 24 million, has officially logged fewer than 500 COVID-19 cases and seven deaths.

To date, Hong Kong, which is densely populated with 7.5 million people, has had 4,700 cases and 78 deaths.

“Hong Kong, you know was a kind of a disaster waiting to happen,” Howard says. The government left the borders open to China, even as infections climbed on the mainland. But people decided to wear their masks. Shops required them for entry. Surveys indicate 98% of people in Hong Kong wore their masks and infections stayed low.

Mongolia, a country of 3 million people bordered by China and Russia, also adopted the widespread use of masks early in the pandemic and has reported just 300 cases and no deaths.

As a data scientist, those numbers impressed Howard. “Statistically, these were very surprising results. Not just anomalous, but requiring deep explanation.” At the time, public health officials here did not encourage mask wearing, fearing that supplies would run out for health workers.

Then Howard found a video on YouTube of a man speaking the words “stay healthy” in a pitch black laser scattering chamber. Without a mask, you see green flecks of light fly toward the camera as the person talks in the dark. With a mask on, there’s nothing to see, giving credence to point: Wearing a mask lowers the risk of spreading the virus.

The creators of the video, which was posted anonymously, turned out to be scientists at the National Institutes of Health and the University of Philadelphia. The New England Journal of Medicine eventually published a letter describing the experiment.

“It became really clear that this is actually a really well-done piece of research,” Howard says, “and it’s very obvious that this piece of fabric is stopping the droplets that transmit disease.”

“It’s all kind of added up to a call to action,” says Howard.

As more research emerged about the effectiveness of masks, Trump announced a change in policy on April 3. He said all Americans should voluntarily wear cloth face coverings, though he muddied the message by saying that he didn’t think he’d be doing it himself.

Though the federal government has declined to issue a mask mandate for the entire country, individual states have taken action. Thirty-four require face coverings in public. Mississippi joined the list on Aug. 4, as cases there have surged.

A July poll by The Associated Press—NORC Center for Public Affairs Research found that 86% of Americans reported wearing face masks when they left the house compared with 73% in May.

The mandates seem to be working. A study in the journal Health Affairs recently concluded that mask mandates in states that have them may have prevented between 230,000 and 450,000 new cases. A recent data analysis by The New York Times found that as COVID-19 cases drop in the U.S., the states that are driving those decreases all have some local mask mandates. Many have also paused or reversed their reopening plans, closing bars, gyms and theaters.

There are however, some people who just won’t be convinced.

Christos Lynteris, PhD, a medical anthropologist at the University of St. Andrews in Scotland, who has studied the social significance of face masks, thinks the reasons for not wearing one are more complicated than party politics.

“It’s a complex phenomenon, with different people approaching it from different perspectives,” he says.

“There are, I think, young people who think that this is not their disease, that it’s a disease for old people, you know, it shouldn’t ruin their lives,” he says.

Lynteris says he recently saw a group of young men trading the same face mask outside an ice cream parlor. The store required a face mask for entry, but the friends only had one mask between them, so as soon as one would come out, he would hand the mask to the next guy who would put it on and go in.

“So they are complying, but you know, they are actually doing something that is extremely dangerous and also a mockery of the effort of an entire society,” he says. “I couldn’t believe my eyes.”

For others, refusing to wear a mask has become a visual symbol of being a free-thinker and nonconformist.

Still others view the face covering as Asian and a tool of communist control, Lynteris says. “You know, Asian masks are for the Chinese, you know, they’re not going to reduce us to mindless masses.”

Howard scratches his head at these attitudes, which he knows exist but can’t fathom.

“It seems about as political to me as putting on a pair of socks. You know, it’s a piece of clothing you wear as a basic hygiene measure,” he says.

Research Is Catching Up

Scientists who study bioaerosols -- the tiniest dried droplets of saliva that can carry viral particles and stay aloft for hours -- have jumped to study the effectiveness of face masks and help answer practical questions, like which fabric is best to use and which design is most effective.

One of them is Linsey Marr, PhD, a professor of civil and environmental engineering at the University of Vermont.

Coronavirus in Context: CDC Director Discusses Next Steps in the War Against COVIDWebMD's Chief Medical Officer, John Whyte, speaks with Robert Redfield, MD, Director, Centers for Disease Control and Prevention (CDC), about next steps in the war against COVID.1141

[MUSIC PLAYING]



JOHN WHYTE: You're watching

Coronavirus in Context.

I'm Dr. John Whyte,

chief medical officer at WebMD.

Today, I'm joined by Dr. Robert

Redfield, the director

of the Centers

for Disease Control

and Prevention.

Dr. Redfield, thanks for joining

me.



ROBERT REDFIELD: Great to be

here.

Thanks for having me.



JOHN WHYTE: You're a virologist

by training.

What has surprised you

about this novel coronavirus?



ROBERT REDFIELD: Well, you know,

I think that it's important

that we don't really know

this virus very well.

We just got introduced about

seven months ago.

I think the things that

surprised us the most--

me the most--

was how infectious this virus

is.

You know, when we saw that it

was a coronavirus,

I think we were thinking it was

going to be more like SARS

or MERS.



Or even with the first cases

we identified in the US,

the first 12 cases

that we did contact tracing

in over 850 people, we only

found two of those contacts, who

were infected both spouses.

So we-- we had a view

that this virus was probably

going to be more like MERS

and SARS, but we rapidly

understood that this is a highly

infectious disease.



And I think that's probably

the first thing that surprised

us.

And the second thing

is that, probably for a majority

of individuals under the age

of 50, it's disproportionately

asymptomatic.

And I think those were the two

things that we learned.

I wish we had been invited

in early.

I had asked my counterpart

George Gao, you know, to have us

come join in back on January 3,

to put CDC in to work

alongside him, to try

to understand the outbreak as it

was unfolding in Wuhan.



You know, I think if we had been

able to get in at that time,

we probably would've learned

quicker than we learned here

that, in fact, it is highly

infectious and two,

that asymptomatic disease is

going to be a critical hallmark

of this infection.



JOHN WHYTE: While we're

at 5 million cases.

But as you know, to put it

in perspective

for our listeners,

we're at 4 million cases

roughly, you know, three weeks

ago.

So the trajectory in terms

of the number of new cases

is higher than we would like.

How do you think we got to 5

million?



Is it people aren't doing

the safeguards that they need

to be doing?

Are people not taking it

seriously?

I was told you're in one

of the old war rooms

in the old executive office

building.

How are we doing in this war

against COVID 19?



ROBERT REDFIELD: Well, I think

you're right.

It is a war.

I think the first thing that I'd

like to say

is that we're pretty

confident that this virus slowly

entered the United States

in late January and February.

And there wasn't

extensive infection

throughout February.

We have about five

different lines of evidence

to support that conclusion

that we've published.



But clearly in March, there

started to be more introduction,

particularly from Europe

and basically ceded large parts

of the United States.

When we looked at March, April,

and May, we had about 2 million

infections that were diagnosed,

as you alluded to.

What's interesting, we went back

and do antibody testing

during that period.



We actually had evidence

that, for every one case that

was diagnosed,

there was actually 10 more

infections.

Probably in those first three

months, we actually had

20 million people in.

But if you divide 20 million

by 90 days,

you can see that we're looking

at probably over 200,000

infections a day

even though we were only

recognizing 10,000 or 15,000.



JOHN WHYTE: Dr. Redfield, we're

over 160,000 deaths

in the United States so far.

Do you expect COVID to be

a leading cause of death

by the end of the year?



ROBERT REDFIELD: You know, John,

I think it's-- it's clearly

going to be one of them.

If you looked back and used

our surveillance systems that we

have-- and we have one

that looks death by pneumonia.

And we had either pneumonia,

influenza like illness,

or COVID like illness.

And they really all probably

represented COVID.



At one point in time in April,

early May, 27% of all deaths

in the United States

was caused by pneumonia,

influenza, or a COVID like.

So clearly-- and I can show you

the curve-- a huge spike

when this outbreak hit New York

and then the follow up deaths.

So it's clearly going to be

a major cause of death

in the United States.



Luckily, the mortality

is improving really for two

reasons.

One is we're recognizing more

infections, so the denominator

is different.

But also we really are getting

better as physicians

and managing these patients.

Good recognition

of the hypercoagulable state.

The importance

of anticoagulation.

The recognition that steroids

has a role in advanced disease.



The earlier ability to use

remdesivir.

So the mortality, I think,

continues to decline.



JOHN WHYTE: Yeah.

We've also changed ventilator

protocols as well.

We're not treating it as much as

the.



ROBERT REDFIELD: Very important,

that the agent in ventilator

protocols, as you know.

And I think we've learned a lot

in escalations--

I'm an internist too--

and how to manage

these patients.

And hopefully, we'll

see on the horizon not too

distant--

we'll see

additional new therapeutics come

into add to the armamentarium

that clinicians have.



So-- and eventually this virus

is going to have its day.

It's either going to infect

a majority

of the global population,

or we're going to have

a biological countermeasure,

that's going to be

an effective vaccine, that's

going to prevent it

from affecting [INAUDIBLE].



JOHN WHYTE: [? We only hope. ?]

Let's talk about vaccines.

But first I want to talk

about the flu vaccine.

And you've been talking about

and cautioning how important it

is, especially this year,

to get the flu vaccine as we

fight COVID.

Last year, you know, roughly not

even 50% of those

that should I've gotten the flu

vaccine received it.



How do you think we're going

to do better this year?

And remind viewers why it's

so important this year.



ROBERT REDFIELD: You know, it

is really important.

And I've said if there's

one thing we all can

do besides the importance

of wearing a mask,

social distancing,

hand washing, and be

smart about gatherings-- that

basically ultimately prepare

ourselves, for the fall,

to get the flu vaccine.

As you mentioned, about 47%

people got the flu vaccine.



JOHN WHYTE: CDC often recommends

the goal is 60% to 70%.



ROBERT REDFIELD: That's right.

Yeah, my goal this year

was to get it up to 65%.

And I think one of the messages

we're trying to do

is that really switch it

from the anti vax or vaccine

hesitancy

that the campaign of

to vaccinate with confidence.

You know, and trying to tell

the American public, please

don't leave

this important accomplishment

of American medicine

on the shelf for yourself,

your family, your church, your--

your workforce.



By getting vaccinated,

you can protect your children.

Clearly, when we look

at the mortality

that we see with flu, one thing

is for certain.

The kids who get vaccinated,

they basically get protected

against death.

It also has an impact

on the rest of us

in terms of severity of illness

and hospitalization.



Some people don't realize.

In the last 10 years,

360,000 people died

in this country from flu.

Flu is a major cause of death.

We have

a biological countermeasure

and a vaccine, and we do have

treatment.

And this is the year I'm asking

people to really think deep down

about getting the flu vaccine.



We've worked with industry.

Industry is plussing up

the amount of vaccine they're

going to make available.

So probably over close to 100

million doses this year.

190 million doses.

The CDC and myself, we've

purchased an extra 10 million

doses.

Normally, we only purchase about

500,000 doses

for uninsured adults

to give to the States.



This year, I've purchase

10 million doses

for uninsured adults

of the States

to make sure States can get

this flu vaccine now.

And the real reason is we're

going to have COVID in the fall,

and we're going to have flu

in the fall.

And either one of those

by themselves

can stress certain hospital

systems.



I've seen hospital

intensive care units stretch

by a severe flu season,

and clearly, we've all seen it

recently with COVID.

So by getting that flu vaccine,

you may be able to then negate

the necessity to have to take up

a hospital bed.

And then that hospital bed

can be more available for those

that potentially get

hospitalized for COVID.



JOHN WHYTE: Let's talk

about the COVID vaccine.

How optimistic are you

that we'll see a vaccine early

next year?

And can you give us a better

sense of time frame?

As you know, Russia announced

today, Sputnik V, their vaccine

is approved while they're still

in phase two.

So how realistic

is it that we're going to have

something January, February?

Or are we thinking more later

first quarter?



ROBERT REDFIELD: I'm very

cautiously optimistic that we're

going to have one or more

vaccines deployed

before the first of the year.

Right now, this operation work

speed--

I'm on the board of it.

I've been in vaccine development

all my life.

And the [INAUDIBLE] plus years

I've spent in the military

at Walter Reed

and then at the University

of Maryland, I've never seen

vaccine development move

like this.



There's actually a very

effective

private public partnership

with the private sector.

And there's six vaccines now

that are moving forward

extremely rapidly.

Three of which now are already

in phase III trials.

And I suspect there'll

be a fourth.

So very optimistic that we're

going to have one or more

vaccines available.



I want people to realize,

since we're going so fast,

some people worry about we're

cutting corners.

And really there's

no scientific integrity to cut--

corners being cut.

There's no corner cut

for safety.

The corner that we're cutting

is the investment in being

able to make the vaccine.

So when companies are

ready for phase III trials,

the US government started

production of 100 million doses

of the vaccine,

as if it was going to work.



JOHN WHYTE: But in fairness

and timelines, we're in August.

You know, some of the industry

had 5,000.

They still need 25,000 more

participants to, you know,

reach their phase III

[INAUDIBLE].

People still have to catch

the virus, right?

And then we have a control group

that we have to compare to.



So the timeline is pretty

compressed if we're thinking

of something by the end

of the year.

Isn't that right?

Early next year and then it

still has to be reviewed.



ROBERT REDFIELD: Very quickly,

if there's any light to the fact

of the sudden surge

and the challenge of all

the new cases we're having is,

you know, a number of the trial

sites are up and running.

They started two weeks ago.

They're enrolling very rapidly.

I do think they'll all have

their enrollment done

between now

and the end of September.

And, uh-- and then we'll

see what the data shows.



The other thing I want to say

that's so different and so

important

here is, unlike the trials

that you may have been involved

with, and I know I was involved

with, we're not excluding

the elderly.



JOHN WHYTE: That's right.



ROBERT REDFIELD: So you can

actually get in the trial

if you're 65 or 70-year-olds.

We're not excluding people

with diabetes, and obesity,

and heart disease,

which normally don't get

in trial.

We're not excluding pregnancy.

So the high risk individuals,

that we're hoping this vaccine

is used for, are being included

in these phase III trials,

so we can determine whether it's

potentially going to have

a immunogenicity and safety

in the population at most risk.

Because that's really where we

want to get this vaccine as

quick as possible.



JOHN WHYTE: My understanding was

that there aren't anyone

enrolled under age 18.

Is that right?



ROBERT REDFIELD: You're right

[? there. ?]

The current trials have not

included children.

That doesn't mean there's not

going to be companion trials.

But now all the trials over 18.

But unlike many of them

that I've been involved

in the past that don't enroll

people over the age 45,

this one's enrolling people

all the way up to over 70.

Same

with multiple medical illnesses.



So they'll have to be follow-up

trials for children

under the age of 18,

but clearly, there's

a comprehensive trial right now

that will accommodate the people

that are either most at risk

because of comorbidities and age

or are most at risk because

of their jobs.

You know, there are physicians,

nurses, intensivists, et cetera.



JOHN WHYTE: What does

Thanksgiving look

like this year, Dr. Redfield?



ROBERT REDFIELD: Well, I pray

it is a moment of Thanksgiving.

You know-- you know,

this whole thing started for me

on New Year's Eve.

And I can say it's been--

it's just been all hands on deck

since then

when I got my first call

about the new mysterious

pneumonia in China

on December 31.



Clearly, it's almost a tale

of two cities.

If the American public will

really take to heart what I've

asked,

wear a mask,

the social distance,

to use great hand--

hand hygiene, and to be

smart about crowds,

and we all do that.

And I keep telling people,

I'm not asking some of America

to do it.

We all got to do it.

This is one

of those interventions that got

to be 95%, 96%, 97%, 98%, 99%,

if it's going to work for us.



JOHN WHYTE: Why can't we get

people to wear masks?

It seems like a small price.



ROBERT REDFIELD: Well, we got

to keep trying.

We've got to keep trying.

You know, I was-- it's

interesting.

It's very

different in different cities.

You know, I was recently

in an area where I--

you know, three, four,

five-year-olds were all wearing

their masks.

Every-- all the parents.

I didn't see anybody

without a mask.



But I've been in other areas

where it's the opposite.

We really do need to get

the mask really does work.

It's really important.

So when you ask me what

Thanksgiving's going to be like,

I think it's just

dependent upon how

the American people choose

to respond.

We're going to continue to try

to do what we can to be

effective.



In-- in speaking,

I've said before, when John

Kennedy said, "don't ask what

your country can do.

Ask for what you can do

for your country."

Kind of try to paraphrase that.

For your country right now

and for the war that we're

in against COVID, I'm asking you

to do four simple things.

Wear a mask, social distance,

wash your hands,

and be smart about crowds.



You do those four things,

it will bring this outbreak

down.

But if we don't do that, as I

said last April,

this could be the worst fall

from a public health

perspective, we've ever had.



JOHN WHYTE: Tell us what you

miss, Dr. Redfield.

Is it you miss traveling?

How has this impacted you

personally?



ROBERT REDFIELD: Well, first,

when I decided to accept

the opportunity to be the CDC

director,

I had to give up something

that I really love dearly,

and that's the practice

of medicine.

I've cared for with some

of my patients

with HIV for more than 25 years.

In a way, I'm looking forward

to, when my tour of duty

is over,

get back to the practice

of medicine, because I truly

love practicing medicine.



At CDC, I think what's really

is the intensity of what we're

doing.

You know, love someone

like yourself

to get into the agency

and see how much is going on.

I mean, there are thousands

and thousands of people working

24/7 on this pandemic.

And the fact is that really all

of our focus

is on this pandemic right now.



I have

other important initiatives.

Ending the AIDS epidemic

in America, that the president

started, that we're still

committed to, you know.

But obviously, some

of that effort gets sidetracked.

Getting tobacco use in children.

All the progress we've made

with these cigarettes.

Want to get that back on.



Making progress

on maternal mortality.

You know, there's no reason why

700 to 800 mothers have to die

in this country

every year giving birth

to babies.



JOHN WHYTE: Women of color

particularly.



ROBERT REDFIELD: That's right.

And the progress that we're

trying to make in getting people

treated for hepatitis C, virus

with diabetes.

So there's a lot of programs.

And when you look

at the collateral damage

of the COVID, it is that we've

all had to turn our focus

disproportionately.



I tell my colleagues at CDC,

please, you know, do

the extra effort to keep

the main programs you're doing

moving forward,

which is not a time to lose

ground.

You know, I think the last seven

months have been just,

just as you said before, we're

kind of in a war.

I will say we're in a war.



And I hope people realize,

and one of the things

I recognized when I became

the director, we really haven't

invested, in this nation,

in the core capabilities

of public health.

It's always been something

we left,

you know, for leftovers.

And hopefully, I've tried

to make the argument.

Now is the time to invest

in public health.



Data, data analytics,

predictive data analysis,

laboratory resilience

in our public health labs,

public health workforce.

You know, we have some states

that we're down to less than 40,

30, 20 contact tracers.

And then, of course, we need

to have the emergency resources

to operationalize that

with a global footprint,

and hopefully pick these things

up where they start,

and to put them out

before they become here.



That's one of my hopes

that we'll take from this

is that people now realize

that public health matters.

This nation is going to spend

somewhere between $3, 4, 5, 6,

7 trillion

in responding to this pandemic.

And I do think if--

if-- if we could make

that investment

in those core capabilities, data

lab people.

And make sure we do it

for the whole nation.



I think many people may not

realize CDC is the background

funding for the public health

infrastructure of every city

and every state in this nation.

We need to over-invest.

Get over-prepared.

I will say that--

that in four or five decades

of investment when

this-- when the big one came.



And this is not a minor one.

This is the greatest

public health crisis that hit

this nation in a century.

That we were under-prepared.

And we need to owe it

to our children

and grandchildren

that this nation is never

under-prepared again

for a public health crisis.



JOHN WHYTE: Well, Dr. Redfield,

I want to thank you and all

of your colleagues

at CDC for working tirelessly

to protect us, you know,

during this time

of the pandemic.

And I hope we can check in

with you to discuss some

of those other priorities,

that that CDC is working on,

to really protect and advance

the health of Americans.

And as you said, really refocus

and invest in public health

and public health strategies.

Thank you.



ROBERT REDFIELD: Thank you very

much.

We look forward to that.

God bless.



[MUSIC PLAYING]

John Whyte, MD, MPH. Chief Medical Officer, WebMD, <br>Robert Redfield, MD, Director, Centers for Disease Control and Prevention (CDC)/delivery/aws/dd/69/dd69ddcb-7c98-3993-88bd-ab7bae911a19/Redfield_081120_,4500k,2500k,1000k,750k,400k,.mp408/12/2020 09:37:0018001200Redfield_081120_1800x1200/webmd/consumer_assets/site_images/article_thumbnails/video/covid19-images/Redfield_081120_1800x1200.jpg091e9c5e81f9d5c1

She has been testing different fabrics and fits of face masks and different sizes of droplets -- from the tiny floating aerosols to the fat drops that mimic sputum that fall quickly to the floor after we cough or sneeze.

To do this, she has placed two mannequins about 12 inches apart in a box that looks like a big microwave. The mannequins have been fitted with tubes through their mouths. One mannequin, let’s call it the cougher, is fitted with a nebulizer -- a machine that’s used to turn medicine into a floating mist. Marr uses the same mix of salt water the government requires to test the effectiveness of n95 masks. To generate larger droplets, she uses an airbrush machine and dyes the saline solution red so she can see where it lands. The other mannequin has a tube that gently draws in air, akin to the flow of a breath. She tests them bare faced and then with just one fitted with a mask and then both wearing masks.

The work is still in progress, but she says some things are clear.

First, only n95 masks, the dome-shaped respirators, block the tiniest aerosols, which is why they’re so critical for health care workers who need a high level of protection.

But as the particles get just a little bit larger, around 2 microns in size, “the ones that we think are actually even more important for transmitting disease, almost all of the different fabrics we tested and types of masks block at least half of those,” she says.

And once the particles are up to about 5 microns in size, most fabric masks block about 80% of those, she says.

Marr says if you want a good face mask, the type of fabric doesn’t matter as much as the layers. You need at least two for decent protection. “If you’re doing two layers, the next most important thing is fit,” she says. It’s even more important than the type of fabric you’ve got. Masks should conform closely to your face and completely cover both your nose and mouth.

She said in all her tests, the most effective fabric they found was a microfiber cloth. It blocks something like 80% of even the smallest particles. But the fabric was stiff, and when they put it on the mannequin, there were gaps around the nose and mouth, and in her tests, Marr says it didn’t perform as well as a cotton T-shirt, which they made according to the CDC’s design, and it fit much better.

Marr says the recent controversy over gaiters, stretchy loops of fabric worn around the head, was unfortunate. She’s afraid some people may have given up on them, when it might have been the option they could wear the most consistently. Tests in her lab found they work fine, especially if they’re doubled.

Though Marr’s testing has been comprehensive and well designed, it is somewhat limited because she isn’t working with actual particles of virus. To work with the virus that causes COVID-19, you need a specialized lab called a biosafety level 3 lab. Those labs work under high security to prevent the virus from accidentally infecting the researchers or escaping into the community.

Don Milton, MD, a professor of applied environmental health at the University of Maryland, recently received that high-level clearance for his lab, and he’s just begun to study how the SARS-CoV-2 virus travels in coughs and sneezes. His study is enrolling people who test positive for the COVID-19 infection.

“Our goal is to assess how much virus is being shed into exhaled breath,” says Jacob Bueno de Mesquita, PhD, a post-doctoral fellow who is working on the study in Milton’s lab.

To do that, they will have people cough, sneeze, and speak, with and without masks, into a giant cone Milton designed calls the “Gesundheit machine.”

Results from a different study, which were published in the journal Nature Medicine in May, found surgical masks were effective at blocking viral particles of both seasonal coronaviruses and influenza and concluded that masks could prevent the transmission of those infections.

There have also been case studies that point to the effectiveness of face masks. In one study, two hair stylists infected with COVID-19 in Missouri who both wore masks during their appointments didn’t pass their infections to any of their 139 clients or secondary contacts. Most of their clients were also wearing masks. These are all the same kinds of studies and observations that Wu conducted in China during Manchurian Pandemic of 1911, “of course using the standards of the time,” Lynteris says. Back then, he says, “It’s kind of science fiction stuff.”

Today however, he thinks it should be good common sense.

After masks helped to stop one of the worst outbreaks of infectious disease in history, Lynteris says Wu would be shocked to find that some people still didn’t believe in them.

“As the inventor of this mask, he clearly believed in this very, very firmly,” he says. “He would be appalled.”

WebMD Health News

Sources

Jeremy Howard, researcher in residence, University of San Francisco, California.

Christos Lynteris, PhD, medical anthropologist, senior lecturer, University of St. Andrews, St. Andrews, Scotland.

Linsey Marr, PhD, professor of civil and environmental engineering, the University of Vermont, Burlington.

Don Milton, MD, professor of applied environmental health, University of Maryland.

Jacob Bueno de Mesquita, PhD, post-doctoral associate, Maryland Institute for Applied Environmental Health, University of Maryland School of Public Health, College Park, MD.

“Face Masks Against COVID-19: An Evidence Review,” preprints.org, April 12, 2020.

New England Journal of Medicine, May 21, 2020.

National Academies of Science, "Rapid Expert Consultation on the Effectiveness of Fabric Masks for the COVID-19 Pandemic,” April 8, 2020.

Associated Press-NORC poll, July 23, 2020.

Health Affairs, August 2020.

MMWR, July 14, 2020.

Nature Medicine, April 3, 2020.

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