Ask the Rev. Doctor Maria

March 24, 2020
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The Rev. Dr. Maria Evans is serving as the Interim Rector at Christ Church in Rolla. She is also a pathologist, board certified in Anatomic and Clinical Pathology, a laboratory medical director, and has served on hospital infection control committees for over 30 years. 

During the coronavirus outbreak, The Rev. Dr. Maria is offering her expertise to help us understand and make our way through this unprecedented experience. If you have a question you'd like to ask The Rev. Dr. Maria, send an email to communications@diocesemo.org

 

Six feet of physical distance?  Seriously?  Why six feet?

COVID-19, like many viruses, infects people by a pattern called droplet transmission. It's long been documented in multiple studies that a sneeze or cough can travel six to eight feet.  An infected person sneezes or coughs droplets in the air, and another person gets the droplets into their nose or mouth, potentially breathing them into the lungs.
 

Yet we're making such a big deal about keeping hands clean.  If this is spread by droplets, why aren't we all wearing masks?

Understanding the effectiveness (and ineffectiveness) of face masks when looking at various studies is complicated, and a lot of the research data is contradictory.  What I'll put out there are a few truisms where we've seen multiple sets of evidence.  The adage is, "Sick people need masks; well people generally don't."
 
1.  Face masks are effective in preventing people with illnesses from spreading their illness; but this is highly dependent on the size of the viral particles, the type of mask being used, and the pattern of facial hair or lack of facial hair.

2.  Face masks are ineffective in a general public setting when not encountering a person known to be ill.  They do have some value when working with someone known to be ill.

3.  People who do not use face masks as a normative part of their work tend to touch them more than people who do; touching them renders them useless, because now a variety of organisms have inoculated the mask.

4.  Our breath saturates a face mask in roughly 20 to 40 minutes, which markedly decreases their effectiveness.
 
It's better to preserve face masks for those who need them -- health care workers and family members of affected people.  Out in public, the benefit is negligible and the drain on health care resources from people buying masks for general use is real.  Covering coughs/sneezes and distancing ourselves from others as a more measurable benefit.
 

Why the big deal about clean hands, then, if we get infected by droplets?

Droplets are how the virus infects us; hands are how we disseminate the virus.  Imagine an infected hand on a person and that person walks much further than six to eight feet, and touches another surface.  Now imagine another person walking by and touching that surface and touching his or her nose, then sneezing close to a third person.  The third person inhales the virus and falls ill.  Viruses hitch rides on our hands and travel much further than a sneeze takes them!  This is why hand washing is so important.
 

There aren't that many cases (or are no cases) in my town.  Why are all these restaurants closing and why is my town limiting the size of groups, or our movements?

Limiting contact with others -- whether it's a personal choice to stay home as much as possible, or limiting social traffic through "stay in place" orders or closure of high public traffic businesses and buildings -- continues to be the most effective way we slow down an outbreak.  We can't catch a virus if we don't have one at home, and stay home.  Ideally, limiting contact is most effective before new cases appear, but "when" is hard to judge. In studying the outbreak in China, though, we saw how strict "stay in place" measures reversed the escalation of cases in Hubei Province.
 
We also know that clusters of cases tend to appear in family groups, and data from China estimates cases there had up to a ten percent risk of another family member becoming infected.  There is value in keeping the virus out of our home, because we know from previous data that we have expected rates of transmission among household members.
 
 
In summary, physically distancing ourselves from one another is not a new way of dealing with infectious agents -- it's been a part of public health strategy since  at least the 7th century BC when lepers were put outside the camp in Leviticus 13:46.  However, we are living into new definitions of it.  At this point, I'm going to take my lab coat off and put my clerical shirt back on.  As faith communities, we have a duty to see Christ in others and be Christ for one another as part of our Baptismal covenant; if the situation is such that individuals in a parish are physically apart from one another, we are called to ask, "How might we be the church at this time?"  We have reams of scientific and social science evidence that "When you isolate the patient, you do much more than physically isolate the patient."  I invite you to have heartfelt conversations within your parish and with lay and clergy leadership on how to "be the church" in these uncertain days.
 
Faithfully,
The Rev. Dr. Maria Evans
who also doubles as
Maria L. Evans, MD, FCAP, FASCP
 
This material is not a substitute for professional medical advice or treatment. The Episcopal Church and its affiliates do not provide any healthcare services and, therefore, cannot guarantee any results or outcomes. Always seek the advice of a healthcare professional with any questions about your personal healthcare, including diet and exercise.

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