Steven C. Amstrup, Ph.D.: Lessons on contagion: It’s the distance, stupid

“What are they trying to protect us from?” he said in a loud voice meant not just for the clerk to hear. “I don’t know anyone who has caught this disease, let alone died from it!” As he swiped his credit card, he continued his complaints about wearing protective masks in a quieter tone. Well, let’s see: we’ve lost over 200,000 Americans to this new Corona virus–more than three times the number of soldiers we lost in Vietnam and the equivalent of three jumbo jets crashing to the ground every day since March. Continuing that trend is what “they” are trying to protect us from. Those of us who live in the less densely settled parts of the country, where relatively few are world travelers, can be thankful that we’ve thus far experienced very low Covid-19 infection rates and have not had to watch as hundreds of our fellow citizens have sickened or died. Instead of viewing the low Covid-19 infection rates in rural America as a blessing we should protect, however, I’ve been surprised to see the resistance of many rural residents to simple health guidelines that will continue to afford us that protection.

Covid-19 is mainly spread through the air when aerosols and droplets, which we all expel as we breathe and speak and which can contain viral particles, land on the permeable tissues (eyes, nasal linings, mouths) of others. Because contaminated particles can travel several feet before settling, maintaining a distance of at least six feet from anyone, whose exposure history we don’t know, lowers our risk of exposure. While wearing a mask, exhaled particles are blocked and slowed in their travel–reducing the exposure distance to a matter of inches rather than several feet.

Experience shows that masks and other social distancing measures dramatically reduce exposure risks and deaths. South Korea and the U.S. both confirmed their first cases of Covid-19 on January 20. The government and South Korean citizens took the threat seriously and immediately engaged mask wearing, widespread testing, and contact tracing. In contrast, the Trump administration called the virus a hoax and even now is not taking it seriously, with the result that the total per capita death rate in the US is over 100 times that of South Korea. This summer, after social-distancing restrictions were prematurely relaxed in Texas, Arizona, and Florida, Covid-19 cases surged. But they fell dramatically when distancing requirements went back into effect. Taking care to maintain our distances will not prevent all infections, but can reduce infection rates to levels that we can trace and manage as we reopen the economy. The evidence is clear: wearing masks dramatically reduces exposure. And the recent flurry of White House exposures reminds us that not wearing masks elevates everyone’s risk–so why don’t we follow the evidence? The United States is the most medically advanced nation in the world, yet because the Trump administration has failed to provide Americans consistent evidence-based guidance, we’ve experienced the most Covid-19 deaths of any nation.

Making America first in Covid-19 deaths is not something to be proud of, but we can change our path. Countries hard hit early in the pandemic have shown that focusing on common-sense distancing, testing and tracing drastically reduces disease and deaths. In Europe, Italy was the hardest hit, by Covid-19, early on. Yet, once they took the threat seriously, Italians got the outbreak under control. Now, the daily death rate in Italy is in single digits while we are still seeing nearly 1,000 new deaths each day in the U. S. Similarly, current daily per-capita deaths in Germany, also hit hard early on, are only 1/50th of our daily fatality rate. And by following scientific evidence, German kids are back in school! We can’t know how many of our loved ones we might have saved, had President Trump provided proper guidance from the beginning, but evidence shows that by wearing masks and being smart about how we interact with people whose histories we don’t know, we can dramatically reduce exposures going forward.

We have the experience and the wisdom to stop behaving as if we are stupid. The evidence is clear: We can protect our rural advantage, and save lives while reopening our economy. To do so, however, we must make testing–with rapid results–universally available, engage the best practicable contact tracing. And most importantly, we need to wear masks and take other precautions to control our distances from those we don’t know.

Steven C. Amstrup, Ph.D., lives in Kettle Falls, Washington.