{uplifting music}
Today we have uh with us Dr. Matt Stiegel and
Dr. Cam Wolfe and Matt is the head of OESO and Cam is an associate professor in
medicine, who is an infectious disease doctor
who's been on the front lines of the COVID care in the hospital.
What I wanted to talk with them about
today was a lot of the things we're going to be
asking both faculty and students and staff as well to do
on campus which is to wear a mask, to socially distance,
and and to wash their hands a lot etc. And you know I think we've all
heard this in a sort of repetitive way in the news
but that doesn't mean that we're not thinking about why are we doing this and
and what's most effective etc. So I wanted to start with
maybe just, Matt you can tell us a little bit about
what are even the type of masks that people might even be thinking about
wearing? Sure so there's sort of two sides of
the coin here when we talk about types of masks
and one is masks are used for respiratory protection
and that side of things. The other side is for source control.
And so we have varying degrees of efficacy for both of those among these
range of masks. So the most common mask you're going to
see these days are these are the cloth mask that are out in the
environment. Great for source control, a variety of
ranges of respiratory protection as well. The second most common is the mask that
we use in healthcare setting, are these disposable masks.
Also excellent for source control and do provide some
respiratory protection. The third kind of mask you'll see is an n95 mask
and you might have seen some of these people wearing them at Home Depot or
Lowe's or those kind of locations but in the healthcare environment in
particular these are only worn in very unique circumstances where
respiratory protection is required. And so for example if you're
if there's an aerosolizing procedure being performed.
And this kind of mask offers 95 percent
particle capture efficiency for 0.3 microns, so it's it's great for
respiratory protection as well as source control. So those are
sort of three different types of masks that are
going to be common and we will commonly see and use.
So cloth mask as you say source control does it give the the actual wearer any
protection? It does, it does and there's a wide range
based on the components whether or not it's you
know 100 percent cotton or double layer or triple layer.
But yes it does. So Cam maybe I think you might
even have a mask nearby by as well, what's the
proper way of wearing a mask? Yeah it's a good question and it
sounds simple but i think there's there's detail to it. So you know for the
just like uh like Matt had said when when we're sort of in a
a non-intensive clinical environment you know most of the masks that we'll see
are really ones that are designed to loop around both ears as their anchor
and then have typically a a wire or some kind of
little pressing area that's a bit more stiff to
make a better seal across the bridge of your nose.
And then the third part is that optimally they not only cover your nose
but they also hook under the base of your chin.
So you know for us that's to be fair actually it's make sure your
own hands are clean first because you're going to put them
right next to your face. It's a loop around the ears,
an adjustment under the chin and most of them just have a little pincher effect
across the nose and then they're actually very comfortable and
the idea about the the pinch on the nose and under the chin
is not only does it further protect my ability to
to guard against my my virus inadvertently transmitting
it actually almost it does make it more comfortable also so you're less
fiddling and less adjusting again avoiding
my potentially dirty hands going near the mask into an area
where I can contaminate myself. It's kind of three things under the chin,
pinched on the nose, loop around the ears. So lots of people
lots of people dangle on down here...
Not effective, not at all. So you know just to continue on that
train of thought you know I think we've all read
a little bit about viral dosage and you know the infectious dose etc.
And you know if you were not wearing a mask
and you're inside, let's say not within six feet,
how long could you be there without incurring risk, and I realize it's not
absolute, and how big a difference is it to be outside?
Yeah maybe I'll start and Matt if you want to jump in as well.
Look i think the the sort of the classic definitions that we always use when we
talk about who's had a high risk exposure or like
who benefits from contact tracing talks about six feet
and and somewhere between 10 to 15 minutes as being a timeline that we
typically think is quantitatively enough risk to be
concerning. I will say that that's that you know there's no red line that
you suddenly cross over when you get to 15 minutes and
one second where you realize you're going to get into trouble.
It's clearly distance related, it's clearly
sort of how much someone may be coughing, when or whether one or both
people are wearing a mask becomes relevant to that. And then the
outdoor stuff actually makes a difference,
all the ventilation makes a difference based on
on air movement. So you can imagine this if you compare six feet in 15 minutes
in an outside breezy day on the beach compared to
six feet and 15 minutes sitting near someone on a couch in
a room watching a video, the the indoor lack of air circulation
probably aids droplet transmission to that other person as time moves
forward. So you know it's hard to quantify I think
on a sort of day-to-day activity level but certainly outside does
or in a well-ventilated place does appear to be meaningfully better.
How would you answer that Matt? Yeah so I completely agree with that.
I'd add on some additional parameters that are part of that exposure
discussion. Would be the concentration of the people
within that environment so you've got a one and one but if you've got a one in
many within there that risk parameter also increases.
In speaking about directional airflow as well.
I mean if you've got a lot of people that don't have masking and one is
expelling a lot of virus and the supply bin is blowing the virus towards people
in a close proximity to them I think that's
another thing where there's an increased potential, inside in
particular. Outside is a little bit different because we've got
so many other parameters with more air basically.
You know I think a lot of our faculty and also our students are going to have
a occasion certainly particularly with
teaching in person where they will potentially be within
six feet of someone, they'll both be masked, and part of the
issue has been you know how much reassurance does that
give people? You know do they should they feel
comfortable, I mean not to spend for a long time, but you know someone might
come up ask a question etc. Is that okay?
I think that's really actually quite okay and I would point to,
I would point to some of our hospital data over the last few months as being a
really good example of how we've already demonstratively shown that's
fine. So some of my colleagues in infection control have
mapped out once we started wearing masks as a universal policy within the
healthcare setting where we've been, we've been working with each other all
the way through this, and then have tracked the number of
times people, our employees have acquired COVID in
the hospital. That flatlined the moment we started
wearing masks amongst ourselves.
The positive benefit that that gives for us all to be universally wearing
them has been really noticeable when you graph it out.
And yet we've been encountering each other and brushing up against each other
for some minutes here and some minutes there
within six feet. Where it's occurred that there's
been transmission has either been
sort of in patient settings where you do have sort of
higher concerning issues particularly if someone wasn't wearing their protective
equipment correctly. Or under certain stances where we drop
our guard. Right in the break room. Where you're eating.
Where you're eating. Exactly, so what do ?We all do we're
really diligent about this when we go about our clinical activities
and then 10 of us sit down around the table and all take our masks off because
we have to eat and yet we're then within proximity for a longer
period of time with our colleagues. Right. So I think we've had great proof
of showing it's effective. Yeah no that's great I mean I think a
lot of people are having social interactions
outside and at a distance and I think you know
we may see more of that as it gets colder out. I mean during the summer
it's one thing but as you drive people indoors again outside of the workplace
they're gonna have to be very careful to to be aware that they're
home now and they can catch it inside with
their friends at a Thanksgiving party, you know day event, as easily as in
the workplace. So you know the the ultimate in social
distancing obviously is quarantine. And you know we we're bringing a lot
of students back and we're discussing you know sort of
asking them to try to stay as isolated or quarantined
as possible before they come here. And I just wonder you know
once we start having students here and contact tracing etc,
you know how aggressive do we have to think about quarantining? You know as a
kid sitting in a class of 30 other kids, one kid gets sick, are we going to be, the
faculty are worried, are we going to be quarantining now 30 kids?
I don't know how you think about that. That's a great question.
Ii know it has been discussed, I don't-- Cam, what what would your take be
on that? It has been discussed at
length, the various parameters that would go into that.
How it would happen, how long it would go, how far
back within that one person in that room, two people in that room? You know
three contacts, I think it's a set of two right now, but um I actually
don't know what that answer is right now.
I think it's an individualized answer Sally.
It bases on how the geometry of the room is set out such that you're spaced apart
within the room. It's very different it's you know it's
very different with the old style ways that we used to lay out lecture halls
with a thousand people in the room, like that's not the expectation from here on.
So your time adjacent to people like in close intimate proximity is
much less. it is dependent on people wearing masks
It is dependent on length of time that folks were together.
And it is dependent on really careful contact tracing.
And so one of the things that we haven't talked about yet is
how student health and employee health and others and in fact all of our county
colleagues have put a lot of effort into
understanding and bringing up an army of people
who will go through sort of analytically looking at all the
people in the room, where they sit, how close they are, whether they're masked,
how far away they are and addressing that. And if you know
if you and I are sitting right beside each other and it becomes clear that
during that class neither of us had our mask on for half an hour, then quarantine in that situation is the right move
is the right move to continue to protect people who have been in that space.
But you know if you're the lecturer and you're
30 feet away from someone in the class and there's someone in the back of the
class who's had COVID as it turned out, that's not a risk to me. But that
requires very careful sort of analytic and
methodical sort of evaluation of those scenarios.
Makes sense. So finally I just want to ask a little
bit about surface transmission and cleaning because I think
people are concerned about you know the classroom, the
library, wherever that somebody with COVID may have
touched the surface. I think we've all seen in the room, in the news
that it's less of a concern than we had heard about originally but Matt maybe
you can comment a little bit about you know the kind of cleaning
that's necessary to feel confident if you have
you know classroom full of students, they've left, you're going to bring in
another class full of students. You know how do we how do we have to think about
that? Sure so I think the the beginning of that discussion would
be we still need to practice proper hand hygiene.
That is absolutely critical in that we have
defined different areas within those environments we've considered high touch
surfaces, which are going to get cleaned in more frequent
more frequency greater frequency than just a normal non-high touch surface
such as you know a windowsill or something like that.
So those are going to be taken care of. I'd say within the room environment
itself, there's going to be staggered seating
options or the the online option as well. And there is the potential and I've sort
of been on the periphery of these discussions of providing
the students with a mat, an individual mat that they would have,
and then use as they go into class so that actual surface where they were
sitting would be their surface and not
somebody's that they touched previously. Yeah i know I think
that's a great idea. I've heard, I've heard some folks on
our team talk about that and that does seem, you know encouraging students
to bring their mat, their own mat to every room
I think, I think could be useful. Yeah I agree. So anyway uh you know this obviously is
an ongoing challenge and ever-evolving uh landscape but I really want to thank
you both for all the guidance you've given
to the academic mission but also everything you're doing to
try to keep us and and the health systems patients
safe. So I'm grateful to you for taking the time to answer the questions
and I'm sure we'll cross paths again soon.
So thank you.