Lowering the Risk of Hospitalizations Until a COVID-19 Vaccine is Ready

By Ricardo Maldonado, M.D.

Expectedly, the number of COVID-19 hospitalizations at EAMC has risen over the past week, doubling from 15 to 30 as of Friday. This wave likely started in young, healthy individuals as we recently saw a quick increase of local cases in the community. This is likely due to infections among college students who will not likely get sick enough to need hospitalization. However, as the number of cases increases among the healthier population, it eventually spills over to those who are more vulnerable. I would expect this number to increase more at the end of this coming week due to the Labor Day weekend.

As we continue to see cases in the community, we should expect the same for hospitalizations. Therefore, we need our community to again help us prevent hospitalizations and deaths. You can do that by wearing a mask in public, especially inside stores or offices where it is more difficult to keep social distance. Masks help prevent transmission among people who are sick but showing no symptoms, also known as being asymptomatic. Studies have suggested that COVID-19 infections decreased among health care workers after universal masking was implemented; our experience at EAMC suggests that as well.

There was an interesting article published on a very reputable medical journal website this week suggesting that mask-wearing could be a form of “variolation” that would cause immunity, and thus decrease the transmission rate until we have a vaccine available.

“Variolation” or “inoculation” was the method first used to “immunize” people against smallpox. It was a process whereby people who were susceptible to smallpox were inoculated with material taken from a vesicle of a person with smallpox. The intent was to cause a mild infection and subsequent immunity. Obviously, this method was stopped once smallpox vaccines were available.

Recent scientific information suggests that although wearing a face mask cannot always completely prevent transmission of the disease, it can reduce the severity of the disease among people who do become infected. It does so because it traps and filters droplets with the virus, thereby reducing the inoculum (amount of biological material or amount of virus) the person would have received if they did not wear a mask. The more droplets with virus you inhale from an infected individual, the higher chances you will have a more severe disease.

Several studies on cruise ship outbreaks showed that when passengers and staff were provided with surgical masks, the rate of asymptomatic infection was much higher as compared with outbreaks without universal masking. What that means is the severity of the disease was lessened due to wearing surgical masks.

While we await the results of vaccine trials, any public health measure that could either decrease the risk of transmission, or if the virus is transmitted, increase the proportion of asymptomatic COVID-19 infections may both make the infection less deadly and increase population-wide immunity without severe illnesses and deaths.

Hopefully, we could control this pandemic by driving down both transmission rates and severity of disease. There is increased information that suggests that population-wide facial masking might benefit both components of the response: 1.) decrease your chances to get sick or pass the illness, and, 2.) if you still get sick while wearing a mask, you could have a milder illness because the number of virus you inhaled was small.

Ricardo Maldonado, M.D. is an Infectious Diseases specialist and is the sole practitioner with East Alabama Infectious Disease. He joined the medical staff at EAMC in 2009. Dr. Maldonado is leading the clinical response to COVID-19 at East Alabama Medical Center.