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Do we really need the COVID-19 police?

Do we really need the COVID-19 police?
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Over Thanksgiving holiday week, I was glad to see more people wearing masks in public than ever before. This compliance was consistent with a growing body of population research from the Centers for Disease Control and Prevention (CDC) and elsewhere revealing that masks and mask mandates (in Kansas, Nebraska, Thailand and throughout over 200 countries) are associated with decreased spread of COVID-19. The public messaging on behalf of masks has grown stronger and more persuasive and pervasive than ever before. 

But there are limits to the science. Here’s what a population study can’t possibly show you: Is it the masking or the distancing that is preventing spread? And how appropriately are people doing either one?

Unfortunately, I have observed that most people I encounter are not wearing their masks firmly or securely over their mouths and noses — too many use them as "chin-wear." Too many are touching their masks frequently, and too many wear their masks over their mouths only, exposing their droplet-laden noses to the air. Worse than that, too many seem to think that as long as they have some kind of mask on, they can’t possibly be spreading COVID-19. Unfortunately, this is not true. 

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I took a plane flight over the holiday, wearing a KN95 mask and a shield in a solo cabin. Recent studies have shown that the large HEPA filters and the rapidly filtered air quite likely protected me, but when I reached the airport, I was herded into a shuttle bus with dozens of others who were not distanced from each other. The same was true at the airport itself.

I took a PCR test before I left, and another when I returned, self-quarantining until I knew the results, but I feared that not enough travelers were following this test-in, test-out strategy for a virus that is so easily transmissible and leads to a high percentage of asymptomatic, contagious cases. And how many have truly quarantined themselves after they have been exposed to a close contact with COVID-19?

A vaccine is coming soon, and while we wait for it we need to make science-based decisions consistently. Instead, our leaders remain inconsistent. In Los Angeles County, for example, restaurants — including fast food — are now closed except for takeout, despite the fact that they account for less than 3 percent of 204 recent outbreaks, whereas government offices, where close to 7 percent of the cases have occurred during these outbreaks, remain open.

Here in New York, it took a SCOTUS ruling to block church and synagogue restrictions. By contrast, liquor stores, bicycle shops, lawyers, accountants and even insurance brokers are considered essential, whereas churches are not. This despite the fact that large churches and synagogues throughout New York have gone to great lengths to follow guidelines of social distancing, whereas liquor stores and bike shops clearly cannot. I am an avid cyclist, but would definitely survive if my local bike shop was closed for a while and I have to fix my own tire. 

It makes sense to close the bars but keep the schools open, as Rhode Island is now doing, because the former can fuel super spreader events and the later has been studied and not been found to be a source of sustained spread. 

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The inconsistencies extend right to the hospitals, where essential surgeries and procedures and screening tests are deemed non-essential and are put on hold as COVID-19 cases increase. On the one hand this is understandable because of how contagious and difficult it is to contain COVID-19, on the other hand, it is important that all the public health damage caused by COVID-19, even if it is indirect, be considered at the same time if proper public health decisions are to be made. Perhaps designated COVID-19 hospitals need to once again be considered in hot zones as the total number of hospitalized patients in the U.S. rises over 90,000.

Vermont has the fewest COVID-19 cases per 100,000 population in the country, at 595. To get there and to stay there, they have focused consistently on basic public health measures including masking, distancing and reducing the size of gatherings. They shut down quickly and reopened slowly. But now in their continuing zeal to ensure public health compliance, I believe they have taken things a step way too far. Vermont Gov. Phil Scott has authorized schools to interrogate their students about whether — during Thanksgiving — they or their parents violated the state’s non-essential travel restrictions requiring quarantine, or their gathering rules. An admission of guilt leads to mandatory participation in online school. If this were the honor system I wouldn’t object, but the notion of a child turning in his or her parents to the state is quite disturbing and could create a deep rift in a family. Score one for the COVID-19 police.

Instead of waiting for a vaccine to save you while you continue to gather and risk your health and those of others; instead of relying on political dogma (which too easily ignores your depression and anxiety) to guide you, by this point in the pandemic I believe you should be able to know what to do based on common sense.

Wearing a mask in public and not crowding into an elevator or a store and washing or disinfecting your hands frequently are basic public health measures all Americans are aware of by now, and shouldn’t need a mandate or fear to follow. 

Marc Siegel, MD, is a professor of medicine and medical director of Doctor Radio at NYU Langone Health. He is a Fox News Medical Correspondent and author of the new book, "COVID; the Politics of Fear and the Power of Science."