That’s not an entirely fair assessment.
In February, everyone believed the virus was transmitted via contaminated hands and surfaces.
Reasons first-responders needed masks when others did not
There are several reasons first-responders and clinicians needed masks and, indeed, face shields, then, when ‘civilians’ did not:
- Reducing risk of infection during intubation: When intubating a patient (sticking breathing and feeding tubes down their throat via their mouth or nose — such as when putting a patient on a ventilator) there is a significant risk that the patient’s saliva or vomit will spray upwards into the face of the clinician doing the intubation. This would directly transmit the virus. Effectively, the clinician’s face becomes the contaminated surface. Masks and face shields reduce the risk of the virus entering the clinician’s body through their mouth, nose or eyes.
- Reducing risk of cross contamination via the clinician’s body: The correct way to use masks and other PPE in a clinical setting with highly-infectious patients is to replace the PPE between patients. So, if the patient’s bodily fluids come into contact with the clinician’s gloves, mask, coveralls, face shield or hat, the contaminated fluid is removed from the clinician when they remove the clothes. Correctly donning and doffing PPE is a time-consuming and complicated process that even clinicians get wrong.
- Reducing the risk of the patient contracting COVID-19 from the clinician: A mask worn correctly by the clinician can catch a high proportion of the virus exhaled by the clinician in either their breath, micro-droplets of saliva or full-on spit that comes out of their mouth while speaking or breathing near their patients.
- A global shortage of PPE: At the time, there was a global shortage of PPE, so it had to be provided where it would make the most impact — clinicians.
So Fauci was quite right to save PPE for first-responders and clinicians.
Why masks aren’t much use, even now
Even now, there are several reasons why requiring people to wear masks is only minimally effective, and is a last resort behind other, more effective methods such as social distancing, testing and localized lockdowns:
- Most people don’t wear masks correctly: Have you seen the way people wear their masks? There are the obviously wrongly worn masks: the ones left cupping someone’s chin because they forgot to bring it up over their mouth and nose after eating or drinking, the ones covering the mouth but not the nose, or, like my brother saw in Hong Kong Airport in February, the mask worn as an eye-mask while sleeping, leaving the airway completely exposed. Then there are the rest of us who wear our masks as well as we can, but usually have leaks around the sides of our cheeks or beneath our eyes. People with glasses, if your mask steams-up your glasses, you’re not wearing it right. (Though your glasses are, hopefully, acting as a second-line of defence to prevent droplets going far from your body.) Contrast this with the pictures you’ve seen of clinicians with red mask-lines where their masks have pushed so hard into their skin that the seal is airtight.
- Most people don’t doff their masks correctly, and it’s debatable what is correct in their situation: If the mask is to protect you from others then you should doff it by unhooking from one ear, folding the mask forwards so the outside surfaces meet, and your fingers only touch the inside surface that has been against your face. Throw it away in a bio-hazard bin and wash your hands. If the mask is to protect others from you, in case you are unaware that you are carrying the virus, then you should doff it by unhooking it from your ear, pinching the outside surface of the mask so that your fingers only touch the outside surfaces, and the bit that touched your face is neatly folded inside. Throw it away in a bio-hazard bin and wash your hands.
The truth is that non-medical people wearing masks is a courtesy to others in a confined space — such as a shop or office — where you are trying to reduce how much of what you breathe out, or accidentally spit, can contact other people.
Reasons the USA is in such a dire situation
Simply staying home, confining yourself to your local ‘bubble’ avoiding mixing with other people and testing early and often are the most effective actions to take. One of the main reasons that the USA is in the dire situation it is in now is because of several factors:
- Cities didn’t lock-down early enough or hard enough: The evidence worldwide is that an early, strong, lockdown is highly effective in reducing the impact of the virus. New Zealand has eradicated the virus. Australia has had locally transmitted cases in the single-digits in most states, except Victoria where a flare-up has led to the longest lockdown in the world. (Victoria had zero deaths and zero locally transmitted cases last night, after months of battling the push numbers down. Notably, the reason Victoria flared up in the first place was because COVID-19 ripped through an apartment block where families used communal laundries, and then people from that building went to work in defiance of stay-at-home orders. That node received the virus from a family that arrived from overseas and were quarantined in a hotel. The cleaner of the room lived in the apartment building and contracted the virus before the family’s test results came back. And the building became a super-spreader node due to another resident who was an interstate truck driver. In all, 90% of cases in Victoria traced back to this incident, as well as many of the cases in New South Wales.)
The problem was not masks. The problem was people not staying home when told to.
- Lack of testing: Even though the USA is testing more people than almost anywhere else on the planet, it is still failing to test nearly enough people. When you look at tests per thousand, the UK and USA were under-performing in testing until recently, despite having so many more cases per million than other countries. The USA only overtook Australia a few weeks ago — and it still lags dramatically behind the UAE and Denmark.
- Lack of a nationalized approach: By delegating responsibility for dealing with the virus to the states, but not allowing states to restrict movement between states, that USA has created a shared-responsibility-is-no-responsibility situation that makes states responsible for solving the problem while denying them the agency to do much about it. Contrast with Australia which has similar state-based confusion with two important differences — states have limited movement between states, with states like Queensland, Western Australia and Tasmania requiring visitors from other states to quarantine, and the entire effort has been overseen by a ‘National Cabinet’ comprising the Prime Minister (national political leader) and each of the state premiers, regardless of their political affiliations, who form policy together then implement it at state level. Contrast this with the Trump nonsense of pitting red and blue states against eachother in the fight for resources and agency.
- Lack of free, nationalised healthcare: It is my understanding that free testing in the USA is difficult to access, and easy-to-access testing is expensive — obviously this isn’t an ideal situation.
- Lack of financial support for people whose livelihoods have been damaged by lockdown and social distancing: Obviously you can’t lock down if it’s going to bankrupt people. In Australia we have been fortunate that the government is paying any business that has lost a third (or half, under certain circumstances) of its turnover a basic wage to be passed-on directly to employees. And extra money goes to places that are locked-down more severely. This has allowed the economy to tick-over and also means that people remain employed in anticipation of a quick economic recovery on the other side. It means that most of the country can subsist. The US financial support seems far less comprehensive than this. It’s little wonder, in a country founded on political dissent and with so little financial support, that people are pushing back against lockdown, masks an everything else. And also little wonder that low-paid workers — often in public-facing jobs — need to work, infected or not.
Based on all these factors, I think it’s disingenuous to say call Fauci a flipper. He was acting on the best advice and information he had at the time, to deal with the situation that presented itself, at the time.