From the desk of the EMD: “I have asthma, I can’t wear a mask.”

July 6, 2020

Last Sunday, I went to an open-air shopping center in an affluent suburb of Atlanta to buy a new iPad at the Apple Store. The Apple Stores in Georgia are still open, and they are doing a great job at requiring masks and social distancing inside. But all around me were people walking about the shopping center, and almost no one was wearing a mask - families with children, young adults, and even the elderly. I felt like a visitor from another planet wearing my mask. Did the pandemic go away and I did not get the memo? Earlier that morning, I watched the news and saw that the numbers of infected were growing. It was worse in the southern and western United States, with hospitalizations and ICU admissions increasing. With over 125,000 Americans dead from COVID-19, what am I missing? This is not a Republican vs. Democratic political issue. This is a public health emergency. Yes, I understand the damage this virus has done to the economy. We, as allergists, have seen our patient volumes tank, along with our income, for the last couple of months. Still, I was doing my part for the economy to increase the price of Apple stock. As we balance the realities of lockdowns vs. reopening, how can allergists communicate the need for masks in public until we get better treatments and vaccines to make us immune to COVID-19?

We are all requiring patients to wear masks for visits to our offices. You may have some patients that show up without them and you furnish one for them to wear. It is these patients that you may want to have a conversation with about the need for wearing masks. These patients may say, “I first heard not to use them and now I am told I should wear them,” or “there is no evidence that masks help.” Yes, there was a mixed message a few months ago about them. It was based on the thought that there was a low disease prevalence with COVID-19 and a concern that there would not be enough masks for health care personnel on the front lines. Now we know that masks are essential to prevent the spread of infection in the community.

Real-world data recently published in Health Affairs showed the effect of mandates from April 8 to May 15 for face masks in public from 15 states and Washington, DC compared to COVID-19 growth rates prior to the mandate. Face mask use in public was associated with a 2% decline in daily COVID-19 growth rates within 21 days. This data estimates that as many as 230,000 - 450,000 COVID-19 cases were possibly averted by May 22. This study provided evidence that states mandating the use of face masks in public had a greater decline in daily COVID-19 growth rates after issuing these mandates compared to states that did not.

“I have asthma, I can’t wear a mask.” Have you heard that line from patients? Of course, there is no reason that our asthma patients can’t wear a face mask. The College provided guidance on May 7th stating: “While there is currently no data to suggest the use of face masks by those with asthma will significantly worsen their asthma symptoms, it is possible that some people with asthma may feel it is more difficult to get an adequate breath while wearing a face mask.” We have to treat the patient, so what can we do if we can’t convince them to wear a mask? A suggestion from our immediate past Executive Medical Director, Dr. Bob Lanier, is the use of a face shield instead. On June 9th, JAMA published an article entitled “Moving Personal Protective Equipment into the Community -- Face Shields and Containment of COVID-19.” The article points out the advantages of face shields for the general public during the pandemic. Especially for that patient who can’t breathe through a mask or is worried that a mask will cause their asthma to flare up, a face shield may be the answer.

All allergists, no matter what your political persuasion, understand the public health consequences of COVID-19. We should take a leading role in stamping out misinformation on masks and work to ensure the health of our patients and the community during these unprecedented times.

Michael Blaiss, MD, FACAAI, Executive Medical Director