Dr. Philip J. Fracica
The influenza (H1N1) pandemic of 1918 and 1919 was the most deadly flu outbreak in history, killing up to 50 million people worldwide. In the United States, where it ultimately killed around 675,000 people, local governments rolled out initiatives to try to stop its spread, including closing schools and public places and requiring people to wear masks in public.
Even though people complied, some complained that decisions infringed on civil liberties and that masks were uncomfortable and ineffective. Still, others formed anti-mask leagues.
Sound familiar? It would be easy to insert “COVID-19” for H1N1 and “2020” for 1918 and 1919. While there are several similarities in ways to slow the spread of today’s virus and one that was 102 years ago, one major difference between 1918 and 2020 are the ways and speed information is shared among people.
“This is the first pandemic of its kind in the age of social media,” said K. Vish Viswanath, Lee Kum Kee Professor of Health Communication and director of the Applied Risk Communication for the 21st Century program at the Harvard T.H. Chan School of Public Health.
Unlike journalists, public health officials, and other “gatekeepers” of information, people on social media don’t necessarily have to abide by strict standards of fact-finding. Viswanath says he’s seeing both misinformation (drawing conclusions from wrong or impartial information) and disinformation (deliberately spreading falsehoods to further an agenda) about COVID-19.
In an effort to respond to common assertions and some misinformation from area residents about public health decisions to slow the spread of COVID-19, the following is a conversation with Dr. Philip Fracica, Bothwell Regional Health Center’s chief medical officer.
Fracica has been Bothwell’s chief medical officer since 2015. For 13 years, he was an assistant professor of medicine at Duke University Medical Center in Raleigh-Durham, North Carolina. While at Duke, he practiced critical care and pulmonary medicine, conducted acute lung injury research, and taught pulmonary critical care.
Assertion: School children don’t need to wear masks or children need to see facial expressions.
“The public health emergency rule issued by the Pettis County Health Center (PCHC) on Aug. 5 states that children 5 and older need to wear a mask,” Fracica said. “One of the biggest challenges with having children wear cloth face coverings relates to them ‘feeling different’ or stereotyping them as being sick. As more people wear masks, children will get used to them. The main group you are trying to protect by the child wearing a mask is the non-household adults that child is in close contact with … like teachers or grandparents. Also, clear masks that allow people to see facial expressions are available and gaining in popularity.”
Assertion: The government doesn’t have the right to make these choices for us.
“Personal rights are an important part of our American heritage,” Fracica said. “However, Rule 19 CSR 20-20.040 of the Missouri Department of Health and Human Services states it shall be the duty of the public health director to, ‘…create and enforce an adequate order to prevent the spread of the disease and other measures considered by the department and/or local health authority as appropriate disease control measures based upon the disease …’”
Assertion: People can go to the bar and drink but can’t go to church and pray.
The PCHC public health emergency rule does not prohibit church or bible study attendance and allow people to go to restaurants and bars,” Fracica said. “You can really go anywhere, as long as you wear a mask or remain six feet away from people. There is an exception when a person is actively eating or drinking. Those at bars would be wise to distance themselves from others while masks are removed.”
Assertion: The numbers and data aren’t enough for COVID-19 to be “that big of a deal” in Pettis County.
“To date, 1% of our population has contracted COVID, 6.7% have tested positive and there have been five deaths,” Fracica said. “The ages and deaths have ranged from the low 20s to the 90s, and all had pre-existing conditions, such as high blood pressure and diabetes. While deaths are the most serious consequence of the pandemic, the potential for long-term respiratory disability for those who survive is real and should be a concern. Another concern should be the loss of productivity for a minimum of 10 days for those testing positive and 14 days for those exposed.”
Assertion: Is it right for the public to follow guidelines established by flawed data, i.e. “50% or more tests are false positives”?
“False positives are more commonly associated with the COVID antibody (blood) test rather than the COVID PCR (nasal or throat swab) test,” Fracica said. “The COVID PCR test is more associated with false negatives, which has more to do with the timing of the test during the infectious period. People can continue to test positive on a PCR test long after they are no longer infectious. This does not mean it is a false positive result as strands of the virus were detected.”
Assertion: A mask rule has never been done before.
“Perhaps not in Pettis County, but there is precedent for mask wearing in the United States during the 1918 influenza pandemic,” Fracica said. “Experts say it’s difficult to say how effective the effort was on its own, but it is clear that communities that implemented stronger health measures, earlier and for longer, fared better than those that didn’t. We want history to be on our side when we are through this pandemic.”
