Michael Niederman, MD on How I Practice Now: Talking to Your Patients About Social Distancing, Contagion, and Face Masks

In this video, Pulmonology Consultant Advisory Board Member Michael Niederman, MD, lists the preventive measures that you should be encouraging your patients to practice during the COVID-19 pandemic. 

Additional Resource:

COVID-19 Care360.

Michael S. Niederman, MD, is associate division chief and the clinical director of the Pulmonary and Critical Care Medicine at the NewYork Presbyterian-Weill Cornell Medical Center. He is also a professor of clinical medicine at Weill Cornell Medical College.

TRANSCRIPT:

Hello, I'm Dr Michael Niederman, professor of clinical medicine and associate chief of pulmonary and critical care medicine at Weill Cornell Medical College and NewYork Presbyterian-Weill Cornell Medical Center.

In terms of dealing with COVID-19, I think it's important for people to realize that the most important thing to advise your patients is social distancing. I think it's very hard for some cultures to do social distancing. Anecdotally, we've observed that there are certain cultural groups that seem to have clustering of disease, which I think largely reflects reluctance or inability to do social distancing.

At the same time, it's important to educate people about contagion. For example, we know that patients can shed the virus for as much as 3 to 5 days before they have any symptoms. And in one study, even though the median time for development of symptoms after infection was 5 days, it took up to 11 days for over 90% of patients to have symptoms. Also, on the other end of the disease, even after the symptoms resolved, viral shedding can occur; viral shedding in one study was present in half the patients for up to 2 weeks after all the symptoms resolved. Now, this doesn't mean that everybody's going to be infectious for that long of period, but I think those are the outer bounds, so I think it's very important to caution your patients about self-quarantine.

One of the other raging controversies right now has to do with whether patients should be wearing masks all the time. I don't think there's a definitive answer now, and the guidance from the CDC has changed. Initially, it was recommended not to be wearing masks. Now people are thinking that masks might be valuable. But I think it's important to understand that there are a couple of issues surrounding that. First, the N95 masks really ought to be reserved for health care workers who are doing high-risk procedures, so I don't think that people in the public should really be wearing N95 masks. Number one, because there's still a shortage. And number two, if you don't get fit tested for an N95 mask, it’s not going to be maximally effective. We do think that surgical masks are effective in many instances because they collect the droplets spread. 

But I think the major reason for people who are not in the health care environment to think about wearing masks is so that if they become sick, they won't infect someone else. And conversely, if most people were wearing masks, the people who you pass on the street or in the market, if they were sick, they won't be transmitting to you.

The other potential value of using masks is that it makes you aware of where your face is so you don’t touch it as often; and that might be very valuable not to do that.

On the other hand, the downside of everyone wearing masks is I don't know if we really have enough right now. And those masks really should be prioritized to health care workers. And number two, I worry that people who wear a mask and don't understand how to use it and what it does and doesn't do, have a false sense of security and in fact get themselves infected because they're being less careful with some of the social distancing and other preventive techniques. 

Obviously, hand washing is key, and it should be done as frequently as possible.

So that's a couple of my thoughts about dealing with coronavirus and the problems that we're facing. I know that this is going to be challenging for all of us, and I hope that we'll have better times in the future to talk about this and other topics. Thank you.

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