(C) Daily Kos This story was originally published by Daily Kos and is unaltered. . . . . . . . . . . Senate cancels future mask mandates. Here’s a defense of masking on airplanes [1] ['This Content Is Not Subject To Review Daily Kos Staff Prior To Publication.'] Date: 2023-10-28 On Thursday the U.S. Senate approved an amendment to a Senate appropriations bill that prevents federal mask mandates on passenger airlines, commuter rail, rapid transit buses, and any other transportation program funded through the 2024 fiscal year. All Republican Senators voted for this as well as 10 Democrats. It’s a great way to insure that essential workers in the above fields quit in droves, or at least bear the heaviest toll when any future deadly variants arrive. On a related note, a patient recently asked me a few questions before taking her first flight since the pandemic started. What did I think of wearing a mask? Should she should take an aspirin before flying to Europe given her history of a prior blood clot? A different patient once asked me about the radiation risks of the new security scanning machines. So let’s get a little nuanced (and a dash neurotic!) while honestly focusing on these three potential hazards of flying: infections, blood clots, and radiation exposure. I’m going to present some vital and overlooked ideas here in a three part miniseries. But first, in honor of the United States Senate hamstringing our public health apparatus and experts, let’s talk about: Infections Stuffing hundreds of people in a missile (with wings and a pressurized cabin) and then flying them at 40,000 feet can facilitate a great opportunity to see the world, and to breathe in other people’s breaths for hours at a time. Before I started wearing an N95 on planes I estimate that 75% of my vacations were partially ruined by getting sick. It’s hard to give you good scientific proof of cause and effect, but one study did show that if we are sitting within one row of someone who is sick with a respiratory illness, there is an 80% chance that we will contract their disease. Do you feel like that person is always sitting next to you, too?? In the modern era of hyper-contagious coronaviruses, I would put that transmission number at 90% - but a lower risk if masked, recently recovered from the same virus, boosted, etc. And so if you really want to cut your risk of picking up some respiratory viruses… ☑️ Wear an N95/KN95 mask on the plane I know it’s uncomfortable. Few people are doing it anymore. You might even get a nasty look or snarky comment. But just think of hardcore healthcare workers like me the next time you are feeling awkward or uncomfortable with a mask strapped to your face. I’ve been doing this everyday at work for over three years. It’s not so bad, really. I saw five patients in the office with Covid last week alone, and two with influenza B. Most came in for “checkups.” Some wore masks, and some didn’t until I asked them to. That’s the way it goes in 2023, right? Planes are the same. A little while back, the media and a lot of anti-mask people including doctors took the wrong conclusion from a Cochrane meta-analysis that seemed to conclude that masks don’t work. But many other doctors, scientists, and the Cochrane people themselves debunked this conclusion, and a recent article in Scientific American again sets the record straight: The Cochrane Library, a trusted source of health information, misled the public by prioritizing rigor over reality… The Cochrane finding was not that masking didn't work but that scientists lacked sufficient evidence of sufficient quality to conclude that they worked… Jefferson (study author) erased that distinction, in effect arguing that because the authors couldn't prove that masks did work, one could say that they didn't work. That's just wrong. I don’t want to get into a war of attrition trading studies that show masks work versus masks don’t work. The studies are all imperfect and really hard to control. Suffice it to say that any unmasked doctor walking into a room to take care of a patient with Covid, tuberculosis, influenza, RSV, or pneumonia is a fool. So if masking works in these situations, how can someone turn around and claim that masking doesn't work for the individual in even less high risk situations? They can’t in good faith. Dr. Linsey Marr, a well known researcher in the field of aerosols, would agree. She’s been a strong supporter of protecting oneself since this whole thing started, and points out that buses and taxis are even higher risk situations for aerosol transmission. She’s a 2023 MacArthur Fellow (aka Genius grant winner). Here are two (scientifically worthless) anecdotes. I’ve now flown up and down in crowded planes 10 times since the pandemic started. 10/10 times I masked up, with zero upper respiratory infections contracted. Viruses are batting 0.000, much like the Phillies with runners in scoring position during the last few games of the NLCS. Patients I see with Covid have very often just returned from traveling on an airplane, or tell me they got sick 3-5 days into their travels after flying. Although some may claim that ventilation on planes is excellent, my own experience has shown that this is neither guaranteed nor usual. For example, I brought a CO2 monitor on a recent flight to Michigan. CO2 monitors can be used to give us an estimation of ventilation quality. Outside fresh air in populated areas is about 425 ppm (parts CO2 per million). In buildings with fair ventilation the ppm should stay below 700 ppm. That’s like my office. On the flight the CO2 ppm stayed around 1,800 ppm. That’s terrible. While taxiing and then waiting on the runway it hit 3,000 ppm. But don’t just take it from me. You can find similar photo documentation of this kind of poor ventilation on social media pics of people with their CO2 monitors. And if you absolutely won’t consider wearing a mask on a plane, that’s OK. That’s your choice, and it will stay that way even if a nightmare SARS CoV-2 variant evolves next year. Recall that the Senate cancelled future mask mandates for federally funded transportation- with no exceptions that I can see. But there’s one more reason to bring a mask, even if you’re not planning on wearing it. If you do get sick while traveling and need to fly home - please wear a mask for other people. And if you are mildly sick and decide to fly anyway… ☑️ Consider packing a decongestant In travelers with upper respiratory tract infections, differential air pressures between blocked eustachian tubes/sinus openings and the cabin may cause pain in the ears or sinuses. This is especially true while ascending and descending. The crying babies who don’t know how to pop their Eustachian tubes yet know exactly what I’m talking about. These symptoms can be relieved by the use of decongestants taken orally or sprayed nasally like Afrin. Talk to your doctor first though, as people with medical conditions like high blood pressure or arrhythmias generally need to avoid decongestants. Nasal sprays may have less systemic side effect potential. I flew with a head cold about 20 years ago and still remember the feeling of an ice pick in my frontal sinuses while the plane was landing. It was intensely painful! I hope I have not offended anyone with this frank discussion of masks on airplanes. I am a family doctor and not a politician, and I’m speaking as sincerely about this option as I can. It’s not easy being green as Kermit says. But if for no other reason than to enjoy your vacation with much less chance of getting sick, consider checking that box. ~ This concludes part 1 of our airplane miniseries! Stay tuned for parts 2 and 3 reviewing blood clot risks and radiation exposure while flying, and whether we have additional boxes to check. Spoiler alert — I think we do. I won’t be posting the next parts on Kos though, so subscribe to Examined where I write on Substack if interested ☑️ Have a great weekend if you can! 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