Arizona, North Carolina Cases Rise; Masks Make A Difference : Consider This from NPR Many states that reopened a few weeks ago are seeing spikes in coronavirus cases and hospitalizations. In Arizona, officials say if cases continue to rise, they may have to be more aggressive about enforcing reopening protocols for businesses.

In major cities across Texas there are disparities in access to COVID-19 testing, resulting in less testing in black neighborhoods than white neighborhoods.

Dr. Atul Gawande spoke with NPR's Mary Louise Kelly about why face masks remain essential in dealing with the coronavirus and the efficacy of different masks.

To help with shortages of PPE, one volunteer group has used 3D printers at home to make nearly 40,000 NIH-approved face shields for health care workers and first responders.

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This episode was recorded and published as part of this podcast's former 'Coronavirus Daily' format.

Masks Are Even More Important Than We Thought

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March 11 - looking back, that might have been the day everything changed.


PRESIDENT DONALD TRUMP: Today, the World Health Organization officially announced that this is a global pandemic.

MCEVERS: The president gave an address from the Oval Office. Stock markets went way down. The NBA played its last games. And soon, just about everything started shutting down. That day was exactly three months ago.


TRUMP: We are moving very quickly. The vast majority of Americans, the risk is very, very low.

MCEVERS: It turns out the risk was very high for more than 100,000 people who lost their lives. And it is not over. Coming up, in some places, it's a lot easier to get a test if you go to a white neighborhood, and why masks are so important. This is CORONAVIRUS DAILY from NPR. I'm Kelly McEvers. It's Thursday, June 11.


MCEVERS: It's becoming clear this week that in some states around the country, states that started reopening weeks ago, the numbers - confirmed cases of coronavirus and hospitalizations - are going in the wrong direction.


MANDY COHEN: So we took early and aggressive action back in March. And we never got a first surge or a first wave, and that was really good. We were...

MCEVERS: Mandy Cohen is secretary of Health and Human Services for North Carolina, where the stay-home order was lifted five weeks ago. Like in Arizona, Florida and Oregon, the number of cases in North Carolina has nearly doubled in the last three weeks, basically since Memorial Day. Cohen says they were ready for cases to rise.


COHEN: But this is an early warning sign for us that we really need to take seriously and make sure that we don't forget that COVID-19 is with us. I know folks are weary at this point, but we really need to stay vigilant, particularly in our state where we never...

MCEVERS: This is the challenge public health officials are facing across the country - telling people, yeah, in some places it's OK to partially return to normal if you stay vigilant about masks and distancing and handwashing. Whether people are hearing that message or not, the numbers tell a clear story about the tradeoffs of reopening.


UNIDENTIFIED REPORTER #1: This morning, Arizona ICUs nearing capacity.

UNIDENTIFIED REPORTER #2: The state's stay-at-home order was lifted on May 15.

UNIDENTIFIED REPORTER #3: The rise is so sharp here in Arizona that one of our biggest hospitals coming out publicly, sounding an alarm about the number of patients they're seeing.

MCEVERS: Arizona is another state dealing with rising cases. It's now up to 30,000 statewide and more people in the hospital.



MCEVERS: On a Phoenix radio station this week, the state's former health director, Will Humble, said something pretty dramatic.


WILL HUMBLE: We're OK right now in hospital capacity. Some individual hospitals are bumping up against their ICU bed capacity. There's other hospitals that could take those patients. But if the trend continues, I think we're on a railroad track to field hospitals and/or another stay-at-home order. And what that really...

MCEVERS: State officials say one thing they could do if cases continue to rise is be more aggressive about enforcing protocols for businesses that are reopening. Up until now, for things like social distancing, face coverings, letting fewer customers in stores, the state has only issued recommendations, not requirements.


MCEVERS: When it comes to keeping case numbers down, scientists are learning more about how important masks are. Dr. Atul Gawande says it's one reason his employer, the Mass General Brigham Hospital System, hasn't had a lot of transmission in the workplace, even though 75,000 people work there. Gawande wrote about that in the New Yorker. And on All Things Considered, he told host Mary Louise Kelly why masks are so important.


MARY LOUISE KELLY: You cite a scientific paper that found that if a majority of people wore masks, this pandemic could end.

ATUL GAWANDE: That's right. You need at least 60 to 75% of us wearing a mask, which means we don't have to be 100%. And the second thing is we've got to be wearing masks that are at least 60 to 75% effective. It needs to be at least a double-layer cloth mask or a proper surgical mask like people wear in the medical world. One of the things that I see is a lot of people are wearing masks, but then they have their nose sticking out or they're pulling it down in order to talk, which defeats the purpose of the mask. So a lot of this is about making sure that we are not having mask theater but actually using the masks in the ways that prevent the infection from spreading.

KELLY: Just explain what is the difference between what you just called a surgical mask and the cloth masks that so many of us are wearing.

GAWANDE: So the kinds of masks that people wear in the hospital are thin. And you think that, like, you know, how does that practically paper thing actually be beneficial? But it's made of a melt blown, cotton candy-like plastic material, sort of like in air filters. And they're charged. They're electrostatically charged, and that catches virus particles.

KELLY: You have a great line in a piece that captures this, where you say that these surgical masks capture viral particles kind of like the way a blanket in our dryer catches socks. And they just stick.

GAWANDE: That's exactly right. That's what makes them breathable - is that electrostatic charge allows you to use pretty thin material. They're easier to wear all day. And yet they're also much more effective than the cloth masks. The cloth masks, if they're multi-layer and thick enough, then they keep you also from spreading the infection. You have to get up to 12 to 16 layers for it to filter as well as a surgical mask. And then...

KELLY: Which would be hot.

GAWANDE: Which is hot. The preference is, especially now that more surgical masks are available on the market, that - you know, we need to make sure our health care workers have it, our nursing homes have it. But they do more and more. And so now getting these kinds of masks to be a regular part of what we do will help even more.

KELLY: It's worth remembering at the start of this pandemic in the U.S., the CDC was recommending against masks for the general public. They were saying only people who were caring for somebody sick with COVID-19 needed to wear them, saying they might actually - if they didn't fit right or if people didn't socially distance 'cause they thought they were safe in a mask, it might actually be counterproductive. In hindsight, was that CDC guidance wrong?

GAWANDE: I don't think it was helpful, and I think it led to some contradictory feeling for the public that they were unsure what the message really was. Now, the reality is that we did not know in early April how valuable and important mask-wearing would be. You know, at this point, as we see in multiple states, from the Carolinas to Tennessee to Arizona, that cases are up. Testing's not keeping up. Hospitalization's been rising since Memorial Day. If this is happening, the only way that we're going to turn around without having to lock down again is going to be if we are being assiduous about wearing masks again.

MCEVERS: Dr. Atul Gawande with Mary Louise Kelly on All Things Considered.


MCEVERS: Getting tested for the virus is easier in cities across Texas if you live in a white neighborhood. The lack of testing in black neighborhoods makes it harder to find and contain outbreaks. In Dallas, KERA's Bret Jaspers looked at two different realities in the same city.




UNIDENTIFIED PERSON #2: All right. Are you being tested today?


UNIDENTIFIED PERSON #2: OK. Just follow past the fence, and he will park you safely between the cones.

BRET JASPERS: On a recent Thursday, volunteers welcomed patients to Friendship-West Baptist Church in South Dallas, the first of several black churches in the area to host free weekly coronavirus testing.

ALICE GILLUM: It's about 10 minutes from home. And it's my church, and we always support our pastor.

JASPERS: Alice Gillum (ph) of South Dallas got a test. Gillum is in her late 70s. And although she doesn't have COVID-19 symptoms, she's been wanting to know if she has the virus just to be sure.

FREDERICK HAYNES: We said, let's use our trusted institutions. The most trusted institution in the black community is the black church.

JASPERS: Gillum's pastor is Frederick Haynes of Friendship-West. He appreciates what local officials are doing to bring tests to South Dallas. There are two large, federally funded drive-through sites - one in South Dallas and one downtown. The city also has a mobile service. But Haynes says many black people don't necessarily trust official channels due to past abuses by the medical industry.

HAYNES: And so we have set it up where black churches are now hosting sites for this opportunity to test.

JASPERS: Nationally, black people have suffered an outsized share of deaths from coronavirus compared to their share of the population. Latinos are seeing a higher proportion of case numbers. These inequities are made worse by the fact that the private health care system places more services in whiter areas, like North Dallas.

Hi, are you Lindsay?


JASPERS: Lindsay Pope (ph) lives in North Dallas and had an elective surgery planned around the time the state started opening up. As the date approached, her doctor suggested she get tested for COVID-19.

POPE: He didn't require the test, but he recommended it. But then I couldn't figure out even where to go.

JASPERS: It wasn't obvious where a healthy, non-symptomatic person who isn't an essential worker could get a coronavirus test. And it still isn't, especially if your doctor isn't doing them. But a friend suggested Pope use a service that comes to your home to do the test.

POPE: I mean, they came out within 45 minutes of when I booked my appointment.

JASPERS: Pope and her husband got three tests in all - two antibody tests and one diagnostic. Add in an appointment fee, and the total bill was almost $700. These on-demand health care services are often not covered by insurance. Pope says it's certainly not attainable for most people, and she wouldn't have done it without having a surgery scheduled.

POPE: If you don't have a network that knows the medical industry or anything like that, I think it would be difficult to even know where to begin.

JASPERS: And that's even without a language barrier or difficulty getting on the Internet to find information. The city is now offering an on-demand service like this for free to people who have symptoms or had recent contact with an infected person.

UNIDENTIFIED PERSON #4: Sir, do you want to come have a seat over here?

JASPERS: Back at Friendship-West Baptist Church, Alice Gillum's husband Arthur (ph) said he couldn't get tested at first because testing had been limited to certain people, like health care workers.

ARTHUR GILLUM: We had to wait, but I was ready to do it as soon as I could.

JASPERS: Texas Governor Greg Abbott announced this week the state will expand testing in underserved communities. But Texas is still among the lowest in per capita testing of all states and isn't averaging Abbott's stated goal of 25,000 tests a day. That raises the question of whether the state is missing flare-ups and where.

MCEVERS: KERA's Bret Jaspers.

When school was canceled in South Orange, N.J., back in March, middle school chorus teacher Jacob Ezzo thought he'd be back at it in a few days.


JACOB EZZO: We went home Friday on that half day thinking it was just going to be a 72-hour, use up our snow days, clean the school and come back.

MCEVERS: So with the long weekend, he thought he would try something with the 3D printer he'd gotten a few months before - try to make face shields out of clear plastic like the ones used by first responders and health care workers.


EZZO: It was on that Sunday I printed off my first one. So I was like, well, I have Monday off. I'll, you know - (laughter) I'll do something interesting.

MCEVERS: Three months later, Jacob is still at home and working with a network of volunteers from across New Jersey who have 3D printers of their own. They've made and delivered nearly 40,000 face shields. Some of those volunteers are Jacob's students.


ZUBIN KREMER GUHA: One of the biggest things I do is the robotics club. That's actually how I first got into 3D printing.

MCEVERS: Like 18-year-old Zubin Kremer Guha.


KREMER GUHA: I saw the opportunity where I could help people out in this hard time. So I thought, if I can, why not?

MCEVERS: Jacob Ezzo says he didn't think their operation would last this long. But it turned out workers really needed the help.


EZZO: When we all started this, we thought we're acting as a stopgap. You know, we're plugging a small hole in the dam until the big industries come online and take over. And they just never came.

MCEVERS: Anastasia Tsioulcas reported that story for NPR. Hat tip to Morning Edition host Steve Inskeep for flagging the March 11 stuff. For more on the coronavirus, you can stay up to date with all the news on your local public radio station.

I'm Kelly McEvers. Thank you for listening. We will be back with more tomorrow.

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