ER doctor among hundreds of Arizona physicians calling for mandatory face masks in public spaces

An emergency room physician in Arizona says it's "utterly selfish" to not wear a mask in public.

Murtaza Akhter signed a letter to Arizona Gov. Doug Ducey, urging the state leader to require people to wear masks in public spaces, such as grocery stores. Akhter and more than 900 other physicians signed the petition as the state saw a recent spike in cases of COVID-19, which is caused by the novel coronavirus.

On Sunday, the World Health Organization (WHO) reported 183,020 new confirmed COVID-19 cases in a single day, a record increase. This comes as the United States faces a surge of cases, with several states showing positive test rates in the double digits. WHO considers a positivity rate above five per cent to be concerning.

In Arizona, rates of positive tests averaged 20 per cent over the last seven days, indicating the outbreak is worsening. According to state data, Arizona saw daily cases surpass 2,000 for four days in a row last week.

Ahkter says he is seeing anecdotal evidence of this recent surge and wants his state governor to take action.

Here is part of his conversation with As It Happens host Carol Off. 

Dr. Akhter, we know the numbers of new cases in the United States of COVID-19 are going up. But just tell us, what does that look like in your emergency room?

We're definitely seeing it in the emergency department. As a researcher, I don't want to use anecdotal data too much, but this matches up with everything we're hearing on the news and everything we're seeing from the Departments of Public Health. We are getting a lot more patients in the emergency department than just a month ago. And not only we're getting a lot more patients, they're also looking sicker, and they have a lot more respiratory complaints. So, for example, cough, shortness of breath, fever, body aches, your typical COVID-like complaints.

And on my last shift, every patient I tested, everyone was positive. I mean, that's crazy to have zero negative tests for all the ones suspected even possible COVID. And they all came back positive. It's concerning.

And you haven't seen that since the crisis began at that intensity?

Correct. Yeah, and when everybody was hearing about it on the news in New York, for example, and definitely even in other countries. We were doing OK or so it felt.

We had stay-at-home orders, which I think went in a place fairly early, which is probably a good thing. If anything, we had a significant decrease of volume in the emergency department. People really were avoiding coming to the ER, so much so that we were concerned that maybe people who were actually sick were avoiding it. And so we didn't have that volume. We had a few COVID-positive patients here and there.

And then what ended up happening is, over the last couple of weeks, we're seeing a lot more patients. Part of that was expected as a stay-at-home order was released. But in particular, we're seeing a surge of COVID cases. And that's not just through state data. I'm personally seeing in the emergency department.

And why do you think that so many of those cases are so advanced when they come into the emergency area?

There are a couple reasons for that. One is that a lot of these patients actually already had COVID and knew it. So when they come to the emergency department, they know. They come in knowing that they had COVID and then they decompensate.

Because remember, when you get sick — God forbid, you were to get sick — but if somebody gets COVID, they don't necessarily decompensate until a week or a couple weeks later. So some of these people are already been diagnosed with COVID, and then a couple weeks later, they're getting hypoxic — struggling to breathe — and then we see them in the emergency department.

As you can imagine, that's particularly concerning when you're hearing about the surge of cases right now, because it means the hospital won't even necessarily surge for a couple of weeks from now. Yet, we're already seeing a lot more patients. Imagine what it's going to look like a couple weeks from now when all the people who are testing positive right now end up getting sicker.

And on top of that, we're only getting more and more patients who are testing positive, presumably because of how much it's spreading in the community. So we're pretty concerned about what a couple weeks from now is going to bring us.

What does it let me use decompensated? What does that mean?

I'm using it generally to "mean people who get sicker."

We are hearing … interviews with people in Arizona, young people — streeters as they call them — saying, "Look, we don't want to wear masks. We're out with their friends." One young fellow said that he had family members who had had the virus, but, well, he would wear a mask, but he wouldn't want to be doing that while he was out having fun. So is that an attitude you're hearing in the state?

Yeah, we're hearing it.

Now, if those young people are only going to hang out with the same people every day and never be exposed to people who are either immunocompromised, who are on medications, who are elderly, then maybe that's OK.

But... as soon as that young, healthy 25-year-old walks into a grocery store — because presumably he needs groceries — and as soon as he maybe coughs because his throat itches a little bit, and that cough affects an elderly person or an immunocompromised person. Now that person has very selfishly, potentially infected somebody else who could die of it.

And so to say, "Listen, I understand the masks can be important, but I'm just not going to wear it," it's very selfish, because the purpose of masks is not just personal protection but to protect others as well.

We live in a society. So unless you're a hermit, to say, "I'm not going to wear a mask" is utterly selfish.

You signed a letter to Arizona governor Doug Ducey asking him to mandate mask wearing. Has he responded?

So what the governor did in the state of Arizona was to basically let the mayors decide. You know, the United States has a sort of federalist attitude. And so in this case, it played itself out to the extreme, where the president passed on the buck to the governors, the governor passed on the buck to the mayors. And as you can imagine, that can go on endlessly until it breaks down.

If you let everybody decide for himself, in this case, at the city level, the only way that really works is if nobody from one city travels to another city.

The coronavirus knows no state borders. It definitely knows no city borders. And so the trend, the virus transmits between cities and the people commuting between these cities. So, I mean, I think it's not going to be as effective … as if the whole state had orders to wear a mask. 

Written by Lito Howse. Interview produced by Chris Harbord. Edited for length and clarity.