On Wednesday about 7 p.m., I drove along Coleman Boulevard in Mount Pleasant to pick up take-out. The restaurant business there is thriving. Parking lots are full, tables are spilling out onto sidewalks and lawns, and people are sitting inside, which is all good.
The problem is almost no one is wearing a mask — neither patrons nor staff. Just two hours earlier at his news conference, Gov. Henry McMaster politely asked us again to wear masks. He did that with the advice of state epidemiologist Dr. Linda Bell because the number of infections, deaths and most importantly reports of staff testing positive for COVID-19 in restaurants are all going up.
Diners in those restaurants are confident they are being served safe food without disease-causing contaminants, that the kitchens and facilities are appropriately cleaned and that staff wash their hands after using the restroom because the state of South Carolina mandates, monitors and enforces a set of regulations and requires restaurants to post their grade, for which only an “A” is acceptable. Every elevator has a placard declaring how many people are safe to ride on it. Compliance with these systems is not maintained by the police, but by a system of inspections and trust, and the businesses’ knowledge that they will be shut down if they are discovered out of compliance.
And yet when the governor was asked why at least restaurant staff aren’t being required to wear masks, he responded that we can’t possibly do that because we don’t have enough police to monitor it. The implication is that the good business owners of South Carolina he is relying on for voluntary help not only won’t take his advice but will break the law by ignoring government orders and risk having their already shaky business shut down for noncompliance or being sued for not obeying health laws when a patron gets sick and dies.
These are the facts about COVID-19 and the likelihood that you will be exposed to a contagious person with the virus. With a mortality rate no higher than 0.5%, for every reported death there are at least 200 cases in the community. South Carolina now has 10-15 deaths many days, which means there are 2,000 to 3,000 new cases a day. With a contagion period of about 10-12 days, including days without symptoms, there are between 20,000 and 40,000 contagious people in S.C. on any one day — perhaps more since deaths lag infections and rates are going up.
So with about 5 million citizens, somewhere between 1 out of every 100 and 1 out of every 200 people you encounter are infected. If we use 1 out of every 150, the chance of meeting one of these people in public can be calculated based on the number of people you are exposed to: If 10 people, the risk is not so high at 7%. But if you are exposed to 50 people, it’s 28%; 100 people, 49%; 200 people, 74%; and 500 people, 96% — very high.
The host without a mask showing you to your table is exposed to everyone coming into the restaurant, and consequently, so are you. So the higher figures clearly come into play, and it is not hard to see how an epidemic spreads.
There is a simple, proven solution to stopping this spread: social distance and wearing a mask in public indoor spaces. The governor has control over this for restaurants and most business employees through executive orders. Further, in an op-ed in Tuesday’s newspaper, Charleston attorney Allan Holmes asked the Legislature to use liability protection as the hammer to drive businesses to require both staff and patrons to comply. But our governor, with at least the tacit approval of Dr. Bell, has abrogated all responsibility to act forcefully and decided to leave it up to “the people.”
The answer is pretty clear, governor. Just look around. “The people” in South Carolina don’t want to wear masks and won’t unless you use the carrot and stick. Fulfill your sworn duty to protect us and do the right thing. Require all indoor business employees, particularly in restaurants, to wear masks. More of the rest of us will follow.
J. Philip Saul, M.D., is a professor of pediatrics and a pediatric cardiologist.