… Despite the inconsistencies among global health authorities and their cough etiquette recommendations, the indication of “cover your cough with your elbow/arm/sleeve” has reached a phenomenal, close to universal acceptance, including elementary school children who are being successfully trained to practice it. Furthermore, this remarkable compliance around the globe has occurred in a very short period of time. Society has adopted this maneuver without asking for or demanding scientific evidence.
The prompt acceptance, implementation, societal/individual behavior modification, and global dissemination of the maneuver present the scientific community with a dilemma: why was this maneuver so popular in light of the lack of evidence to support it? Involved are several facts and actions: a) no peer review publication documenting this maneuver, b) no scientific evidence supporting the effectiveness of such a maneuver, and c) no scientist author, developer or designer fathering such a maneuver.
…The lack of scientific evidence supporting this particular maneuver is a valid argument for most global health agencies to avoid including it in their set of written recommendations, however it is still conditionally included in pictorial recommendations, as seen in CDC campaigns [18].
Whether or not this particular maneuver is based on scientific evidence, the general public accepted it and voluntarily adopted a change in behavior. This can serve as an example for the scientific community to understand how knowledge should be structured, translated, and communicated to get the message across and subtly induce positive behavioral change in the population.
In summary, assessed public health maneuvers, including facemasks, do not fully protect against the millions of smaller cough droplets, as micron size droplets dehydrate rapidly, form nuclei, remain airborne, and penetrate deep in the lung when inhaled, augmenting the risk of infection, of developing disease, and even increasing mortality due to transmitted infection.
Conclusions
…The results acquired in this study indicate that all CE maneuvers assessed do not block droplets expelled as aerosol when coughing. This aerosol can penetrate profound levels of the respiratory system. Practicing these assessed primary respiratory hygiene/cough etiquette maneuvers would still permit direct, indirect, and/or airborne transmission and spread of IRD, such as influenza and Tuberculosis.
Acquired data suggests that in the case of an individual infected with a highly pathogenic microorganism, infectious cough droplets would still be released to the surrounding environment when covering the mouth/nose with any of the assessed respiratory maneuvers, allowing the probability of infecting susceptible individuals.
