Evermore the evidence builds that the way to protect yourself from the potentially deadly SARS-CoV-2 virus stalking the planet is to stay as far away as possible from other people, any of whom could be carriers; avoid enclosed areas with poor air circulation; and get yourself fit.
The latest study underlining that these simple actions dominate comes from French researchers who looked at the wide variety of environmental, social and physical factors affecting the differing damage the pandemic coronavirus has inflicted on cities and countries around the world.
Global death rates for COVID-19 – the disease caused by SARS-CoV-2 – range from a staggering 282 per 100,000 people in New York City to zero in Cambodia, Laos, and a handful of other countries. The study titled “Understanding SARS-CoV-2 propagation, impacting factors to derive possible
scenarios and simulations” found that face coverings have no apparent protective value and that disease hits the overweight particularly hard.
“We found no county with an obesity level less than 8 percent with a severe epidemic,” reported researchers from Aspire Technologies and Sorbonne University, joined by Lewis Mehl-Madrona from the University of Maine.
Open space and fresh air appear to play major, protective roles, according to the study, which might help explain why Alaska with its room to get away from others even in the city has one of the lowest death rates in the nation for COVID-19.
Aspire is a company that specializes in data analysis. Mehl-Madrona is a medical doctor and psychiatrist whose attention after graduation from the Stanford University School of Medicine increasingly turned to the traditional healing practices of Native Americans.
His stated goal of trying “to bring the wisdom of indigenous peoples about healing back into mainstream medicine and to transform medicine and psychology through this wisdom coupled with more European derived narrative traditions” puts him somewhat outside the norm for American physicians.
Colleague Dr. François Bricaire, professor emeritus at the Sorbonne, is on the other hand very much in the mainstream. A member of the French National Academy of Medicine and a consultant to the French government on SARS-CoV-2, he heads the infectious and tropical disease department at the Pitié-Salpêtrière Hospital in Paris and has long been involved in research on vaccines and a variety of infectious diseases from ZIKA to Ebola to HIV and tuberculosis.
Given that the latest study appears on MedRxiv – the Facebook of science where the vast majority of SARS-CoV-2 research makes its first appearance these days – reputations matter, particularly given that the French study suggests that if you think you are safe because the people around you are wearing face coverings, you’re kidding yourself.
Masks and lockdowns
The study, which compared the spread of disease across countries on a global level, found no evidence to indicate that either face coverings or lockdowns did much if anything to blunt SARS-CoV-2, but the lockdown conclusion was largely attributed to governments reacting too late.
Though it might, in some cases, have looked like lockdowns worked, the researchers concluded the reality was that COVID-19 had reached its natural peak and was already falling in many places when lockdowns were imposed.
“The countries of Spain, Italy, France, Belgium, UK, Netherlands, Switzerland, Sweden, and possibly Portugal, Malta, and Greece peaked before any lockdown took place,” the study says. “Most countries that locked down early avoided a severe peak…(but) no clear trend existed for lockdown in terms of mortality.”
One of Europe’s hardest-hit countries, “Belgium hit a plateau of 83 deaths on April 4th with consecutively 70, 75 and 86 to start dropping on April 8th, placing the probable peak and turnaround infection period around March 16th,” the study says. “That places the turnaround right after public places lockdown and before individual people locked down.”
The numbers are based on a median delay between infection and death of somewhere between 21 days and 25 days.
“France hit its plateau of excess mortality on April 1st,” the study said, “which places its probable peak around March 12th and March 14th, after the ban on large gatherings, right before public places locked down, and four days before individual peoples were locked down.”
European governments were at the time operating in the dark, the study adds, with infections skyrocketing and “without knowledge as to where they were in the curve except for predictions from mostly faulty epidemic models.
“Looking at a different part of the world, Japan had no lockdown, performed relatively few tests (less than most European countries), has very dense cities and one of the oldest populations, yet suffered a mild epidemic that did not seem to rebound. Japan simply instructed its population very early to avoid closed places, large crowds, and unnecessary physical contact with strangers as a policy that could be applied in the long term. Could that have sufficed? Perhaps their relatively superior diet and health helped.”
Sweden followed a policy similar to Japan, but the Nordic nation has an obesity rate about five times that of Japan. The Swedish death rate of today is about 50 times higher than that of Japan and near the 57 per 100,000 dying in the U.S.
Still, the death rate in Sweden is only about a fifth that of NYC. The French study points the finger of blame for the horror in NYC and some other major urban centers at population density, bad building design and subways.
“All five hardest-hit cities were thickly populated and had a dense subway system (London, New York, Madrid, Brussels, Milan, Paris),” the study says. “Metro/subway ridership is often an indication of office concentrations in modern buildings with shut windows, possibly recycled air or HVAC (heating, ventilation and air conditioning) where clusters may form. Both variables may correlate.
“Did metro mass transportation contribute to the high infection rate or was it office buildings or a combination (as there’s a high correlation between daily death count and cases count)?” the study asks.
It doesn’t specifically answer that question, but notes one key similarity between mass transit and most modern office buildings: a lack of fresh air. In this regard, the study underlines what has been known since Americans were ordered to keep their bedroom windows open during the time of the deadly Spanish flu pandemic more than 100 years ago.
Locked up with a pathogen
The pandemic has been largely driven by clusters of infections, the study notes, and “the majority of infection clusters occurred in closed spaces, which were poorly ventilated or ventilated, cooled, and heated through HVAC. Health care facilities and hospitals typically have HVAC as do most slaughterhouses, hotels, social facilities, discotheques, buses, schools, companies of moderate size or larger, call centers, and gyms.”
All of those were locations that recorded clusters even when people were all masked up as in fish-processing plants in Alaska. The study suggests this might be a warning that it is time to redesign buildings to provide for windows that open to allow access to fresh air.
“All five hardest-hit cities had a high concentration of modern office buildings and hotels with shared and/or a culture of centralized HVAC in office buildings, malls, homes,” the study says. “For most buildings, the easiest way to deliver outside air directly across the building envelope is to open a window.
“Window ventilation not only bypasses ductwork but increases outside air fraction and increases total air change rate as well. Administrators and building operators should discuss a plan for increasing perimeter, and specifically window, ventilation when outdoor temperatures are adequate for this practice.”
It does not appear that any governments – national, state or city – ordered businesses to keep their doors and windows open during the pandemic though there were strong indications before the latest study that such an order could help reduce infection rates.
This study, as with others before and one just out, notes the dearth of infections in open-air environments.
A “rapid review” of outdoor transmissions posted on MedRxiv today by scientists from the United Kingdom concluded that although infections appear possible in crowds “when the natural social distancing of everyday life is breached…for an extended period (say, for instance, in a crowded stadium at an NFL football game),” there are “very few examples of outdoor transmission of COVID-19 in everyday life among (approximately) 25,000 cases considered, suggesting a very low risk.”
The French study came to the same conclusion, observing that “recent manifestations across the world in countries with tens of thousands of people gathering with close contacts in a very restricted open air space with few masks did not lead to cluster formation in spite of massive testing further confirming contamination happens indoors.
“Most identified clusters happened in health-care facilities or hospitals, slaughterhouses, schools, hotels, social facilities, discotheques, subway/metro, buses, companies, worship places, family reunions, gyms (and) call centers.”
The study indicates these are good places to avoid unless well ventilated. Possibly so, too, closed motor vehicles. In Europe, where the Tour de France is now underway, the cyclists riding without masks in a tightly packed peloton that sometimes passes through crowds sometimes short on masks has, to date, avoided infection.
But Tour race director Christian Prudhomme, who spent the first nine days of the race riding around in closed motor vehicles with dignitaries invited to follow the race, is now in isolation after becoming infected.
Prudhomme has always been seen masked in public appearances and the dignitaries in the car with him have been seen masked. Those face coverings, it goes almost without saying, have been the subject of much debate.
“Asian countries easily wore masks and were spared,” the new study says. “Denmark, Finland, and Norway skipped masks and were spared. African countries tried to wear masks and took them off and were spared. Open-air music festivals and demonstrations on June 21st with or without masks did not show an increase in cases or the appearance of clusters within 14 days.
“Given a median delay between infection and symptoms of 5.1 days, depending upon testing policies, the effects of masks wearing should appear within five days and become definitive within 14 days.”
The study could find no connection between orders to mask up and drops in infections within that five to 14-day window.
The face-covering data can, unfortunately, be cooked in all sorts of ways to draw conclusions pro or con. A favorite study cited by face-covering advocates is said to report, as LiveScience headlined: “Hairstylists with COVID-19 didn’t infect any of their 139 clients. Face masks may be why.”
“May” would appear an understatement given that the study provides no indication the hairstylists involved were shedding virus, let alone in what quantities. All that is known is that they were infected. The study published by the Mortality and Morbidity Weekly Report of the Centers for Disease Control (CDC) delves deeply into what kind of mask were worn in the hairdressers’ salon but never says whether any SARS-CoV-2 was found in the salon or in the masks of the infected hairdressers.
The study also concedes that “viral shedding is at its highest during the two to three days before symptom onset; any clients who interacted with the stylists before they became symptomatic were not recruited for contact tracing.” In short, the clients studied were those least likely to be infected by the hairstylists if the hairstylists were shedding viruses at any point, which is itself an unknown.
The French study notes that after masks were ordered in California, infections went up when they should have been going down, and likewise in Texas there was “an up curve in which masks did not appear to show any effect.”
Overall, the study concludes, “evidence as to (masking) efficacy is weak, and it becomes weaker when transposed into real life for a large population and raises the question as to long term effects of prolonged mask wearing in populations.
“Masks wearing, is a political, sociological decision. The data does not support that it’s being a meaningful factor in real-life conditions where it may actually give an illusion of protection.”
But the study did not wholly rule out masks, conceding that “masks may have a mitigating role in situations of high density with HVAC or travel on poorly ventilated public transportation.” Then again, those are the sort of places people should be avoiding.
Rogue infectious disease expert Anders Tegnell, Sweden’s chief epidemiologist, has argued that the illusion of protection might actually make mask wearing dangerous, but others contend there is value in the piece of mind masks provide by offering the sense that everyone is cooperating to try to limit the spread of SARS-CoV-2.
And a recent study in New York concluded that face coverings were “associated with a 6.6 percent reduction of transmission overall.” The same study, it should be noted, found that “interventions reducing contact rates were associated with a 70.7 percent reduction of transmission overall.”
By that measure, avoiding other people offers about 11 times the protection of putting on a mask and mingling with them. The above study, like most these days, was posted on MedRxiv and is not peer-reviewed.
The great weight debate
And then there is that weighty matter of body fat, something that was epidemic in many Western countries before the pandemic. Physicians in most countries have been telling patients to lose weight for decades now.
The advice has gone unheeded. The French study would indicate many who refused to listen are paying with their lives.
“For each unit of increase in obesity percentage, the average total death per million increased by 8.76 percent on a global average,” the researchers reported. “However, as the epidemic was at different stages in different continents, we decided to do the regression by continent.
“This gave us the following results: For each percent increase in obesity, mortality per million increases by 6.48 percent in Africa, 10.88 percent in South America, 9.07 percent in North America, 12.89 percent in Europe and 8.51 percent in Asia.”
Those numbers are simply mindboggling.
“In the presence of obesity,” the study added, “other variables (diabetes prevalence, smoking, age 70 years or older, life expectancy, population density) were insignificant, further demonstrating the importance of obesity as a significant indicator in the epidemic course. Japan, the country with the oldest population in the world, with very high population density, with no lockdown, few restrictions and low testing outperformed by most other countries, has the lowest obesity rate in the world at 4.3 percent and had minimal deaths (1.1 per 100,000).”
An English study has suggested a high level of overall physical fitness can help to trump obesity, but by and large, study after study has shown COVID-19 a significantly greater threat to fat people than the thin people.
Western countries have, unfortunately, been badly losing in the war against obesity. In the U.S., heavily advertised, calorie-dense fast food remains a staple for many, city designs continue to promote travel in motorized vehicles over encouraging people to move about under their own power and thus get some exercise, and streets have become so dangerous because of traffic that children are no longer conditioned to get about under human power by walking or riding a bike to school.
The obesity problem appears so well established that the French didn’t even bother to mention doing anything about it when outlining potential solutions to the battle against SARS-CoV-2 and possible future pandemics.
“Our simulations also show that in case of a new epidemic, changing air-conditioning systems to fresh air; reducing population on public transport; favoring some teleworking; shutting down large, closed gathering places that offered prolonged contact; and favoring open air activities could reduce spread drastically without lockdown side effects, and even benefit the economy because of investments, innovation, and a healthier population,” they wrote instead.
They also suggested exposing people to more sunshine could help, given some statistical indications that ultraviolet light helps kill SARS-CoV-2 while boosting human production of vitamin D which appears to have some protective value.
“Given the correlation to UVs and the need for UV exposure combined with the literature on the benefits of vitamin D on respiratory diseases, inflammatory diseases, and even COVID-19, authorities could lead campaigns to ensure their populations have adequate sun
exposure and vitamin D levels to protect in fall/winter from the common cold, influenza or a milder COVID,” the study says.
Some health officials have over the years suggested Alaska – which is notoriously low on winter sunshine and already has a significant problem with seasonal affective disorder (SAD) driven by lack of exposure to the sun – should have a state-mandated, midday siesta during which people are encouraged to get out to catch some rays, but that idea has never been taken seriously.
With a second wave of infections now underway in parts of Europe, the researchers also predicted three likely outcomes for SARS-CoV-2 in the future.
- “Best case – Herd immunity or isolation is successful in the southern hemisphere before
October and the virus disappears” as a deadly threat there.
- “Memory immunity case – The virus returns and 8 percent to 15 percent of major cities’ population (3 percent to 5 percent rural) has lost its acquired immunity but can rely on memory immunity to produce quickly protective cells, thus reducing R0 (reproductive rate) faster and severity faster. That would lead us to a curve that is 30 percent lower in number of cases and 38 percent lower in severity if little action is taken and 50 percent lower in number of cases and 70 percent lower in severity if effective moderating action is taken.
- “Seasonal case – The virus returns and 8 percent to 15 percent of major cities’ population (3 percent to 5 percent rural) has retained its acquired immunity thus reducing R0 faster and severity even faster. That would lead us to a curve that is 60 percent lower in number of cases and 70 percent lower in severity if little action is taken and 70 percent lower in number of cases and 80 percent lower in severity if some effective moderating action is taken. If these projections are correct, in the following years we would have experienced the birth of a new common cold.”The French are not the first to make the suggestion that SARS-CoV-2 coronavirus could evolve to join older coronaviruses now lumped among the many viruses that make the “common cold” common.
“In all cases,” the scientists added, “we expect the next stages to be milder because of natural evolution, our ability to adapt, and maybe our ability to take reasonable, constructive, smart action.”
Natural evolution is a given and human adaptability largely so. Intelligent responses are harder to predict, especially in countries such as the U.S. plagued with political and social skirmishes fueled by a media trying to keep itself financially afloat by selling fear based on the picture of a world populated with Hollywood images of good guys and bad guys.
The French scientists suggest the situation in Sweden – where some media essentially accused the government of killing the many old people who died of COVID-19 – has been badly overblown.
“…The effect of COVID on the population in Sweden where little restrictions were applied was an 8 percent increase in death compared to previous years, assuming all excessive death was caused by COVID and none by influenza,” they write.
“The 2020 mortality from all causes was 0.48 percent. Within that, the over-mortality related to COVID was 0.04 percent. This is no comfort for those who lost loved ones, but as immunity builds, future eventual outbreaks are likely to be milder and more can be done to prevent
“Over a semester of COVID in Sweden, where the population was recommended to be cautious and large events were canceled, but also where influenza seemed almost absent, the situation in terms of over mortality over a semester led to a situation 8 percent to 10 percent more severe than that of previous years in which there were influenza outbreaks.”
Elsewhere, they argue, COVID deaths appear simply inflated. The data for France indicate an excess mortality of 17,691 people, but “this is lower than the 29,779 (COVID deaths) declared by France,” the study says.
Even if all of that countries excess deaths are blamed on COVID – and not on intervening influenza or other factors linked to the lockdown (like not rushing to an emergency room to get symptoms of a heart attack checked out) – the study says, actual deaths are “still lower by 40 percent than the COVID-19 death total, indicating most likely a very large comorbidities factor attributed to COVID.”
COVID-19 deaths have focused heavily on people with co-morbidities, usually more than one and often with one or more that qualify as a deadly chronic disease.
In France, the researchers suggest, “comorbidities in COVID deaths counts…could turn out to be 30 percent to 60 percent of COVID attributed deaths.” Sorting all of this out, they added, will take time, but it may be that a lot of people at the end of life died with COVID but were already near the end when they caught COVID.
“Having a longer look at history gives us a better insight into what happened in one of the hardest-hit countries in the world, but also one that displayed sufficient data transparency because of its structures,” they added. “In France, 2020 in terms of mortality was slightly milder, or comparable to 2016/2017, 1973, 1997, 2000 influenzas and milder than 1969, 1956, 1963, and 1962.”
“This suggests a disproportion between the epidemic’s impact and the populations’ overall reactions which could lead to actions and regulations that are counterproductive on physical, physiological, and the psychological health of populations, making them fragile against COVID-19.”