Now almost two years into the Great Pandemic, humans are discovering they’re not nearly as smart as they’d like to believe, and clearly not above the nature they once thought they had conquered.
California residents who slid through the first waves of the crisis in better shape than the residents of many states met the latest wave by pulling on their face diapers, getting their vaccinations and smugly thinking all would be fine if they just went about life as if there were no SARS-CoV-2 virus.
The virus apparently had different ideas.
Infections rates for Covid-19, the disease the virus causes, are now rising steadily in California amid growing fears of a winter surge as people move indoors and began breathing greater volumes of each other’s air.
The unvaccinated are being blamed, but vaccinations do not appear to be the be-all to end-all. Despite an adult vaccination rate near 85 percent, the Netherlands is seeing a surge in infections that has it considering another lockdown, Reuters reports.
Vaccinations have fortunately reduced death and hospitalization rates, which is a good thing. The Dutch report 70 percent of those now in intensive care units were either unvaccinated or only partially vaccinated.
But neither the vaccines nor newly reordered masking appear to be as effective as had been hoped in halting the spread of the disease. Thus the decision in the Netherlands to consider “cancellation of events, closing theatres and cinemas, and earlier closing times for cafes and restaurants,” according to Reuters.
“It seems like we’ve been here before,” Dr. Michael Osterholm, director of the University of Minnesota’s respected Center for Infection Disease Research and Policy (CIDRAP) observed in a Thursday podcast, noting it was being broadcast on the one-year anniversary of the Pfizer vaccine.
“There was a sense of euphoria” at Pfizer’s claimed success in blocking infections, he added. Some of the euphoria has now faded. The Pfizer and other vaccines have proven very good, but far from perfect.
There is today, Osterholm said, “a lot of uncertainty….We’re going to need a big dose of humility again.”
Nature is reminding us once again that we’re not as smart as we like to think we are, but we have slowly but steadily been learning.
SARS-CoV-2 circulation in indoor air has finally become a subject of serious discussion, though in the U.S. the administration of President Joe Biden seems to believe an effort to coerce all Americans into getting vaccinated will do more for public health than fixing building ventilation.
Scientists have a slightly different view.
“SARS-CoV-2 indoor air transmission is a threat that can be addressed with science,” the Environmental Health Matters Initiative (EHMI) of the National Academies of Science, Engineering, and Medicine (NASEM) titled a research paper on the subject issued early this month.
“Airborne transmission of SARS-CoV-2 by aerosols implies that infection risks can be reduced by making changes to the built environment: increasing exchange of indoor with outdoor air, air filtration, and germicidal ultraviolet irradiation,” the group concluded. “Limiting the number of people within spaces and distancing them reduces the strength of the source – people – and the intensity of the exposure.”
Similar problems were faced with secondhand smoke more than a decade ago when a panel of experts convened by the federal Occupational Safety and Health Administration and the American Conference of Governmental Industrial Hygienists suggested that a new technology – displacement ventilation in buildings – held the potential to reduce by 90 percent the potential carcinogens airborne in secondhand smoke in restaurants, bars and casinos.
The idea was never pursued, however, because it was cheaper and easier for businesses to go smoke-free and kick the smokers outside to enjoy their addiction.
A decade later, a 2020 study by the Centers for Disease Control and Prevention cited bars and restaurants as hotspots for Covid-10 infections.
“Adults with confirmed Covid-19 (case-patients) were approximately twice as likely as were control-participants to have reported dining at a restaurant in the 14 days before becoming ill,” the non-peer-reviewed study said. “In addition to dining at a restaurant, case-patients were more likely to report going to a bar/coffee shop, but only when the analysis was restricted to participants without close contact with persons with known COVID-19 before illness onset. Reports of exposures in restaurants have been linked to air circulation. Direction, ventilation, and intensity of airflow might affect virus transmission, even if social distancing measures and mask use are implemented according to current guidance.”
This enclosed-space risk has not diminished since then even though some medical professionals advocating masking as a health-protective measure seem to have missed the point.
The incongruous logic there is at the heart of a continuing public battle over masking generally waged between the tribe on the right and the tribe on the left.
Ali H. Mokdad, a professor of health metrics sciences at the University of Washington, told the California Mercury News newspaper that the state may be “paying for your success, which is weird. You succeed in controlling the virus, and now you’re having infections.”
The debate continues
The Institute for Health Metrics and Evaluation at the University of Washington has been modeling the spread of SARS-CoV-2 since the beginning of the pandemic. In July of last year, it estimated that universal masking could reduce infections by 67 percent.
The number has gone up and down since. IHME as of today was projecting a 30 percent increase in infections by the end of the year, but charting a course that had universal masking reducing that by more than 80 percent.
A study out of Bangladesh indicated a 9.3 percent reduction in infections due to masking. A University of Vermont study concluded that any possible reductions could, however, be wiped out by masking encouraging more close contacts between the infected and the uninfected.
Rather amazingly, throughout the pandemic, at least in the U.S., there has been no little attention given to spreading the message that if people feel sick they should stay home and stay away from others to reduce the spread of Covid-19.
After a Kenai reporter was diagnosed with the disease, she put on a mask and then posted a photo of herself out and about. Hopefully, it was only to drive to the pharmacy, and hopefully she stayed in the car.
But the mask did raise questions. There is no reason to wear a mask in your car if you are alone. The only reason to wear a mask in your car would be in hopes of reducing the chance of spreading SARS-CoV-2 to others in the car.
Unfortunately, there seems a continuing and widespread misunderstanding of how infectious airborne diseases are transmitted. That can only help fuel the next surge many health experts fear is coming.
IHME Director Dr. Christopher Murray blames it on “three things coming together in the Northern Hemisphere: winter seasonality, waning immunity for those who got vaccinated – as we now understand much better as we have more evidence that vaccine-derived immunity for protection against infection does wane quite considerably by six months. So we have many people who were vaccinated early in the Northern Hemisphere who are now likely susceptible.
“The third factor that’s fueling these winter increases is the fact that people are much less cautious than last winter, as mask use is much lower. Currently, it is below 40 per in the US – slightly higher than that in Europe, but much lower than a year ago. People’s mobility levels are just below the pre-COVID baseline as opposed to 20 percent to 30 percent below the pre-COVID baseline. Putting those together, we expect that despite progress on vaccination, we will see a winter surge. The question really comes down to how big will that Northern Hemisphere winter surge be.”
Murray’s conclusions on masks and individual behavior, it is worth noting, are out of line with the Vermont study that found that any benefit for masks disappeared as mobility levels went up and close contacts increased.
“A higher number of daily contacts with adults and older adults increases the probability of becoming infected,” concluded the peer-reviewed study published in the Journal of Public Health and Surveillance. “Occupation, living in an apartment versus a house, and wearing a face mask outside work increased the number of daily contacts.”
The increase in infections while masked appears related to risk compensation either directly or subtly. The Vermont study citing “occupation” found people who went to work in places where they thought they were protected by masks increased their risk of getting infected.
“Wearing a face mask outside of work,” on the other hand, appears to have increased close contacts between friends, acquaintances, families and the like, leading to more infections.
“Remember March of 2020, before masks? Back then, as we became aware that the coronavirus was circulating around the country at an alarming clip, packed up our offices, and pulled our kids out of in-person school, the nation’s top experts urged us not to bother covering our nose and mouths,” Tim Reqaurth wrote at Slate this week.
“Among the complex reasons for the hesitation was a simple one: distrust of the public. “I worry that if people put on masks, then they’ll think, OK, I’m protected, and they won’t wash their hands as vigorously or be careful not to touch their faces,” one expert told Slate’s What Next very early in the pandemic. The White House Coronavirus Task Force, the U.K. scientific council SAGE, and the World Health Organization cited similar concerns at the time, too. Masks would only provide a false sense of reassurance, reversing any public health gains they might offer.”
Those scientists appear now to have been right, but Requarth went on to pooh-pooh their conclusions, arguing that people put on masks and continued to wash their hands and practice social distancing with no offer of evidence for that conclusion.
And the Vermont study would tend to indicate he’s badly wrong in his assumption.
Meanwhile, anyone who watches the behavior of Americans today would question whether any self-protective measures are employed by the masked.
Masking has become so pro forma – done where it is ordered by government edict – that it is not unreasonable to wonder if there are not by now cases of people infected with SARS-CoV-2 stuck to the mask they borrowed from a friend or acquaintance because they needed a mask to put over their face to comply with a mandate.
Slate being a left-leaning publication, Requarth tried to dismiss risk compensation because of “a deep connection between the anti-regulatory rhetoric of conservatives and the moral tsk-tsking of prominent voices in the medical establishment over time, from the CDC to the surgeon general.”
“For some in the medical community, if the social goal is a healthier population, then we should just educate people to make better choices,” he writes. “It’s easy to see the appeal of this position for the medical establishment: It shifts the onus of health from practitioners to patients.”
Trying to blame the medical community for shifting “the onus of health from practitioners to patients” seems badly out of sync with the biggest reality of the pandemic.
The SARS-CoV-2 virus isn’t killing many people fit people of healthy weight. It’s killing obese people and people in poor health, many of them suffering from problems largely or in part of their own making.
Green Bay quarterback Aaron Rogers isn’t dying because he has Covid-19. He isn’t even in the hospital. He hasn’t even been missing team meetings since testing positive last week; he’s simply been restricted to virtual attendance.
Much the same has been true of other professional athletes.
Cyclist Peter “Sagan had his own brush with Covid-19 this year, coming down with the virus in early February,” VeloNews reports. “The bout with the virus put paid to much of his classics season, though he picked up a win in March at the Volta a Catalunya and again the following month at the Tour de Romandie.”
Cycling is one of the most demanding of aerobic sports. Nobody competes, let alone wins, with lungs working at less than 100 percent efficiency. Sagan recovered from Covid-19 pretty quickly, as Rogers appears to be doing, because both were in tiptop health before infection.
This has largely been the case for the fit everywhere.
The CDC has reported that only 6 percent of the deaths in the U.S. were caused by Covid-19 alone. Ninety-four percent of the dead were reported to have been suffering from another potentially deadly ailment, and on average, the dead were suffering from 2.9 such medical conditions.
Many of those people were old and poor candidates for improvements in health driven by weight loss and exercise programs, but some dying today would certainly have benefitted from a weight and fitness approach to the pandemic from the beginning.
Sadly, just the opposite happened.
“Many Americans knew they’d put on weight with all the stress-baking and stay-at-home shift in routines,” UCLA Health reported in April. “But two recent studies show pandemic weight gain has been significant – up to two pounds a month according to a March 2021 JAMA Network study, and more than 30 pounds over 12 months for some people, a recent survey by the American Psychological Association found.”
Obesity more than triples the odds of severe Covid-19 (odds ratio 3.13), a peer-reviewed meta-analysis concluded in December, along with greatly increasing the odds for heart disease, diabetes, a variety of cancers and more.
Wearing a mask, according to a popular meta-analysis published about the same time that concluded there is a benefit to masks, lowers the risk of contracting Covid-19 by about a third (odds ratio 0.38).
Think about those odds ratios. If you’re obese, losing the weight has a more than eight times greater influence on your contracting severe Covid-19 than putting on a mask.
But losing weight is hard. Putting on a mask is easy. And American politicians have a long history of playing to what is easy.
Sadly, there doesn’t appear to be an easy fix to the Great Pandemic. But individuals can protect themselves. It’s not rocket science.
If you want to avoid the SARS-CoV-2 virus, keep your distance from other people and stay out of places where their breath accumulates. And if you can’t stay out of those places, minimize the time you spend in them as much as possible.