With the World Health Organization (WHO) on Sunday suggesting 60 percent of Europe could be infected with the Omicron variant of the SARS-CoV-2 virus by March, it’s a good time to take a look back at the history of the flu and ask a few questions about masks.
The past is rarely a perfect blueprint for the future, and a coronavirus such as SARS-CoV-2 is different from an influenza virus, but the past is often a prologue for the future and SARS-CoV-2 is to date tracking along the lines influenza followed in the wake of the Spanish flu pandemic of 1918-19.
But first a question about the masks and face coverings that a variety of countries around the globe, including the United States, have pushed as the life preservers of the COVID-19 pandemic driven by the constantly evolving SARS-CoV-2 virus.
The virus has now moved on from the more deadly Delta variant to the more contagious but less deadly Omicron variant, and this is one of several important points being made about the latter.
“Because the proportion of cases that are asymptomatic or mild has increased compared with previous SARS-CoV-2 variants, the global infection-detection rate has declined globally from 20 percent to 5 percent,” The Lancet, a highly respected medical journal, reported last week.
“Understanding the burden of omicron depends crucially on the proportion of asymptomatic infections. A systematic review based on previous SARS-CoV-2 variants suggested that 40 percent of infections were asymptomatic. Evidence suggests that the proportion of asymptomatic infections is much higher for Omicron, perhaps as high as 80 to 90 percent.”
So if 60 percent of heavily masked Europe is going to be known to be infected by March, and if 80 or 90 percent of the rest of the population is likely to be infected but not know it because they have no symptoms, does that mean that without masks everyone in Europe would be infected?
Because the numbers here work out to an infection rate of over 90 percent if these things are true. And The Lancet did more or less suggest just about everyone is going to get infected with or without masks and/or vaccines.
“Surprisingly, Institute for Health Metrics and Evaluation (IHME) models suggest that the transmission intensity of omicron is so high that policy actions – increasing mask use, expanding vaccination coverage in people who have not been vaccinated, or delivering third doses of COVID-19 vaccines — taken in the next weeks will have limited impact on the course of the omicron wave,” the Institute’s Christopher JL Murray wrote for the Lancet. “IHME estimates suggest that increasing use of masks to 80 percent of the population, for example, will only reduce cumulative infections over the next four months by 10 percent. Increasing COVID-19 vaccine boosters or vaccinating people who have not yet been vaccinated is unlikely to have any substantial impact on the omicron wave because by the time these interventions are scaled up the omicron wave will be largely over.”
All of this comes at a time when the U.S. government’s response to the pandemic has been focused on efforts to force Americans to get vaccinated, boosted and masked. President Joe Biden last week trumpeted a plan to distribute 400 million, high-quality N95 masks for free, and CNN reported an “administration official” Monday said that “last week masks began shipping and arriving at pharmacies and grocers around (the) country. We expect that throughout the week the number of stores and N95s arriving to scale up significantly.”
The story echoed the Centers for Disease Control position that “masking is a critical public health tool to prevent the spread of COVID-19, and it is important to remember that any mask is better than no mask.”
People versus peoples
There is some evidence to support the belief that masks offer some protection at the individual level, and N95s are the gold standard for masks. But the evidence that masks do much of anything at the population level remains thin due to a lack of research and testing.
There are “models” suggesting great public benefits from masking, and for people who must use public transportation or work in closed spaces potentially full of SARS-CoV-2 pathogens, there are really no options other than masking to try to get some protection.
The two randomized controlled trials (RCTs) done on masks, however, have shown little or no benefit, and testing of masks in mask-test dummies (more on this to follow) concluded masks could make things worse.
You’ve likely read nothing about the latter study because it challenges the conventional wisdom. As to the RCTs – RCTs being the gold standard of medical testing – both attracted considerable attention along with debate as to their meaning.
The first, in Denmark, concluded masks did nothing, but the authors conceded that because infections rates were low at the time the trial was conducted they couldn’t dismiss the possibility masks might help in some situations. The second, in Bangladesh, found an 11 percent reduction in infections in a masked population versus an unmasked one based on the infection of 7.63 percent of the people in the masked group and 8.6 percent of the peole in the control group.
Some argued this showed masks of great benefit. Others argued the opposite. You can form your own opinion based on the numbers.
Now, to the study of how masks actually work that got almost no media attention anywhere. It was conducted by engineers in India who did what engineers for General Motors did in the early 1970s to allow for the testing of seat belts, they created a crash-test dummy.
Or, in this case, a mask-test dummy.
They built a sprayer that could be adjusted to mimic “normal breathing, coughing (and) sneezing, and installed it in the head of a manikin, they reported. They then used the manikin “to replicate the spray similar to that of an actual cough or sneeze as explained before by matching the parameters like droplet size, velocity range, and spray size. The main objective is to check for the penetration characteristics and get comprehensive insights into the spray impingement and penetration phenomena. An actual spray is used for impingement in (the) current study instead of (a) single droplet, which has been investigated in our previous work.”
Their study was published online at MedRxiv, the preprint server for health sciences, on Nov. 28. MedRxiv is not peer-reviewed. Much of the science surrounding the rapidly and steadily evolving SARS-CoV-2 virus has been published first there, and none of it has been peer-reviewed.
Which MedRxiv studies attract media attention appear to some degree influenced by what is politically correct, and masks have become politically correct (PC). The Indian study was not PC.
Very few health professionals have been willing to publicly question maskings. Anders Tegnell, chief epidemiologist for the Swedish public health authority was one of the few who did. In April 2020, he warned that masks could create a false sense of security.
“It is very dangerous to try to believe that masks are a silver bullet,” he messaged the European Centre for Disease Prevention and Control (ECDC), only to be taken to task by Science magazine months later.
Sweden’s “cumulative death rate since the beginning of the pandemic rivals that of the United States, with its shambolic response,” Berlin-based reporter Gretchen Vogel wrote there. “And the virus took a shocking toll on the most vulnerable.”
Tegnell has admitted to a failure in protecting the elderly in Swedish care homes, but he has not wavered in his position on masking as generally unhelpful if not dangerous. And as of today, the death rate in Sweden since the start of the pandemic stands at 153 per 1`00,000, significantly lower than the U.S. at 266 per 100, according to the Worldometer tracker.
Sweden is generally in line with the rest of Europe with death rates in Hungary (426/100,000), Poland (275/100,000), Belguim (247/100,000), Italy (239/100,000), the United Kingdom (225/100,000), Greece (220/100,000) Spain (197/100,000), France (196/1`00,00), Austria (154/100,000) and a few other countries higher, death rates in Switzerland (145/100,000) and Germany (140/100,000) near statistically the same; and the numbers in the Netherlands (123/100,000), Denmark (62/100,000) and Norway (which largely closed its borders but like Sweden did not widely mask at 29/100,000) and a few other countries lower.
These wide differences between European countries mimic those in the U.S. states where there is a more than fourfold difference between the 361 per 100,000 dead in Mississippi and the 81 per 100,000 dead in Hawaii.
A peer-reviewed study of death rates in 30 different industrialized countries published in the journal Diabetes, Obesity and Metabolism last February concluded these big differences were best “explained by differences in obesity rates, population health, population densities, age demographics, delays in imposing national virus control measures, per capita gross domestic product and climate (in that order).”
The national virus control measure that appears to have worked best is keeping people away from each other. Infection and death rates throughout the various waves of the pandemic have gone up as people started mingling and gone down when, worried about the spreading virus, they spent less time mingling.
The mingle factor is a huge confounder in trying to find any effect as to mask as University of Vermont researchers who appeared of the opinion masks help. After studying them, however, they came to this conclusion:
COVID-19 cases were not related to masks but to “the number of contacts with adults and seniors, particularly contacts with people who are themselves COVID-19 positive. The factors that predict contacts, in turn, are working environment, living environment and, disturbingly, regularly wearing a mask outside of work. This study reinforces the concerns about risks for persons who have high levels of public contact during the pandemic.”
How could this be possible?
Well, according to the engineers at the Indian Institute of Science, Bangalore, and a participating colleague at the University of California San Diego, it could be because masks don’t magically make SARS-CoV-2 viruses disappear.
Now, admittedly these are engineers, and the “follow-the-science” preachers in the U.s. appear to think one should only listen to epidemiologists on the subject of SARS-CoV-2, interdisciplinary science apparently having gone out of vogue.
Whatever the case, the engineers did build a model, masked it, pumped virus-size nanoparticles into the mask and discovered that the masks do a nice job of blocking the spittle that is a part of every human breath, but not the viruses contained in the spittle.
“It is evident from the data that the droplets of different sizes atomize into even smaller daughter droplets, resulting in significant aerosolization,” they wrote. Aerosols are the itsy-bitsy particles that can stay suspended in the air for considerable lengths of time and thus cover considerable distances.
To study what this means, the engineers put their mannikins face to face and let one cough on the other.
After studying the results, they concluded that simple, single-layer masks are “not sufficient to reduce the risk of infection even if the single-layer masks are worn by both infected and susceptible person. Thus, the experiments clearly suggest the necessity of the need of multiple layers as well as social distancing in mitigating the spread of contagious respiratory diseases.”
The masks did entrap some particles. Whether the entrapment was significant, the researchers said, requires more study. And they added that this aspect “mandates the necessity to follow proper disposal methods for handling face masks after utilization.”
Anyone who has observed the behavior of masked humans these days knows how careless people have become in their handling of masks. Masks are often more for show than health. It wouldn’t be at all surprising if there is someone out there now who became infected by borrowing a mask from someone else so they could be appropriately “dressed” to rush into a store in communities where masking was mandated.
Actually, it wouldn’t be surprising if any number of people ended up infected in this way.
Meanwhile, you might have noticed people’s hands are all over their masks all the time, and afterward, their hands are all over other things. Given this, maybe it shouldn’t be a surprise that infections with the Omicron variant – which recent research discovered survives for a much longer than earlier variants on human hands and plastic – have exploded around the world.
The study in India, it should be noted, was conducted before the even-more contagious Omicron variant emerged. And given that developing COVID-19 after exposure to any SARS-CoV-2 appears to be “dose-related,” as many things are, the infectiveness of Omicron might be an important element in its rapid spread.
If it causes more disease at a lower dose, that change might well mask any progress masks were making in slowing the spread of SARS-CoV-2 – if masks were making any progress.
Be thankful then that Omicron appears less deadly than the SARS-CoV-2 variants that proceeded it. There is now worldwide agreement that is the case, but considerable debate about whether the next variants will be more or less virulent than Omicron, which is where the history of the flu becomes interesting.
The forgotten epidemics
The devastation of the Spanish flu epidemic of 1918-19 is hard to imagine even with what is going on today. In a peer-reviewed study of influenza from 1900 to 2018, published in Infectious Disease Modeling last June, University of Toronto (Canada) researcher Michele Campolieti put the U.S. death rate for that influenza outbreak at 589.6 per 100,000.
That is more than twice the death rate in the U.S. for Covid-19as of today, according to the Worldometer tracker, and more than 60 percent higher than the 361.4 per 100,000 death rate in Mississippi, the state hardest hit by the current pandemic.
Given the nightmare of the Spanish flu, the years that followed with flu death rates near 150 per 100,000 have been forgotten. Alaska’s present death rate of 142 per 100,000 would have been almost normal in those years.
Campolieti’s data shows mortality pushing near to 150 deaths per 100,000 for four years in the 1920s, and it pushed near 125 per 100,000 again in 1935 but there was through all the waves that following 1918-19 a constant, downward trend.
“…The mortality rates for influenza (including pneumonia) show a steady decline during the first half of the 20th century before leveling off in the 1950s,” she wrote, echoing the observations of MIT researcher Peter Doshi who in 2008 penned a history of the flu from 1900 to 2004 for the American Journal of Public Health.
Doshi’s work reflected what a wildlife ecologist might describe as a species’ natural adaptation to a new pathogen.
The average seasonal rate once near 100 deaths per 100,000 in the 1920s fell to an average “rate of 10.2 deaths per 100 000 population in the 1940s (and) to 0.56 per 100,000 by the 1990s,” he observed.
From the 1920s on, he wrote, pandemic years – pandemic being defined by the arrival of a new virus and not the number of people dead – “do not stand out as exceptional outliers, nor were these pandemics visually discernable from nonpandemics in seasonal or monthly influenza mortality graphs. In fact, although nonpandemic influenza seasonal death rates never exceeded prior pandemic seasonal death rates, many nonpandemic seasons were more deadly than subsequent pandemics.”
But there was that always trending downward in deaths despite annual ups and downs. Doshi attributed this to natural adaptations.
“The overall decline in influenza-attributed mortality over the 20th century cannot be the result of influenza vaccination, because vaccination did not become available until the 1940s and was not widely used until the late 1980s,” he wrote. “This rapid decline, which commenced around the end of World War II, points to the possibility that social changes led to a change in the ecology of influenza viruses.”
The death rate in these 60 years fell from the nearly 589 deaths per 100,000 during the Spanish flu to less than one per 100,000 by the start of the 1990s when doctors began to heavily push flu vaccines.
“I found that declining mortality rates occurred simultaneously with expanded influenza vaccine coverage since 1980, especially for the elderly (65 years and older),” Doshi said. “However, recent research suggests that vaccination is an unlikely explanation of mortality trends. A 2005 US National Institutes of Health study of over 30 influenza seasons ‘could not correlate increasing vaccination coverage after 1980 with declining mortality rates in any age group.’
“Other research has reviewed available international studies of inactivated influenza vaccine effectiveness and efficacy. One study concluded that ‘evidence from systematic reviews shows that inactivated vaccines have little or no effect on the effects measured.’ Considered in light of the data presented here, these studies imply that other causes – such as an improvement in living conditions or naturally acquired immunity from similar strains of influenza virus – may have been partially responsible for the declining trends in recorded influenza mortality.”
Or, there could be still other factors.
Focusing too intently on vaccines, Doshi warned more than a decade ago, “risks overlooking other significant microbial and nonmicrobial host and environmental factors that influence the course of human disease. The severity and clinical expression of disease depend on a multiplicity of additional factors, such as the novelty of the pathogen to the host, age, cocirculating pathogens, living conditions, physiological status, and access to treatment.”
Some of those factors – most notably a new novel pathogen in the form of SARS-CoV-2, an older population thanks to improvements in health care, higher density living conditions in some hard-hit places like New Jersey and declining physiological status – have now come back to boost the death rate in the Covid-19 pandemic, which has focused heavily on people with comorbidities and those of middle-age and older.
As of Monday, Centers for Disease Control data showed that 98.82 percent of the more than 848,000 Americans whose deaths are blamed on Covid-19 were over the age of 40 and 88.75 percent of the deaths were among people over age 50.
And the majority of these people were suffering with physiological weaknesses ranging from metabolic disease linked to obesity to high-blood pressure, diabetes, heart disease and more before they were infected.
The one thing that could be said at the start of the pandemic in early 2020 is even more true of the pandemic now: It is not killing the young and the fit; it is predominately killing the old and the weak.
Which is, sadly, sort of how nature works no matter how humankind might like to believe that it’s moved beyond nature.