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We’re living in strange times. As we grapple with new and dismaying terms — flattening the curve, social distancing — let me ask a rhetorical question. When you’re “with yourself” do you feel alone? I do sometimes. And then I try to remember three things: the differences between being alone and being lonely, the deep ties that bind us, and the connection I feel when practicing kindness or gratitude.
Take a moment to consider these questions:
It’s a little counterintuitive that there’s really no need to feel lonely when you’re alone. Yet as I hope you can see, we’re really not. Being able to reminisce and actively participate in feeling the strength of existing connections is a source of significant ongoing strength and stability. As many of us know, this also works with others who have passed on from this life. We can summon the connection that exists with others. These days, when medical and public health guidance instructs us to practice social distancing, please continue to be mindful of our natural abilities to maintain emotional proximity.
Practicing more kindness and having gratitude toward others and toward ourselves is a great way to feel closer, rather than feel farther apart. Most likely, you already know this from life experience. I’d just like to underscore its great value. Ask yourself what would it mean to practice more kindness, to be even more grateful? How have you been able to do so in the past? Now is the time to put all of this and more to good work in our present and immediate future.
Finally, as an added and needed bonus, I recommend this: go outside. Spend time in nature, whether it’s just a walk around the block, hopefully with the sun shining overhead, or out along a path by some trees or a body of water. Enjoy feeling the elements and feeling grounded and present and grateful to be alive. Nature helps.
If we all do this together, each in whatever way works best individually — though of course, not together in any sort of crowded way — we will feel more united. What I am offering here is an attitude and a practice, entirely based in reality, steeped in the good practice of medicine and psychiatry, and informed by practices of spirituality. Be good to your precious self. There is no real need for loneliness. You are not alone.
Follow me on Twitter @JohnSharpMD
For additional blogs and information about the new coronavirus and COVID-19, please see the Harvard Health Publishing Coronavirus Resource Center.
The post How to <i>not</i> practice emotional distancing during social distancing appeared first on Harvard Health Blog.
Ever since the U.S. Centers for Disease Control and Prevention began recommending that all Americans 6 months of age and older get an annual flu shot, it’s been touted as the best method of preventing influenza.
While it’s true that influenza is a highly infectious airborne disease, controversy exists over the use of influenza vaccines, commonly known as flu shots, for its prevention, and this is particularly true for high-risk groups like seniors.
For starters, more than 80% of the respiratory influenza-like illness infections that occur during flu season are not actually caused by type A or type B influenza.1 A flu shot, therefore, will not prevent the vast majority of respiratory infections caused by bacteria and other types of viruses during the flu season.
Further, there are hundreds of influenza viruses, and they’re constantly changing, which means each year health officials must make an educated guess as to which strains are most likely to circulate in the upcoming flu season. The three or four type A and type B influenza viruses that are chosen are then added to that year’s seasonal flu shot, with varying and often disappointing results.
It’s also often stated that influenza vaccination reduces hospitalizations and deaths among the elderly, but research published in the Annals of Internal Medicine calls this into serious question.
An observational study funded by the National Institute on Aging and conducted by researchers from the University of California, Berkeley, the University of California, Santa Cruz and Clemson University reviewed data from 170 million episodes of care and 7.6 million deaths among adults aged 55 to 75, from the year 2000 to 2014.
The goal was to determine the effectiveness of the influenza vaccine in reducing hospitalizations and deaths among elderly people in the study area in England and Wales, using a research design that reduced the possibility of bias and confounding.
While turning 65 was associated with a significant increase in the rate of seasonal influenza vaccination, the study’s authors stated that “no evidence indicated that vaccination reduced hospitalizations or mortality among elderly persons.”2 The researchers concluded:
“Current vaccination strategies prioritizing elderly persons may be less effective than believed at reducing serious morbidity and mortality in this population, which suggests that supplementary strategies may be necessary.”3
While stating that influenza vaccines did nothing to reduce hospitalizations and death rates among seniors, the researchers offered questionable “supplementary strategies” as a solution — namely increasing vaccination among other populations:
"Our findings raise questions … about the overall effectiveness of a vaccination strategy that is limited to standard vaccines and focuses too much on elderly persons. Supplementary strategies, such as vaccinating children and others who are most likely to spread influenza, may also be necessary to address the high burden of influenza-related complications among older adults.”4
However, it’s important to note that flu shot effectiveness is typically low across all age groups, ranging from 10% during the 2004 to 2005 flu season to 60% during the 2010 to 2011 flu season. Further, in 10 out of 14 flu seasons between 2004/2005 and 2017/2018, overall influenza vaccine effectiveness was less than 50%.5
During the 2019 to 2020 flu season, the interim estimates released by the CDC state that the overall estimated effectiveness of seasonal influenza vaccine from October 23, 2019 to January 25, 2020 was just 45%.6
Likewise, during the 2018 to 2019 flu season, the vaccine failed to offer any protection more than half the time, and for adults over 50, it was more or less useless, offering a mere 24% effectiveness rate against all influenza types.7 Even the CDC stated, “ … more effective influenza vaccines are needed.”8
There are risks of side effects, as well, including among children. A 2009 U.S. study compared health outcomes for children between 6 months and age 18 who did and did not get annual flu shots over eight consecutive flu seasons and found that children who had received inactivated influenza vaccinations had a three times higher risk of influenza-related hospitalization, with asthmatic children at greatest risk.9
This evidence suggests that annual flu shots may lead to reduced protection against influenza and even increase risks for coming down with influenza.10
The featured study is important, in part, because it attempted to eliminate bias that has been widespread among previous research into flu vaccines among the elderly.
For instance, a 2006 study found seniors who received influenza vaccines had a 44% reduced risk of dying during flu season compared to unvaccinated seniors, which sounds promising, until you learn that those who were vaccinated were also 61% less likely to die before the flu season ever started — a finding attributed to the "healthy user" effect.11,12
“The reductions in risk before influenza season indicate preferential receipt of vaccine by relatively healthy seniors,” the researchers noted. “In this study, the magnitude of the bias demonstrated by the associations before the influenza season was sufficient to account entirely for the associations observed during influenza season.”13
A 2019 systematic review published in the journal Vaccine also found evidence of widespread bias. Out of 22 studies, 9% were found to be at moderate risk of bias, 59% were at serious risk of bias and 32% were at critical risk of bias. “For all-cause hospitalization outcomes, we found a wide range of results, mostly deemed at serious risk of bias,” the researchers noted.14
Despite the CDC’s continued assurance that annual flu shots are the best bet for seniors to avoid getting infected with type A or B influenza, the product has a dismal history in terms of effectiveness. Research published in 2006 analyzed influenza-related mortality among the elderly population in Italy that was associated with increased vaccination coverage between 1970 and 2001.15
Researchers found that after the 1980s, there was no corresponding decline in excess deaths among the elderly, despite rising influenza vaccine uptake. According to the authors, "our study challenges current strategies to best protect the elderly against mortality, warranting the need for better controlled trials with alternative vaccination strategies."16
The Flucelvax vaccine introduced during the 2017-2018 flu season is grown in dog kidney cells rather than chicken eggs. Touted as a new-and-improved flu shot that would protect more people, U.S. Food and Drug Administration research found no significant difference between it and the conventional flu shot in protecting seniors.
While flu shots overall had only 24% effectiveness in preventing influenza-related hospitalizations in people aged 65 and older, the Flucelvax vaccine had an effectiveness rate of only 26.5% in that population.17
Health officials also frequently state that if you get the influenza vaccine, it will lessen disease severity should you get infected with type A or B influenza viruses. But a 2017 study by French researchers found such claims not to be true. Looking at data from vaccinated and unvaccinated elderly patients diagnosed with influenza, all they found was a reduction in initial headache complaints among those who had been vaccinated:18
“Compared to non-vaccinated influenza patients, those who had been vaccinated had a slightly reduced maximum temperature and presented less frequently with myalgia, shivering and headache.
In stratified analyses, the observed effect was limited to patients infected with A(H3) or type B viruses. After adjusting by age group, virus (sub)type and season, the difference remained statistically significant only for headache, which was less frequent among vaccinated individuals … Our findings reinforce the need for influenza vaccines providing better protection.”
Echoing other studies, a systematic review and meta-analysis published in The Lancet Infectious Diseases similarly stated, “Evidence for protection [from influenza vaccines] in adults aged 65 years or older is lacking.”19
Natural killer (NK) cells are a specific type of white blood cell. They’re an important component of your cell-mediated (innate) immune system and are involved in both viral diseases and cancer. NK cells tend to lose functionality as you age, which explains why you may become more susceptible to influenza and other viral and bacterial infections as you get older.
Researchers discovered that with enough NK cells in your system, you will not contract influenza.20 KLRD1 is a receptor gene found on the surface of NK cells, and the level of KLRD1 found in a person’s blood prior to exposure to the influenza virus was able to predict with high accuracy whether that individual would contract influenza.
People whose immune cells consisted of 10% to 13% NK cells did not get influenza while those whose levels fell below 10% did.21 Fortunately, you can counteract decline and boost your NK cells (no matter what your age), by doing the following — none of which involves getting an annual flu shot:
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Get regular exercise — In one study, moderate exercise improved NK cell function in cancer patients.22 |
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Quit smoking — Quitting smoking will also help, as smoking impairs NK cell function.23 |
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Enzymatically modified rice bran (EMRB) — EMRB is produced by exposing rice bran fiber to enzymes isolated from the shiitake mushroom. In one 2013 study, a rice bran product called MGN-324 increased NK cell activity by as much as 84% in patients with multiple myeloma after three months of treatment.25 In an earlier study, old mice injected with EMRB had a fivefold increase in NK cell activity within two days.26 |
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Cardamom — A relative of turmeric, known for its potent immune-boosting benefits, cardamom increases NK cell activity.27 |
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Black pepper — Like cardamom, black pepper has also been shown to enhance the cytotoxic activity of NK cells and promote healthy immune function.28 |
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Colostrum — Colostrum is milk produced within the first 24 to 48 hours of giving birth. Colostrum from cows is very similar to human colostrum, and colostrum products are typically derived from cows. The colostrum contains an array of immune and growth factors required by the offspring. In a 2012 study on mice, oral administration of skimmed and concentrated bovine late colostrum was shown to activate the immune system and protect against influenza infection by boosting NK cell activity.29 Another 2014 animal study concluded that, "Colostrum supplementation enhanced NK cell cytotoxicity and improved the immune response to primary influenza virus infection in mice." Colostrum-supplemented mice that did contract influenza also had less severe infection and a lower viral burden in the lungs compared to controls.30 An earlier study, published in 2007, found treatment with oral colostrum for two months prevented influenza infection three times more effectively than influenza vaccination.31 |
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Mushrooms — Mushrooms such as shiitake, maitake and oyster mushrooms, also boost NK cell activity courtesy of beta-glucans, a polysaccharide known for its immune-boosting and cancer-fighting activities.32 |
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Active hexose correlated compound (AHCC) — AHCC is a commercially available fermented mushroom extract that supports healthy immune function, primarily by enhancing NK cell activity. As noted in a paper published in the Natural Medicine Journal:33
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Probiotics — Beneficial bacteria found in traditionally fermented foods also boost NK cell activity,34 and those with low NK cell levels tend to experience greater benefits from probiotic supplementation than those with healthy levels of NK cells. |
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Ginseng — Panax ginseng augments NK cell activity and boosts cytokine production that lowers inflammation via a polysaccharide called ginsan.35 |
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Melatonin — Melatonin, a neurohormone produced by your pineal gland, is a well-recognized modulator of cancer risk that may also boost NK production. A 2005 paper discussed the immunoregulatory action of melatonin on your innate immune system, and that exogenous melatonin (melatonin supplementation) "augments NK cells and monocytes in both the bone marrow and the spleen with a latency of 7 to 14 days."36 |
The Dallas Independent School District (DISD) is suing Angela Bolton-Smith trying to force autism testing on her son, Trent, who is 7 years old and a former student in the district. Trent has been diagnosed with attention deficit hyperactivity disorder (ADHD) and dyslexia, so Bolton-Smith requested that DISD evaluate him for special education services.
DISD began the testing, but then decided they needed to conduct additional evaluations to determine if the boy has autism. Bolton-Smith, who is a special education teacher who has evaluated students with special needs in the district, declined the additional testing, setting off an escalating response from the district, culminating in a lawsuit against her.
In July 2019, when asked why she didn’t want Trent tested for autism, Bolton-Smith told Fox 4 News, “Because there was no supporting documentation, number one. There's no history … He's been with the same pediatrician, and the biggest thing, because I am an evaluator as well. I understand what autism is. I didn't see those characteristics in him.”1
After DISD refused to provide special education services to the student until autism testing was performed, Bolton-Smith appealed to the Texas Education Agency (TEA), which sided with her and the student, stating DISD “did not ensure that it evaluated and determined the student’s eligibility for special education services,” and should have “completed the initial full and individual evaluation,” according to Fox 4 News.2
DISD, however, did not back down, instead requesting a special hearing for the decision to be reconsidered. The district cited federal regulations that parents “cannot choose individual tests” and said Bolton-Smith agreed to allow her son to be tested for “all areas of suspected disability.”3 An independent hearing officer heard the case, and sided with Bolton-Smith once again.4
Outrageously, rather than agreeing to provide special education instruction without autism testing, DISD took the highly unusual step of appealing in federal court, again pressing the issue that federal law requires the student to be tested for all suspected disabilities.
In a statement, DISD noted, “The Individuals with Disabilities Education Act mandates school districts to test in every area of suspected disability. Dallas ISD is seeking to comply with that federal law.”5
Bolton-Smith, however, told CBS News, “It’s almost like Dallas ISD wants to take the parent out of the picture — and they feel like they are the experts — and us like parents, moms and dads, that we won’t know what’s best for our children.”6
Nancy Rodriguez, who is running for DISD board trustee, is among those who have heavily criticized DISD’s lawsuit. In a Facebook post that was later deleted, Rodriguez called the situation a “travesty,” describing Bolton-Smith as a “good mom who just wants the best for her son.”7
Bolton-Smith, meanwhile, fears that her son could be misdiagnosed with autism and stigmatized. Further, according to Rodriguez, the district offers very little assistance to children with autism. Rodriguez stated:8
“He [Trent] qualifies for special ed services under an evaluation and diagnosis performed at Scottish Rite, but the District refuses to provide them unless his mother allows them to evaluate him for autism.
She's a diagnostician for the District and says she sees no autism symptoms in her son and doesn't understand why they want the evaluation, since they offer practically no services for autistic kids. She worries that he'll be stigmatized if the District saddles him with an incorrect autism diagnosis.
Ms. Bolton-Smith has been to two hearings before the TEA--and won both--but the District continues to persecute her and her son. She's spent over $90,000 on lawyers so far. It is beyond me how any of this is in the interest of anyone--not Ms. Bolton-Smith's son, not the other kids in the District, no-one, that is, but the lawyers. DISD's leadership has gone badly astray.”
Bolton-Smith’s attorney has also called the case extremely rare, saying she has only seen three others like it in the last three decades. DISD also refused mediation and Bolton-Smith is now countersuing them to recover legal fees.9 This is an extreme example of a school district attempting to override parental rights to medical testing for their children, and it’s unclear what the district’s motives truly are.
District leadership have stated that they are simply attempting to provide students with a “free appropriate public education,” but trying to force a student to be tested for autism — after his doctors have not made such a diagnosis or recommendation, and without the consent of his mother, who herself evaluates students for special needs within the district — reeks of dictatorship.
While cases involving school districts overreaching their powers are still, fortunately, sporadic, there’s a growing push for health care providers in the U.S. and Canada to vaccinate minor children without their parents’ consent if they feel a child is “mature” enough to make his or her own health risk decisions. Timothy Caulfield, a professor of health law and policy at the University of Alberta, told the Calgary Herald:10
"From an ethical and legal perspective, if they are a competent teenager, then they are the ones you should be having the conversations with … I would say there is an obligation to revisit this topic [of vaccination] with a patient who has become competent."
Calgary Herald continued:11
"The mature minor doctrine plays out on a case-by-case basis. So, a minor may be competent to make decisions about vaccines, but maybe not open-heart surgery.
Still, given vaccines are considered safe, and given that discussions around vaccinations would be relatively straightforward, 'I think it's entirely possible a 13-, 14- or 15-year old would be competent on their own to consent' to the shots, Caulfield said."
A Washington, D.C., lawmaker introduced a bill in 2019 to allow minor children of any age to get vaccines in the city without a parent's knowledge or consent after a doctor says a child is "mature" enough to make the decision.12 A similar bill introduced in 2020 in Virginia would also allow minors to consent to a number of medical services, including vaccines, birth control and more, without parental consent.
Part of the problem with such bills is that, if a child receives a vaccination, for instance, at school or elsewhere without a parent knowing, they will not be able to monitor for side effects or could end up repeating the procedure at a later date. Should a reaction occur, meanwhile, the parent will have no way of knowing about the medical procedure that could have caused it.
There are also reports of hospitals persecuting parents for exercising their right to choose medical procedures for their children, including the vitamin K injection.
The American Academy of Pediatrics (AAP) recommends that all newborns receive a shot of vitamin K at birth, which is intended to help prevent a rare condition known as vitamin K deficiency bleeding.13 Babies have very little vitamin K when they’re born, which is necessary to help form clots and stop bleeding.
Giving a dose of vitamin K can help babies, most of whom are born with insufficient vitamin K levels, to avoid potentially life-threatening internal bleeding, including in the brain or intestines, but the vitamin K shot is not the only solution. Oral vitamin K can also be used, as can naturally increasing the infant’s levels via breastfeeding (which requires that the mother’s vitamin K levels be optimized).
Some parents, therefore, choose to refuse the vitamin K shot for their newborn, a medical decision that’s well within parents’ rights in most U.S. states, but not all hospitals act accordingly when parents make that choice.
The issue reached a breaking point in September 2019, when a class-action lawsuit was filed against Illinois hospitals, including Silver Cross, University of Chicago Medical Center and Christ Hospital, the AAP, the Department of Children and Family Services (DCFS) and pediatricians by Illinois families who had their babies taken from them for refusing the vitamin K injection.14
Recordings of a call between members of the Illinois Department of Health’s Perinatal Advisory Committee (PAC) have since been released, revealing that doctors were even plotting to take custody of newborns and administer vitamin K injections in violation of the parents’ rights.15
A bill that would require mandatory depression screening for public school students was also introduced in 2020, this time in New Jersey, but was vetoed by Governor Phil Murphy.
The bill would have applied to students in seventh through 12th grade. With their parents’ consent, the students would have filled out a computerized screening intended to identify signs of depression. Assemblyman Dr. Herb Conaway, D-Burlington, who proposed the bill, said in a news release, “This is a way to make sure that every kid gets screened, so that we can prevent future tragedies.”16
The bill raised serious controversy, however, in part because the confidentiality of the screenings was in question, as was the potential for false positives. Diagnosing depression is not exactly an exact science, nor something that’s easily quantifiable via a computerized screening.
Further, while the bill was introduced as a way to reduce the rising rates of teen suicide in the state, the first-line treatment for depression is typically antidepressant drugs, which have been shown to increase suicide risk in teens.17
Another little-known fact that flies in the face of parental consent is what happens to the blood that’s taken from the heel prick given to virtually all newborn babies in the U.S. The purpose is to collect drops of blood to test for certain genetic, metabolic and congenital disorders, including phenylketonuria (PKU), cystic fibrosis, sickle cell disease and others.
Not only is this the only test babies receive that’s performed by the state department of health, but it’s also mandatory, except in some cases of religious exemption. Every year, nearly 4 million U.S. babies receive newborn screening, and more than 5,000 are identified as having one of the screenable conditions.18
In some states, however, the blood drops taken from the child are not simply disposed of after the test. Instead, they’re sent to storage facilities that, in some cases, keep them indefinitely, raising serious concerns about privacy, patients’ rights and the right of informed consent.
While it’s clear that large databases of newborn blood samples provide unprecedented research opportunities, there’s also the potential for such samples to be used in unforeseen ways that threaten privacy. At the very least, parents have the right to informed consent about how their child’s blood samples are used in the future, and the right to opt-out of such storage should also exist and be easily exercisable.
Further, in the case of accessing special education services for a child, parents should have the right to make decisions about which screenings to opt in and out of, without persecution. In Bolton-Smith’s case, she feels the district’s lawsuit is a form of retaliation from the district.
“It’s almost like because you filed a complaint we are going to retaliate so this whole situation feels like retaliation because I used my right to file a complaint with the state of Texas,” Bolton-Smith told Fox 4 News. “No parent should have to feel someone else gets to tell them how to raise their child. Or what’s best for that child.”19
With 101,606 reported COVID-19 cases across 96 countries and territories as of March 6, 2020,1 and no known cure, people are seeking ways to protect themselves against infection. Logically, many are resorting to wearing face masks when venturing out in public.
However, as face masks are becoming harder to come by, health experts are issuing public statements saying the masks won't protect healthy people against infection. Is that true? Or is it a ploy to ensure an adequate supply for health care workers? As reported in a March 4, 2020, Time article:2
"'It seems kind of intuitively obvious that if you put something — whether it's a scarf or a mask — in front of your nose and mouth, that will filter out some of these viruses that are floating around out there,' says Dr. William Schaffner, professor of medicine in the division of infectious diseases at Vanderbilt University.
The only problem: that's not effective against respiratory illnesses like the flu and COVID-19. If it were, 'the CDC would have recommended it years ago,' he says. 'It doesn't, because it makes science-based recommendations.'"
According to the U.S. Centers for Disease Control and Prevention, surgical masks are not designed to provide protection against airborne pathogens and are not considered respiratory protection. They're only designed to prevent large-particle droplets (which may contain pathogens) from reaching your mouth and nose.3,4
Part of the problem is that these kinds of masks won't form a seal around your face. Most people also have a tendency to touch their face a lot, thus depositing pathogens from their hands to their face anyway.
According to U.S. Surgeon General Dr. Jerome Adams, wearing a mask may actually increase your risk of infection, as most people will touch their face even more frequently when wearing one.5 The CDC only recommends surgical masks for:
Mayo Clinic infectious diseases specialist Dr. Nipunie Rajapakse explains:6
"The current recommendations regarding masks are that if you yourself are sick with fever and cough, you can wear a surgical mask to prevent transmission to other people.
If you are healthy, there is not thought to be any additional benefit to wearing a mask yourself because the mask is not airtight and does not necessarily prevent breathing in of these viral particles, which are very tiny."
The CDC also does not recommend that the general public wear N95 respirators, which are designed to be tight-fitting and capable of filtering out at least 95% of much smaller (0.3 micron in size) airborne particles. According to the U.S. Food and Drug Administration:7
"For the general American public, there is no added health benefit to wear a respiratory protective device (such as an N95 respirator), and the immediate health risk from COVID-19 is considered low."
You wouldn't think the health risk from COVID-19 was "considered low" by looking at or listening to the news though. Perhaps journalists didn't get the memo?
Either way, it strikes many as odd that facemasks and N95 respirators are universally considered key instruments for infection control in health care settings, yet the general public is now told they won't protect against respiratory diseases such as COVID-19.
One reason cited for why the public should not use N95 respirator masks either, even though they protect against airborne pathogens, is because they require fit testing to ensure a tight seal around the face.8
However, according to the CDC's fit test Q & A document,9 this is a relatively simple affair. The qualitative pass/fail test that an individual would conduct to assess whether the mask is properly fitted is a smell test. If you can smell an odorous substance through the mask, it's not tight-fitting enough.
What's more, this test only needs to be done once, when selecting the best-fitting brand, make, model and size of the respirator. Once you know which model fits your face best, you don't need to do the fit test again until or unless your facial structure changes due to dental or cosmetic surgery, for example, or "an obvious change in body weight." Health care workers, however, must do the fit test once a year regardless, in order to maintain NIOSH compliance.
So, what's the real deal on the use of face masks? Do they only protect health care workers from getting sick, and sick patients from spreading it to others, or might they prevent healthy lay people from being infected as well? A 2009 study10 in Emerging Infectious Diseases sought to answer this question in the wake of the bird flu (H5N1) outbreak. According to the authors:11
"Many countries are stockpiling face masks … to reduce viral transmission during an influenza pandemic. We conducted a prospective cluster-randomized trial comparing surgical masks, non–fit-tested P2 masks, and no masks in prevention of influenza-like illness (ILI) in households.
During the 2006 and 2007 winter seasons, 286 exposed adults from 143 households who had been exposed to a child with clinical respiratory illness were recruited … Adherence to mask use was associated with a significantly reduced risk of ILI-associated infection.
We concluded that household use of masks is associated with low adherence and is ineffective in controlling seasonal ILI. If adherence were greater, mask use might reduce transmission during a severe influenza pandemic."
In other words, mask use was ineffective due to low adherence, not because they don't prevent the transmission of illness. In fact, were more people to wear masks, infection rates would probably be lower.
Then there's the article12 "Disrupting the Transmission of Influenza A: Face Masks and Ultraviolet Light as Control Measures," published in Health Policy and Ethics in 2007, which states:
"In the event of an influenza pandemic, where effective vaccine and antiviral drugs may be lacking, disrupting environmental transmission of the influenza virus will be the only viable strategy to protect the public. We discuss two such modalities, respirators (face masks) and ultraviolet (UV) light.
Largely overlooked, the potential utility of each is underappreciated. The effectiveness of disposable face masks may be increased by sealing the edges of the mask to the face. Reusable masks should be stockpiled, because the supply of disposable masks will likely prove inadequate …
Respirators (N–95 and N–100; both commercially available) are masks designed to shield the wearer from inhalational hazards, as opposed to surgical masks, which are designed to protect others from contaminants generated by the wearer. In the discussion that follows, use of the word mask refers only to the former …
Current respirator filters are typically made of polypropylene wool felt, or fiberglass paper. Particles collide with and become enmeshed within these nonwoven fibers. Another mechanism for the filtering media may be the electrostatic charge that these fibers have, which attract and hold oppositely charged particles. The influenza virus has charges at its hemagglutinin spikes …
N95 respirators … have been reported to be protective in preventing transmission of the severe acute respiratory syndrome (SARS) virus … but use of these masks failed to prevent a cluster of cases in one hospital.
If one assumes that influenza is transmitted by respiratory droplets (… which immediately fall to the ground) rather than by aerosols (… which remain suspended in air for long periods of time), the supposition may be that keeping a safe distance may obviate the need for a face mask.
It is stated that the range of such droplets is generally no more than 3 ft. We are unable to locate the basic science behind that assertion … Laschtschenko found that talking sprayed viable bacteria 6 m (approximately 20ft).
Koeniger … found that even whispering sprayed bacteria … 7.4 m (approximately 24 ft) and a mixture of coughing, speaking, and sneezing carried bacteria 12.4 m (40 ft) … From these very old reports, the distinction between respiratory droplets and aerosols may be more apparent than real.
As a respiratory droplet falls to the ground, the aqueous portion quickly evaporates, but the bacterial or viral portion remains. Theoretically, a viral particle, if it remains viable, could be carried by wind or reaerosolized by ground disturbances."
The paper does highlight several factors that can render respirator masks unreliable and ineffective. There's the issue of fit and seal against the face, the fact that they cannot be repeatedly reused, the risk of contact contamination when touching or removing the mask, and the fact that your eyes are also a portal for viral infection.
Still, N95 and N100 respirators "offer the potential of mitigating a potentially uncontrollable pandemic," the authors note, adding "It is our hope that this brief review … draws the attention of policymakers to allow for wider implementation of their use as public health measures."
All of that said, studies13,14 looking at disease transmission rates among people who use either face masks or N95 respirators have shown conflicting results. Some conclude they lower the risk of infection while others find they're no more effective than handwashing. The following excerpt from a systematic review published in 2012 is a case in point:15
"There are limited data on the use of masks and respirators to reduce transmission of influenza … Inclusion criteria included randomized controlled trials and quasi‐experimental and observational studies of humans … with an outcome of laboratory‐confirmed or clinically‐diagnosed influenza and other viral respiratory infections.
There were 17 eligible studies. Six of eight randomized controlled trials found no significant differences between control and intervention groups (masks with or without hand hygiene; N95/P2 respirators).
One household trial found that mask wearing coupled with hand sanitizer use reduced secondary transmission of upper respiratory infection/influenza‐like illness/laboratory‐confirmed influenza …
One hospital‐based trial found a lower rate of clinical respiratory illness associated with non‐fit‐tested N95 respirator use compared with medical masks.
Eight of nine retrospective observational studies found that mask and/or respirator use was independently associated with a reduced risk of severe acute respiratory syndrome (SARS) …
None of the studies established a conclusive relationship between mask/respirator use and protection against influenza infection. Some evidence suggests that mask use is best undertaken as part of a package of personal protection especially hand hygiene. The effectiveness of masks and respirators is likely linked to early, consistent and correct usage."
A 2015 systematic review came to similar conclusions, stating:16
"The concepts of droplet and airborne transmission that are entrenched in clinical practice have recently been shown to be more complex than previously thought.
Several randomized clinical trials of facemasks have been conducted in community and healthcare settings, using widely varying interventions, including mixed interventions (such as masks and handwashing), and diverse outcomes.
Of the nine trials of facemasks identified in community settings, in all but one, facemasks were used for respiratory protection of well people. They found that facemasks and facemasks plus hand hygiene may prevent infection in community settings, subject to early use and compliance."
At present, health authorities recommend using the following strategies to minimize the spread of infection:17
If you have symptoms of illness such as coughing or sneezing, be sure to wear a surgical mask to contain the spread whenever you're around others. As for whether or not you should wear a mask to prevent contracting COVID-19 (or some other infectious disease), the answer is a bit more elusive.
Based on the published evidence, however, it appears it can be at least moderately helpful provided you're:
As reported by The Washington Post,18 face masks of all kinds are now in such short supply, even hospitals are having a hard time getting enough. Mike Bowen, executive vice president of Prestige Ameritech, the largest U.S.-based manufacturer of surgical masks, claims he's been warning governments about the coming of this day.
"This is the precise scenario he began warning about almost 15 years ago, when he pleaded with federal agencies and lawmakers to boost U.S. production of medical masks," The Washington Post writes.19
"He had predicted an eventual health scare and not enough manufacturers. He was right … 'What I've been saying since 2007 is, 'guys, I'm warning you, here's what is going to happen, let's prepare,' Bowen said … 'Because if you call me after it starts, I can't help everybody.'
The coronavirus outbreak has … exposed major vulnerabilities in the medical supply chain. Many U.S. companies, especially hospitals and pharmaceutical firms, rely on Chinese manufacturers for products … like masks and gloves. Now, much appears upended.
There is no global, centralized plan for fast-tracking production of what's known as personal protective equipment … 'Prestige Ameritech is presently the lone voice warning of the insecure U.S. mask supply,' Bowen wrote to President Barack Obama in June 2010 …
'The U.S. protective mask supply could — and mostly likely would — be disrupted, confiscated or diverted in the event of a pandemic,' Bowen wrote to President Trump three years ago … 'A lack of planning on their part is not an emergency on my part,' Bowen said. 'They had their chance. I told them over and over.'"
There's still an awful lot we don't know about COVID-19, its origin, infection mechanisms, incubation and transmission rates, and its treatment. At present, the incubation period appears to be somewhere between two and 14 days, which isn't exactly a precise measurement.20
Complicating matters is the finding that you can spread the virus during that incubation period, and may remain contagious for an undetermined time even after you've recovered. January 30, 2020, German doctors reported21 a case of transmission from an asymptomatic carrier, saying:
"… it is notable that the infection appears to have been transmitted during the incubation period of the index patient, in whom the illness was brief and nonspecific. The fact that asymptomatic persons are potential sources of 2019-nCoV infection may warrant a reassessment of transmission dynamics of the current outbreak.
In this context, the detection of 2019-nCoV and a high sputum viral load in a convalescent patient (Patient 1) arouse concern about prolonged shedding of 2019-nCoV after recovery."
As for how it spreads, the virus can pass from one person to another through respiratory droplets emitted when talking, coughing or sneezing. Aside from breathing the virus in, you may be infected by touching a contaminated surface, or when shaking hands or sharing a drink or utensils with an infected person22 — whether asymptomatic or symptomatic, and possibly for some days after they've recovered.
Now, if COVID-19 can spread during the incubation period and for some time after recovery, wearing a face mask as a precautionary strategy may be rather sensible. After all, surgical masks are meant to limit the spread of the virus.
If you don't know whether you've been exposed, you won't know if you're contagious. So, limiting the wearing of face masks to people who are already symptomatic means people will be walking around spreading the disease for up to two weeks. If they're wearing a mask, they limit the spread of the contagion.
While not a short-term solution for the current shortage of protective masks, perhaps it would be wise to increase global production in preparation for these kinds of outbreaks, just like Bowen has suggested for the past 15 years.
