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Medicine, masks & COVID-19

COVID-19 medicine, protection, and research updates

Friday, June 26, 2020

John Gordon, Content Developer

It’s time for an update on the pandemic! We’re better able to fight COVID-19 the more we learn about it, and we’re learning more about it all the time. Here’s a rundown of some of the new research and findings. This is going to be another long one, so if you don’t have time for everything, skim for the “The short version” sections.

What about masks? Do they really help?

After some of that early mixed messaging, it’s been made pretty clear that we should all be wearing masks. But actual precise data and analysis on their effectiveness has been a little hard to come by. This article in Science magazine was helpful to me. It doesn’t give specific percentages around how much mask-wearing can cut transmission, but it has a lengthy discussion on the types of particles we breathe out, from relatively large droplets to microscopic aerosols (particles that are only a few millionths of a meter), and how diseases similar to COVID-19 are able to spread through these various particles. It also has an interesting analogy between cigarette smoke and the aerosols we exhale; the aerosols and the particles in smoke are approximately the same size and spread and settle similarly. So if you can imagine the distance at which you can smell someone smoking a cigarette, you could potentially also breathe in exhaled aerosols at that distance (which isn’t to say that you would be infected by that amount of exposure—you need more than that—it’s just a way to think about the stuff we exhale and inhale).

Perhaps more interestingly, new research out of Cambridge and Greenwich universities suggests that if everyone just wore masks we could pretty much get the pandemic under control (even with reduced social distancing measures). And that’s not even assuming the masks are fancy surgical masks—simple homemade masks are good enough. Low-tech masks don’t completely eliminate the risk of infection, but they don’t have to. If everyone wore a mask, transmission rates would be reduced to the point where each infected person (on average) would pass on the infection to fewer than one other person; that means there’d be fewer and fewer cases until the number was so small it could be controlled until a vaccine is developed.

The short version: Wear masks! Wear them even if you feel healthy! Wearing a cloth mask doesn’t significantly protect you from being infected by others, but it is pretty effective at catching lots of the particles you breathe out, keeping others from being infected by you. You can carry the coronavirus without knowing it, so be courteous and safe and wear a mask. “My mask protects you; your mask protects me.”

Who can spread it?

There’s been some confusion around which infected people are most likely to spread COVID-19. Since early on in the pandemic, it has been generally understood that asymptomatic carriers—people who are infected with the virus but haven’t shown symptoms—could still easily spread the disease. In early June, however, representatives from the World Health Organization claimed that asymptomatic transmission of the virus was “very rare.” After the scientific community responded with a resounding “Um . . . what?” the WHO clarified its comments. True asymptotic transmission, they say, is very rare. That’s transmission from people who don’t show symptoms and will never show symptoms. But people who aren’t yet showing symptoms (but will eventually develop them), or who show very mild symptoms, are still very much able to spread the virus.

That clarification was helpful, but scientists at various health agencies and institutes remain skeptical. Anthony Fauci stated that the WHO claim wasn’t supported by enough data—he pointed out that some truly asymptomatic people definitely do transmit the virus, and we don’t know enough yet to say if it’s “very rare.” Also, it’s not yet clear how many COVID-19 cases are really asymptomatic; some researchers estimate that fewer than 20 percent of cases are asymptomatic, while others believe that the number may be as high as 45 percent.

Here’s a good, brief summary of the announcement and the discussion around it.

The short version: It may be harder for asymptomatic people to infect others, but it’s really too early to say. People should continue wearing masks regardless—an infected person can’t know whether they’re truly asymptomatic or not yet symptomatic. So keep your community healthy and just wear a mask.

Blood types? Say what?

Don’t worry about this one too much—I just thought it was an interesting new piece of information. Apparently your blood type may affect the severity of an infection. Researchers from the US, Italy, and China have all found that COVID-19 patients with Type A blood seem to be more likely to suffer from respiratory failure, while those with Type O blood seem to be less likely. This is a statistical association—researchers don’t know what the real connection might be—and there are many other risk factors around the severity of an infection that are probably more significant than blood type.

The short version: People with Type A blood (like me) may be more likely to have a severe infection. People with Type O blood (like my brother) may be less likely to have a severe infection. Both types of people should continue to take precautions against getting infected in the first place. Also, I’ll just add this to the “My Lousy Brother” list, right below “Able to get tan” and “People always talk about how handsome he is.”

Surface-to-surface? Can I touch stuff?

The Centers for Disease Control has recently updated some of their guidelines on surface-to-surface transmission of COVID-19. As we’ve learned more about the virus, it seems like the main way it jumps from person to person is through close contact—basically by breathing in droplets or particles from an infected person. Surface-to-surface transmission—an infected person touching a surface or object, and then a healthy person touching that object and their face—appears to be a relatively uncommon way for the disease to be passed. Still, the CDC is clear that we should continue to be vigilant about thoroughly washing our hands and cleaning surfaces.

The short version: You probably won’t contract COVID-19 from touching something a sick person touched. But even though the risk is low, keep washing your hands, and still be careful about touching your face. It’s a bad disease, and it’s worth avoiding even small risks, especially when doing so is as easy as keeping your hands clean.

How should we classify this disease?

Since it first emerged, we’ve thought about COVID-19 as mostly a respiratory disease—something that affects the lungs and airways. But some scientists are starting to question that. Based on some of COVID-19’s peculiar complications—blood clots, kidney damage, strokes, dark red “Covid toes”—it may be that it’s a vascular disease, something that affects our blood vessels. This article has a good discussion of the theory. Essentially, some scientists think that the virus may be damaging the endothelial cells that line the inside of our blood veins and arteries. These cells protect the cardiovascular system (our heart and lungs) and release proteins that affect “everything from blood clotting to the immune response.” It could be that the damage to these cells is what’s ultimately causing the dangerous respiratory symptoms we associate with COVID-19. This might also explain why kids with COVID-19 usually avoid the worst complications of the disease—their endothelial systems are healthier to begin with. If it’s true that COVID-19 is primarily a vascular disease, it might mean that we’ve been treating COVID-19 the wrong way (or we’ve been missing additional treatments that could be useful). There are existing drugs that protect endothelial cells, and future research might show that they could be helpful.

The short version: We may have been thinking about COVID-19 the wrong way—it could be a disease that affects your veins and arteries just as much as it affects your lungs and airways. The way we classify diseases affects how we treat them, so hopefully classifying this one as accurately as possible will lead to more effective treatments.

Any news on treatments?

It seems like the drug dexamethasone may be effective at treating people critically ill with COVID-19. We want to approach this kind of news with caution, because new research findings could change the story (remember the remdesivir rollercoaster?), but the science looks really promising. Dexamethasone is a common, inexpensive drug (a course of treatment would cost about $50 on average) that was part of a huge study to test the effectiveness of existing drugs against COVID-19. Administered in low doses, the drug appears to cut the risk of death for patients on ventilators from 40 percent to 28 percent, and for patients on oxygen it cuts the risk of death from 25 percent to 20 percent. Those are big numbers when it comes to medical research. As the chief investigator of the study put it, “This is the only drug so far that has been shown to reduce mortality—and it reduces it significantly. It's a major breakthrough.”

The short version: It looks like we might have another effective tool to use against COVID-19! But don’t go out trying to get your hands on the drug in question. Dexamethasone is effective when given to patients who are already severely ill. Like, in a hospital and hooked up to tubes ill. It’s not meant to prevent infections or to treat mild symptoms.

Hard talk from Osterholm

Finally, here’s a recent interview with Michael Osterholm, the Director of the Center for Infectious Disease Research and Policy at the University of Minnesota. Osterholm was one of the scientists who saw the pandemic coming a mile away, and he doesn’t mince words about what he believes the likely outcomes are. It’s occasionally grim reading, but, you know, information is our best tool in this pandemic.