Do be careful, masks, distancing, get vaccinated, ventilation, avoid crowded places, test, trace, isolate, quarantine. #DOITALL - BE CAREFUL
I am posting this after Boris Johnson announced - to much celebration - that the UK will end its mask mandate again because cases of Omicron are falling.
This is not about the economy. Wearing masks has zero economic impact - who is going to be impacted economically by you wearing a mask in public transport or in a shop? It seems to be more about a concept of freedom that some have, that we are more free if we don't use masks to protect others from a sometimes deadly disease. How is that freedom?
People who were brought up in Asian countries where mask wearing was habitual already before the pandemic find this whole thing very strange. It is an act of kindness to others and a normal part of life - when you feel sick, or during flu season or on crowded trains, you wear a mask to protect others from any sickness you might have.
I never understood why masks are so stigmatized here in the U.S. I’m from Japan where we have been regularly masking since before the pandemic—when feeling a tickle in our throats, during flu season, on crowded trains, etc. Masking is our way of showing kindness to others.— Risa Hoshino, MD (@risahoshinoMD) July 7, 2021
This is a graphic I did to promote mask wearing:
Masks are a way to show kindness to others
No masks: let others see your smile
Masks: save others from ambulances
Eyes can smile too
Image credits: File:Coronavirus COVID-19 pandemic.jpg - Wikimedia Commons
The masks do work to some extent the other way around, to protect the mask wearer - especially the better FFP2 and N95 masks - but even those work best of all if everyone wears them.
This is about these better masks and it has some links to help if you need to buy them: What are N95 and FFP2 face masks and do you really need them?
LETTER TO PARENTS FROM ST PETERS CHURCH OF ENGLAND SCHOOL - EXETER - "WEARING A FACE COVERING INDOORS IS A KIND AND THOUGHTFUL APPROACH THAT SUPPORTS OUR SCHOOL COMMUNITY AND OUR FAMILIES"
Throughout the pandemic, governors and myself have always looked to do all we can to keep everyone in our school and wider community as safe as is reasonably possible.
Students, parents, carers and staff have engaged superbly with our collaborative efforts; thank you.
Public health information is clear in Devon. Covid has not gone away.
Despite the Prime Minister’s announcement earlier today regarding wearing of face masks in classrooms, I will be requesting that students do wear them in classrooms as well as corridors in line with other local and national schools.
This is because:
- Public Health predict increased Covid in our area over the coming weeks
- Our own evidence of increasing absences amongst students and staff indicate we should not be reducing approaches to keep our community safe
- Wearing a face covering in indoor areas is a kind and thoughtful approach that supports our school community and our families, many of whom have vulnerable children and adults living with them.
Therefore we will still be expecting all of our community to wear appropriate face coverings in corridors as well as classrooms.
Exeter school are one of over 100 schools who have written similar letters to the parents of their students according to the Telegraph:
I hope this article can help support schools like this that wish to keep mandating masks and promote understanding of why they want to continue with the masks with the general public.
WE ARE IN A SITUATION OF HIGH AND RISING CASES AMONGST SCHOOL AGE KIDS AND LEVELING OFF IN OTHER AGE GROUPS
Cases are rising again in England in the age-group 10 - 19 and have never peaked in the age group 0–9
Data from here
They are also leveling off in the age group of their parents, 30–49 as you see in that graphic, a pattern that has happened before. There is evidence that kids do spread COVID to their parents.
For the latest update on the COVID situation in England see the video for the Independent SAGE update for 21st Jan, 2022.
We are over the previous peak but with an approach like this of letting up on measures with cases still high, it can plateau, only slowly decline, or indeed we could have a rise to a second peak as -may already be starting to happen in teenagers
PEOPLE WHO WEAR MASKS SMILE MORE WITH THEIR EYES
This is a scientific study which shows that mask wearing leads to people smiling with their eyes more than they did before mask wearing.
Smiling for a photo.
With mask - more use of Orbicularis oculi which raises cheeks and creases skin at corner of eyes.
EVEN THE BEST MASKS FOR GENERAL USE WORK BETTER IF EVERYONE WEARS THEM
All masks protect wearer to some extent. But even FFP2 / 3 works best if everyone wears them.
When you see school assembly photos with a few kids wearing masks - these may be kids either vulnerable or their parents are highly vulnerable. So ironically what it means is vulnerable kids and ones with at risk parents are trying their best to protect healthy kids from COVID.
If both the person with COVID and the person at risk of the disease wear well fitting FFP2 risk of infection is reduced 700-fold with one study [F = well fitting].
The risk of infection is reduced 67-fold if the other wears a surgical mask. article here
IT IS OKAY TO RE-USE THE DISPOSABLE FFP2 / N95 MASKS - AND NO NEED TO FIT TEST - BUT DON’T WASH THEM
You can wear the masks until they are soiled or go moldy or torn obviously unfit for use. Expert comment here:
With UK regs changing to mandatory #masks, here's a short [thread] to answer the question: can you wear a disposable #facemask more than once? The answer is YES. Many manufacturers state that masks should be disposed of after 8 hours but this is not true. Read on to find out why ... 1/ pic.twitter.com/f9jXCKq3LT— Prof Claire J. Horwell (@claire_horwell) December 2, 2021
Also you don’t need to fit test them - just find the mask that fits your face best if you have a choice. They still work much better than a surgical mask.
Masks can do a lot to help stop transmission within your own household too especially if a member of your household is a case or contact.
5/ Pre-covid, we conducted tests on FFP2 & surgical masks, for community use during [volcanic] ash exposures. We found that, with no fit training or testing, FFP2 masks were still much more effective at filtering PM2.5 (tiny particles) than surgical masks. https://t.co/nW1U7iY5Rb— Prof Claire J. Horwell (@claire_horwell) July 12, 2021
YOU CAN PREVENT IT REACHING THE REST OF YOUR HOUSEHOLD BY ISOLATING FAST AS SOON AS YOU GET SYMPTOMS
If you get +ve remember you can often prevent it getting to the rest of your household if you isolate from them in a separate room soon as you have symptoms while waiting for results.
So many of the people I talk to don’t know this, or don’t fully appreciate it - what a difference it can make. Who wouldn’t do this if they knew it could save the people close to them from a sometimes deadly disease?
Whatever the government does - if anyone in your household gets it, you can do these things, do your best to prevent it spreading to anyone else in your own household. Same if anyone becomes a contact in your household.
There is a far higher risk of getting COVID from someone else in your household than from any other setting. But even then only 1 in 5 of those at home actually infect anyone else with Omicron. So there is lots of potential for reducing that further.
This table shows the result of one meta-review
So if enough people protect their households in this way, it could block a significant % of all transmission.
This is what the WHO recommend if you get any cases in your household.
Not just for vulnerable cases, for everyone.
In more detail then you can also take many other precautions to protect others in your household.
Isolate in their rooms and only a designated carer sees the case, and especially if the UK gov was to support isolation away from home in quarantine / isolation hotels like NY does - for those who want it - and supported isolation.
And - to protect them most of all, isolate as soon as you develop symptoms while waiting for the test result.
Infographics from here:
Anecdotally many people don't even seem to know the importance of preventing transmission in households. Who wouldn't want to protect others in their own household if they knew of a way to do it? But through a false analogy with flu, many don't realize how much potential there is to block COVID in your own house.
If we all did this it would make a huge difference.
IF YOU WANT TO BE ULTRA CAREFUL YOU CAN TRY WEARING A MASK HABITUALLY AT HOME AT TIMES OF HIGH COVID PREVALENCE
Some of the people I talk to do this, if they have vulnerable members. I haven’t seen it recommended by the CDC or WHO but it may help.
In China some people habitually wore masks at home, all the time when there was community spread in the area. Households that were wearing masks already before the index case got infected had a fifth of the risk of transmission to other members of the household than ones that don't. That was in the first wave early on and as far as I know there haven't been any follow up studies since then to test this. That study is mentioned here:
In a study of 124 Beijing households with > 1 laboratory-confirmed case of SARS-CoV-2 infection, mask use by the index patient and family contacts before the index patient developed symptoms reduced secondary transmission within the households by 79%.
AFAIK that is still the only study of habitual mask wearing in households before anyone gets infected as a way to control COVID. If anyone reading this knows of any other such study please let me know, thanks!
AFAIK nobody has tried a Randomized Control Trial where households in areas with intense community spread are randomly selected to wear masks habitually at home to test for reduced transmission.— Robert Walker BSc, science blogger & fact checker (@DoomsdayDebunks) August 2, 2021
The observational study for ancestral suggests an easily detectable 79% reduction! https://t.co/tb9LoegW3I
This would work by reducing transmission in the presymptomatic and mild symptoms stage of infection before you know you have COVID.
Best if everyone wears masks, masks work best as a source control so you are also protecting the others if you have COVID unknown to you. But some protection the other way too.
Why would masks stop transmission in shops and not at home? Surely worth a try.
Likely it also will help with other respiratory diseases too. I wish someone would look into this and advise us properly - not seen it mentioned anywhere as a possible mitigation measure except when someone in the house already is a case or contact.
Perhaps we could use a Randomized Control Trial to test if this works. Interested in any comments on whether you think this is feasible and how to do it.
We could select, say, a 1000 families of four that are willing to mask up at home for three weeks when community spread in their area is above 1 person in 1000 infected per day.
Of course many won’t be interested, but some will be
- Asian communities because of cultural acclimatization with mask wearing
- Households with immunosuppressed people
We just need 1000 households to agree. Then from that list, select half of them at random to wear masks for three weeks, and the other half don’t. This then is a randomized control trial since the two samples are equivalent, selected only by randomization
As I explain there we could have answers in a few weeks, if the difference is as striking as those early Beijing results suggest. We could also use the same methods to test different types of mask. E.g. does an n95 or FFP2 mask provide significantly more protection in practice? This could be useful data for mask wearing generally in other situations.
Has anyone done such a trial, or is anyone proposing one, anyone know?
#DOITALL AND PROTECT OTHERS
We need to speed up vaccination & slow down the virus. We need vaccines to get to people first. The vaccine is a fake virus and shows your body what to fight. It's 10 days after infection to learn to fight the virus without vaccination. Many die of Omicron or get seriously ill.
Later in 2022 we may have a vaccine or combination of vaccines as effective as the measles vaccine with mucosal immunity (codagenix) + broad spectrum antibodies (e.g. US army multi-variant also protects against SARS) + t-cell immunity (Gritstone bio).
I talk about that towards the end of this blog post: New map showing scale of vaccine inequity - 3.2 billion not received a first dose yet - but we are changing this - the stronger economies could do a lot to accelerate this and vaccinate the world faster
MUCH BETTER VACCINES ON THEIR WAY — AND ALREADY FAR BETTER THAN FLU VACCINES - POTENTIAL TO BECOME MUCH MORE EFFECTIVE STILL EVEN THAN PRIZER - NOT FAR OFF THE MEASLES VACCINE
Some western governments with their “live with the virus” strategies seen to assume that Pfizer / Moderna are as good as the vaccines will ever get. This is so far from the truth.
Later in 2022 we are likely to have a vaccine or combination of vaccines far more effective than Pfizer and possibly as effective as the measles vaccine. But the stronger economies seem to have little awareness of this. The new vaccines are largely financed by weaker economies because they were unable to access the early batches of Pfizer etc - and they are also funded by CEPI.
This means they will be available to other weaker economies at prices they can afford - and many will be available through COVAX. So we will no longer have the same vaccine inequity we had in 2021. The very best vaccines in the world in 2022 will be going to everyone fairly with the weaker economies getting them at the same time as everyone else.
This is good for everyone as we can only end the global health emergency if we stop it globally.
OUR CURRENT VACCINES AGAINST OMICRON ARE LIKE SALK’S POLIO VACCINE - TO STOP YOU GETTING SEVERE DISEASE AND BLOCKING TRANSMISSION AS A SECONDARY GOAL
Our current vaccines against Omicron are a bit like Salk's vaccine against polio. They mainly prevent you getting severe disease and death though the boosters are 70 to 75% effective at reducing symptomatic disease too. Meaghan Kall on Twitter
1. VACCINE EFFECTIVENESS (symptomatic infection)— Meaghan Kall (@kallmemeg) December 10, 2021
*caveat: early estimates*
Real-world surveillance data shows a significant reduction in VE for Omicron vs Delta
* 2x AZ, VE is ZERO
* 2x Pfizer, VE is ~30%
BUT! Boosters increase VE to 70-75% (Pfizer, in the 1st month) pic.twitter.com/qcHCUEwSPL
THREE TYPES OF IMMUNITY - VACCINES IN DEVELOPMENT TO TRIGGER ALL THREE
Our bodies have three types of immunity and the best way to stop a disease is to target all three. The vaccines so far have only targeted antibodies.
- T-cell immunity - especially effective after the disease has established itself in your body - seeks out and destroys cells that got converted by the virus into virus producing factories
- Mucosal immunity - fights the virus right away in the nasal passages - this helps you defeat the virus before it even enters your body and it also is especially good for stopping transmission to others - these are the IgG antibodies
- Antibody immunity (IgA antibodies) - the ones that nearly all our vaccines so far target. These are small Y shaped molecules that latch onto the virus and stops it entering cells - this works to stop it once it gets into the lungs and the rest of the body but doesn’t do so much in the nasal passages
Future 2nd & 3rd generation vaccines should have more effectiveness at preventing the early stages of infection (antibody mediated or sterilizing immunity). Others improve t-cells. Mucosal immunity may be most important of all for stopping transmission. If we don't address transmission, we'll be chasing variants forever
We don't need perfection. Taiwan and China could likely control COVID outbreaks with a vaccine much less than 95% effective at stopping transmission. Rigorous contact tracing, surge testing, and then mask wearing and distancing during a local outbreak might be enough at << 95%
So as vaccines get better then it will be easier and easier to control COVID even very transmissible variants like Omicron. Then - perhaps as soon as later in 2022 - we may reach a situation like the measles vaccine where we can keep levels of the virus very low mainly through vaccination with little else by way of pugblic health measures.
The amazing new vaccines include:
GRITSTONE BIO - T-CELL IMMUNITY TO FIGHT THE VIRUS AFTER IT STARTS TO TURN CELLS INTO VIRUS FACTORIES
- Gritstone bio t-cell immunity - this fights the disease after it starts to convert your cells into “virus factories”. The t-cells tour your body sniffing out and destroying these virus factories by looking for signs of the innards of the virus.
Gritstone bio’s candidate vaccine is now moving to phase 2/3 and Omicron escaped only 3 out of 146 t-cell epitopes (bits of virus innards that the vaccine shows to the immune system).
2nd generation vaccines like Gritstone may be even more effective than Pfizer and work against all variants
Trains B cells to make antibodies that stick to the spikes stopping virus entering cells
Trains killer T-cells to recognize virus innards. Prevents virus making copies inside cells.
Virus innards change slowly, common to all variants.
Gritstone should be more effective and suitable for immunocompromised with suppressed B cells.
CODAGENIX - MUCOSAL IMMUNITY - FIGHT THE VIRUS IN YOUR NASAL PASSAGES BEFORE IT INFECTS ANYONE
Then there’s Codagenix which gives mucosal immunity (Igg antibodies). It’s a nasal spray and it blocks the virus before it starts to replicate in your body and before you can spread it to others.
Codagenix should dramatically reduce the risk of transmission to others. This also just completed phase 1. evidence that it appears to block replication in the nose before it reaches the lungs.. Inhaling away the virus: Is the next generation of COVID vaccines on its way?
"Our vaccine candidate appears able to block surrogate SARS-CoV-2 replication in the nose before it reaches the lower airways or lungs. This is likely achieved by stimulating both a systemic and mucosal immune response, highlighting the value of an intranasal, live-attenuated vaccine model.”
COVI-VAC is now in a larger scale phase II trial with 6000 healthy volunteers - and if all works well then it can proceed to larger phase III trials.
HEXAPRO TWEAK - MUCH STRONGER ANTIBODY IMMUNITY AND EASY TO MAKE IN HEN’S EGGS
ButanVac, in clinical trials is grown in hens eggs, 5 or 10 to an egg instead of 1 to 2 to an egg. License free to weaker economies. Spike proteins stuck in the shape just before virus invades a cell which should trigger a far more effective response than natural immunity.
Pfizer / Moderana used a similar technique (the 2P tweak) but this new Hexapro tweak is even better.
Spike proteins more stable
Immune response stronger
Stored at high temperatures
In phase 1 trials
Free license for weaker economies
US MILITARY’S SINGLE VACCINE ABLE TO VACCINATE AGAINST MANY VARIANTS OF SARS AND COVID - AND ALSO FUTURE VARIANTS
New vaccine in phase 1 based on a football shaped particle with 24 sides which can have a different spike attached to each face - developed by US army.
This defends simultanously against multiple variants of both COVID and SARS. It's expected to lead to broad immunity not just against the variants it targets but also others including even maybe more distantly related coronaviruses - e.g. a similar vaccine candidate accidentally protected against one of the four coronavirus common colds.
These are just a selection of some of the more interesting vaccines in clinical trials. The NY times have a useful vaccine tracker that gives an overview.
As of writing this there are 146 vaccines in clinical trials.
This is extraordinary - it is unusual to have more than one vaccine targeting the same disease. With polio we now have three vaccines.
With so many people now vaccinated in some countries many of these are now being trialed as boosters instead of, or as well as a primary vacicne.
More details of all of these vaccines here.
The WHO are talking about ending the acute phase, the global health emergency and the death and tragedy. But depending on how much we put into it we could also end almost all transmission or get it as low level as measles. And with a good enough vaccine it could be eliminable.
It is technically eliminable in the sense that China don't have it endemic and feasibly with a good enough vaccine may never have it endemic. We've never done that for flu and if you allow non pharmaceutical interventions it fits the definition of an eliminable disease already.
Meanwhile we are also at last solving the problems of vaccine inequity. We could end it far faster with more support from the stronger economies but we are getting there.
. New map showing scale of vaccine inequity - 3.2 billion not received a first dose yet - but we are changing this - the stronger economies could do a lot to accelerate this and vaccinate the world faster
This work by many in weaker economies and academics in the stronger economies generous with their IP is why the WHO say that 2022 is the year we can end this pandemic.
They don’t mean that it becomes another deadly disease like flu that kills thousands every year - but really end it - down to very low levels of deaths like measles.
I cover that here:
. Be very careful over Christmas - many things to make it safer - a rough few months but amazing science - with vaccine equity WHO say 2022 is the year we can end this pandemic - WHO Live Q/A on Omicron
We can all do our part to slow down the spread of Omicron, as people get vaccinated, first with our first generation vaccines and later with the even more effective next generation vaccines.