By Kevin Kavanagh
Republished from Infection Control Today
Dr. Jerome Adams, surgeon general in the Trump administration, said this month that the guidelines the Centers for Disease Control and Prevention issued in May on removing of masks were “premature” and “wrong.” Two years ago, most would not believe such a statement, but after the last year and a half, Adams’s statement is viewed by many as just another instance of misguided policy from the CDC. At issue was the May 14 policy reversal of no longer requiring vaccinated individuals to wear masks. The CDC stated it was based solely on science. However, many felt that this would open the door for no one to wear masks. Unfortunately, this is what appears to have happened.
Then came the Delta variant, virus which is up to 2.25 times as infectious as the wild type virus and has a higher replication rate producing 1,000 times more virons. In addition, it appears to be able to evade immunity. Israel reports vaccine efficacy has dropped to 64% in preventing symptomatic disease, down approximately 30 percentage points. Thus, there is concern that even vaccinated individuals can develop symptomatic diseases and may spread the virus. Most agree that the vaccines are effective in preventing deaths and hospitalizations, but even mild to moderate disease carries the risks of long Covid-19.
Thus, neither masks nor vaccinations will truly afford safety in areas where there is high viral spread. Each is a layer of armor and all need to do both until this virus dissipates.
The CDC and our federal response cause concern. In 2020, advisements on masking were reversed once asymptomatic spread was identified. In the public’s eye, this was held by many to be a sign of incompetence rather than evolving science. But since then, there have been a number of missteps in dealing with the coronavirus, SARS-CoV-2.
The rapidity of viral spread around the world, along with case reports from choirs, restaurants, and hospitals made an extremely strong case for aerosolization of SARS-CoV-2 — so strong that 239 international scientists asked the World Health Organization and other public-health organizations on July 6, 2020, to recognize aerosolized spread of the virus. The National Academies of Science issued an expensive report on SARS-CoV-2 airborne transmission in October 2020. On Feb. 15, 2021, warnings were sent to the White House, CDC and the National Institutes of Health regarding SARS-CoV-2 aerosolization by 12 prominent infectious-disease authorities. Their letter called for strengthening of CDC guidelines for small-droplet spread with attention to the provision of respirators (N-95 masks) to workers and those exposed to SARS-CoV-2 aerosols.
But it took until May 6 for the CDC to recognize that airborne transmission can be a major spread of the virus. Ironically, a week later the CDC removed the masking requirement for those who are vaccinated, making the need for N-95 masks much less. Others are starting to follow former Surgeon General Adams’ advice. On July 19, 2021, the American Academy of Pediatrics recommended that all children over the age of 2, regardless of vaccination status, wear masks in schools this fall.
One of the safeguards which was present in 2020 was the presence of civilian scientists on the White House Coronavirus Task Force. However, on January 20, President Biden dissolved his Covid-19 transition task force, removing non-governmental employees, including some who later signed the Feb. 15 letter.
Needless-to-say, early recognition of aerosolization would require the use of N-95 masks and make upgrading ventilation systems an imperative. Proper interventions require infrastructure changes and allocation of significant resources. We also need to implement a comprehensive system of genomic sequencing of viral specimens to track community spread. Throughout this pandemic testing has been woefully inadequate in the United States, unless of course you are a member of a professional sports team.
All of these advisements tend to mitigate the seriousness of SARS-CoV-2 and lessen the need for interventions. We need to have a paradigm shift in the way we view this virus, planning and implementing strategies to allow us to live with an endemic pathogen. We need to treat respiratory pathogens with the same vigor and diligence we put forth to prevent water, surface and foodborne disease.
The advice that you’re safe if you “vax it OR mask it” no longer holds with the Delta variant. We must do both. We also need to be taking this virus seriously. We need to remember that many civilizations in the past have been brought down by infectious disease, and species have gone extinct. What separates mankind from the rest of the biosphere is our intelligence and ability to leverage science. If we do not do this, we are in no better position than a tadpole. Unfortunately, almost all of our leaders appear to be hoping the virus will miraculously disappear. This did not work last year, and it will not work in 2021.