The Overseas Situation Report Friday 21 January 2022

by Mike Evans

Adaptability is the simple secret of survival.”

– Jessica Hagedorn

In Spain the government is trying to make a case for Covid 19 to be reduced from a pandemic to an endemic situation across the world. According to the World health Organisation this is too soon. Whilst there has been a big change in the number of cases with the new variant Omicron the severity of this variant is a lot less than the previous variants and for this reason the Spanish Government feels that the world should downgrade the virus to endemic.

With governments and populations worldwide desperate for an end to the pandemic, discussion about when the virus might be reclassified has intensified.

“Spain wants to lead this debate because it is timely and necessary to do so,” Health Minister Carolina Darias has said, adding that Spain asked the European Centre for Disease Prevention (ECDC) to “study new strategies” to deal with Covid.

Spain is in a good position to open the debate, having one of the world’s highest vaccination rates with 90.5 per cent of its population over the age of 12 fully immunised. But the question has sparked disagreement between governments seeking some sort of normality and some parts of the medical community which advocate keeping its guard up. The country is working with the scientific community to eventually shift from “managing a pandemic to managing a disease which we hope science will reclassify as an endemic illness”, Spanish Prime Minister Pedro Sanchez said this week.

Although Omicron has triggered a surge in infections, there have been fewer deaths and lower rates of hospital admissions, with many governments easing restrictions, reducing isolation times, and loosening border controls.

While this is being debated it could well be the time to see what good things have come out of the past 2 years of pandemic that could help us in the future.

In the USA, Dr. Megan Ranney, professor of emergency medicine and academic dean of public health at Brown University, feels there are a lot of good things to be taken from the pandemic which could be carried on in the future.

Respect for masks is at the top of that list. According to Dr. Ranney, she says, “We’re all anxious to see each other’s faces again. Once the majority of us have been vaccinated against Covid-19, masks will become less necessary. Mandates for public masking will be lifted, and universal masking will become less common. That’s OK.

But the pandemic has unequivocally proven the public health value of masks. And they should stick around in certain situations. Masks have never been controversial in health care. My mask-wearing clearly protects my patients; that’s why we wear masks in the operating room, or when doing sterile procedures. But masks also protect me, whether from a co-worker with the flu or a patient with tuberculosis. That’s why I was one of the earliest advocates for high-quality personal protective equipment for health care workers in March 2020.

Our understanding of the value of masks for the public, on the other hand, has been fraught with controversy, and has dramatically evolved since the beginning of this pandemic.

At the start of the pandemic, medical professionals advocated the use of masks were not conducive and did not protect people from the virus. But by April 2020, we had realised how important public masking could be. Because SARS-CoV-2 is spread by asymptomatic as well as symptomatic people, simply “staying home if you’re sick” doesn’t stop the virus’ spread; we need to protect each other from asymptomatic spreaders, too. Because the virus spreads by aerosols, simply maintaining a 6-foot distance from other people is insufficient; only with good masks can you stop breathing in the viral particles expelled by someone across the room. And although N95s and the equivalent are the most reliable, we have learned that even cloth masks can do a terrific job at filtering out the virus when good-fitting, well-made and appropriately used.

In other words, when people mask up, whether with cloth or surgical-grade masks, we dramatically decrease the rates of transmission of SARS-CoV2.

And they will continue to have value in certain circumstances going forward.

For example, even once the pandemic is mostly contained, there will likely be sporadic outbreaks of Covid-19 for years to come, particularly in areas with low vaccination rates or when novel variants appear. In those cases, we should be willing to once again temporarily mask up, to keep our community safe until the outbreak can be tamped down.

There will also always be groups of people who are not fully protected from Covid-19, even after being vaccinated. We already have studies showing that people who are immunocompromised (like transplant patients) do not develop full immunity. Those people should be encouraged and supported in masking in public. By maintaining masking in crowded places for the rest of us — on public transportation, in malls, or in other indoor locations — we destigmatize protecting the vulnerable.

We should also not forget the impact of universal masking on other respiratory diseases. According to Dr Ranney, I can count on one finger (really!) the number of cases of influenza I saw in my emergency department this winter. Based on national data, the same is true across the country. Although SARS-CoV2 is far worse than the flu, the flu is not benign; in a normal year, it is estimated to kill 12,000-60,000 people (depending on how bad that year’s variant is). The total lack of flu this year is a tremendous gift.

Data from Australia, Chile and South Africa shows a tiny fraction of influenza cases from April to July, the months that constitute the typical flu season in the Southern Hemisphere.

In those three regions, there were just 51 influenza positive specimens among 83,307 tests for a positivity rate of 0.06 percent.

In contrast, the positive rate in those regions during the same time period in years prior was close to 14 percent. And paediatricians across the world will tell you how few of the normal “winter viruses” they’ve seen this year. This is, at least partly, due to masking. This, too, is an extraordinary feat, and worth repeating. In the United States, circulation of the flu virus dropped sharply within 2 weeks of the government declaring a national emergency March 1. From a flu test positivity rate of 19 percent during September 2019 to February, the rate declined to just 0.3 percent from March 1 to May 16. School closings, bans on mass gatherings and stay-at-home orders helped stop community spread of the flu, as well as the coronavirus, the CDC report said.

“The global decline in influenza virus circulation appears to be real and concurrent with the Covid-19 pandemic and its associated community mitigation measures,” CDC researchers reported Thursday. For this reason, Health services around the world are encouraging people to get the Flu vaccine to keep risk of illness as low as possible.

To sum up on the wearing of masks, when we are all willing to wear masks, even just in certain situations, the mask both loses its stigma and gains power to protect all of us from both big threats like Covid-19, and smaller threats like the flu. It no longer signals that a person is sick, or that a person is strange, nor that they have a particular cultural or ethnic background. It is no longer scary or felt to be an imposition on our rights. Mask-wearing can simply signal that we care about others’ health, and about our own.

This will require a sea change in our public attitudes, but other countries have done it: after the original SARS outbreak, many Asian countries normalised mask-wearing. And this sea change in attitudes is already starting to happen in the United States. Masks don’t have to signify something scary or unfamiliar. Check out Taylor Swift’s flowery mask at the Grammys, or Jennifer Aniston’s “famous face mask.” As the parent of an almost-teenager, I can tell you that her mask has become her favourite new accessory. It has become a form of self-expression or a marker of being part of the in-group. It is also a growing domestic business opportunity.

No doubt as time moves on, other things we started to do during the pandemic will become the “norm”.

Until the next time, Stay Safe.

Total Cases Worldwide – 340,306,683

Total Deaths Worldwide 5,586,507

Total Recovered Worldwide – 273,578,135 

Total Active Cases Worldwide 61,142,041(18% of the total cases) 

Total Closed Cases Worldwide – 279,164,642  

Information and Resources:  

https://www.worldometer.info/coronavirus/

https://www.nbcnews.com/think/opinion/

https://www.france24.com/en/live-news/20220120-spain-leads-calls-for-covid-19-to-be-treated-like-flu

Archives