Four misconceptions about COVID-19

Discarded mask on ground
It protects you too.
  • Your mask protects others but not you
  • Herd immunity can be achieved through natural infection
  • The second wave will be worse than the first
  • The pandemic may last for years

I have avoided writing about COVID-19, as there’s plenty of information out there, both good and bad. But I persistently hear a few misconceptions even from my well-informed, concerned friends and family. So I thought I’d address four of the most common here.

Your mask protects others but not you

I learned a lot about masks when I broke a story in the Canadian Medical Association Journal in 2009, during the H1N1 influenza epidemic. At that time, the Public Health Agency of Canada was recommending handwashing, but not masks, to protect citizens against the virus — a position that flew in the face of expert advice to wear masks.

During the current pandemic, well-meaning public health messages have stressed that wearing a mask protects the people you interact with. Here’s a typical one from the Public Health Agency of Canada:

  • DO wear a non-medical mask or face covering to protect others.

People are inferring from this that masks don’t protect the wearer. Not so! Masks aren’t a one-way filter. If you wear a mask, it is definitely protecting you too. Why aren’t public health authorities mentioning this? After all, a major slice of humanity cares more about themselves than others. I notice that public health agencies often simplify messages in a way that leaves out important information. Maybe they are worried that people will think a mask is a 100% guarantee that you won’t get infected.

For the record, there are no guarantees. But wearing a mask cuts the risk to the wearer as well as people around them.

Because it’s not foolproof, don’t rely on a mask alone to protect yourself. Keep distancing, hand sanitizing, and socializing outdoors, even when wearing a mask. And add a mask to these other practices. For a mask to work, you have to wear it.

Also, make sure the mask is tight-fitting. I wear an N95 mask (available at hardware stores, look for NIOSH N95 printed on each mask) because it keeps out even small particles, lasts a long time and is secured tightly to the face with straps around the head, not the ears. A medical or N95 mask can be pinched over the nose. If you’re wearing a non-medical mask, don’t let your mask fall below your nose. Don’t pull it down on your chin – any virus particles on the outside of the mask can fly up into your mouth or nose. When you take off your mask, remove it completely using the straps and immediately wash your hands.

Herd immunity can be achieved through natural infection

When I started hearing this from sources in the U.S. and Sweden, I was mystified. From my experience working on medical journals, I knew that “herd immunity” was usually discussed in the context of vaccination. The question is, what percentage of the population do you need to immunize to stop spread of a disease? For a highly contagious disease like measles, it has to be pretty high, around 85%.

COVID-19 is fairly contagious, although not as contagious as measles, so rates of combined immunization and infection to achieve herd immunity have been estimated at 50% to 60%. In reality, we won’t know for sure until we start immunizing people and see when the cases drop to zero. But compare even those estimates with the current COVID-19 infection rate in Canada, which is about 0.4%.

For most viruses, the kinds of rates needed for herd immunity are rarely achieved with natural infection. We do see some herd immunity through natural infection with colds and, before a vaccine was available, chickenpox. The disease spreads through a community, infecting a high proportion of susceptible people, then disappears once a high enough percentage of the population has had the illness currently or in the past.

For COVID-19, though, we cannot tolerate infection rates to achieve herd immunity through infection. This would mean an unacceptable burden of death, as well as other long-term effects on COVID’s victims that are coming to light: blood clots and organ damage. The health care system would be overloaded for years. But we can achieve herd immunity through immunization.

The second wave will be worse than the first

This is based on the Spanish influenza epidemic of 1918, which coincidentally followed a seasonal pattern similar to that of COVID-19. There was a first wave in the spring, then lower rates during the summer, then a second wave in the fall, much worse and deadlier than the first.

The second wave of Spanish flu was caused by people behaving badly. No law of nature made it inevitable; it was preventable. A lack of public health measures, massive public gatherings, as well as World War I troop movements and returns without quarantine, led to the highest death rate in human history.

The same goes for the second wave of COVID-19, which is already underway as of this writing. Humans caused it, and we can prevent it from worsening. The re-opening of the economy may have been, in hindsight, too quick and too unsafe. Some measures clearly led to clusters of infection that spread. We can get it under control, but we need to return to greater safety measures. A worse second wave is avoidable, not inevitable. It’s a question of political will and public co-operation.

The pandemic may last for years

Is it something in human nature that treats the moment as if it will never end? Maybe it’s evolutionary biology: to survive a crisis, we need to focus on it to the exclusion of all else, so we don’t have the brainpower left over to think that the future may be different.

Others use the crisis to ride their personal utopian hobby-horse: they say the future will need to be different, preferably in their own ideological mould.

Public health authorities warn that infections and safety measures may last several years, but what they don’t say is that the number of infections will decline, outbreaks will become sporadic, and the safety measures will be much less draconian.

It all depends on vaccination. The more effective the vaccines and the more people who get vaccinated, the faster we can get back to the things that matter most to us.

I foresee a scenario like this: vaccines are rolled out in the first half of 2021. As health care workers, the elderly, and vulnerable groups are vaccinated, infection rates start to fall. After everyone is vaccinated, cases drop significantly. If the vaccines are effective enough, the cases drop to zero. The authorities cautiously open up activities and sectors of the economy. They wait for cases to show up. There are still a few outbreaks, which are closely studied. Some vaccines are dropped because they aren’t effective enough, and others are preferred, in a vaccine shakeout. If any viral mutations make a vaccine less effective, they are incorporated into an updated vaccine.

The virus doesn’t go to zero worldwide, but becomes endemic in a few regions, with occasional flare-ups. Eventually the world gets to zero or near-zero cases. Scientists around the globe start tracking coronaviruses in animals, leading to occasional culls of infected animal populations. Coronaviruses are something we learn to live with, like influenza viruses.

We don’t think about how much our lives are affected by diseases past, but they are. We expect decent wages and low prices because the Black Death raised the value of workers. We have screens on our windows to prevent malaria. We wash fruits and vegetables to prevent food-borne illness. We treat drinking water and build sewage systems to prevent cholera. COVID-19 will undoubtedly leave a mark on our society, but we don’t yet know what it will be.

Why diseases matter

I was 25 when I got very, very sick. After six weeks of illness, four doctors who had no idea what was wrong, and two weeks in hospital, I was finally treated for giardia diarrhea I had caught in the countryside two months earlier. It took months to feel back to my old self, and I had post-traumatic stress symptoms for years.

Once I got back to something like everyday life, I began to notice that our society’s views of illness did not match the reality in many ways. As I started to work at the Canadian Medical Association Journal and learned much more about illness, this view was reinforced.

The reality is that most illness – in Canada and certainly elsewhere – is a matter of bad luck. You are in the wrong place at the wrong time and you catch something. Or something in your body misfires. Or a remote relative had a bad gene.

On a public-health level, society can make changes to prevent disease: vaccinations, good sanitation and water treatment, advisories to wash your hands, and surveillance and screening programs. But at the moment that those systems break down and a person gets a disease, there’s really not much that can be done.

At the same time, health classes in schools do not teach much about disease causation or medical care. Many Canadians come from cultures (and I’m talking about my own here) that see illness as a failing, either of morals or self-care or stoicism. Others see illness as someone’s – either the patient’s or the doctor’s — “fault.” Still others see illness in superstitious terms, even in this day and age. Many Canadians still think little of medical science and still say “I’ve never taken a day off work sick.” Well, either they were very lucky or they were going to work with viruses and infecting their colleagues.

Sometimes I prefer the views of those from other countries where diseases are more prevalent and acknowledged as a fundamental part of human existence. I believe from my own experience and my work that disease, disability and death are part of what makes us human.

Back in Canada, there’s an inaccurate view among people who have not had serious diseases that they happen only to people with poor lifestyles or people in other countries. That is manifestly not true. If you think about it, either you or your friends and family members have been profoundly affected by diseases: heart disease, cancer, rheumatoid arthritis, multiple sclerosis, ALS, SLE, diabetes, etc., etc.

There are a lot of things said in the street, in the media and even in medical literature about what causes these diseases, but biomedical researchers working on them are much more circumspect. In many cases, we do not really understand how these diseases start, or the things we have been saying are turning out to be incomplete — or even completely incorrect.

My feeling is that we are at the beginning of a coming explosion of knowledge on diseases, which will transform prevention and treatment. Because how can you prevent or treat a disease until you understand what is causing it?

The cause of multiple sclerosis: we’re getting closer

My feature on the state of research into MS causes (published Dec. 1, 2016, in Nature Outlook) had a long and complex genesis, which is also true of the disease I wrote about.

I have long been interested in how diseases happen, from my days writing about research for my column in the Canadian Medical Association Journal (CMAJ). I covered a whole variety of health issues, of course, but the ones that were of most concern  the ones that could wipe out populations and cultures were diseases.

A few years ago at the Canadian Science Writers Association conference, Dr. Brian Goldman presented a news clip on an experimental treatment for MS touted by Paolo Zamboni, which he (suspiciously) called “liberation therapy” based on a theory that MS is caused by chronic cerebrospinal venous insufficiency. Or let’s just say veins blocked by metal buildup. Goldman was critical of the glowing media descriptions of the treatment, as they were not evidence-based.

I was sitting at the same table with Dr. Goldman at lunch, and our gang of science writers debated the ethics of this type of coverage. I recall I said, “Of course, we don’t know what causes MS.” Because that was the understanding at the time.

That discussion stuck with me, especially as I met more people with MS over the past few years. Then, in reporting for CMAJ, I covered two research stories on discoveries relevant to the cause of MS. I starting following the references in one of the articles to other research, and I soon learned that the evidence was mounting for several causal factors. Some researchers were looking into whether these factors were linked. In fact, right now there’s a new article every month on these factors.

But I had seen nothing (and I looked) in the media about the good, solid, research that had been slowly amassing over years about Epstein-Barr virus and vitamin D, in particular.

I pitched an idea for a feature on this research at this year’s Canadian Science Writers Association conference as part of a “Dragon’s Den” pitch session to a panel of four editors. And long story short I was eventually asked to write it for Nature Outlook.

Why I included the Elmvale Acres Ottawa cluster

I was in the midst of my research on MS causes, and I was particularly interested in the paper from Winnipeg researchers showing clusters of incident cases of MS in that city. As the authors of this paper told me, clusters are an important clue into causation. They can indicate genetic differences, especially in a multicultural city like Winnipeg, or environmental factors. I was fascinated because the clustering in Winnipeg (unfortunately, for copyright reasons, I couldn’t reproduce the study’s maps, which are worth a thousand words) looked like maps of disease outbreaks. That doesn’t mean they are it is just a possibility worth exploring.

I had wanted to get the human angle on this research, to show that this research is about real people, not just dots on a map. I was even thinking of calling the MS society in Winnipeg to contact patients in the affected neighbourhoods. At this point, several of my friends who knew I was working on the article called or emailed to say there was a CBC story on a cluster right in my city – Ottawa.

I contacted the man at the centre of the CBC story, Jacques Dutrisac. Now, I have some graduate courses in statistics and I’ve read plenty of biostatistics. I know that disease clusters often occur by chance alone. There’s also a well-known perceptual effect that once you have a problem you tend to see it all around you. Careful and complex statistical methods like those used in the Winnipeg paper are needed to determine “true” clustering.

So, to be honest, I called Dutrisac prepared for the possibility that the cluster in the Elmvale Acres neighbourhood of Ottawa might be by chance alone. Dutrisac is a wonderful raconteur and sleuth. Not only had he kept track of all of his former friends and neighbours with MS, he had their names, locations, schools, ages, and ethnic background. He was telling me about one after the other, and I was taking notes. After our chat, I made a table of all 14 people with MS (at that point another neighbour with MS has come to light as a result of the publicity around the cluster). The prevalence of MS in Canada (where it is highest in the world) is 291 per 100,000 or a little under 3 per 1000. In an area of less than 1000 people, the rate was at least five times higher than the national average. When I looked at the fact that the people affected not only lived in a kilometre-radius area, but were all about the same age in fact, most exactly the same age as Dutrisac –, went to the same schools and were two-thirds francophone… well… that can’t possibly be by chance.

So I feel that I’m being responsible as a journalist in covering a cluster that has not yet been studied, but should be.