Coronavirus – the science: Big shift in thinking on face masks

This is a series of regular updates from Irish Times Environment & Science Editor Kevin O’Sullivan on scientific initiatives and developments on coronavirus.

Previous editions can be found here.

Hardening face mask science

The line was: evidence for wearing face masks in public is inconclusive, people won’t wear them properly any way and widespread demand will inevitably reduce supplies of medical-quality masks. All is now changed.

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US Centers for Disease Control and Prevention broke ranks after droplet tests indicated transmission of a virus could go beyond two metres – and advised cloth masks be worn in public.

In early April a British Medical Journal article suggested the precautionary principle should apply as masks “could have a substantial impact on transmission with a relatively small impact on social and economic life.” This had a profound effect on thinking on this side of the Atlantic.

In recent days, Arizona State University scientists showed masks save lives; 80 per cent adoption could reduce mortality by 24 to 65 per cent.

Yet the Irish position has shifted only marginally, to saying they may be required while shopping or on public transport. In line with WHO, the view that it’s more important to ensure continuity of supply of higher-grade face masks for healthcare workers and patients prevails here.

The science could not be clearer and it’s odds on everyone will have to mask up as it’s clearly important – along with “wash your hands” and physical distancing. Clarity is urgently needed, however, and time for hundreds of thousands people emerging from lockdown to make or source masks – and to get used to wearing them.

There is a broad consensus now that wearing even a basic cloth mask properly along with rapid testing/tracing capacity and appropriate use of effective app technology will be all needed, if crushing Covid is to be realised.

Open-up brigade v. Covid realists

For those cooped up or cocooned at home who are beginning to hear strange voices saying “this Covid thing is a vague threat and overhyped in terms of risk now we’re over the peak”, a short reminder of its medical nastiness and horrible unpredictability is merited as an antidote for those cut loose arguments: Covid-19 affects the lungs and in more seriously ill people the kidney, the gut and the brain.

It increases risk of blood clotting – and there is no indication why some get the virus and others don’t. It harder to identify in older people, who are among most vulnerable to the disease, and more difficult to treat. Those exposed to air pollution are believed to be more at risk.

People of all ages with Covid pneumonia can suddenly become terribly ill and have to go into ICU. In some young children, it is believed to cause a form of toxic shock syndrome. What’s more, ethnic minorities and poorer people and those with other conditions are much more likely to die. Recovery can be difficult and can take months.

And we don’t know how it will live on in populations; how it might re-assert itself. Will it be like winter flu or remain dormant for a while like herpes? Will it return in a more virulent form? A University of Minnesota report suggests the pandemic could stretch on for two more years with recurring spikes until roughly two-thirds or more of the population is immune. So please lift that re-emergence lid carefully.

Can you teach an old drug new tricks?

Mr Trump’s overhyping of hydroxychloroquine aside, the antimalarial drug serves a great purpose. But self-administering it – as many did in the US after his intervention – was a shocking example of loose words costing lives.

Niamh O’Boyle, assistant professor of pharmaceutical chemistry at TCD provides a timely warning: “Your old, crumpled box of anti-malarial drugs has been lying squashed at the back of a drawer from an overseas trip many years ago. You heard that guy on the TV saying it was a miracle cure for coronavirus. It can’t hurt to take it just in case, right?

“But a few hours later, you start to get stomach cramps, blurred vision and vomiting. Soon after, your heart starts to skip a beat and you’re feeling faint.”

You are likely to be suffering from a hydroxychloroquine overdose.

Many commonly-used prescription drugs are safe only below a certain dose. At the correct dose, this drug can be a lifesaver for treating malaria, and managing rheumatoid arthritis.

Scientists have shown it could stop Covid-19 from growing in plastic containers in the lab by preventing the virus attaching and getting inside human cells.

“However, plastic containers are a world away from the intricate and beautifully evolved structures that are our human bodies,” Boyle notes.

There is no evidence right now for effects – good or bad – in humans suffering from Covid though it’s being tested in the WHO solidarity clinical trial involving many hundreds of patients. “Until the results from large trials like this emerge in the coming weeks and months, it is likely to be used only for severely-ill patients in hospital.”

So, is hydroxychloroquine a marvellous medicine or a false hope? Right now, until those trials results are in, we just don’t know. Boyle’s bottom line: don’t take this drug without proper medical supervision: “Imagine how you’d feel being rushed into A&E with self-inflicted injuries at a time like this.”

Mind how you go on fast-tracking trials

Some scientists have proposed a way to speed up the clinical trial process by deliberately exposing volunteers to the virus to determine a vaccine’s efficacy.

"This approach is not without risks but has the potential to expedite candidate vaccine testing by many months," according to Nir Eyal, professor of bioethics at Rutgers University in the US.

Volunteers would have to be young and healthy, he stresses: “Their health would also be closely monitored, and they would have access to intensive care and any available medicines,” he told the Guardian. The result could be a vaccine that would save millions of lives by being ready for use in a much shorter time than one that went through standard phase three trials.

Young people might jump at the opportunity to join such a trial but this is a virus that does kill the odd young person, Eyal points out. We don’t know why yet. The final piece of the jigsaw (those large phase-three trials) are still some way off, so there is time to get the conditions right.

Grounds for optimism

Europe is getting it right: Much of Europe was slow to respond to coronavirus, but you cannot quibble with statistics. Almost all EU countries have now got their transmission score (a mathematical indicator, the R0) down below 1 – each case is leading to infection of less than one other person. If they don't keep it that way, the scientist and great R0 explainer Angela Merkel will issue a swift reprimand.

Defying prediction: It was predicted to claim 10 million lives in Africa. So far a continent of 1.2 billion people has suffered fewer Covid-19 deaths than the US was recording each day last week. Reasons are unclear – a young population, warm weather reducing droplet spread, BCG vaccination; who knows? – a continent holds its breath.

Blood test breakthrough: US military scientists have designed a new Covid-19 test that could potentially identify carriers before they become infectious and spread the disease. The blood test is quicker than the usual swab test though it deploys the same PCR technique. Once validated, Mr Trump, would you mind facilitating its global rollout?