New Coronavirus News from 20 Nov 2022

With COVID, flu and RSV circulating, it’s time to follow the evidence: Return to mask mandates [The Conversation, 20 Nov 2022]

By Catherine Clase, Charles-Francois de Lannoy and Ken G. Drouillard

The number of children and babies with respiratory illnesses currently exceeds the capacity of our health system to care for them. More adult Canadians will die directly of COVID-19 this year than died last year or in 2020.

Eight per cent of vaccinated people with COVID infections that don’t require hospitalization end up with long COVID, with each subsequent infection repeating the risk. COVID increases the risk of cardiovascular and other health problems, enough to cause a stark rise in excess deaths and to shorten life expectancy.

In 2020, when adult intensive care units were at risk of being overwhelmed, we wore masks and accepted restrictions. With pediatric intensive care now at risk, will leaders follow the evidence and tell us to mask up? While federal officials and several provinces are now recommending masks in all indoor public settings — although Ontario’s Chief Medical Officer of Health Kieran Moore was seen without one at a party — there are no returns to mandates for the public yet.

Wear the best mask available
We now know that masks prevent the spread of respiratory diseases; some better than others.
The most effective masks, and the only ones recognized as respiratory protection by formal standards, are respirator masks: N95s, CaN99s, FFP3s and reusable elastomeric respirators. In workplaces, respirators are fit-tested to the individual, resulting in greater than 99 per cent protection.

Even without fit testing, respirator masks prevent more than 90 per cent of particles smaller than one micron from reaching the wearer (submicron particles, the smallest among those thought to be relevant).

Respirator masks are relatively expensive — typically a few dollars each — but thanks to Canadian manufacturers, they are available and there are no longer concerns about supply chains for front-line workers. They can be safely reused, with good retention of their filtration. New designs are comfortable and fit most faces.

N95s are secured with overhead attachments, providing a good seal at the edges. KN95s and KF94s have excellent filtration material, but their ear loops do not provide as secure a seal, and their filtration is around 70 per cent. A certified medical mask with a well-fitted cloth mask over it, preferably with overhead ties, provides comparable filtration at lower cost.

Certified Level 1 medical masks alone do not fit well, which affects their filtration ability because unfiltered air passes around the edges with every breath. In tests on humans, these have typically filtered at around 50 per cent, similar to well-designed two-layer cotton cloth masks, ideally with overhead ties; both are around 50 per cent.

Poorly fitting cloth masks and non-certified procedure masks are likely worse than 50 per cent, but better than nothing. The World Health Organization advises: “Make wearing a mask a normal part of being around other people,” to which we would add: wear the best mask available.

The filtration data above are mirrored by epidemiologic data showing that protection correlates with mask type. In studies of source control (prevention of contamination of the air by respiratory particles), the same hierarchy of efficiency is seen, with N95s at the top. N95s with exhalation valves are an exception and should not be used to prevent spread of respiratory diseases.

Masks protect against COVID-19 and other respiratory infections. They are also an ideal tool to counter COVID variants, as well as RSV and influenza. Working on basic physical principles — impaction, sedimentation and diffusion — they protect regardless of the variant or strain.

Staying home when sick is helpful, but many people are infectious before they have symptoms, or never have symptoms. Wearing a mask to prevent infected particles from reaching the environment is basic pollution management: control is best at the source.

Wearing a mask to protect the individual, once controversial, is now settled by filtration science and epidemiology. The impact of mask mandates in countries where spontaneous mask wearing was low was repeatedly demonstrated, proving that masks protect us all.

Why people aren’t wearing masks
Why aren’t people wearing masks? Some remember the inconsistency of the advice early in the pandemic. Masks may be conflated with closures and capacity restrictions and the resulting hardships. Whatever the reason — stigma, peer pressure or concern about virtue signalling — countries outside Asia do not have a mask-wearing culture.

Under these circumstances, it will likely take more than strong recommendations to achieve the high uptake of mask use that will be most effective in reducing transmission of respiratory viruses. Masks protect individuals, imperfectly. Mask mandates (or high voluntary use of masks) protect populations.

Bringing back mask mandates with unequivocal signalling from governments about the effectiveness of both masks and mask mandates would be the best immediate response to our current crisis. Confidence that mask-wearing is effective correlates geographically with willingness to wear a mask: in time, we hope knowledge will change culture. Strong communication from political and public health leadership would increase community understanding that the minor inconvenience of wearing a mask in public indoor spaces is justified by the death and disability prevented.

In North America, the strategy of using masks according to personal judgment has predictably failed, the strategy of strongly recommending masks is unproven, and it’s too late to experiment. Mask mandates, however, are backed by strong evidence of effectiveness in both Canada and the United States.

Mask mandates are less damaging to a recovering economy than physical distancing and capacity limits, and less damaging to learning than a return to remote schooling.

Schools and universities represent a particularly important opportunity. COVID spreads between children in schools to infect the whole population; this is mitigated by mask wearing. After Massachusetts lifted its mask mandate, school boards did so at different times, creating a natural experiment: transmission was higher among students and staff where mandates were liftedcompared with where they were still in place.

There is no convincing evidence to date that masks reduce social or language skills.

Decreasing spread in schools would increase learning by reducing student and teacher sick days and preserving in-person instruction. Keeping children in schools keeps parents at work.

Mask mandates will not produce a rapid fix of our current problems with respiratory viruses. Indicators will lag by weeks. Until we have a whole-of-society approach that recognizes that COVID is airborne, mask mandates offer us the best immediate opportunity to preserve our health-care system, mitigate death and disability from respiratory viruses, support the economy and safely maintain social contacts in our private lives.

New COVID variants BQ.1, BQ.1.1 dominate; what're omicron's symptoms? [USA TODAY, 20 Nov 2022]

By Adrianna Rodriguez Karen Weintraub

The virus that causes COVID-19 is bringing more variants our way, requiring a few changes to the fight against it.

The BA.5 variant of omicron, which has dominated the U.S. since early summer, is fading fast. According to data released Friday, half the cases in the U.S. are now due to two descendants of BA.5, called BQ.1 and BQ.1.1.

Not much is known about those two variants, but the severity and duration of disease seem similar to the other omicrons, and milder than the original and delta variants.

The biggest challenge from the new variants will be for people who are immunocompromised because of disease or medications. Treatments designed to prevent and treat infection in the immunocompromised won't work against BQ.1 and BQ.1.1.

Here's what we know:
What is the current COVID variant and what happened to omicron?
The omicron variant that caused so many infections last winter is still around, but it has split into many subvariants. The two subvariants – BQ.1 and BQ.1.1 – now account for half of COVID-19 cases in the U.S., according to the Centers for Disease Control and Prevention.
BA.5 now accounts for 24% of cases.

Are the BQ.1 and BQ.1.1 more dangerous?
Lab studies suggest the viral descendants of BA.5 and BA.2, which includes all the new dominant variants, might cause slightly more severe disease than BA.1 or the original omicron, said Jeremy Luban, a professor of molecular medicine, biochemistry and molecular biotechnology at UMass Chan Medical School.

But it's not clear whether that's true in the real world, he said, as lab studies can't capture factors like human behavior.

The new variants are clearly more transmissible because they are taking over and making people sick despite previous vaccinations and infections, he said in a Thursday news conference with other members of the Massachusetts Consortium on Pathogen Readiness.

Will vaccines and the bivalent booster still work against omicron variants?
Yes.

"Any kind of boost really reduces your chances of getting very sick from COVID," said Dr. Kathryn Stephenson, an infectious disease expert at Beth Israel Deaconess Medical Center in Boston.

People who got the bivalent booster will be more protected against a severe COVID-19 infection compared with those who are unvaccinated or got a vaccine long ago.

In a study posted Friday, Pfizer and its vaccine partner BioNTech say that the latest booster increases the level of neutralizing antibodies against both BQ.1 and BQ.1.1, which protect against infection.

Moderna reported similar results for its booster earlier in the week, and it said last week that its bivalent shot also showed “robust neutralizing activity” against the BQ.1.1 variant, suggesting it offers some protection against the newest strains.

What does BQ stand for?
The World Health Organization uses the Greek alphabet as a classification system to simplify understanding and avoid stigmatizing countries where strains of the SARS-CoV-2 virus that causes COVID-19 are identified.

The WHO named the original B.1.1.529 variant after the 15th letter, omicron. Within variants, the agency assigns numbers to sublineages.

BA.5 was classified as an omicron variant but has mutations that distinguish it from other omicron subvariants, such as BA.1 and BA.2. BA.5 is the parental strain of BQ.1 and BQ.1.1.
What are the symptoms of the new omicron variants?

The symptoms of BQ.1 and BQ.1.1 appear to be the same as for other COVID-19 variants. The most common symptoms include exhaustion, fever, a cough, congestion, shortness of breath, sore throat, nausea, diarrhea, and muscle aches or headache. Loss of smell, which originally characterized COVID-19 infections, is no longer as common.

Before you get sick:Have these essentials at home to ease cold, flu and COVID symptoms

Can I get BQ.1 or BQ.1.1 if I've had BA.5?
Yes. Theoretically anyone is vulnerable if exposed to enough viral particles. But people who have been boosted or infected within the last three to six months are less likely to be infected again and certainly less likely to suffer severe disease, Stephenson said.

What to do if I get infected by BQ.1 or BQ.1.1?
If you test positive for the coronavirus or feel sick with related symptoms, the CDC recommends:
• Stay home for at least five days and isolate from other household members
• Wear a well-fitted mask around others in the home

If you're fever-free for 24 hours and symptoms improve after the five days, the CDC says you can end isolation, but take precautions for five additional days. This includes wearing masks and avoiding travel.

What if I have a compromised immune system?
This is a "pretty scary" time for people who don't have good working immune systems, either because of older age, diseases like cancer, or treatments that reduce immunity, Luban said.

The last two protective monoclonal antibodies don't work against the BQ.1 and BQ.1.1 variants, said Jake Lemieux, an infectious disease specialist at Massachusetts General Hospital.

That includes Evusheld, which was used to prevent severely immunocompromised people from getting very sick with COVID-19. It's a big loss, he said: "I do hope there will be a replacement drug for prophylaxis that retains activity against circulating variants."

Flu, RSV and COVID: What to know about the 'tripledemic'
Doctors are saying we're currently in a "tripledemic" with three respiratory viruses, including COVID-19, flu and RSV circulating simultaneously.

Vaccinating against both flu and COVID-19 will help limit severe infections, said Dr. William Schaffner, an infectious disease specialist at the Vanderbilt University School of Medicine.

There are currently no vaccines or specific treatment for respiratory syncytial virus, or RSV, which can infect people repeatedly and are particularly dangerous for the very young and very old, he said.

It's not clear why, but both flu and RSV are circulating much earlier this year than they did before the pandemic, said Dr. Tina Tan, vice president of the Infectious Diseases Society of America, which held a news conference Friday that included her and Schaffner.

"Whether or not these will go back to normal (in future years), nobody knows," she said.

Tan, a pediatrician at the Ann & Robert H. Lurie Children’s Hospital of Chicago, said she knows everyone is ready for a "new normal," but she worries that not enough people are getting COVID-19 boosters and annual flu shots, and that children and adults have fallen behind on other routine vaccinations as well.

"Vaccines need to be part of that new normal to prevent individuals from becoming ill with the viruses and bacteria that are circulating," she said. "That is the new normal."

Can we have a COVID-free Thanksgiving? Here are some tips.

Extreme precautions are no longer needed, experts say. But Lemieux said people should be careful if they have very young, very old or immunocompromised people at their holiday gatherings.

He suggests guests use a home COVID-19 test before sitting down together in an enclosed space and that people who are sick shouldn't go at all.

"I don't want to say 'cancel Thanksgiving,' but I also don't want to say 'don't worry about respiratory viruses,'" said Lemieux, who also worries about the flu and RSV getting passed around along with the turkey.

Some things to keep in mind:
►If you develop cold symptoms, get tested for COVID-19: Take a test right away because the antiviral Paxlovid, which can help prevent severe disease in high-risk people, works only if given within five days of infection.
►If you're traveling, wear a mask: Masking while traveling to celebrations also makes sense, said Dr. Lael Yonker, a pediatrician at Massachusetts General Hospital. She's had her children wear masks leading up to the holiday.
►Get vaccinated against the flu and COVID-19: For Schaffner's family gathering, everyone must be vaccinated against flu and boosted against COVID-19, he said. "No one wants to be a dreaded spreader," he said.

When can we stop worrying about new variants?
Experts have been waiting for the virus that causes COVID-19 to settle into a seasonal pattern and stop mutating so much, but it hasn't happened yet. While current vaccines are considered safe and very effective against severe disease, they do not prevent all infections.

Next-generation vaccines, currently under development, could provide broader or longer-term protection against COVID-19. Companies are also exploring delivering the vaccine through the nose rather than by shots, which might provide more protection against infection.

Pfizer and BioNTech announced Wednesday that they have started a 180-person early-stage trial of a new candidate vaccine they hope will broaden and extend protection against the virus. The new vaccine will target the "spike" protein on the surface of the original virus plus the version of spike on the BA.5 variant, as well as a nonspike protein that doesn't seem to be mutating as much.

The trial will include three different doses and variations to see if the candidate vaccine is better than the current one.