Two fascinating studies

Globally, in the first wave of the pandemic, the UK experienced some of the highest per-capita mortality from covid-19. We are now entering a second spike (I fear not a second wave but a sting in the tail of the first wave). But, there are two studies into COVID 19 that have caught my eye in the last few days and they give me hope. The first suggests that the level of exposure to the disease may determine the severity of the infection (called “the infectious dose”) and the second seems to be linked- that mask wearing is itself not only efficacious in protecting us but, because it prevents the higher forms of infection, it may cause the virus itself to mutate and therefore to become less harmful.

The lancet produced a study last month saying that it was the “viral load at diagnosis” which was an “independent predictor of mortality”. Significantly, it was guarded of course. If this were coupled with an immune trigger for people with asymptomatic and mild forms of COVID then that alone would be enough to halt the pandemic.

Of course, the key is the guarded optimism. We simply do not know. And there is no doubt that ignorance has led to chaos as Prof Carl Heneghan observed a while back for the BBC.

Heneghan said, We need to slow down our thinking. But every time the government sees a rise in cases it seems to panic.” He is right. But simple precautions might well have benefit, and must be better than knee-jerk orders. the simple approach should be to self-isolate where possible and not to party or gather in large numbers unless it is absolutely necessary. I cannot fathom for one minute why pubs should be opening as they are. Now, is surely the time to enrich our society with gatehrings if necessary but outside. Now is the time for continental cafe culture and the wather has been good enough for that. Inbstead, we have gone wild and the virus is back.

The views from the US that suggest masks are going to be the answer are stabs in the dark and it would be unwise to rally behind one particular hypothesis except that, in this case, that hypothesis supports one particular activity that has come into question. I think it cannpot be questioned any longer. It may even be a bit of a silver bullet: it may not be. But anything more we do reinforces our defence if we stick to it.

The theory started in California but has received support from a reseracher, Dr Julian Tang, in Leicester. Dr Monica Gandhi in the San Francisco talks about what she calls, “’Variolation’ – a term originally derived from the smallpox pre-vaccine era – is quite feasible and may add to the protective physical effects of universal masking – by low level stimulation of the wearer’s immune system as it is exposed to low levels of airborne SARS-CoV-2, which can induce an immune response but without any overt infection and disease. This is after all the response to a typical vaccine – where the recipient’s immune systems are stimulated, subclinically, to produce protective immune responses to combat the infection if exposed at a future date. Of course, more formal studies are required to confirm this effect, and there are likely natural experiments ongoing around the world at the moment.”

Many of Dr Gandhi’s observations seem to be based on an Argentinian cruise ship that gave everyone masks and achieved an 80% asymptomatic spread of COVID 19 in contrast to the cruise ships that failed to mask up and reported huge loss of life and highly contageous outbreaks.

We live in hope.