tag:theconversation.com,2011:/au/topics/masks-23647/articlesMasks – The Conversation2024-02-11T19:05:49Ztag:theconversation.com,2011:article/2228892024-02-11T19:05:49Z2024-02-11T19:05:49ZVaccination, testing, clean air: COVID hasn’t gone away – here’s where Australia needs to do better<p>In May 2023 the World Health Organization (WHO) declared COVID was no longer a <a href="https://www.who.int/news/item/05-05-2023-statement-on-the-fifteenth-meeting-of-the-international-health-regulations-%282005%29-emergency-committee-regarding-the-coronavirus-disease-%28covid-19%29-pandemic">public health emergency of international concern</a>. For many, this signalled the pandemic was over. </p>
<p>But the virus continues to <a href="https://ourworldindata.org/covid-cases">infect millions of people</a> <a href="https://theconversation.com/covid-barely-gets-a-mention-these-days-heres-why-thats-a-dangerous-situation-220867">globally</a> and the WHO recognises COVID as <a href="https://www.scientificamerican.com/article/rampant-covid-poses-new-challenges-in-the-fifth-year-of-the-pandemic/">an ongoing pandemic</a>. </p>
<p>In Australia, more than <a href="https://nindss.health.gov.au/pbi-dashboard/">50,000</a> infections have been reported so far in 2024. And this is likely to be a significant underestimate, as we are <a href="https://www.covid19data.com.au/testing">testing</a> much less than we used to. As of February 1 there were 287 outbreaks in <a href="https://www.health.gov.au/resources/publications/covid-19-outbreaks-in-australian-residential-aged-care-facilities-1-february-2024?language=en">residential aged care homes</a>, and <a href="https://www.health.gov.au/sites/default/files/2024-02/covid-19-outbreaks-in-australian-residential-aged-care-facilities-1-february-2024.pdf">people are still dying</a> from the virus. </p>
<p>Although we’ve come a long way since earlier in the pandemic, as we enter its fifth year, COVID continues to have negative effects on individuals, health services and society at large.</p>
<p>To reduce the impact on health services and the community, the Australasian College for Infection Prevention and Control, of which we are on the board of directors, <a href="https://www.acipc.org.au/wp-content/uploads/2024/02/Position-Statement-Current-and-Continuing-Impact-of-COVID-19-Issued-9-February-2024.pdf">is calling for</a> ongoing infection prevention and control strategies in Australia. These include supporting people to access vaccination and testing, and cleaner air in shared indoor spaces.</p>
<h2>Vaccination</h2>
<p>COVID vaccination reduces severe illness and can in turn reduce pressure on the health system. But, to reap the greatest benefits, a high proportion of the population must be vaccinated and receive regular booster doses. </p>
<p>Boosters are important as we know <a href="https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2804451">immunity wanes over time</a>, both after <a href="https://theconversation.com/how-long-does-immunity-last-after-a-covid-infection-221398">infection and vaccination</a>. Also, because COVID <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10015854/">continues to evolve</a>, vaccines are updated to keep up with <a href="https://theconversation.com/what-are-the-new-covid-booster-vaccines-can-i-get-one-do-they-work-are-they-safe-217804">circulating strains</a>.</p>
<p>Current advice from the <a href="https://www.health.gov.au/news/atagi-update-on-the-covid-19-vaccination-program">Australian Technical Advisory Group on Immunisation</a> (ATAGI) indicates adults over 75 should receive a <a href="https://immunisationhandbook.health.gov.au/contents/vaccine-preventable-diseases/covid-19">routine booster</a>, and adults 65 to 74 should consider doing so. Younger people are only eligible if they have an increased risk of severe COVID, for example due to a particular medical condition. </p>
<p>There’s also no recommendation that people <a href="https://immunisationhandbook.health.gov.au/contents/vaccination-for-special-risk-groups/vaccination-for-people-at-occupational-risk">at greater occupational risk</a> of catching COVID, such as health-care workers, childcare workers or emergency and essential services workers receive another vaccination at this stage.</p>
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Read more:
<a href="https://theconversation.com/its-4-years-since-the-first-covid-case-in-australia-heres-how-our-pandemic-experiences-have-changed-over-time-220336">It's 4 years since the first COVID case in Australia. Here's how our pandemic experiences have changed over time</a>
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<p>Yet broadening eligibility could help in several ways. For example, having a high proportion of the population unvaccinated or undervaccinated may increase opportunities for the virus <a href="https://theconversation.com/the-emergence-of-jn-1-is-an-evolutionary-step-change-in-the-covid-pandemic-why-is-this-significant-220285">to mutate</a> and for new variants to develop. </p>
<p>Also, although older people are generally at greatest risk from a COVID infection, <a href="https://www.abc.net.au/news/2024-02-05/nsw-multiple-covid-19-infections-health-immunology/103417278">COVID in younger age groups</a> can still in some cases cause severe and potentially long-term illness (and we know vaccination <a href="https://aci.health.nsw.gov.au/statewide-programs/critical-intelligence-unit/post-acute-sequelae">reduces the risk</a> of long COVID). </p>
<p>We believe the current advice provided by the <a href="https://www.health.gov.au/top-up-covid-19-protection">Australian government</a> is <a href="https://www.health.gov.au/our-work/covid-19-vaccines/information-for-aged-care-providers-workers-and-residents-about-covid-19-vaccines">out of date</a>. There needs to be a review of ATAGI advice to allow booster access for more people, as is offered in other <a href="https://www.cdc.gov/mmwr/volumes/73/wr/mm7304a2.htm?s_cid=mm7304a2_e&ACSTrackingID=USCDC_921-DM121333&ACSTrackingLabel=This%20Week%20in%20MMWR%3A%20Vol.%2073%2C%20February%201%2C%202024&deliveryName=USCDC_921-DM121333">countries</a>, such as the United States. </p>
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<img alt="A male health-care worker draws up a vaccine." src="https://images.theconversation.com/files/574565/original/file-20240209-22-ckbqbl.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/574565/original/file-20240209-22-ckbqbl.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/574565/original/file-20240209-22-ckbqbl.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/574565/original/file-20240209-22-ckbqbl.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/574565/original/file-20240209-22-ckbqbl.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/574565/original/file-20240209-22-ckbqbl.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/574565/original/file-20240209-22-ckbqbl.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Younger people are no longer routinely offered COVID boosters in Australia.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/cu-covid19-vaccine-doctor-hands-male-1897030525">Supamotionstock.com/Shutterstock</a></span>
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<p>Even among those who are eligible, uptake is poor. Recent <a href="https://www.health.gov.au/resources/publications/covid-19-vaccine-rollout-update-12-january-2024?language=en">figures</a> show only 16.6% of people aged between 65 and 74 have received a booster dose in the past six months. </p>
<p>As such, in tandem with updated guidelines, there should be focused promotion of COVID boosters to all vulnerable people, as well as nation-wide promotion of free access to vaccinations for the wider population.</p>
<p>The <a href="https://www.health.gov.au/resources/publications/national-covid-19-health-management-plan-for-2023?language=en">Australian government has recognised</a> the need for a strong vaccination program as a means to minimise levels of severe COVID and death. So securing and delivering an ongoing supply of up-to-date vaccinations is paramount.</p>
<h2>Testing</h2>
<p>While testing <a href="https://www.health.gov.au/topics/covid-19/testing">is encouraged</a> if you have COVID symptoms, there’s no requirement or incentive to test or report positive results. This poses two problems: under-reporting of COVID cases, and people not knowing they have COVID (and therefore not knowing they might transmit it). </p>
<p>In <a href="https://www.health.nsw.gov.au/Infectious/covid-19/Pages/reports.aspx">New South Wales</a> for example, laboratory confirmed cases are trending downwards while wastewater testing suggests COVID prevalence remains high.</p>
<p>Reinstating easy access to rapid antigen and PCR testing would enable people to better manage their illness, and provide a clearer picture for health authorities. </p>
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Read more:
<a href="https://theconversation.com/should-we-still-be-using-rats-to-test-for-covid-4-key-questions-answered-218016">Should we still be using RATs to test for COVID? 4 key questions answered</a>
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<h2>Ventilation</h2>
<p>COVID <a href="https://www.nature.com/articles/d41586-022-00925-7">is airborne</a> and evidence shows <a href="https://theconversation.com/ventilation-reduces-the-risk-of-covid-so-why-are-we-still-ignoring-it-194820">clean air is key</a> to minimising <a href="https://academic.oup.com/cid/article/75/1/e97/6414657">its spread</a>.</p>
<p>In September 2023 the Australasian Health Infrastructure Alliance released <a href="https://healthfacilityguidelines.com.au/news/new-project-resource-pandemic-preparedness-health-infrastructure-planning-design-guidance">guidance</a> on pandemic preparedness. This document calls for the design of any new health-care building to take minimising the risk of infection transmission into account.</p>
<p>There are <a href="https://www.idhjournal.com.au/article/S2468-0451(23)00061-5/fulltext">examples</a> where investment in building design to minimise infectious disease transmission has had positive results. But guidance documents lack the legal clout needed to drive true change, and these examples are the exception. COVID still spreads in our hospitals and aged care facilities.</p>
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<img alt="Two hospital staff pushing a bed through a hospital corridor." src="https://images.theconversation.com/files/574544/original/file-20240208-18-mttc4d.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/574544/original/file-20240208-18-mttc4d.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/574544/original/file-20240208-18-mttc4d.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/574544/original/file-20240208-18-mttc4d.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/574544/original/file-20240208-18-mttc4d.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/574544/original/file-20240208-18-mttc4d.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/574544/original/file-20240208-18-mttc4d.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">New health-care facilities should be built with ventilation in mind.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/male-female-multi-ethnic-nursing-staff-606480698">Spotmatik Ltd/Shutterstock</a></span>
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<p>Infection prevention and control specialists should play a key role in designing health-care facilities and residential aged care homes. Strategies to <a href="https://www.cdc.gov/coronavirus/2019-ncov/community/ventilation.html">optimise ventilation in buildings</a> must involve early consultation with qualified ventilation specialists who can address requirements such as the <a href="https://www.mja.com.au/journal/2022/217/11/healthy-indoor-air-our-fundamental-need-time-act-now">air exchange rate</a> relative to the size of the building and number of expected occupants. </p>
<p>Mandating this would ensure we build facilities which minimise the transmission of most respiratory infections – not just COVID.</p>
<h2>Other things</h2>
<p>Support for communities to engage in key prevention strategies such as promoting the use of <a href="https://royalsociety.org/topics-policy/projects/impact-non-pharmaceutical-interventions-on-covid-19-transmission/">surgical masks</a> or preferably <a href="https://www.covid19.act.gov.au/stay-safe-and-healthy/face-masks#:%7E:text=Particulate%20filter%20respirators%20(PFRs)%2C,tight%20seal%20to%20the%20face.">P2/N95 respirators</a> and <a href="https://www.australianunions.org.au/2024/01/30/half-of-workers-are-working-while-sick-or-injured/">staying home when unwell</a> is important. Employers have a responsibility to enable access to paid sick leave, especially for those working with vulnerable communities and in health care. </p>
<p>Hand hygiene, although a foundation of infection prevention and control, appears to have <a href="https://www.nature.com/articles/d41586-023-00642-9">less of a role</a> in controlling COVID transmission. So we need to spend less time thinking washing our hands will protect us from COVID, and more time on what the evidence actually shows will help us ride this stage of the pandemic. </p>
<p>We also need new research initiatives such as large-scale clinical trials to prevent and treat <a href="https://www.health.gov.au/topics/covid-19/long-covid">long COVID</a>, and more funding for the development of new vaccines and antiviral drugs as new variants arise.</p><img src="https://counter.theconversation.com/content/222889/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Stephane Bouchoucha is affiliated with Deakin University Centre for Quality and Patient Safety (QPS) research in the Institute for Health Transformation (IHT) and the Centre for Innovation in Infectious Disease and Immunology Research (CIIDIR). Stephane is also the President of the Australasian College for Infection Prevention and Control (ACIPC) and was the recipient of an Early Career Research Grant from ACIPC in 2016. </span></em></p><p class="fine-print"><em><span>Matt Mason is affiliated with The Australian College for Infection Prevention and Control, the Australian Centre for Pacific Islands Research at the University of the Sunshine Coast, the Pacific Region Infectious Diseases Association, and the Collaborative for the Advancement of Infection Prevention and Control. He is also a member of CRANAplus. Matt is a current recipient of an Australian College for Infection Prevention and Control Early Career Researcher Grant and has undertaken contracted consultations for the Pacific Community. </span></em></p><p class="fine-print"><em><span>Peta-Anne Zimmerman is affiliated with the Menzies Health Institute, Queensland, the Australasian College for Infection Prevention and Control, the Pacific Region Infectious Diseases Association, and the Collaborative for the Advancement of Infection Prevention and Control. Peta-Anne undertakes contracted consultancies for the World Health Organization and is a focal point for the Global Outbreak Alert and Response Network.</span></em></p><p class="fine-print"><em><span>Sally Havers is affiliated with the University of Queensland and the Herston Infectious Diseases Institue. Sally is President Elect of the Australasian College for Infection Prevention and Control and a recipient of an ACIPC Early Career Researcher Grant in 2023. </span></em></p>We need to see suitable infection prevention measures alongside targeted public health campaigns to reduce COVID infections across the community.Stephane Bouchoucha, Associate Professor in Nursing and Associate Head of School (International), Deakin UniversityMatt Mason, Lecturer and Academic Lead for Work Integrated Learning, University of the Sunshine CoastPeta-Anne Zimmerman, Senior Lecturer/Program Advisor, Griffith Graduate Infection Prevention and Control Program, Griffith UniversitySally Havers, Conjoint Nurse Researcher, School of Nursing, Midwifery and Social Work, The University of QueenslandLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2203362024-01-24T19:08:47Z2024-01-24T19:08:47ZIt’s 4 years since the first COVID case in Australia. Here’s how our pandemic experiences have changed over time<figure><img src="https://images.theconversation.com/files/571024/original/file-20240124-17-t6k3t1.jpg?ixlib=rb-1.1.0&rect=0%2C10%2C6709%2C4456&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/sydney-nswaustralia-apr-01-2020-traffic-1689817072">Sebastian Reategui/Shutterstock</a></span></figcaption></figure><p>It might be hard to believe, but four years have now passed since the <a href="https://www.health.gov.au/topics/covid-19/about">first COVID case</a> was confirmed in Australia on January 25 2020. Five days later, the <a href="https://www.who.int/publications/m/item/covid-19-public-health-emergency-of-international-concern-(pheic)-global-research-and-innovation-forum">World Health Organization</a> (WHO) declared a “public health emergency of international concern”, as the novel coronavirus (later named SARS-CoV-2) began to spread worldwide.</p>
<p>On March 11 the WHO would declare COVID a pandemic, while around the same time Australian federal and state governments hastily <a href="https://www.aph.gov.au/About_Parliament/Parliamentary_departments/Parliamentary_Library/pubs/rp/rp2021/Chronologies/COVID-19StateTerritoryGovernmentAnnouncements">introduced measures</a> to “stop the spread” of the virus. These included shutting Australia’s international borders, closing non-essential businesses, schools and universities, and limiting people’s movements outside their homes.</p>
<p>I began my project, <a href="https://www.frontiersin.org/articles/10.3389/fpubh.2023.1092322/full">Australians’ Experiences of COVID-19</a>, in May 2020. This research has continued each year to date, allowing me to track how Australians’ attitudes around COVID have changed over the course of the pandemic.</p>
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<a href="https://theconversation.com/life-death-intimacy-and-privilege-4-works-of-covid-fiction-and-what-they-say-about-us-189311">Life, death, intimacy and privilege: 4 works of COVID fiction – and what they say about us</a>
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<h2>Evolving pandemic experiences</h2>
<p>We recruited participants from across Australia, including people living in regional cities and towns. Participants range in age from early adulthood to people in their 80s. </p>
<p>The first three stages of the project each involved 40 interviews with separate groups of participants (so 120 people in total). These interviews were done in May to July 2020 (stage 1), September to October 2021 (stage 2), and September 2022 (stage 3). Stage 4 was an online survey with 1,000 respondents, conducted in September 2023.</p>
<p>Limitations of this project include the small sample sizes for the first three stages (as is common with qualitative interview-based research). This means the findings from those phases are not generalisable, but they do provide rich insights into the experiences of the interviewees. The quantitative stage 4 survey, however, is representative of the Australian population.</p>
<p>The findings show that as the conditions of the pandemic and government management have changed across these years, so have Australians’ experiences. </p>
<p>In the <a href="https://bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-021-10743-7">early months of the pandemic</a>, some people reported becoming confused, distressed and overwhelmed by the plethora of information sources and the fast-changing news environment. On the other hand, seeking out information provided reassurance and comfort in response to their anxiety and uncertainty about this new disease.</p>
<p>Australians <a href="https://www.taylorfrancis.com/chapters/edit/10.4324/9781003280644-28/covid-19-crisis-communication-deborah-lupton">continued to rely heavily</a> on news reports and government announcements in the first two years of the pandemic. Regular briefings from premiers and <a href="https://theconversation.com/chief-health-officers-are-in-the-spotlight-like-never-before-heres-what-goes-on-behind-the-scenes-166828?utm_source=twitter&utm_medium=bylinetwitterbutton">chief health officers in particular</a> were highly important for how they learned what was happening, as were updates in the media on case numbers, hospitalisations, deaths and progress towards vaccination targets.</p>
<h2>Trust has eroded</h2>
<p>Australians appear to have lost a lot of trust in COVID information sources such as news media reports, health agencies and government leaders. Early strong support of federal, state and territory governments’ pandemic management in <a href="https://bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-021-10743-7">2020</a> and <a href="https://www.tandfonline.com/doi/full/10.1080/14649365.2023.2240290">2021</a> has given way to much lower support more recently.</p>
<p>My <a href="https://papers.ssrn.com/sol3/papers.cfm?abstract_id=4626720">2023 survey</a> (this is published as a report, not peer-reviewed) found doctors were considered the most trustworthy sources of COVID information, but even they were trusted by only 60% of respondents. </p>
<p>After doctors, participants trusted other experts in the field (53%), Australian government health agencies (52%), global health agencies (49%), scientists (45%) and community health organisations (35%). Australian government leaders were towards the lower end of the spectrum (31%). </p>
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Read more:
<a href="https://theconversation.com/covid-remains-a-global-emergency-the-world-health-organization-says-but-were-at-a-transition-point-what-does-this-mean-198876">COVID remains a global emergency, the World Health Organization says, but we're at a transition point. What does this mean?</a>
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<p>In <a href="https://academic.oup.com/heapro/article/38/1/daac192/7026242?login=false">2021</a>, Australians responded positively to the vaccine targets and “<a href="https://www.premier.vic.gov.au/victorias-roadmap-delivering-national-plan">road maps</a>” set by governments. These clear guidelines, and especially the promise that the initial doses would remove the need for lockdowns and border closures, were strong incentives to get vaccinated in 2021. </p>
<p>Unfortunately, the prospect that vaccines would control COVID was shown to be largely unfounded. While COVID vaccines were and continue to be very effective at protecting against severe disease and death, they’re less effective at <a href="https://coronavirus.jhu.edu/vaccines/vaccines-faq">stopping people becoming infected</a>. </p>
<p>Once very high numbers of eligible Australians became vaccinated against the delta variant, <a href="https://pubmed.ncbi.nlm.nih.gov/37068078/">omicron reached Australia</a>, resulting in Australia’s first big wave of infection. This led to disillusionment about vaccines’ value for many participants. </p>
<p>In the <a href="https://papers.ssrn.com/sol3/papers.cfm?abstract_id=4626720">2023 survey</a>, respondents reported a high uptake of the first three COVID shots. But when asked whether they planned to get another vaccine in the next 12 months, almost two-thirds said they did not, or they were unsure.</p>
<h2>Enter complacency</h2>
<p>Complacency now seems to have set in for many Australians. This can be linked to the progressive withdrawal of strong public health measures such as quarantine, mandatory isolation when infected, and testing and tracing regimens. </p>
<p>Meanwhile, the media, government leaders and health agencies have played less of an active public role in conveying COVID information. This has led to uncertainty about the extent to which COVID is still a risk and lack of incentive to take protective actions such as mask wearing.</p>
<p>In <a href="https://papers.ssrn.com/sol3/papers.cfm?abstract_id=4626720">2023</a>, after mandates had ended, only 9% of respondents said they always wore a mask in indoor public places. Only a narrow majority of respondents even supported compulsory masking for workers in health-care facilities. </p>
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<img alt="Two people wearing masks in an office." src="https://images.theconversation.com/files/571055/original/file-20240124-15-m95huw.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/571055/original/file-20240124-15-m95huw.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=364&fit=crop&dpr=1 600w, https://images.theconversation.com/files/571055/original/file-20240124-15-m95huw.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=364&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/571055/original/file-20240124-15-m95huw.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=364&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/571055/original/file-20240124-15-m95huw.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=457&fit=crop&dpr=1 754w, https://images.theconversation.com/files/571055/original/file-20240124-15-m95huw.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=457&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/571055/original/file-20240124-15-m95huw.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=457&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">People have become more lax with mask wearing since mandates ended.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/young-people-face-masks-back-work-1746069578">Ground Picture/Shutterstock</a></span>
</figcaption>
</figure>
<p>The <a href="https://papers.ssrn.com/sol3/papers.cfm?abstract_id=4626720">2023 survey</a> confirmed many Australians no longer feel at risk from COVID. Some 17% of respondents said COVID was definitely still posing a risk to Australians, while a further 42% saw COVID as somewhat of a risk. This left 28% who did not view COVID as much of a continuing risk, and 13% who thought it was not a risk at all.</p>
<h2>COVID is still a risk</h2>
<p>Whether or not people feel at continuing risk from COVID, the pandemic is still significantly affecting Australians. The <a href="https://papers.ssrn.com/sol3/papers.cfm?abstract_id=4626720">2023 survey</a> found more than two-thirds of respondents (68%) reported having had at least one COVID infection to their knowledge, including 13% who had experienced three or more. Of those who’d had COVID, 40% said they experienced ongoing symptoms, or long COVID.</p>
<p>If the pandemic loses visibility in public forums, people have no way of knowing the risk of infection continues, and are therefore unlikely to take steps to protect themselves and others.</p>
<p>Updated case, hospitalisation, death and vaccination numbers should be communicated regularly, as <a href="https://theconversation.com/covid-is-surging-in-australia-and-only-1-in-5-older-adults-are-up-to-date-with-their-boosters-220839">used to be the case</a>. To combat confusion, complacency and misinformation, all health advice should be based on the latest robust science.</p>
<p>Australians are operating in a vacuum of information from trusted sources. They need much better and more frequent public health campaigns and risk communication from their leaders.</p><img src="https://counter.theconversation.com/content/220336/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Deborah Lupton does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Trust, particularly in government leaders, has diminished over time.Deborah Lupton, SHARP Professor, Vitalities Lab, Centre for Social Research in Health and Social Policy Centre, and the ARC Centre of Excellence for Automated Decision-Making and Society, UNSW SydneyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2179022023-11-20T04:25:24Z2023-11-20T04:25:24ZWith COVID surging, should I wear a mask?<p>COVID is <a href="https://theconversation.com/were-in-a-new-covid-wave-what-can-we-expect-this-time-216820">on the rise again</a>, with a peak likely over the holiday season. </p>
<p>Given this, health authorities in a number of Australian states have recommended people start <a href="https://www.thenewdaily.com.au/life/health/2023/11/15/covid-australia-eighth-wave">wearing masks again</a>. In <a href="https://www.abc.net.au/news/2023-11-17/wa-public-hospitals-mask-requirements-roger-cook-covid-19/103120580">Western Australia</a>, masks have been made mandatory in high-risk areas of public hospitals, while they’ve similarly been reintroduced in health-care settings in <a href="https://www.adelaidenow.com.au/coronavirus/mandatory-face-masks-introduced-in-lyell-mcewin-and-modbury-hospitals-as-covid-wave-hits-sa/news-story/b4bad98deb02a66dde4cf866f60b607a">other parts of the country</a>.</p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1725393459010232775"}"></div></p>
<p>Hospitals and aged care facilities are definitely the first places where masks need to be reinstated during an epidemic. But authorities are <a href="https://www.thenewdaily.com.au/life/health/2023/11/15/covid-australia-eighth-wave">differing in their recommendations</a> currently. Calls to mask up, particularly in the wider community, <a href="https://www.9news.com.au/national/queensland-covid-chief-health-officer-confirms-covid-wave/a3a92381-bd6f-4175-a366-3b8e0f627990">have not been unanimous</a>.</p>
<p>So amid rising COVID cases, should you be wearing a mask?</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/were-in-a-new-covid-wave-what-can-we-expect-this-time-216820">We're in a new COVID wave. What can we expect this time?</a>
</strong>
</em>
</p>
<hr>
<h2>COVID is still a threat</h2>
<p>Unfortunately, SARS-CoV-2 (the virus that causes COVID) has not mutated into just a trivial cold.</p>
<p>As well as causing symptoms in the initial phase – which can be especially serious for people who are vulnerable – the virus can lead to <a href="https://www.nature.com/articles/s41579-022-00846-2">chronic illness</a> in people of any age and health status due to its ability to affect blood vessels, <a href="https://academic.oup.com/eurheartjsupp/article/25/Supplement_A/A42/7036729">the heart</a>, lungs, brain and immune system.</p>
<p>COVID and its ongoing effects are contributing to <a href="https://www.nature.com/articles/s41591-023-02521-2">substantial disability</a> in society. Loss of productivity due to long COVID is affecting <a href="https://www.mckinsey.com/industries/healthcare/our-insights/one-billion-days-lost-how-covid-19-is-hurting-the-us-workforce">workforce and economies</a>.</p>
<p>While public messaging to “live with COVID” has seemingly encouraged us to move on from the pandemic, SARS-CoV-2 has other ideas. It has <a href="https://erictopol.substack.com/p/the-virus-is-learning-new-tricks">continued to mutate</a>, become <a href="https://www.ebgtz.org/resource/omicron-faqs/">more contagious</a>, and to evade the protection offered by vaccines. </p>
<p>COVID is not endemic, but is <a href="https://www.cnbc.com/2022/02/02/covid-will-never-become-an-endemic-virus-scientist-warns.html">an epidemic virus</a> like influenza or measles, so we can expect waves to keep coming. With this in mind, it’s definitely worth protecting yourself – particularly when cases are rising. </p>
<h2>What can we do to protect ourselves?</h2>
<p>We know SARS-CoV-2 transmits <a href="https://www.thelancet.com/article/S0140-6736(21)00869-2/fulltext">through the air</a> we breathe. We also know a lot of the transmission risk is <a href="https://abcnews.go.com/Health/covid-transmission-asymptomatic/story?id=84599810">from people without symptoms</a>, so you can’t tell who around you is infectious. This provides a strong rationale for universal masking during periods of high transmission. </p>
<p>The need is highest in hospitals where thousands of unsuspecting patients have caught COVID during the course of the pandemic and <a href="https://www.theage.com.au/national/victoria/a-death-sentence-more-than-600-people-die-after-catching-covid-in-hospital-20230621-p5di7x.html">hundreds have died</a> as a result in Victoria alone. Aged care facilities are similarly vulnerable.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/covid-mask-mandates-might-be-largely-gone-but-here-are-5-reasons-to-keep-wearing-yours-177824">COVID mask mandates might be largely gone but here are 5 reasons to keep wearing yours</a>
</strong>
</em>
</p>
<hr>
<p>Masks <a href="https://theconversation.com/yes-masks-reduce-the-risk-of-spreading-covid-despite-a-review-saying-they-dont-198992">do work</a>. A Cochrane review suggesting they don’t was flawed and subject to <a href="https://www.thestar.com/news/canada/how-the-cochrane-review-went-wrong-report-questioning-covid-masks-blows-up-prompts-apology/article_80b67196-5872-5b1a-a208-b0a525f8de5b.html">an apology</a>. </p>
<p>Masks work equally by protecting others and protecting you. By visualising human exhalations too tiny to see with the naked eye, my colleagues and I showed how masks <a href="https://theconversation.com/which-mask-works-best-we-filmed-people-coughing-and-sneezing-to-find-out-143173">prevent outward emissions</a> and how each layer of a mask improves this.</p>
<p>The most protective kind of mask is <a href="https://theconversation.com/time-to-upgrade-from-cloth-and-surgical-masks-to-respirators-your-questions-answered-174877">a respirator or N95</a>, but any mask protects <a href="https://www.cdc.gov/mmwr/volumes/71/wr/mm7106e1.htm">more than no mask</a>. </p>
<p>Wearing a mask when visiting health-care or aged-care facilities is important. Wearing a mask at the shops, on public transport and in other crowded indoor settings will improve your chances of having a COVID-free Christmas.</p>
<h2>What about vaccines?</h2>
<p>Although the virus’ evolution has challenged vaccines, they remain very important. Boosters will improve protection because vaccine immunity wanes and new mutations make older vaccines less effective. </p>
<p>In May 2023 the <a href="https://www.who.int/news/item/18-05-2023-statement-on-the-antigen-composition-of-covid-19-vaccines">World Health Organization</a> outlined why <a href="https://erictopol.substack.com/p/the-ba286-variant-and-the-new-booster">monovalent boosters</a> matched to a single current circulating strain gives better protection than the old bivalent boosters (which target two strains). The XBB boosters are available <a href="https://www.sbs.com.au/news/article/the-covid-19-vaccines-australians-cant-get-yet/ueac5puue">in the United States</a>, and will be available in Australia <a href="https://www.health.gov.au/ministers/the-hon-mark-butler-mp/media/new-covid-19-vaccines-available-to-target-current-variants?language=en">from December 11</a>.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/what-are-the-new-covid-booster-vaccines-can-i-get-one-do-they-work-are-they-safe-217804">What are the new COVID booster vaccines? Can I get one? Do they work? Are they safe?</a>
</strong>
</em>
</p>
<hr>
<p>Testing and treatment will also help. There are effective antivirals for COVID, but you cannot get them without a COVID test, and <a href="https://theconversation.com/were-in-a-new-covid-wave-what-can-we-expect-this-time-216820">testing rates</a> are very low. Having some RAT tests on hand means you can quickly isolate and get antivirals if indicated. </p>
<p>Finally, safe indoor air is key. Remember that SARS-CoV-2 spreads silently, mainly by inhaling contaminated air. Opening a window or using an air purifier can significantly reduce your risk, especially in crowded indoor settings <a href="https://iopscience.iop.org/article/10.1088/2752-5309/ace5c9">like schools</a>. A <a href="https://ozsage.org/media_releases/">multi-layered strategy</a> of vaccines, masks, safe indoor air, testing and treatment will help us navigate this COVID wave.</p>
<hr>
<p><em>Editor’s note: This article has been updated to reflect the announcement that monovalent XBB 1.5 vaccines will be deployed as part of Australia’s COVID vaccination program.</em></p><img src="https://counter.theconversation.com/content/217902/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>C Raina MacIntyre receives funding from mask manufacturer Detmold for testing of their masks and is on an advisory board for mask manufacturer Ascend. She receives funding from Sanofi for investigator-driven influenza research, and from NHMRC and MRFF. She has been an expert advisor for Ontario Nurses Association (ONA) In the matter of a proceeding under the Labour Relations Act, 1995 between ONA and Hamilton Health Sciences Corporation.</span></em></p>Wearing a mask at the shops, on public transport and in other crowded settings will improve your chances of a COVID-free Christmas.C Raina MacIntyre, Professor of Global Biosecurity, NHMRC Principal Research Fellow, Head, Biosecurity Program, Kirby Institute, UNSW SydneyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2140652023-10-26T01:12:15Z2023-10-26T01:12:15Z3 ways to prepare for bushfire season if you have asthma or another lung condition<figure><img src="https://images.theconversation.com/files/555707/original/file-20231025-25-7t7ylm.jpg?ixlib=rb-1.1.0&rect=4%2C0%2C994%2C666&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/sunlight-shining-through-smoke-haze-coloring-1605818323">Shutterstock</a></span></figcaption></figure><p>Australia’s bushfire season is officially <a href="https://www.nsw.gov.au/media-releases/fire-season-commences">under way</a> during an <a href="https://www.climatecouncil.org.au/resources/what-the-return-of-el-nino-means/">El Niño</a>. And after three wet years, and the <a href="https://www.afac.com.au/auxiliary/publications/newsletter/article/seasonal-bushfire-outlook-spring-2023#:%7E:text=For%20spring%202023%2C%20increased%20risk,bushfire%20this%20season%20are%20widespread">plant growth</a> that comes with it, there’s fuel to burn.</p>
<p>With the prospect of <a href="https://theconversation.com/its-official-australia-is-set-for-a-hot-dry-el-nino-heres-what-that-means-for-our-flammable-continent-209126">catastrophic bushfire</a> comes smoke. This not only affects people in bushfire regions, but those <a href="https://theconversation.com/bushfire-smoke-is-everywhere-in-our-cities-heres-exactly-what-you-are-inhaling-129772">in cities and towns</a> far away, as smoke travels. </p>
<p>People with a <a href="https://www.atsjournals.org/doi/10.1164/rccm.202012-4471LE">lung condition</a> are among those especially affected.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/our-mood-usually-lifts-in-spring-but-after-early-heatwaves-and-bushfires-this-year-may-be-different-213643">Our mood usually lifts in spring. But after early heatwaves and bushfires, this year may be different</a>
</strong>
</em>
</p>
<hr>
<h2>What’s so dangerous about bushfire smoke?</h2>
<p>Bushfire smoke <a href="https://www.health.nsw.gov.au/environment/air/Pages/common-air-pollutants.aspx">pollutes the air</a> we breathe by increasing the concentration of particulate matter (or PM).</p>
<p>Once inhaled, <a href="https://www.health.nsw.gov.au/environment/air/Pages/particulate-matter.aspx">small particles</a> (especially with a diameter of 2.5 micrometres or less, known as PM2.5) can get deep into the lungs and into the bloodstream. </p>
<p>Concentration of gases in the air – such as <a href="https://www.health.nsw.gov.au/environment/air/Pages/ozone.aspx">ozone</a>, <a href="https://www.health.nsw.gov.au/environment/air/Pages/nitrogen-dioxide.aspx">nitrogen dioxide</a> and <a href="https://www.health.nsw.gov.au/environment/air/Pages/sulphur-dioxide.aspx">sulfur dioxide</a> – also increase, to pollute the air.</p>
<p>All these cause the airway to <a href="https://www.alfredhealth.org.au/news/the-effects-of-bushfire-smoke-explained/">narrow and spasm</a>, making it hard to breathe. </p>
<p>This can be even worse for people with existing asthma or other respiratory conditions whose airways are already inflamed.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/bushfire-smoke-is-everywhere-in-our-cities-heres-exactly-what-you-are-inhaling-129772">Bushfire smoke is everywhere in our cities. Here's exactly what you are inhaling</a>
</strong>
</em>
</p>
<hr>
<p>Emergency department visits and hospital admissions for asthma-related symptoms <a href="https://www.sciencedirect.com/science/article/pii/S0013935119305742?dgcid=author">rise</a> <a href="https://pubmed.ncbi.nlm.nih.gov/33601224/">after exposure</a> to bushfire smoke.</p>
<p>Smoke from the bushfires in summer 2019/20 <a href="https://www.mja.com.au/system/files/issues/213_06/mja250545.pdf">resulted in</a> an estimated 400 deaths or more from any cause, more than 1,300 emergency department visits for asthma symptoms, and more than 2,000 hospital admissions for respiratory issues.</p>
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<p>Even if symptoms are not serious enough to warrant emergency medical attention, exposure to bushfire smoke <a href="https://www.qld.gov.au/health/staying-healthy/environmental/after-a-disaster/bushfires/bushfire-smoke-and-your-health#:%7E:text=Signs%20of%20smoke%20irritation%20include,throat%2C%20runny%20nose%20and%20coughing">can lead to</a> cough, nasal congestion, wheezing and asthma flares.</p>
<p>If you have <a href="https://theconversation.com/what-causes-asthma-what-we-know-dont-know-and-suspect-96409">asthma</a>, <a href="https://theconversation.com/explainer-what-is-chronic-obstructive-pulmonary-disease-25539">chronic obstructive pulmonary disease</a>, <a href="https://www.nhlbi.nih.gov/health/bronchiectasis#:%7E:text=Bronchiectasis%20is%20a%20condition%20that,These%20tubes%20are%20called%20airways.">bronchiectasis</a> or another lung condition, or you care for someone who has, here’s what you can do to prepare for the season ahead.</p>
<h2>1. Avoid smoke</h2>
<p>Monitor your local air quality by downloading one or both of these apps:</p>
<ul>
<li><p><a href="https://asthma.org.au/what-we-do/current-projects/airsmart/">AirSmart</a> from Asthma Australia has live air-quality information to help you plan and act</p></li>
<li><p><a href="https://airrater.org/">AirRater</a>, developed by Australian scientists, can be another useful app to monitor your environment, track your symptoms and help manage your health. </p></li>
</ul>
<p>During times of poor air quality and smoke stay indoors and avoid smoke exposure. Close windows and doors, and if you have one, use an air conditioner to recirculate the air. </p>
<p>Avoid unnecessary <a href="https://28bysamwood.com/blog/fitness/should-you-exercise-if-its-smoky-outside/">physical activity</a> which makes us breathe more to deliver more oxygen to the body, but also means we inhale more polluted air. Consider temporarily moving to a safer residence. </p>
<p>Well-fitting N95/P2 masks can reduce your exposure to fine smoke particles if you must travel. However they can make it more difficult to breathe if you are unwell. In that case, you may find a mask with a valve <a href="https://theconversation.com/how-to-protect-yourself-against-bushfire-smoke-this-summer-154720">more comfortable</a>.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/555709/original/file-20231025-17-n7pp9e.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Person holding a N95/P2 respirator" src="https://images.theconversation.com/files/555709/original/file-20231025-17-n7pp9e.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/555709/original/file-20231025-17-n7pp9e.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/555709/original/file-20231025-17-n7pp9e.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/555709/original/file-20231025-17-n7pp9e.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/555709/original/file-20231025-17-n7pp9e.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/555709/original/file-20231025-17-n7pp9e.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/555709/original/file-20231025-17-n7pp9e.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Well-fitting N95/P2 masks can help.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/sydney-australia-20200105-trojan-p2-disposable-1608222889">Daria Nipot/Shutterstock</a></span>
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</figure>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/how-to-protect-yourself-against-bushfire-smoke-this-summer-154720">How to protect yourself against bushfire smoke this summer</a>
</strong>
</em>
</p>
<hr>
<h2>2. Have an action plan</h2>
<p>Taking your regular preventer medication ensures your lung health is optimised before the danger period. </p>
<p>Ensure you have a <a href="https://www.nationalasthma.org.au/health-professionals/asthma-action-plans">written action plan</a>. This provides you with clear instructions on how to take early actions to prevent symptoms deteriorating or to reduce the severity of flare-ups. Review this plan with your GP, share it with a family member, pin it to the fridge.</p>
<p>Make sure you have emergency medication available, know when to call for help, and what medication to take while you wait. You may consider storing an emergency “reliever puffer” in your home or with a neighbour.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/how-to-manage-your-essential-medicines-in-a-bushfire-or-other-emergency-127516">How to manage your essential medicines in a bushfire or other emergency</a>
</strong>
</em>
</p>
<hr>
<h2>3. Have the right equipment</h2>
<p>High-efficiency particulate air (HEPA) filters <a href="https://www.phrp.com.au/issues/online-early/residential-indoor-air-quality-and-hepa-cleaner-use/">can reduce</a> smoke exposure inside the home during a fire event by 30-74%. These filters remove particulate matter from the air. </p>
<p>A spacer, which is a small chamber to contain inhaled medication, can help you take emergency medication if you are breathing quickly. You may want to have one to hand.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/from-face-masks-to-air-purifiers-what-actually-works-to-protect-us-from-bushfire-smoke-128633">From face masks to air purifiers: what actually works to protect us from bushfire smoke?</a>
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</em>
</p>
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<img src="https://counter.theconversation.com/content/214065/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The authors do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>People with a lung condition are among those particularly vulnerable to bushfire smoke. But you can prepare for the season ahead.Kazi Mizanur Rahman, Associate Professor of Healthcare Innovations, Faculty of Health Sciences and Medicine, Bond UniversityJoe Duncan, Clinical Associate Lecturer, Northern Clinical School and Lecturer, Internal Medicine. Rural Clinical School (Northern Rivers), University of SydneyJo Longman, Senior Research Fellow, The University Centre for Rural Health, University of SydneyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2050142023-05-22T20:06:36Z2023-05-22T20:06:36ZDoes my treatment work? How major medical reviews can be ‘gold standard’ evidence, yet flawed<figure><img src="https://images.theconversation.com/files/525758/original/file-20230512-37784-bjz76q.jpg?ixlib=rb-1.1.0&rect=1%2C0%2C997%2C667&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/stack-paper-files-565403764">Shutterstock</a></span></figcaption></figure><p>Medical decision-making is complex. There are often hundreds, if not thousands, of published studies that may impact how to manage your medical condition.</p>
<p>Some studies look at which drug is best in a particular situation, or whether pain is better treated by, say, avoiding exercise or seeing a physio for therapeutic massage.</p>
<p>In this morass of difficult choices, <a href="https://community.cochrane.org">Cochrane reviews</a> stand out as internationally trusted and <a href="https://www.cochrane.org/about-us/our-funders-and-partners">independent</a>. They are considered the “gold standard” in evidence-based medicine.</p>
<p>They involve teams of researchers looking through all the published academic research on a topic to produce an overall answer on what the best evidence says about different treatments.</p>
<p>However, Cochrane has recently <a href="https://theconversation.com/yes-masks-reduce-the-risk-of-spreading-covid-despite-a-review-saying-they-dont-198992">come under fire</a> after a controversial review that looked at whether wearing masks in the community during COVID worked to reduce the spread of respiratory viruses.</p>
<p>Studies like this can <a href="https://www.mdlinx.com/article/cochrane-reviews-controversy-are-the-concerns-valid/7tjNVFB6sLR2l9VoaXqQDc">raise the question</a> of how useful Cochrane reviews are, particularly for the general public.</p>
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<h2>Issues with evidence-based medicine</h2>
<p>As with any research process, Cochrane reviews are not perfect. And they cannot answer all medical questions.</p>
<p>The entire process – from gathering data based primarily on randomised clinical trials, to reviewing that data and coming to some conclusion about the evidence – was mostly developed in the context of clinical interventions. <a href="https://theconversation.com/randomised-control-trials-what-makes-them-the-gold-standard-in-medical-research-78913">Randomised trials</a> are a type of medical study where people are given treatments in a controlled, random way, giving a robust estimate of whether the treatment works for the condition that’s being studied.</p>
<p>People regularly question whether this “gold standard” framework deals well with things other than surgery, drugs and the like. </p>
<p>For example, take the mask review mentioned above. <a href="https://theconversation.com/yes-masks-reduce-the-risk-of-spreading-covid-despite-a-review-saying-they-dont-198992">Much of the criticism</a> was focused not on the specifics of the included papers, but on the general idea of whether randomised clinical trials are an appropriate way to measure the impact of masks on respiratory disease. </p>
<p>What is the “gold standard” if randomised trials are impossible, unethical, or otherwise inappropriate? For example, if an intervention like vaccination is already proven effective, you can’t ethically randomise people into a group that doesn’t get the treatment.</p>
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<em>
<strong>
Read more:
<a href="https://theconversation.com/yes-masks-reduce-the-risk-of-spreading-covid-despite-a-review-saying-they-dont-198992">Yes, masks reduce the risk of spreading COVID, despite a review saying they don't</a>
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</em>
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<p>This gets at the underlying question of what a Cochrane review is actually there to do. The key aim of aggregating research this way is to filter out the noise and provide the most accurate data on a specific question.</p>
<p>Sometimes, the most honest answer is that we just don’t have enough evidence to make a conclusion.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/525571/original/file-20230511-15-c6zxpk.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C998%2C561&q=45&auto=format&w=1000&fit=clip"><img alt="Doctor in white coat, stethoscope around neck, taking notes from laptop" src="https://images.theconversation.com/files/525571/original/file-20230511-15-c6zxpk.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C998%2C561&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/525571/original/file-20230511-15-c6zxpk.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=337&fit=crop&dpr=1 600w, https://images.theconversation.com/files/525571/original/file-20230511-15-c6zxpk.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=337&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/525571/original/file-20230511-15-c6zxpk.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=337&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/525571/original/file-20230511-15-c6zxpk.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=424&fit=crop&dpr=1 754w, https://images.theconversation.com/files/525571/original/file-20230511-15-c6zxpk.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=424&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/525571/original/file-20230511-15-c6zxpk.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=424&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Sometimes, there is evidence, but not from randomised clinical trials.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/crop-close-indian-woman-doctor-white-2078659765">Shutterstock</a></span>
</figcaption>
</figure>
<p>In other cases, there is evidence, but not from randomised clinical trials. Then the debate becomes about how much weight to give this evidence, whether and how to include it, and how to draw conclusions based on this data. </p>
<p>This may seem arbitrary, but there are good reasons to be wary of findings based only on observational research. A systematic review of observational trials of hormone replacement therapy led to widespread use in the late 90s for preventative health, until randomised trials <a href="https://www.annualreviews.org/doi/abs/10.1146/annurev.publhealth.26.021304.144637">showed</a> the therapy had little to no benefit. </p>
<p>This isn’t actually a new problem. Indeed, it’s something Cochrane has been <a href="https://training.cochrane.org/handbook/current/chapter-24">grappling with for years</a>.</p>
<p>For example, <a href="https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD010216.pub7/full">a recent Cochrane review</a> into vaping to help people quit smoking included quite a few non-randomised trials. These were not given the same weight as randomised research, but did provide support for the central finding of the review.</p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/controlled-experiments-wont-tell-us-which-indigenous-health-programs-are-working-74618">Controlled experiments won't tell us which Indigenous health programs are working</a>
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<h2>Cochrane is OK about being criticised …</h2>
<p>There have been many issues raised with Cochrane teams over the years. This includes <a href="https://www.sciencedirect.com/science/article/pii/S0895435621002778#!">problems</a> with how reviewers <a href="https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0096920">rate trials</a> included in the reviews.</p>
<p>However, the organisation is famously transparent. If you have an issue with a particular review, you can post your comments publicly. <a href="https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD015017.pub3/read-comments">I did this</a>, sharing my concerns about a review on using the drug ivermectin to treat COVID.</p>
<p>Cochrane is also good at incorporating criticism. It even has <a href="https://community.cochrane.org/news/prizes-and-awards/bill-silverman-prize">a prize</a> for the best criticism of its work.</p>
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<em>
<strong>
Read more:
<a href="https://theconversation.com/the-government-says-ndis-supports-should-be-evidence-based-but-can-they-be-204763">The government says NDIS supports should be 'evidence-based' – but can they be?</a>
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<h2>… even if reviews take time</h2>
<p>There’s a reason so many experts trust Cochrane. The occasional controversy aside, Cochrane reviews are generally the most detailed and rigorous summary of the evidence on any question you can find. </p>
<p>This attention to detail comes at a cost. Cochrane reviews are often the final word on a subject, not just because they are so robust, but because they take a <a href="https://www.mdlinx.com/article/cochrane-reviews-controversy-are-the-concerns-valid/7tjNVFB6sLR2l9VoaXqQDc">very long time</a> to come out.</p>
<p>Cochrane aims to publish reviews within two years. But more than half take <a href="https://pubmed.ncbi.nlm.nih.gov/32413390/">longer</a> to complete. Cochrane reviews are also meant to be updated regularly, but many have not been updated for <a href="https://europepmc.org/article/med/34427395">more than five years</a>.</p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/clinical-trials-are-useful-heres-how-we-can-ensure-they-stay-so-16113">Clinical trials are useful – here's how we can ensure they stay so</a>
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<h2>In a nutshell</h2>
<p>Cochrane reviews can be flawed, cannot answer all medical questions and, while comprehensive, can take long to complete.</p>
<p>But there’s a reason that these reviews are considered the gold standard in medical research. They are detailed, lengthy, and very impressive pieces of work. </p>
<p>With <a href="https://www.cochranelibrary.com/cdsr/reviews">more than 9,000</a> Cochrane reviews so far, these are still usually the best evidence we have to answer a range of medical questions.</p><img src="https://counter.theconversation.com/content/205014/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>I have previously worked with several members of Cochrane Australia on unaffiliated projects.</span></em></p>Major reviews of medical evidence, known as Cochrane reviews, have come under fire. But is that fair?Gideon Meyerowitz-Katz, PhD Student/Epidemiologist, University of WollongongLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2016302023-04-02T11:46:49Z2023-04-02T11:46:49ZAgeism and the pandemic: How Canada continues to let older adults suffer and die from COVID-19<iframe style="width: 100%; height: 100px; border: none; position: relative; z-index: 1;" allowtransparency="" allow="clipboard-read; clipboard-write" src="https://narrations.ad-auris.com/widget/the-conversation-canada/ageism-and-the-pandemic--how-canada-continues-to-let-older-adults-suffer-and-die-from-covid-19" width="100%" height="400"></iframe>
<p>Three years into this pandemic, most Canadians have taken off their masks and many have stopped getting booster shots. However, COVID-19 is rising among the <a href="https://www150.statcan.gc.ca/t1/tbl1/en/tv.action?pid=1310039401">leading causes of death</a> in Canada, <a href="https://www.finder.com/ca/what-are-the-top-10-causes-of-death-in-canada">reaching the No. 3 spot</a>.</p>
<p>This is the first time an infectious disease has pushed its way into the top five causes of death during the <a href="https://www.ons.gov.uk/peoplepopulationandcommunity/birthsdeathsandmarriages/deaths/articles/causesofdeathover100years/2017-09-18">last 80 years or so of the antibiotic era</a>.</p>
<p>Older adults account for most of those deaths, and we are letting it happen.</p>
<h2>COVID-19, aging and ageism</h2>
<p>COVID is a <a href="https://www.cdc.gov/globalhealth/immunization/diseases/index.html">vaccine-preventable disease</a>, but we are not using vaccines as well as we could. Most Canadians don’t understand the importance of booster shots in <a href="https://www.bmj.com/content/380/bmj-2022-072529">protecting them from long-term health issues that may follow infection</a>, such as long COVID. Even fewer recognize that getting vaccinated <a href="https://immunize.ca/">helps protect their entire community</a>, including older adults. </p>
<figure class="align-center ">
<img alt="A man and his grandson wearing face masks touching elbows greeting social" src="https://images.theconversation.com/files/518590/original/file-20230330-27-pzod8w.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/518590/original/file-20230330-27-pzod8w.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/518590/original/file-20230330-27-pzod8w.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/518590/original/file-20230330-27-pzod8w.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/518590/original/file-20230330-27-pzod8w.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/518590/original/file-20230330-27-pzod8w.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/518590/original/file-20230330-27-pzod8w.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Healthy seniors are assets to their communities. They are caregivers, volunteers and keepers of cultural knowledge.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
</figcaption>
</figure>
<p>Most COVID deaths are in older people. That’s not just a problem for them. It’s a problem for everyone. When older adults are healthy they are an incredible asset to our communities — they are <a href="https://www150.statcan.gc.ca/n1/pub/75-006-x/2020001/article/00007-eng.htm">caregivers</a>, <a href="https://www150.statcan.gc.ca/n1/pub/75-006-x/2021001/article/00002-eng.htm">volunteers</a> and <a href="https://www.bayshore.ca/resources/respect-your-elders-how-seniors-contribute-to-a-better-world/">repositories of knowledge and culture</a>. When they are unwell it is a <a href="https://www.canada.ca/en/public-health/services/publications/science-research-data/economic-burden-illness-canada-2010.html">tremendous strain</a> on them, their caregivers and <a href="https://www.cambridge.org/core/journals/canadian-journal-on-aging-la-revue-canadienne-du-vieillissement/article/abs/chronic-health-conditions-changing-prevalence-in-an-aging-population-and-some-implications-for-the-delivery-of-health-care-services/0FFB314D39504F95027340EBD7534DCB">our health-care system</a>.</p>
<p><a href="https://www.cihi.ca/en/hospital-stays-in-canada">COVID has become the second-leading cause of hospitalization in Canada</a>, after childbirth. Among those over 50, it is the single leading cause of hospitalization. </p>
<p>We had <a href="https://www.publichealthontario.ca/en/data-and-analysis/infectious-disease/covid-19-data-surveillance/covid-19-data-tool?tab=outbreaks">more outbreaks in long-term care facilities in 2022</a> than we had in <a href="https://health-infobase.canada.ca/covid-19/current-situation.html">2020 and 2021 combined, and more deaths and more hospitalizations than the first two years of the pandemic combined</a>. </p>
<p>COVID is not over, but we are acting like it is. Many COVID research programs are <a href="https://www.covid19immunitytaskforce.ca/citf-leadership/">winding down</a>. Can you imagine winding down research into any other condition on the top five mortality list? </p>
<p>The reason for not doing more to prevent COVID-19 appears to be ageism, plain and simple. There is no logical explanation for accepting an unnatural degree of hospitalization and premature deaths in elders except that we value the lives of younger people more. </p>
<h2>The toll of COVID-19 in older people</h2>
<p>Unfortunately, dying isn’t even necessarily the worst of it. </p>
<p>It’s just the part that’s easier to count and that makes the most headlines. There is still a sea of suffering out there, as older people — who are more likely to have other health issues — get sick with COVID and take a long time to recover, if they do recover. </p>
<figure class="align-center ">
<img alt="Rows of small white crosses on a lawn with a building in the background" src="https://images.theconversation.com/files/518114/original/file-20230329-16-glion1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/518114/original/file-20230329-16-glion1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=425&fit=crop&dpr=1 600w, https://images.theconversation.com/files/518114/original/file-20230329-16-glion1.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=425&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/518114/original/file-20230329-16-glion1.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=425&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/518114/original/file-20230329-16-glion1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=534&fit=crop&dpr=1 754w, https://images.theconversation.com/files/518114/original/file-20230329-16-glion1.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=534&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/518114/original/file-20230329-16-glion1.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=534&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Canada had the highest proportion of COVID deaths in long-term care of any country in the Organisation for Economic Co-operation.
and Development. Crosses outside a Mississauga, Ont. long-term care centre during the first wave of the pandemic.</span>
<span class="attribution"><span class="source">THE CANADIAN PRESS/Nathan Denette</span></span>
</figcaption>
</figure>
<p>For older adults, respiratory illness is often a <a href="https://doi.org/10.1007/978-3-030-22009-9_550">catalyst for other health problems</a>, triggering a spiral that ends in premature death. Illness also causes many people to <a href="https://www.nber.org/books-and-chapters/women-working-longer-increased-employment-older-ages/women-working-longer-labor-market-implications-providing-family-care">retire early because they or the people they care for are chronically ill</a>.</p>
<p>Canada had the <a href="https://www.cihi.ca/sites/default/files/document/covid-19-rapid-response-long-term-care-snapshot-en.pdf">highest proportion of COVID deaths in long-term care</a> of any country in the Organisation for Economic Co-operation and Development, because we did not prioritize preventing infectious disease. Now, because of the demographic bulge of the Baby Boom, the <a href="https://toronto.ctvnews.ca/wait-list-for-long-term-care-beds-in-ontario-nearly-doubled-in-10-years-oltca-says-1.6229216">demand for long-term care for older adults is rising</a>, even as COVID outbreaks continue in such facilities.</p>
<p>It’s hard to believe that after the <a href="https://www.cbc.ca/news/canada/montreal/quebec-herron-inquest-day-3-1.6170046">horror show</a> in so many Canadian long-term care homes during early months of COVID that we have slipped back into complacency, allowing Canadians’ parents, grandparents, neighbours and friends to become infected because the rest of us won’t take simple actions.</p>
<p>It doesn’t have to be this way, and it shouldn’t. </p>
<h2>Excess COVID-19 deaths in older adults are not inevitable</h2>
<p>Typically, people under 50 are likely to have much more social contact through school, social events and work, making them the most likely to be exposed to the virus. However, they are also the least likely to protect themselves — and others — by keeping up with their <a href="https://health-infobase.canada.ca/covid-19/vaccination-coverage/#a5">booster shots</a> and <a href="https://angusreid.org/covid-unmasked-unwilling/">wearing masks</a>. </p>
<figure class="align-center ">
<img alt="An older woman walking outdoors with a younger woman who has her arm through the older woman's. Both are wearing face masks." src="https://images.theconversation.com/files/518589/original/file-20230330-1159-b3w2ko.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/518589/original/file-20230330-1159-b3w2ko.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/518589/original/file-20230330-1159-b3w2ko.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/518589/original/file-20230330-1159-b3w2ko.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/518589/original/file-20230330-1159-b3w2ko.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/518589/original/file-20230330-1159-b3w2ko.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/518589/original/file-20230330-1159-b3w2ko.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">If more Canadians kept up with their vaccines, there could be less COVID-19 in the community and vulnerable populations would be better protected.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
</figcaption>
</figure>
<p>It may be easier for them to believe and behave as if the threat of COVID has passed, because they are far <a href="https://health-infobase.canada.ca/covid-19/current-situation.html">more likely to make a quick and complete recovery</a> from COVID. But they are also the ones <a href="https://health-infobase.canada.ca/covid-19/current-situation.html">most likely to spread it to those who have far less immune protection</a> and far less choice. </p>
<p>We shouldn’t treat COVID-19 in older adults as inevitable. With better testing, policy makers could have better information to make decisions about how to reduce the number of infections. If more Canadians kept up with their vaccines, there could be less COVID-19 in the community and vulnerable populations would be better protected.</p>
<p>Older adults have inherent value and dignity, and are an asset to their communities. They are people who have already contributed to society in family, professional and social capacities, and who continue to do so. They deserve to live as long and as well as possible.</p><img src="https://counter.theconversation.com/content/201630/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Dawn ME Bowdish receives funding from the COVID-19 Immunity Task Force (Public Health Agency of Canada) for her research on COVID-19 infections and vaccinations in older adults. She is on the Board of Directors of the Lung Health Foundation. </span></em></p>COVID-19 is the third-leading cause of death in Canada, but it’s older people who are dying. That we accept this and carry on as if the pandemic is over reveals our ageism: We don’t value older people.Dawn ME Bowdish, Canada Research Chair in Aging & Immunity, McMaster UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1989922023-02-06T19:04:54Z2023-02-06T19:04:54ZYes, masks reduce the risk of spreading COVID, despite a review saying they don’t<figure><img src="https://images.theconversation.com/files/508261/original/file-20230206-504-kijojf.jpg?ixlib=rb-1.1.0&rect=0%2C68%2C4593%2C2984&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.pexels.com/photo/calm-black-woman-with-coffee-wearing-medical-mask-standing-in-metro-6280959/">Pexels/Uriel Mont</a></span></figcaption></figure><p>The question of whether and to what extent face masks work to prevent respiratory infections such as COVID and influenza has split the scientific community for <a href="https://www.baltimoresun.com/news/bs-xpm-2007-03-06-0703060040-story.html">decades</a>. </p>
<p>Although there is strong evidence face masks <a href="https://www.sciencedirect.com/science/article/pii/S0020748920301139?via%3Dihub">significantly reduce transmission of such infections</a> both in health-care settings and in the community, some experts do not agree. </p>
<p>An updated <a href="https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD006207.pub6/full">Cochrane Review</a> published last week is the latest to suggest face masks don’t work in the community. </p>
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<p>However there are problems with the review’s methodology and its underpinning assumptions about transmission. </p>
<p>The Cochrane Review combined randomised controlled trials (RCTs) using <a href="https://ebn.bmj.com/content/16/1/3">meta-analysis</a>. RCTs test an intervention in one group and compare it with a “control” group that doesn’t receive the intervention or receives a different intervention. A meta-analysis pools the results of multiple studies. </p>
<p>This approach assumes (a) RCTs are the “best” evidence and (b) combining results from multiple RCTs will give you an average “effect size”.</p>
<p>But RCTs are only the undisputed gold standard for certain <em>kinds</em> of questions. For other questions, a mix of study designs is better. And RCTs should be combined in a meta-analysis <em>only</em> if they are all addressing the same research question in the same way. </p>
<p>Here are some reasons why the conclusions of this Cochrane Review are misleading. </p>
<h2>It didn’t consider how COVID spreads and how masks work</h2>
<p>COVID, along with influenza and many other respiratory diseases, is transmitted primarily <a href="https://theconversation.com/covid-how-the-disease-moves-through-the-air-173490">through the air</a>. </p>
<p>Respirators (such as N95s) are designed and regulated to prevent airborne infections by fitting <a href="https://theconversation.com/high-filtration-masks-only-work-when-they-fit-so-we-created-a-new-way-to-test-if-they-do-155987">closely to the face</a> to prevent air leakage and by filtering out 95% or more of potential infectious particles. </p>
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Read more:
<a href="https://theconversation.com/high-filtration-masks-only-work-when-they-fit-so-we-created-a-new-way-to-test-if-they-do-155987">High-filtration masks only work when they fit – so we created a new way to test if they do</a>
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<p>In contrast, surgical masks are designed to prevent splatter of fluid on the face and are loose-fitting, causing unfiltered air to leak in through the gaps around the mask. The filtration of a surgical mask is not regulated. </p>
<p>In other words, respirators are designed for respiratory protection and cloth and surgical masks are not. </p>
<p>The review starts with an assumption that masks provide respiratory protection, which is flawed. An understanding of these differences should inform both studies and reviews of those studies. </p>
<h2>The studies addressed quite different questions</h2>
<p>A common mistake in meta-analysis is to combine apples and oranges. If apples work but oranges don’t, combining all studies in a single average figure may lead to the conclusion that apples do not work. </p>
<p>This Cochrane Review combined RCTs where face masks or respirators were worn <em>part</em> of the time (for example, when caring for patients with known COVID or influenza: “occasional” or “targeted” use) with RCTs where they were worn at <em>all</em> times (“continuous use”). </p>
<p>Because both SARS-CoV-2 and influenza viruses are airborne, an unmasked person could be infected anywhere in the building and even after an infectious patient has left the room, especially since some people have <a href="https://www.pnas.org/doi/10.1073/pnas.2109229118">no symptoms</a> while contagious. </p>
<figure class="align-center ">
<img alt="Clinicians in PPE pulls up her gloves" src="https://images.theconversation.com/files/508255/original/file-20230206-21-bn9aws.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/508255/original/file-20230206-21-bn9aws.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=480&fit=crop&dpr=1 600w, https://images.theconversation.com/files/508255/original/file-20230206-21-bn9aws.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=480&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/508255/original/file-20230206-21-bn9aws.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=480&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/508255/original/file-20230206-21-bn9aws.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=603&fit=crop&dpr=1 754w, https://images.theconversation.com/files/508255/original/file-20230206-21-bn9aws.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=603&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/508255/original/file-20230206-21-bn9aws.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=603&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">The results will depend on whether they’re occasionally or continuously used.</span>
<span class="attribution"><a class="source" href="https://unsplash.com/photos/hYcSP6SpoK0">Unsplash/Viki Mohamad</a></span>
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<p>Most RCTs of masks and N95s included in the review have not had a <a href="https://jamanetwork.com/journals/jama/fullarticle/184819">control arm</a> – therefore finding no difference could indicate equal efficacy or equal inefficacy. </p>
<p><a href="https://jamanetwork.com/journals/jama/fullarticle/2749214">Studies</a> examining wearing a surgical mask or respirator (such as an N95) only when in contact with sick people or when doing a high-risk procedure (occasional use) have generally shown that, when worn in this way, there is no difference. </p>
<p>An RCT comparing occasional versus continuous use of respirators in health care workers <a href="https://www.atsjournals.org/doi/10.1164/rccm.201207-1164OC?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%20%200pubme">showed</a> N95 respirators and surgical masks were equally <em>ineffective</em> when only worn occasionally by hospital workers. They had to wear them <em>all the time at work</em> to be protected. </p>
<p>We also combined only apples and apples in a <a href="https://onlinelibrary.wiley.com/doi/10.1111/irv.12474">meta-analysis</a> of two RCTs conducted in exactly the same way and measuring the same interventions and outcomes. We found N95 respirators provide <em>significant protection</em> against respiratory infections when surgical masks did not, even against infections assumed to be “droplet spread”. </p>
<h2>Most trials addressed only half the question</h2>
<p>Face masks and respirators work in two ways: they protect the wearer from becoming infected <em>and</em> they prevent an infected wearer from spreading their germs to other people. </p>
<p>Most RCTs in this Cochrane Review looked only at the former scenario, not the latter. In other words, the researchers had asked people to wear masks and then tested to see if those people became infected. </p>
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Read more:
<a href="https://theconversation.com/as-viral-infections-skyrocket-masks-are-still-a-tried-and-true-way-to-help-keep-yourself-and-others-safe-195788">As viral infections skyrocket, masks are still a tried-and-true way to help keep yourself and others safe</a>
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<p>A previous <a href="https://pubmed.ncbi.nlm.nih.gov/20092668/">systematic review</a> found face masks worn by sick people during an influenza epidemic reduced the risk of them transmitting the infection to family members or other carers. Preventing an infection in one person also prevents onward transmission to others within a closed setting, which means such RCTs should use a special method called “cluster randomisation” to account for this. </p>
<p>Data from a RCT of N95 respirator use by <a href="https://journals.sagepub.com/doi/full/10.1177/0300060516665491?rfr_dat=cr_pub++0pubmed&url_ver=Z39.88-2003&rfr_id=ori%3Arid%3Acrossref.org">health workers</a> showed even their unmasked colleagues were protected. Yet some of the trials included in the review did not use cluster randomisation.</p>
<h2>The new paper combined health and community settings</h2>
<p>This is another apples-plus-oranges issue. Different settings have widely differing risks of transmission, since airborne particles build up when sick patients are exhaling the virus in <a href="https://theconversation.com/heres-where-and-how-you-are-most-likely-to-catch-covid-new-study-174473">underventilated, crowded settings</a> especially if many infected people are present (such as in a hospital). </p>
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<p>A genuine protective effect of masks or respirators shown in a RCT in a high-risk setting will be obscured if that trial is combined in a meta-analysis with several other RCTs that were conducted in low-risk settings. </p>
<p>A large <a href="https://www.science.org/doi/10.1126/science.abi9069">RCT in the community in Bangladesh</a> found face masks reduced the risk of infection by 11% overall and 35% in people over 60 years. In contrast, in <a href="https://onlinelibrary.wiley.com/doi/10.1111/irv.12474">hospitals</a>, N95 reduce risk by 67% against bacterial infections and 54% against viral infections.</p>
<p>Viruses like influenza also vary substantially from year to year – some years there is very little influenza, and if a RCT is conducted during such a year, it will not find enough infections to show a difference. The review failed to account for such seasonal effects.</p>
<h2>But did they actually wear the mask?</h2>
<p>The authors of the Cochrane Review acknowledged compliance with masking advice was poor in most studies. In the real world, we can’t force people to follow medical advice, so RCTs should be analysed on an “intention to treat” basis. </p>
<p>For example, people who are prescribed the active drug but who choose not to take it should not be shifted to the placebo group for the analysis. But if in a study of masking, most people don’t actually wear them, you can’t conclude that <em>masks</em> don’t work when the study shows no difference between the groups. You can only conclude that the <em>mask advice</em> didn’t work in this study. </p>
<figure class="align-center ">
<img alt="Woman fits a facemask" src="https://images.theconversation.com/files/508256/original/file-20230206-17-y18dj7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/508256/original/file-20230206-17-y18dj7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/508256/original/file-20230206-17-y18dj7.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/508256/original/file-20230206-17-y18dj7.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/508256/original/file-20230206-17-y18dj7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/508256/original/file-20230206-17-y18dj7.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/508256/original/file-20230206-17-y18dj7.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">People don’t always wear masks when advised to do so.</span>
<span class="attribution"><a class="source" href="https://www.pexels.com/photo/woman-wearing-face-mask-3873197/">Pexels/Polina Tankilevitch</a></span>
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<p>There is a great deal of <a href="https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0246317">psychological evidence</a> on why people do or don’t choose to comply with advice to mask and how to improve uptake. The science of masking needs to separate the impact of the <em>mask itself</em> from the impact of the <em>advice to mask</em>. </p>
<p>Mask-wearing <a href="https://www.ijidonline.com/article/S1201-9712(21)00274-5/fulltext">goes up</a> substantially to over 70% if there is an actual mandate in place.</p>
<h2>It didn’t include other types of research</h2>
<p>A comprehensive review of the evidence would also include other types of study besides RCTs. For example, a <a href="https://www.sciencedirect.com/science/article/pii/S0140673620311429">large systematic review</a> of 172 various study designs, which included 25,697 patients with SARS-CoV-2, SARS, or MERS, concluded masks were effective in preventing transmission of respiratory viruses. </p>
<p>Well-designed <a href="https://www.cdc.gov/mmwr/volumes/71/wr/mm7106e1.htm?s_cid=mm7106e1_w">real-world studies</a> during the pandemic showed any mask reduces the risk of COVID transmission by 50–80%, with the highest protection offered by N95 respirators. </p>
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Read more:
<a href="https://theconversation.com/which-mask-works-best-we-filmed-people-coughing-and-sneezing-to-find-out-143173">Which mask works best? We filmed people coughing and sneezing to find out</a>
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<p><a href="https://pubmed.ncbi.nlm.nih.gov/20095070/">Many lab-based studies</a> have shown respirators are superior to masks at preventing airborne respiratory infections and the <a href="https://thorax.bmj.com/content/75/11/1024.long">incremental superiority</a> from a single to two layered cloth mask to a three-layered surgical mask in blocking respiratory aerosols.</p>
<h2>Yes, masks reduce the spread of COVID</h2>
<p>There is strong and consistent evidence for the effectiveness of masks and (even more so) respirators in protecting against respiratory infections. Masks are an important protection against serious infections. </p>
<p>Current COVID vaccines protect against death and hospitalisation, but do <a href="https://fortune.com/well/2023/01/06/kraken-xbb15-omicron-covid-variant-most-transmissible-yet-could-spawn-more-immune-evasive-variants-study-china-vaccine-monoclonal-antibodies-breakthrough-infection/">not prevent infection</a> well due to waning vaccine immunity and substantial immune escape from new variants. </p>
<p>A systematic review is only as good as the rigour it employs in combining similar studies of similar interventions, with similar measurement of outcomes. When very different studies of different interventions are combined, the results are not informative.</p><img src="https://counter.theconversation.com/content/198992/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>C Raina MacIntyre receives funding from mask manufacturer Detmold for testing of their masks and is on an advisory board for mask manufacturer Ascend. She receives funding from Sanofi for investigator-driven influenza research, and from NHMRC and MRFF. She has been an expert advisor for Ontario Nurses Association (ONA) In the matter of a proceeding under the Labour Relations Act, 1995 between ONA and Hamilton Health Sciences Corporation.
</span></em></p><p class="fine-print"><em><span>Abrar Ahmad Chughtai had testing of filtration of masks by 3M for his PhD. 3M products were not used in his research. He also has worked with Paftec on research in respirators (no funding was involved).</span></em></p><p class="fine-print"><em><span>Dr Fisman has served as an expert witness for the Ontario Nurses Association and the Elementary Teachers' Federation of Ontario in legal challenges related to safer working conditions in healthcare and schools. Dr. Fisman has served on advisory boards for Pfizer, Astrazeneca, Merck, Seqirus and Sanofi vaccines against SARS-CoV-2, influenza, and S. pneumoniae. He holds current funding from the Canadian Institutes for Health Research and Health Canada.</span></em></p><p class="fine-print"><em><span>Trish Greenhalgh receives funding from UK National Institute for Health and Care Research and the NIHR School for Primary Care Research. She is affiliated with University of Oxford and University of Oslo. She has served as an unpaid adviser tot he philanthropic fund BALVI and is a member of Independent SAGE. </span></em></p>An updated Cochrane Review suggests face masks don’t reduce the spread of COVID in the community. But there are several reasons why this conclusion is misleading.C Raina MacIntyre, Professor of Global Biosecurity, NHMRC Principal Research Fellow, Head, Biosecurity Program, Kirby Institute, UNSW SydneyAbrar Ahmad Chughtai, Senior lecturer, UNSW SydneyDavid Fisman, Professor in the Division of Epidemiology, University of TorontoTrish Greenhalgh, Professor of Primary Care Health Sciences, University of OxfordLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1547202022-12-27T19:20:27Z2022-12-27T19:20:27ZHow to protect yourself against bushfire smoke this summer<figure><img src="https://images.theconversation.com/files/498606/original/file-20221202-20-fswf2q.jpg?ixlib=rb-1.1.0&rect=5%2C0%2C1911%2C1279&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://unsplash.com/photos/Ihsi88KpQkE">Matt Palmer/Unsplash</a></span></figcaption></figure><p>It’s bushfire season. So you might be wondering about the best way to protect yourself from the health impacts of smoke.</p>
<p>Guidelines suggest wearing <a href="https://files-em.em.vic.gov.au/public/Smoke/EMK-01.19-Community-SAQH-Protocol.pdf">respirators</a>, <a href="https://www.health.nsw.gov.au/environment/air/Pages/bushfire-protection.aspx">avoiding</a> outdoor air and avoiding vigorous activity outdoors. Many people use the cheaper option of a surgical mask during bushfires. But there has never been a clinical trial to measure how well these interventions work. That’s why our group is <a href="https://kirby.unsw.edu.au/breathe">looking into it</a>.</p>
<p>In the meantime, here’s what you can do to reduce your exposure to bushfire smoke.</p>
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<em>
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Read more:
<a href="https://theconversation.com/its-summer-so-bushfires-and-covid-collide-3-ways-one-affects-the-other-169833">It's summer, so bushfires and COVID collide. 3 ways one affects the other</a>
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<h2>Who’s at risk?</h2>
<p>Australia’s 2019/2020 summer bushfires resulted in <a href="https://www.theguardian.com/australia-news/2020/may/26/australias-summer-bushfire-smoke-killed-445-and-put-thousands-in-hospital-inquiry-hears">more than 400 estimated deaths</a> and thousands of hospitalisations from smoke exposure.</p>
<p>You don’t have to have a lung condition to suffer the <a href="https://theconversation.com/smoke-from-bushfires-poses-a-health-hazard-for-all-of-us-11493">ill-effects of bushfire smoke</a>. Breathing difficulties, eye irritation and heart attacks are among the <a href="https://theconversation.com/how-does-bushfire-smoke-affect-our-health-6-things-you-need-to-know-130126">well-documented</a> short-term impacts.</p>
<p>But people with asthma, <a href="https://theconversation.com/explainer-what-is-chronic-obstructive-pulmonary-disease-25539">emphysema</a>, chronic bronchitis and other lung conditions are particularly susceptible to smoke exposure, triggering asthma attacks and breathing difficulties.</p>
<p>This was the typical pattern we saw during our <a href="https://www.atsjournals.org/doi/10.1164/rccm.202012-4471LE?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%20%200pubmed">own research</a>, conducted during the same bushfire season. We showed smoke exposure caused ill health in people with and without existing lung disease.</p>
<p>However, we found people under 65 had a higher risk of ill health after smoke exposure than older people. This may be because younger people tend to go outdoors more during bushfires.</p>
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Read more:
<a href="https://theconversation.com/how-does-bushfire-smoke-affect-our-health-6-things-you-need-to-know-130126">How does bushfire smoke affect our health? 6 things you need to know</a>
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<h2>1. Be prepared</h2>
<p>If you live in an area potentially affected by bushfire smoke, the first thing to do is to get an early alert about fires and smoke using one or more apps. Examples include, the <a href="https://www.rfs.nsw.gov.au/news-and-media/stay-up-to-date">Fires Near Me app</a> or the <a href="https://airrater.org">AirRater app</a> for air quality.</p>
<p>You can also use a <a href="https://iser.med.unsw.edu.au/sites/iser/files/_local_upload/Air%20quality%20self-assessment%20guide.pdf">visual method</a> to assess air quality. This involves identifying a landmark on the horizon about 5 kilometres away and noting if it becomes hazy. This would be the trigger for using a respirator or avoiding outdoor air.</p>
<h2>2. Stay inside if it’s safe</h2>
<p>Try to <a href="https://files-em.em.vic.gov.au/public/Smoke/EMK-01.19-Community-SAQH-Protocol.pdf">avoid exposure</a> to smoke, avoiding outside air and staying indoors if it is practical and safe to do so. Vigorous exercise outdoors can be dangerous as it results in greater smoke inhalation and risks to the heart and lungs.</p>
<p>Close all doors and windows, set air-conditioning to recirculate, and seal gaps under or around doors, windows and wall vents with towels, blankets or plastic. </p>
<p>Unfortunately, these instructions are the opposite of what to do if there is COVID at home, when you would want fresh air in the house. If that is the case, wear a mask indoors in common areas and social distance from the person with COVID.</p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/our-buildings-arent-made-to-keep-out-bushfire-smoke-heres-what-you-can-do-129367">Our buildings aren't made to keep out bushfire smoke. Here's what you can do</a>
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<h2>3. Wear a respirator (not just a surgical mask)</h2>
<p>Most people who need to go outside during a bushfire can use some type of disposable respirator to filter the smokey air.</p>
<p>You will have seen people wearing these P2, P3 or N95 <a href="https://theconversation.com/how-to-get-the-most-out-of-your-n95-mask-or-other-respirator-177229">respirators</a> to protect themselves and others from SARS-CoV-2, the virus that causes COVID.</p>
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<p>These and <a href="https://www.addler.com.au/differences-p1-p2-p3-n95-respirators/">other types of disposable respirators</a> filter very fine particles and fit closely around the face. Choose one with a full band around the back of the head (rather than ear loops) as these provide a better fit.</p>
<p>Some disposable respirators have valves, which means they filter inhaled air but allow you to exhale more comfortably. This option may help people with asthma or lung disease to breathe more comfortably. If you have COVID, though, wearing a respirator with a valve does not reduce the risk of you infecting others, because the air you breathe out through the valve is unfiltered and contaminated.</p>
<p>Respirators will filter particles <a href="https://www.aiha.org/news/201022-osha-addresses-claims-that-n95s-do-not-protect-against-sars-cov-2">larger than 0.3 microns</a> (micrometres). However, they may not filter smaller particles contained in smoke, which is why avoiding outside air is still important.</p>
<p>People who live in bushfire-prone areas may want to consider a type of respirator they can clean and re-use when needed, known as <a href="https://healthcareworkersaustralia.com/elastomeric-mask/">an elastomeric respirator</a>. Their filters need to be changed at specified intervals.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/499478/original/file-20221207-24-nezay8.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Elastomeric face mask" src="https://images.theconversation.com/files/499478/original/file-20221207-24-nezay8.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/499478/original/file-20221207-24-nezay8.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=406&fit=crop&dpr=1 600w, https://images.theconversation.com/files/499478/original/file-20221207-24-nezay8.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=406&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/499478/original/file-20221207-24-nezay8.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=406&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/499478/original/file-20221207-24-nezay8.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=510&fit=crop&dpr=1 754w, https://images.theconversation.com/files/499478/original/file-20221207-24-nezay8.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=510&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/499478/original/file-20221207-24-nezay8.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=510&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">An elastomeric mask, such as this one, can be re-used.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/reusable-halfface-elastomeric-respirator-air-purification-2196383995">Shutterstock</a></span>
</figcaption>
</figure>
<p>If you have trouble getting one of the mentioned respirators, you can use a disposable <a href="https://breathesafeair.com/mask-ratings/">KN95 respirator</a>. However, these have ear loops and do not fit well around the face, so air can leak through. </p>
<p>Surgical masks are not likely to protect you because they are so loose. But medical-grade ones provide good filtering. For this to be effective, wear one with a <a href="https://www.insider.com/ways-to-make-your-face-mask-more-effective-2021-2">mask brace or clip</a> to provide a better fit and to help prevent air leaking in from the sides.</p>
<h2>In a nutshell</h2>
<p>Be prepared by downloading an app to monitor bushfires and air quality near you, and stocking up on good quality respirators ahead of time if you can. You can re-use these if they are not visibly soiled or damaged.</p>
<p>Staying out of the smoke is also important, particularly if you have asthma, emphysema and other lung disease. Young people may be less aware of the health effects of smoke exposure, and even people without lung disease can experience ill health due to smoke.</p>
<hr>
<p><em>Do you have asthma, emphysema, chronic bronchitis or bronchiectasis? Do you live in an area in Australia affected by bushfires or bushfire smoke (including metropolitan areas)? You may be eligible to be part of <a href="https://kirby.unsw.edu.au/breathe">our study</a> into the best way to protect yourself from bushfire smoke.</em></p><img src="https://counter.theconversation.com/content/154720/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>C Raina MacIntyre has consulted for mask companies including Detmold and Ascend. She receives funding from the NHMRC and the MRFF currently.</span></em></p>Be prepared. Download an air quality app, stock up on respirators and stay inside if you can.C Raina MacIntyre, Professor of Global Biosecurity, NHMRC Principal Research Fellow, Head, Biosecurity Program, Kirby Institute, UNSW SydneyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1957882022-12-14T13:13:59Z2022-12-14T13:13:59ZAs viral infections skyrocket, masks are still a tried-and-true way to help keep yourself and others safe<figure><img src="https://images.theconversation.com/files/499681/original/file-20221207-12-ly6akr.jpg?ixlib=rb-1.1.0&rect=147%2C61%2C8032%2C5346&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Masks are an easy and low-cost way to reduce the amount of virus entering the air and spreading to others.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/multiracial-people-in-the-city-wearing-face-mask-royalty-free-image/1369532854?phrase=masks%20&adppopup=true">william87/iStock via Getty Images Plus</a></span></figcaption></figure><p>The cold and flu season of 2022 has begun with a vengeance. Viruses that have been unusually scarce over the past three years are <a href="https://www.cdc.gov/surveillance/nrevss/rsv/index.html">reappearing at remarkably high levels</a>, <a href="https://www.washingtonpost.com/wellness/2022/12/07/face-masks-tripledemic-flu-covid-rsv/">sparking a “tripledemic”</a> of COVID-19, the flu and respiratory syncytial virus, or RSV. This November’s national hospitalization levels for influenza were the <a href="https://www.cdc.gov/flu/weekly/index.htm">highest in 10 years</a>. </p>
<p>We are <a href="https://sph.umich.edu/faculty-profiles/martin-emily.html">infectious disease epidemiologists</a> and <a href="https://sph.umich.edu/faculty-profiles/eisenberg-marisa.html">researchers</a>, and we have spent our careers focused on understanding how viruses spread and how best to stop them. </p>
<p>To respond to the COVID-19 pandemic, we and our public health colleagues have had to quickly revive and apply decades of evidence on respiratory virus transmission to chart a path forward. Over the course of the pandemic, epidemiologists have <a href="https://doi.org/10.1073/pnas.2014564118">established with new certainty</a> the fact that one of our oldest methods for controlling respiratory viruses, the face mask, remains one of the <a href="https://theconversation.com/evidence-shows-that-yes-masks-prevent-covid-19-and-surgical-masks-are-the-way-to-go-167963">most effective tools</a> in a pandemic. </p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/wg8HmJ0i-H4?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">Day care centers, college dorms and public gatherings can promote superspreader events.</span></figcaption>
</figure>
<h2>A slew of circulating viruses</h2>
<p>Unlike the many past waves of COVID-19 since the spring of 2020, this fall’s surge of respiratory disease is not due to a single novel virus. Rather, now that masks and other measures have gone by the wayside, the U.S. has returned to the classic cold and flu season pattern. In a typical year, many viruses cocirculate and cause similar symptoms, leading to a wave of illness that includes ever-shifting combinations of <a href="https://doi.org/10.1093/infdis/jiu327">more than 15 types and subtypes of viruses</a>. </p>
<p>Nowhere is this pattern more obvious than in young children. Our research has shown <a href="https://doi.org/10.1093/infdis/jiy232">that classrooms house many viruses at once</a>, and that individual kids can be infected with <a href="https://doi.org/10.1093/infdis/jis934">two or three viruses</a> even during a single illness. </p>
<p>While mere inconveniences for most people, respiratory viruses like the seasonal flu are responsible <a href="https://doi.org/10.1097/JOM.0000000000001120">for missed work</a> and school. In some cases they can lead to severe illnesses, especially in very young children and older adults. After years of fighting one virus, parents are now exhausted by the reality of battling many, many more.</p>
<p>But there is a straightforward way to cut down on the risk for ourselves and others. When it comes to individual decisions, masks are among the most low-cost and most effective steps that can be taken to broadly reduce transmission of a multitude of viruses. </p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/XBU8QpnC9Zc?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">As of early December 2022, the Centers for Disease Control and Prevention is now recommending that people wear masks indoors in five New York counties.</span></figcaption>
</figure>
<h2>The latest research</h2>
<p>Long before the COVID-19 pandemic, researchers were studying the effectiveness of masks at reducing transmission of other respiratory viruses. Meta-analyses of viral spread during the <a href="https://doi.org/10.1056/NEJMoa030685">original SARS epidemic in 2002-2003</a> showed that one infection <a href="https://doi.org/10.1136/bmj.39393.510347.BE">was averted for every six people wearing a mask</a>, and for every three people who were <a href="https://www.fda.gov/medical-devices/personal-protective-equipment-infection-control/n95-respirators-surgical-masks-face-masks-and-barrier-face-coverings">wearing an N95 mask</a>. </p>
<p>Mask-wearing by health care workers has long been considered a primary strategy for <a href="https://doi.org/10.1086/313960">protecting young at-risk infants</a> from RSV infection transmitted in hospital settings. Scientific evaluation of the effectiveness of masks has historically been clouded by the fact that mask-wearing is often used in conjunction with other strategies, such as hand-washing. Nonetheless, the use of personal protective equipment, including masks, as well as gowns, gloves and possibly goggles in the health care setting, has been commonly <a href="https://doi.org/10.1111/irv.12379">associated with reduced transmission of RSV</a>. </p>
<p>Similarly, one of the largest pre-COVID-19 randomized studies of mask-wearing, conducted with over a thousand University of Michigan residence hall students in 2006 to 2007, found that symptomatic respiratory illness was reduced among mask-wearers. This was especially true when <a href="https://doi.org/10.1086/650396">masks were combined with hand hygiene</a>. </p>
<p>More recently, researchers measured the amount of virus present in exhaled breath from people with respiratory symptoms to study how well masks blocked the release of virus particles. Those who were randomly selected to wear a mask had lower levels of respiratory shedding for influenza, rhinovirus – which causes the common cold – and non-SARS coronaviruses, <a href="https://doi.org/10.1038/s41591-020-0843-2">than those with no mask</a>.</p>
<p>Now, three years into the pandemic, evidence around masks and our experience using them has grown enormously. Laboratory studies and outbreak investigations have shown that masks <a href="https://doi.org/10.1126/science.abc6197">lower the amount of virus that enters the air</a> and reduce the quantity of viruses <a href="https://doi.org/10.1126/science.abd9149">that enter our airways when we breathe</a>. Recent studies have shown that wearing a surgical mask in an indoor public setting <a href="http://dx.doi.org/10.15585/mmwr.mm7106e1">reduces the odds of testing positive for COVID-19</a> by 66%, and wearing an N95/KN95 type of mask lowers the odds of testing positive by 83%. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/500119/original/file-20221209-34318-dcc7sc.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Chart showing the relative odds of testing positive for COVID-19 depending on mask-wearing and mask type." src="https://images.theconversation.com/files/500119/original/file-20221209-34318-dcc7sc.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/500119/original/file-20221209-34318-dcc7sc.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=337&fit=crop&dpr=1 600w, https://images.theconversation.com/files/500119/original/file-20221209-34318-dcc7sc.jpeg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=337&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/500119/original/file-20221209-34318-dcc7sc.jpeg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=337&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/500119/original/file-20221209-34318-dcc7sc.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=424&fit=crop&dpr=1 754w, https://images.theconversation.com/files/500119/original/file-20221209-34318-dcc7sc.jpeg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=424&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/500119/original/file-20221209-34318-dcc7sc.jpeg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=424&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">A study of mask-wearing in public indoor settings found that people who wore surgical masks were 66% less likely to contract COVID-19 than those who wore none.</span>
<span class="attribution"><span class="source">Centers for Disease Control and Prevention</span></span>
</figcaption>
</figure>
<h2>Infections drop when schoolchildren are masked</h2>
<p>Our own research has shown the major impact of mask-wearing on transmission of SARS-CoV-2 – the virus that causes COVID-19 – and other viruses. During the circulation of the <a href="https://theconversation.com/delta-variant-makes-it-even-more-important-to-get-a-covid-19-vaccine-even-if-youve-already-had-the-coronavirus-164203">highly transmissible delta variant</a> in the fall of 2021, we found that schoolwide mask requirements were <a href="https://www.michigan.gov/-/media/Project/Websites/coronavirus/Folder21/20211109_Data_and_modeling_update_vFINAL.pdf?rev=7559c12956754727abe039594f179c25">linked to a reduction in COVID-19 infections</a>. School-age children living in districts without mask requirements were infected at a higher rate that increased faster in the early weeks of the school year than their counterparts in districts with complete or partial mask requirements. Similar patterns occurred in other states coinciding with the <a href="https://doi.org/10.1056/NEJMoa2211029">lifting of school mask requirements</a> in spring 2022.</p>
<p>Our preliminary work in a community with frequent mask-wearing behavior has found that the <a href="https://doi.org/10.1101/2022.12.08.22283268">rate of non-COVID respiratory illness in families fell by 50%</a> during 2020 and 2021 compared with earlier years. In our study, as participants reported the relaxing of mask-wearing and other mitigation behaviors in early 2022, the viruses that are now gripping the U.S. began to return. This resurgence started, curiously enough, with a reappearance of the four “common cold” seasonal coronaviruses.</p>
<figure class="align-center ">
<img alt="A graph showing that COVID-19 infection rates were significantly higher in school districts without mask requirements." src="https://images.theconversation.com/files/500487/original/file-20221212-116135-2cfnvi.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/500487/original/file-20221212-116135-2cfnvi.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=287&fit=crop&dpr=1 600w, https://images.theconversation.com/files/500487/original/file-20221212-116135-2cfnvi.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=287&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/500487/original/file-20221212-116135-2cfnvi.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=287&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/500487/original/file-20221212-116135-2cfnvi.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=361&fit=crop&dpr=1 754w, https://images.theconversation.com/files/500487/original/file-20221212-116135-2cfnvi.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=361&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/500487/original/file-20221212-116135-2cfnvi.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=361&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Michigan school districts without mask requirements experienced higher COVID-19 case rates in fall 2021 during the two months after back-to-school.</span>
<span class="attribution"><span class="source">Michigan.gov Data and Modeling Updates, Eisenberg and Martin Research Groups, University of Michigan, Ann Arbor</span></span>
</figcaption>
</figure>
<p>Unfortunately, vaccines are only available for two of the major causes of respiratory illness: <a href="https://www.cdc.gov/coronavirus/2019-ncov/vaccines/index.html">SARS-CoV-2</a> and <a href="https://www.cdc.gov/flu/prevent/flushot.htm">influenza</a>. Likewise, antiviral treatments are also more commonly available for SARS-CoV-2 and influenza than for RSV. RSV vaccines, which have been in development for many years, are expected to <a href="https://www.path.org/resources/rsv-vaccine-and-mab-snapshot/">become available soon</a>, but not in time to stem the current wave of illness. </p>
<p>In contrast, masks can reduce transmission for all respiratory viruses, with no need to tailor the intervention to the specific virus that is circulating. Masks remain a low-cost, low-tech way to keep people healthier throughout the holiday season so that more of us can be free of illness for the time that we value with our family and friends.</p><img src="https://counter.theconversation.com/content/195788/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Emily Toth Martin receives funding from the National Institutes of Health, the Centers for Disease Control and Prevention, and Flu Lab.</span></em></p><p class="fine-print"><em><span>Marisa Eisenberg receives funding from the National Institutes of Health, National Science Foundation, Michigan Department of Health and Human Services, and the Centers for Disease Control and Prevention. </span></em></p>Decades of research show that respiratory illnesses are dramatically reduced when people wear face masks.Emily Toth Martin, Assistant Professor of Epidemiology, University of MichiganMarisa Eisenberg, Associate Professor of Complex Systems, Epidemiology and Mathematics, University of MichiganLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1961792022-12-12T13:37:37Z2022-12-12T13:37:37ZChina’s loosened COVID-19 policies – following years of aggressive lockdowns and quarantines – have left the country vulnerable<figure><img src="https://images.theconversation.com/files/500103/original/file-20221209-29029-7l4vwf.jpg?ixlib=rb-1.1.0&rect=0%2C195%2C5202%2C3392&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">The Chinese government has loosened restrictions designed to limit the spread of COVID-19.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/epidemic-control-workers-wear-ppe-as-they-walk-to-disinfect-news-photo/1447909402?phrase=china%20zero%20covid%20&adppopup=true">Kevin Frayer/Stringer via Getty Images</a></span></figcaption></figure><p>After nearly three years of aiming to eliminate <a href="https://www.theguardian.com/world/2022/nov/29/china-zero-covid-policy-explained-30-seconds-lockdowns-outbreaks">COVID-19 through</a> mass lockdowns, robust contact tracing programs and international travel bans, the Chinese government has announced it is rolling back the “zero-COVID” policies that helped <a href="https://go.gale.com/ps/i.do?id=GALE%7CA618606601&sid=googleScholar&v=2.1&it=r&linkaccess=abs&issn=00280836&p=HRCA&sw=w&userGroupName=mlin_oweb">suppress the spread of the coronavirus</a> in the country. The Chinese Communist Party <a href="https://www.nytimes.com/2022/12/07/world/asia/china-zero-covid-protests.html">announced these changes</a> on Dec. 7, 2022, as <a href="https://www.nytimes.com/interactive/2021/world/china-covid-cases.html">rates of COVID-19 are on the rise</a> in major cities, following <a href="https://www.nytimes.com/2022/12/07/world/asia/china-zero-covid-protests.html">protests</a> demanding the end of zero-COVID policies. </p>
<p>The situation in China stands in stark contrast to the trajectory of the pandemic in the U.S. SARS-CoV-2 emerged with a bang, but thanks to a strong vaccination effort and the fact that a large portion of U.S. residents have been infected with the coronavirus, COVID-19 cases seem to be reaching somewhat of a steady state and <a href="https://doi.org/10.1056/NEJMp2004361">normal life has mostly resumed</a>.</p>
<p>I am a <a href="https://scholar.google.com/citations?user=YCsTY4sAAAAJ&hl=en&oi=ao">medical anthropologist</a> who studies <a href="https://www.sup.org/books/title/?id=23706">public health trends in China</a> from an epidemiologic and social perspective. </p>
<p>After largely <a href="https://www.nytimes.com/2020/08/23/world/asia/china-coronavirus-normal-life.html">containing the coronavirus in 2020</a>, China began enforcing a strict <a href="https://www.nytimes.com/2022/01/21/world/asia/china-zero-covid-policy.html">zero-COVID policy</a> leading up to the Beijing Olympics in 2022. The result is that China has not followed the standard path of a pandemic where people slowly gain immunity through exposure or vaccination, allowing society to open up over time. Combined with <a href="https://doi.org/10.1136/bmj.n969">questions about the efficacy of China’s vaccines</a> and comparatively low vaccination rates, many public health experts think that China will be hit hard by the coronavirus as the country rapidly <a href="https://www.nytimes.com/2022/12/02/health/china-covid-lockdowns.html">lifts its zero-COVID policy</a>. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/500104/original/file-20221209-41828-65pkn0.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="A health worker checking a traveller at a checkpoint." src="https://images.theconversation.com/files/500104/original/file-20221209-41828-65pkn0.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/500104/original/file-20221209-41828-65pkn0.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/500104/original/file-20221209-41828-65pkn0.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/500104/original/file-20221209-41828-65pkn0.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/500104/original/file-20221209-41828-65pkn0.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/500104/original/file-20221209-41828-65pkn0.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/500104/original/file-20221209-41828-65pkn0.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">After the coronavirus first emerged in late 2019, the Chinese government severely limited travel in the region of Wuhan.</span>
<span class="attribution"><a class="source" href="https://newsroom.ap.org/detail/VirusOutbreakChina/5fffda0e9b8841e8923776fefe4a693b/photo?Query=china%20lockdowns%20wuhan&mediaType=photo&sortBy=&dateRange=Anytime&totalCount=261&currentItemNo=9">AP Photo/Ng Han Guan</a></span>
</figcaption>
</figure>
<h2>China’s initial reaction to COVID-19</h2>
<p>Public health campaigns and control of emerging disease in China are entirely reliant on and directed by the government, which promotes health both for the <a href="https://globalizationandhealth.biomedcentral.com/articles/10.1186/s12992-019-0486-6">good of the people and the nation</a>. When COVID-19 emerged, the Chinese government was quick to institute mask-wearing policies and testing regimens, and it <a href="https://www.cnbc.com/2020/04/08/coronavirus-china-ends-lockdown-of-wuhan-city-where-outbreak-started.html">locked down the city of Wuhan and the surrounding region</a> where the coronavirus originated. With only the aid of these <a href="https://doi.org/10.1016/S0140-6736(20)31278-2">nonpharmaceutical interventions</a>, the Chinese government was very successful in containing the spread of COVID-19 after the initial wave hit Wuhan. </p>
<p>From the time China started recording cases in late December 2019, until the government ended its initial period of lockdown in April 2020, <a href="https://www.cnbc.com/2020/04/08/coronavirus-china-ends-lockdown-of-wuhan-city-where-outbreak-started.html">the government documented </a> 82,000 cases of COVID-19 and just over 3,300 deaths. Though not officially called a zero-COVID policy at the time, the control measures were born out of a goal of <a href="https://doi.org/10.2471%2FBLT.20.254045">eliminating COVID-19</a> from the country. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/500105/original/file-20221209-41225-k8glwk.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="A line of people waiting to be swabbed for COVID-19." src="https://images.theconversation.com/files/500105/original/file-20221209-41225-k8glwk.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/500105/original/file-20221209-41225-k8glwk.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/500105/original/file-20221209-41225-k8glwk.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/500105/original/file-20221209-41225-k8glwk.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/500105/original/file-20221209-41225-k8glwk.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/500105/original/file-20221209-41225-k8glwk.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/500105/original/file-20221209-41225-k8glwk.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">In the months leading up to the 2022 Beijing Olympics, China began ramping up zero-COVID measures, including mandatory testing requirements.</span>
<span class="attribution"><a class="source" href="https://newsroom.ap.org/detail/VirusOutbreakChina/f24fab8b8eae4ee4a90c714caadbf960/photo?Query=china%20zero%20covid&mediaType=photo&sortBy=&dateRange=Anytime&totalCount=796&currentItemNo=230">AP Photo/Mark Schiefelbein</a></span>
</figcaption>
</figure>
<h2>Ramping up zero-COVID</h2>
<p>Life returned to normal in China after the initial wave of COVID-19 ravaged Wuhan. For most of 2020 and the first half of 2021, Chinese people were <a href="https://www.theguardian.com/world/2022/nov/29/china-zero-covid-policy-explained-30-seconds-lockdowns-outbreaks">out and about</a> in shopping malls, restaurants and bars. </p>
<p>During this same period, the coronavirus was rampaging across the U.S, Europe and other regions of the world, leading many health experts to say that the lockdowns in China, though brutal, were <a href="https://go.gale.com/ps/i.do?id=GALE%7CA618606601&sid=googleScholar&v=2.1&it=r&linkaccess=abs&issn=00280836&p=HRCA&sw=w&userGroupName=mlin_oweb">successful</a>. Between May 2020 and August 2021, people in China saw COVID-19 as a <a href="https://www.newyorker.com/news/news-desk/what-chinese-people-think-of-their-governments-zero-covid-policy">distant threat</a> and supported the government’s actions. </p>
<p>The situation changed in August 2021 when the Chinese government officially adopted what it calls the “<a href="https://www.ijbs.com/v18p5314.htm">Dynamic zero-COVID</a>” strategy to combat the new delta variant. This strict prevention policy included provisions for mass lockdowns <a href="https://doi.org/10.1016/S2213-2600(22)00142-4">aimed at eliminating</a> the disease in a particular region, even if just a small number of cases were found. </p>
<p>China <a href="https://www.newsweek.com/omicron-march-beijing-strains-china-zero-covid-policy-before-2022-olympics-1667828">ramped up enforcement of the policy</a> as the 2022 Winter Olympics approached. A <a href="https://www.theguardian.com/world/2021/nov/02/china-locks-down-shanghai-disneyland-and-tests-34000-visitors-after-single-covid-case">single case</a> could trigger a massive lockdown where the government would severely limit people’s movement and enforce quarantines, as occurred several times in Shanghai Disney. In some instances, people were held in stores or office buildings for <a href="https://www.nytimes.com/2022/01/21/world/asia/china-zero-covid-policy.html">several days</a> after exposure to an infected person. </p>
<p>Summer and fall 2022 were relatively quiet, with only around 1,000 confirmed infections per day. But since early November 2022, COVID-19 cases in China <a href="https://www.nytimes.com/interactive/2021/world/china-covid-cases.html">have climbed steadily</a>, with more than <a href="https://www.nytimes.com/interactive/2021/world/china-covid-cases.html">35,000 new cases detected per day</a> in the first week of December. </p>
<figure class="align-right zoomable">
<a href="https://images.theconversation.com/files/500106/original/file-20221209-34427-s6fynh.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Chinese president Xi Jinping with people in masks behind him." src="https://images.theconversation.com/files/500106/original/file-20221209-34427-s6fynh.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/500106/original/file-20221209-34427-s6fynh.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/500106/original/file-20221209-34427-s6fynh.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/500106/original/file-20221209-34427-s6fynh.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/500106/original/file-20221209-34427-s6fynh.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/500106/original/file-20221209-34427-s6fynh.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/500106/original/file-20221209-34427-s6fynh.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Following a wave of protests in late November and early December, the Chinese Communist Party announced that it would roll back some of the strictest travel limitations and quarantine requirements.</span>
<span class="attribution"><a class="source" href="https://newsroom.ap.org/detail/VirusOutbreakChina/1ca47c62c5f94606bc1a2586088c1d71/photo?Query=xi%20jinping%20zero%20covid%20&mediaType=photo&sortBy=&dateRange=Anytime&totalCount=76&currentItemNo=47">Jack Taylor/Pool Photo via AP</a></span>
</figcaption>
</figure>
<h2>What happens next?</h2>
<p>As of early December, COVID-19 rates in China were still relatively <a href="https://www.nytimes.com/interactive/2021/us/covid-cases.html">low compared to many places, including the U.S.</a>. But China faces some unique challenges thanks to low levels of immunity in the population and a disease control strategy that prioritized nonpharmaceutical interventions like mask-wearing, social distancing and <a href="https://www.nytimes.com/2022/06/14/business/china-covid-testing.html">frequent testing over vaccine administration</a>.</p>
<p>To date, 90% of the population in China <a href="https://www.nytimes.com/interactive/2021/world/covid-vaccinations-tracker.html">has been vaccinated</a>. Older people have been more reluctant, though, and only <a href="https://www.cnbc.com/2022/11/29/china-says-covid-vaccination-rates-for-seniors-has-climbed-over-the-last-two-weeks.html">66% of those over 80</a> have received two doses of a vaccine. A further concern arises from studies indicating that China’s vaccines may <a href="https://doi.org/10.1136/bmj.n969">not be as effective as the mRNA vaccines</a> used in the West. So far, China has <a href="https://www.cnn.com/2021/12/13/china/china-western-mrna-vaccine-mic-intl-hnk/index.html">not been willing to import</a> and administer Western mRNA vaccines. </p>
<p>In addition to concerns over vaccination, the zero-COVID policy has, to a large extent, successfully suppressed the coronavirus in China. The result is that since most people have not been exposed to the virus, they have not had a chance to develop immunity. This has likely <a href="https://www.theatlantic.com/health/archive/2022/12/china-zero-covid-wave-immunity-vaccines/672375/?utm_source=substack&utm_medium=email">left the country very susceptible</a> to a large outbreak. </p>
<p>There is also a social dimension to the problems facing China today. <a href="https://www.cbsnews.com/news/china-lockdowns-zero-covid-policy/">Recurring lockdowns</a> over the past year have damaged the economy and lessened <a href="https://www.nytimes.com/2022/12/03/opinion/china-covid-protests.html?smid=nytcore-ios-share&referringSource=articleShare">peoples’ patience</a> with restrictive policies. Despite government efforts to <a href="https://www.theguardian.com/world/2022/nov/28/china-censors-maskless-crowd-footage-in-world-cup-broadcasts">limit access to outside information</a>, people in China are learning that most other countries are functioning normally. Maintaining stringent zero-COVID policies has become increasingly difficult, as they <a href="https://www.nytimes.com/2022/12/01/opinion/china-covid-protests.html">wear on a populace</a> that wants life to return to normal.</p>
<p>The Dec. 7 announcement to ease COVID-19 restrictions is a continuation of a trend a few weeks in the making, but has been seen by many as a <a href="https://www.nytimes.com/2022/12/07/world/asia/china-zero-covid-protests.html">response to the widespread protests</a>. Testing centers <a href="https://www.nytimes.com/2022/12/01/world/asia/china-covid-protests-restrictions.html?utm_source=substack&utm_medium=email">are closing</a> and infected people are now allowed to <a href="https://www.reuters.com/world/china/china-allow-some-positive-covid-19-cases-quarantine-home-sources-2022-12-01/?mc_cid=b8f3c7dbfb&mc_eid=d60d414cea&utm_source=substack&utm_medium=email">quarantine at home</a> for the first time since the pandemic began. The digital health passes, issued to people who tested negative through daily PCR tests, are <a href="https://www.washingtonpost.com/world/2022/12/07/china-covid-easing-restrictions/">also no longer required</a> to enter public places. </p>
<p>In much of the world, COVID-19 has followed that <a href="https://www.jstor.org/stable/20025233">natural trajectory</a> of a pandemic. The story is different in China. The relaxation of zero-COVID policies may bring China more in line with the rest of the world in terms of what the people there can do, but the virus also gets a chance to run its natural course now that government actions will not suppress the spread. It is likely that in the coming months, the Chinese people will face the pain and suffering that many other places experienced in 2020 and 2021.</p><img src="https://counter.theconversation.com/content/196179/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Elanah Uretsky does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Strict lockdowns, quarantines and testing have prevented many people in China from catching COVID-19. With concerns over Chinese vaccine efficacy and uptake, China may be facing a looming COVID-19 surge.Elanah Uretsky, Associate Professor of International and Global Studies, Brandeis UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1883962022-11-29T12:06:46Z2022-11-29T12:06:46ZSix common COVID myths busted by a virologist and a public health expert<figure><img src="https://images.theconversation.com/files/496209/original/file-20221118-13513-coiz9c.jpg?ixlib=rb-1.1.0&rect=14%2C0%2C9475%2C5349&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/woman-wearing-anti-virus-protection-mask-1678274461">r.classen/Shutterstock</a></span></figcaption></figure><p>Almost three years into the pandemic, myths and misinformation remain widespread. Here we, a virologist and a public health researcher, debunk some common misconceptions about COVID.</p>
<h2>Myth 1: The virus is becoming milder</h2>
<p>There’s a <a href="https://psyarxiv.com/vam4t">prevailing myth</a> in the omicron era that <a href="https://www.npr.org/sections/goatsandsoda/2022/01/14/1072504127/fact-check-the-theory-that-sars-cov-2-is-becoming-milder">SARS-CoV-2</a> (the virus that causes COVID-19) is becoming “<a href="https://www.bmj.com/content/379/bmj.o2516">milder</a>”.</p>
<p>It’s true that earlier omicron variants (BA.1 and BA.2) were <a href="https://www.bmj.com/content/375/bmj.n3151">less likely</a> than delta to cause severe illness, partly because they were more likely <a href="https://www.nature.com/articles/s41586-022-04479-6">to infect the upper airway</a> than the lower airway. This means omicron infections didn’t infect the lungs as aggressively as delta did.</p>
<p>But disease outcomes are critically dependent <a href="https://www.nature.com/articles/s41467-022-31395-0">on immunity</a> and the UK is <a href="https://www.nature.com/articles/s41599-022-01073-z">privileged in this regard</a>. When BA.2 hit Hong Kong in spring 2022, <a href="https://www.bmj.com/content/377/bmj.o980">poorer vaccination coverage</a> meant a <a href="https://www.bmj.com/content/376/bmj.o707">devastating outbreak</a>.</p>
<p>Even in England’s well-vaccinated population there have been <a href="https://coronavirus.data.gov.uk/details/deaths?areaType=nation%26areaName=England#card-weekly_deaths_with_covid-19_on_the_death_certificate_by_date_registered">almost 29,000 COVID deaths</a> between January and early November 2022, and <a href="https://coronavirus.data.gov.uk/details/healthcare?areaType=nation%26areaName=England#card-patients_admitted_to_hospital">tens of thousands</a> of hospitalisations.</p>
<p>Individual risk may have fallen, but high omicron infections and reinfections have considerable impact at population level. Subvariants continue to <a href="https://pubmed.ncbi.nlm.nih.gov/36198317/">escape antibody immunity</a>, and some (like BA.5) appear to have reacquired a <a href="https://www.forbes.com/sites/williamhaseltine/2022/08/29/increased-disease-potential-of-covid-variant-ba5-currently-circulating-in-the-united-states/?sh=1da18eb64b9d">preference for the lower airway</a>. This, along with other factors, <a href="https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(22)00595-3/fulltext">increased the risk of hospitalisation</a> with BA.5 compared to BA.2.</p>
<p>So SARS-CoV-2 is not inherently mild, or necessarily becoming milder. We must also remember that <a href="https://www.independent.co.uk/news/uk/politics/covid-plan-vulnerable-charities-johnson-b2016536.html">millions of people</a> can’t respond effectively to vaccines or are at heightened risk. Effective public health should combine updated vaccines against this moving target <a href="https://www.bmj.com/content/376/bmj.o1">with limiting infections</a> to <a href="https://www.nature.com/articles/d41586-022-00155-x">slow viral evolution</a>.</p>
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<em>
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Read more:
<a href="https://theconversation.com/i-have-covid-symptoms-should-i-do-a-test-186368">I have COVID symptoms. Should I do a test?</a>
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</em>
</p>
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<h2>Myth 2: COVID only affects older and vulnerable people</h2>
<p>One common reason people don’t get vaccinated is <a href="https://www.ons.gov.uk/peoplepopulationandcommunity/healthandsocialcare/healthandwellbeing/bulletins/coronavirusandvaccinehesitancygreatbritain/13januaryto7february2021">perceiving a low personal risk</a> from infection. Again, high prevalence inflates smaller individual risks. For younger people, even a mild infection can lead to long COVID, which affects <a href="https://www.mayoclinic.org/diseases-conditions/coronavirus/in-depth/coronavirus-long-term-effects/art-20490351">up to one in five adults</a> aged 18-64.</p>
<p>This myth is particularly problematic in relation to children. Kids are far less prone to severe COVID than adults, but among paediatric infectious diseases, COVID is a significant cause of <a href="https://www.science.org/doi/10.1126/science.ade1675">death</a> and <a href="https://blogs.bmj.com/bmj/2021/07/06/we-should-shift-our-focus-from-covid-19-mortality-to-morbidity-particularly-in-children/">illness</a>. Children can also <a href="https://www.longcovidkids.org/">develop long COVID</a>. Despite <a href="https://theconversation.com/uptake-of-childrens-covid-vaccines-is-low-in-the-uk-and-their-slow-confused-approval-is-to-blame-178382">lacklustre UK government messaging</a>, many healthcare agencies around the world <a href="https://www.cdc.gov/vaccines/covid-19/planning/children.html">recommend</a> vaccinating kids against SARS-CoV-2. </p>
<h2>Myth 3: Washing hands is enough to prevent COVID spread</h2>
<p>SARS-CoV-2 spreads via <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8242678/">tiny particles</a> of moisture suspended in the air called aerosols. Droplets (for example from sneezing) and fomites (droplet-contaminated objects) play a role, but are not the major route of spread.</p>
<p>As such, <a href="https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/928720/S0789_EMG_Role_of_Ventilation_in_Controlling_SARS-CoV-2_Transmission.pdf">ventilation</a> and <a href="https://www.pnas.org/doi/10.1073/pnas.2014564118">masks</a> are key to reducing COVID transmission. But hand washing and sanitising have been more popular <a href="https://yougov.co.uk/topics/health/articles-reports/2021/08/13/washing-hands-tops-list-brits-anti-covid-measures-">anti-COVID measures</a>. </p>
<p>Some organisations were <a href="https://www.who.int/news-room/commentaries/detail/modes-of-transmission-of-virus-causing-covid-19-implications-for-ipc-precaution-recommendations">slow to accept airborne transmission</a>. So messaging at the start of the pandemic, including from the UK government, over-emphasised the importance <a href="https://blogs.bmj.com/bmj/2020/03/17/uks-coronavirus-policy-places-too-much-responsibility-in-the-hands-of-the-public/">of hand washing</a>. </p>
<figure class="align-center ">
<img alt="Hands being washed under a tap." src="https://images.theconversation.com/files/496515/original/file-20221121-14-5assup.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/496515/original/file-20221121-14-5assup.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=387&fit=crop&dpr=1 600w, https://images.theconversation.com/files/496515/original/file-20221121-14-5assup.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=387&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/496515/original/file-20221121-14-5assup.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=387&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/496515/original/file-20221121-14-5assup.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=486&fit=crop&dpr=1 754w, https://images.theconversation.com/files/496515/original/file-20221121-14-5assup.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=486&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/496515/original/file-20221121-14-5assup.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=486&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Hand washing doesn’t offer significant protection against airborne viruses.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/coronavirus-pandemic-prevention-wash-hands-soap-1661809675">Maridav/Shutterstock</a></span>
</figcaption>
</figure>
<p>A psychological phenomenon known as a “<a href="https://link.springer.com/referenceworkentry/10.1007/978-0-387-79948-3_1141">primacy effect</a>” describes when people are more influenced by the first things they experience, and retain these concepts. It appears the early focus on <a href="https://www.nature.com/articles/d41586-021-00251-4">droplets and fomites</a> stuck in people’s minds, even once we knew <a href="https://www.thelancet.com/article/S0140-6736(21)00869-2/fulltext">SARS-CoV-2 was airborne</a>.</p>
<p>Hand hygiene is important for reducing transmission of other diseases, but is <a href="https://www.theguardian.com/world/2020/oct/05/did-early-focus-on-hand-washing-and-not-masks-aid-spread-of-covid-19-coronavirus">not sufficient for airborne viruses</a>.</p>
<h2>Myth 4: Masks don’t work</h2>
<p>Face masks <a href="https://www.pnas.org/doi/full/10.1073/pnas.2119266119">work</a> by protecting the wearer and others. But as with all mitigation strategies, this is never 100%. Masks work best alongside other measures and must be worn properly.</p>
<p>Masks range from cloth face coverings, to surgical masks, up to FFP2/N95 and FFP3/N99 respirators. Any barrier helps, but cloth masks mainly limit droplets and <a href="https://www.gavi.org/vaccineswork/whats-most-effective-face-mask-preventing-covid-19-transmission">do little</a> to protect the wearer from aerosols. <a href="https://www.fda.gov/medical-devices/personal-protective-equipment-infection-control/n95-respirators-surgical-masks-face-masks-and-barrier-face-coverings">Surgical masks</a> with non-woven layers are significantly better, yet still offer limited protection compared with <a href="https://www.pnas.org/doi/pdf/10.1073/pnas.2110117118">respirators</a>.</p>
<p>Worn properly, FFP2 and FFP3 respirators filter <a href="https://www.gavi.org/vaccineswork/whats-most-effective-face-mask-preventing-covid-19-transmission">95% and 99%</a> of particles respectively, down to the size of aerosols. In this way they <a href="https://www.theguardian.com/commentisfree/2021/dec/27/best-masks-covid-tests-cloth-surgical-respirators">protect the wearer and others</a>.</p>
<h2>Myth 5: Vaccines don’t reduce transmission</h2>
<p>Delta caused noticeable <a href="https://www.thelancet.com/action/showPdf?pii=S0140-6736%2822%2901190-4">breakthrough infections</a> in people who had been vaccinated and reinfection is now <a href="https://www.ons.gov.uk/peoplepopulationandcommunity/healthandsocialcare/conditionsanddiseases/articles/coronaviruscovid19latestinsights/infections#reinfections">common with omicron</a>. This is due to the evolution of antibody-evasive mutations within SARS-CoV-2’s spike protein, along with natural antibody waning.</p>
<p>Research <a href="https://www.newscientist.com/article/2336617-vaccinations-and-past-infections-reduce-risk-of-spreading-covid-19/">consistently supports</a> that vaccination reduces omicron transmission as well as severity. Studies show that, while not eliminating the risk entirely, vaccinated people with breakthrough infections are <a href="https://www.gavi.org/vaccineswork/new-research-proves-covid-19-vaccines-can-slow-spread-disease-even-omicron">less likely</a> to spread the virus to others.</p>
<figure class="align-center ">
<img alt="A woman receives a vaccination." src="https://images.theconversation.com/files/497247/original/file-20221124-14-zlxbz3.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/497247/original/file-20221124-14-zlxbz3.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=338&fit=crop&dpr=1 600w, https://images.theconversation.com/files/497247/original/file-20221124-14-zlxbz3.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=338&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/497247/original/file-20221124-14-zlxbz3.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=338&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/497247/original/file-20221124-14-zlxbz3.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=424&fit=crop&dpr=1 754w, https://images.theconversation.com/files/497247/original/file-20221124-14-zlxbz3.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=424&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/497247/original/file-20221124-14-zlxbz3.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=424&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">COVID vaccines do reduce transmission.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/medical-nurse-safety-gloves-protective-mask-1908888244">Gorodenkoff/Shutterstock</a></span>
</figcaption>
</figure>
<h2>Myth 6: Vaccines were rushed through</h2>
<p>COVID vaccine trials were not rushed. Remarkable cooperation, ample funding and innovative design accelerated things. But what’s usually the greatest bottleneck – patient recruitment – was bypassed by the sheer abundance of people exposed to SARS-CoV-2.</p>
<p>Vaccines saved an estimated <a href="https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(22)00320-6/fulltext">20 million lives globally</a> in 2021. But as effective as they are, vaccines, like all medicines, are not perfect.</p>
<p>Up to October 2022, the UK’s Office for National Statistics <a href="https://www.ons.gov.uk/peoplepopulationandcommunity/birthsdeathsandmarriages/deaths/datasets/monthlymortalityanalysisenglandandwales">recorded 56 deaths</a> in England and Wales involving COVID vaccines. All these deaths are tragedies. Patient reporting systems like the Medicines and Healthcare products Regulatory Agency <a href="https://www.gov.uk/government/publications/coronavirus-covid-19-vaccine-adverse-reactions/coronavirus-vaccine-summary-of-yellow-card-reporting">yellow card scheme</a> show higher numbers before investigations.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/we-measured-vaccine-confidence-pre-pandemic-and-in-2022-its-declined-considerably-193580">We measured vaccine confidence pre-pandemic and in 2022 – it's declined considerably</a>
</strong>
</em>
</p>
<hr>
<p>When <a href="https://coronavirus.data.gov.uk/details/vaccinations?areaType=nation&areaName=England">millions of people</a> are vaccinated, serious and potentially fatal reactions do occur on rare occasions. This is partly due to our genetic diversity, but other factors also contribute.</p>
<p>Rare reactions include <a href="https://www.gov.uk/government/publications/regulatory-approval-of-pfizer-biontech-vaccine-for-covid-19/summary-of-product-characteristics-for-covid-19-vaccine-pfizerbiontech">anaphylaxis</a> (allergic responses to vaccine ingredients), blood clots and myocarditis and pericarditis (inflammation of the heart muscle or surrounding sac).</p>
<p>It became clear after millions of inoculations that the AstraZeneca vaccine could <a href="https://www.bhf.org.uk/informationsupport/heart-matters-magazine/news/coronavirus-and-your-health/astrazeneca-covid-vaccine#:%7E:text=Blood%20clots%20after%20the%20vaccine,occurred%20after%20the%20second%20dose.">cause rare blood clots</a> in the veins. Untreated, this can be fatal. These occur more in younger adults, but the UK now uses mainly mRNA vaccines.</p>
<p>Myocarditis after mRNA vaccination has caused concern, mainly in <a href="https://pubmed.ncbi.nlm.nih.gov/35993236/">adolescent males</a>, but is generally rare, mild, and gets better on its own. By contrast, <a href="https://pubmed.ncbi.nlm.nih.gov/35389977/">myocarditis from a COVID infection</a> is more common, long-lasting, and far more likely to require intensive care. In other words, the benefits of COVID vaccination clearly outweigh the risks.</p><img src="https://counter.theconversation.com/content/188396/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Simon Nicholas Williams has received funding from Senedd Cymru, Public Health Wales and the Wales COVID-19 Evidence Centre for research on COVID-19. However, this article reflects the views of the author only and no funding bodies were involved in the writing or content of this article.</span></em></p><p class="fine-print"><em><span>Stephen Griffin is affiliated with Independent SAGE. </span></em></p>For one, washing your hands is unlikely to prevent COVID spread.Simon Nicholas Williams, Lecturer in Psychology, Swansea UniversityStephen Griffin, Associate Professor of Viral Oncology, University of LeedsLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1947262022-11-20T15:22:34Z2022-11-20T15:22:34ZWith COVID, flu and RSV circulating, it’s time to follow the evidence: Return to mask mandates<figure><img src="https://images.theconversation.com/files/495816/original/file-20221117-13-u0jyep.JPG?ixlib=rb-1.1.0&rect=0%2C10%2C3190%2C2069&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Ontario Premier Doug Ford and Health Minister Sylvia Jones in conversation at Queen's Park, the day after Ontario’s chief medical officer of health ‘strongly recommended’ mask wearing.</span> <span class="attribution"><span class="source">THE CANADIAN PRESS/Chris Young</span></span></figcaption></figure><iframe style="width: 100%; height: 100px; border: none; position: relative; z-index: 1;" allowtransparency="" allow="clipboard-read; clipboard-write" src="https://narrations.ad-auris.com/widget/the-conversation-canada/with-covid--flu-and-rsv-circulating--it-s-time-to-follow-the-evidence--return-to-mask-mandates" width="100%" height="400"></iframe>
<p>The number of children and babies with respiratory illnesses currently <a href="https://globalnews.ca/news/9273442/mcmaster-childrens-hospital-patient-crisis-grows/">exceeds the capacity of our health system</a> to care for them. More adult Canadians will die directly of COVID-19 this year <a href="https://public.tableau.com/app/profile/bill.comeau/viz/CanadaCovid19_16636261617930/Dashboard1">than died last year or in 2020</a>. </p>
<figure class="align-right zoomable">
<a href="https://images.theconversation.com/files/495812/original/file-20221117-23-1isdxx.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Bar graph showing deaths from COVID in Canada" src="https://images.theconversation.com/files/495812/original/file-20221117-23-1isdxx.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/495812/original/file-20221117-23-1isdxx.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=260&fit=crop&dpr=1 600w, https://images.theconversation.com/files/495812/original/file-20221117-23-1isdxx.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=260&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/495812/original/file-20221117-23-1isdxx.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=260&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/495812/original/file-20221117-23-1isdxx.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=326&fit=crop&dpr=1 754w, https://images.theconversation.com/files/495812/original/file-20221117-23-1isdxx.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=326&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/495812/original/file-20221117-23-1isdxx.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=326&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">COVID deaths in 2022 outnumber those in 2020 or 2021.</span>
<span class="attribution"><span class="source">(Bill Comeau)</span></span>
</figcaption>
</figure>
<p>Eight per cent of vaccinated people with COVID infections that don’t require hospitalization <a href="https://doi.org/10.1038/s41591-022-01840-0">end up with long COVID</a>, with each subsequent infection <a href="https://doi.org/10.1038/s41591-022-02051-3">repeating the risk</a>. COVID increases the risk of <a href="https://doi.org/10.1038/s41591-022-01689-3">cardiovascular</a> <a href="https://doi.org/10.1016/S0140-6736(22)01214-4">and</a> <a href="https://www.ecdc.europa.eu/sites/default/files/documents/Prevalence-post-COVID-19-condition-symptoms.pdf">other health</a> <a href="https://doi.org/10.1038/s41591-022-01840-0">problems</a>, enough to cause a stark rise in <a href="https://www.cdc.gov/nchs/nvss/vsrr/covid19/excess_deaths.htm">excess deaths</a> and to <a href="https://www.cdc.gov/nchs/data/vsrr/vsrr023.pdf">shorten life expectancy</a>.</p>
<p>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 <a href="https://www.cbc.ca/news/canada/toronto/ontario-dr-kieran-moore-announcement-1.6650571">several provinces are now recommending masks in all indoor public settings</a> — although <a href="https://toronto.ctvnews.ca/ontario-s-top-doctor-goes-against-own-advice-while-maskless-at-toronto-party-1.6159050">Ontario’s Chief Medical Officer of Health Kieran Moore was seen without one at a party</a> — <a href="https://www.ctvnews.ca/canada/what-provinces-and-territories-are-saying-about-mask-mandates-as-covid-19-rsv-flu-cases-rise-1.6157262">there are no returns to mandates for the public yet</a>.</p>
<h2>Wear the best mask available</h2>
<p>We now know that <a href="https://doi.org/10.1073/pnas.2014564118">masks prevent the spread of respiratory diseases</a>; some better than others. </p>
<figure class="align-right ">
<img alt="A young woman wearing a white face masks with overhead ties" src="https://images.theconversation.com/files/495815/original/file-20221117-16-6d6tbj.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/495815/original/file-20221117-16-6d6tbj.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=427&fit=crop&dpr=1 600w, https://images.theconversation.com/files/495815/original/file-20221117-16-6d6tbj.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=427&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/495815/original/file-20221117-16-6d6tbj.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=427&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/495815/original/file-20221117-16-6d6tbj.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=536&fit=crop&dpr=1 754w, https://images.theconversation.com/files/495815/original/file-20221117-16-6d6tbj.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=536&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/495815/original/file-20221117-16-6d6tbj.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=536&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">A Vitacore CaN99 respirator with overhead elastic; N95s, CaN99 and FFP3 typically provide greater than 90 per cent filtration without formal fit testing.</span>
<span class="attribution"><span class="source">(Gurleen Dulai, Ranmeet Dulai)</span>, <span class="license">Author provided</span></span>
</figcaption>
</figure>
<p>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. </p>
<p>Even without fit testing, respirator masks prevent <a href="https://doi.org/10.1093/annhyg/meq085">more than</a> <a href="https://doi.org/10.1371/journal.pone.0245688">90 per cent</a> <a href="https://doi.org/10.1097/MD.0000000000023709">of particles</a> smaller than one micron from reaching the wearer (submicron particles, the smallest among <a href="https://doi.org/10.1016%2FS2213-2600(20)30323-4">those thought</a> <a href="https://doi.org/10.1080/23744235.2022.2140822">to be</a> <a href="https://doi.org/10.1038/s41564-021-01047-y">relevant</a>).</p>
<p>Respirator masks are relatively expensive — typically a few dollars each — but thanks to Canadian manufacturers, they are <a href="https://www.clothmasks.org/">available</a> and there are no longer concerns about supply chains for front-line workers. They can be safely <a href="https://www.clothmasks.org/extended-use">reused, with good retention of their filtration</a>. New designs are comfortable and fit most faces. </p>
<figure class="align-left ">
<img alt="A young woman wearing a black face mask with ear loops" src="https://images.theconversation.com/files/495818/original/file-20221117-14-4riq8j.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/495818/original/file-20221117-14-4riq8j.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=460&fit=crop&dpr=1 600w, https://images.theconversation.com/files/495818/original/file-20221117-14-4riq8j.jpeg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=460&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/495818/original/file-20221117-14-4riq8j.jpeg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=460&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/495818/original/file-20221117-14-4riq8j.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=578&fit=crop&dpr=1 754w, https://images.theconversation.com/files/495818/original/file-20221117-14-4riq8j.jpeg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=578&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/495818/original/file-20221117-14-4riq8j.jpeg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=578&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">A KN95/KF94 mask with ear loops typically provides about 70 per cent filtration.</span>
<span class="attribution"><span class="source">(Gurleen Dulai, Ranmeet Dulai)</span>, <span class="license">Author provided</span></span>
</figcaption>
</figure>
<p>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 <a href="https://doi.org/10.1371/journal.pone.0258191">their filtration</a> is <a href="https://doi.org/10.1371/journal.pone.0245688">around 70 per cent</a>. A certified medical mask with a well-fitted cloth mask over it, preferably with overhead ties, provides <a href="https://doi.org/10.1038/s41591-022-01840-0">comparable</a> <a href="https://doi.org/10.1016/j.ajic.2021.10.041">filtration</a> at lower cost.</p>
<figure class="align-right ">
<img alt="A young woman wearing a cloth face mask over a surgical mask" src="https://images.theconversation.com/files/495821/original/file-20221117-27-lavqq2.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/495821/original/file-20221117-27-lavqq2.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=600&fit=crop&dpr=1 600w, https://images.theconversation.com/files/495821/original/file-20221117-27-lavqq2.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=600&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/495821/original/file-20221117-27-lavqq2.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=600&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/495821/original/file-20221117-27-lavqq2.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=754&fit=crop&dpr=1 754w, https://images.theconversation.com/files/495821/original/file-20221117-27-lavqq2.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=754&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/495821/original/file-20221117-27-lavqq2.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=754&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">A well-fitting cloth mask over a certified medical mask typically produces about 70 per cent filtration.</span>
<span class="attribution"><span class="source">(Gurleen Dulai, Ranmeet Dulai)</span>, <span class="license">Author provided</span></span>
</figcaption>
</figure>
<p>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 <a href="https://doi.org/10.1371/journal.pone.0264090">typically </a><a href="https://doi.org/10.1371/journal.pone.0245688">filtered </a><a href="https://doi.org/10.1001/jamainternmed.2020.8168">at around 50 per cent</a>, similar to <a href="https://doi.org/10.1016/j.mayocp.2020.07.020">well-designed</a> <a href="https://doi.org/10.1371/journal.pone.0264090">two-layer cotton cloth masks, ideally with overhead ties</a>; both are around 50 per cent.</p>
<p>Poorly fitting <a href="https://doi.org/10.1016/j.ajic.2021.10.041">cloth masks</a> and non-certified procedure masks are likely worse than 50 per cent, but better than nothing. The World Health Organization advises: “<a href="https://www.who.int/emergencies/diseases/novel-coronavirus-2019/advice-for-public/when-and-how-to-use-masks">Make wearing a mask a normal part of being around other people</a>,” to which we would add: wear the best mask available.</p>
<figure class="align-left ">
<img alt="A young woman wearing a blue surgical face mask" src="https://images.theconversation.com/files/495823/original/file-20221117-23-agh7u5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/495823/original/file-20221117-23-agh7u5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=514&fit=crop&dpr=1 600w, https://images.theconversation.com/files/495823/original/file-20221117-23-agh7u5.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=514&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/495823/original/file-20221117-23-agh7u5.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=514&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/495823/original/file-20221117-23-agh7u5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=646&fit=crop&dpr=1 754w, https://images.theconversation.com/files/495823/original/file-20221117-23-agh7u5.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=646&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/495823/original/file-20221117-23-agh7u5.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=646&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">A Level 1 certified mask provides filtration around 50 per cent because of visible gaps and poor fit. To test fit, breathe out rapidly and feel for air leaks around the mask with your hands.</span>
<span class="attribution"><span class="source">(Gurleen Dulai, Ranmeet Dulai)</span>, <span class="license">Author provided</span></span>
</figcaption>
</figure>
<p>The filtration data above are mirrored by epidemiologic data showing that <a href="http://dx.doi.org/10.15585/mmwr.mm7106e1">protection correlates with mask type</a>. 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.</p>
<p><a href="https://doi.org/10.1136/bmj-2021-068302">Masks protect </a><a href="https://doi.org/10.1073/pnas.2014564118">against COVID-19</a> and other respiratory infections. They are also an <a href="https://doi.org/10.7326/M20-6625">ideal tool to counter COVID variants</a>, as well as <a href="https://theconversation.com/influenza-and-covid-19-whats-in-store-for-the-fall-winter-respiratory-virus-season-193076">RSV and influenza</a>. Working on basic physical principles — <a href="https://doi.org/10.7326/M20-6625">impaction, sedimentation and diffusion</a> — they protect regardless of the variant or strain. </p>
<p>Staying home when sick is helpful, but many people are infectious <a href="https://doi.org/10.1186/s12879-022-07440-0">before they have symptoms, or never have symptoms</a>. Wearing a mask to prevent infected particles from reaching the environment is basic pollution management: control is best at the source. </p>
<p>Wearing a mask to protect the individual, once controversial, is now settled by <a href="https://www.clothmasks.org/mask-hierarchy">filtration science</a> and <a href="http://dx.doi.org/10.15585/mmwr.mm7106e1">epidemiology</a>. The impact of mask mandates in countries where spontaneous mask wearing was low was repeatedly demonstrated, proving that masks protect us all.</p>
<h2>Why people aren’t wearing masks</h2>
<p>Why aren’t people wearing masks? Some remember the <a href="https://doi.org/10.1111/1467-9566.13525">inconsistency of the advice</a> early in the pandemic. Masks may be conflated with closures and capacity restrictions and the resulting hardships. Whatever the reason — <a href="https://www.theguardian.com/world/2021/oct/26/the-great-cover-up-why-the-uk-stopped-wearing-face-masks">stigma, peer pressure or concern about virtue signalling</a> — countries outside Asia do not have a mask-wearing culture. </p>
<figure class="align-center ">
<img alt="Infographic summarizing the literature on filtration properties of respirators and masks." src="https://images.theconversation.com/files/495814/original/file-20221117-27-xjcwhn.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/495814/original/file-20221117-27-xjcwhn.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=776&fit=crop&dpr=1 600w, https://images.theconversation.com/files/495814/original/file-20221117-27-xjcwhn.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=776&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/495814/original/file-20221117-27-xjcwhn.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=776&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/495814/original/file-20221117-27-xjcwhn.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=976&fit=crop&dpr=1 754w, https://images.theconversation.com/files/495814/original/file-20221117-27-xjcwhn.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=976&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/495814/original/file-20221117-27-xjcwhn.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=976&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Infographic summarizing the literature on filtration properties of respirators and masks.</span>
<span class="attribution"><span class="source">(Shiblul Hasan)</span>, <span class="license">Author provided</span></span>
</figcaption>
</figure>
<p>Under these circumstances, it will likely take more than strong recommendations to achieve the <a href="https://doi.org/10.1073/pnas.2014564118">high uptake of mask use that will be most effective</a> in reducing transmission of respiratory viruses. Masks protect individuals, imperfectly. Mask mandates (or high voluntary use of masks) protect populations.</p>
<p>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. <a href="https://doi.org/10.1038/s41398-022-01814-3">Confidence that mask-wearing is effective correlates geographically with willingness to wear a mask</a>: 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. </p>
<p>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 <a href="https://www.nber.org/papers/w27891">both Canada</a> and the <a href="https://doi.org/10.1377/hlthaff.2020.00818">United States</a>. </p>
<p>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.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/495824/original/file-20221117-25-ga6i04.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Two line graphs showing relationship between school openings, mask use and community COVID 19 cases and deaths" src="https://images.theconversation.com/files/495824/original/file-20221117-25-ga6i04.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/495824/original/file-20221117-25-ga6i04.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=249&fit=crop&dpr=1 600w, https://images.theconversation.com/files/495824/original/file-20221117-25-ga6i04.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=249&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/495824/original/file-20221117-25-ga6i04.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=249&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/495824/original/file-20221117-25-ga6i04.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=313&fit=crop&dpr=1 754w, https://images.theconversation.com/files/495824/original/file-20221117-25-ga6i04.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=313&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/495824/original/file-20221117-25-ga6i04.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=313&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">The relationship between mode of school opening (remote, hybrid and in-person) and mask use at school with community cases and deaths, based on county-level data in the U.S.</span>
<span class="attribution"><a class="source" href="https://doi.org/10.1073/pnas.21034201">(Chernozhukov et al, PNAS 2021:118;e2103420118)</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
</figcaption>
</figure>
<p>Schools and universities represent a particularly important opportunity. COVID spreads between children in schools <a href="https://doi.org/10.1073/pnas.2103420118">to infect the whole population; this is mitigated by mask wearing</a>. After Massachusetts lifted its mask mandate, school boards did so at different times, creating a natural experiment: <a href="https://doi.org/10.1056/NEJMoa2211029">transmission was higher among students and staff where mandates were lifted</a> compared with where they were still in place. </p>
<p>There is <a href="https://web.archive.org/web/20220826213955/https:/healthychildren.org/English/health-issues/conditions/COVID-19/Pages/Do-face-masks-interfere-with-language-development.aspx">no convincing</a> <a href="https://www.cdc.gov/coronavirus/2019-ncov/science/science-briefs/masking-science-sars-cov2.html">evidence</a> 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 <a href="https://www.washingtonpost.com/business/2022/11/15/work-absences-childcare/">keeps parents at work</a>.</p>
<p>Mask mandates will not produce a rapid fix of our current problems with respiratory viruses. Indicators will lag by weeks. Until we have a <a href="https://doi.org/10.1038/s41586-022-05398-2">whole-of-society approach</a> that recognizes that <a href="https://doi.org/10.1016/S0140-6736(21)00869-2">COVID is airborne</a>, 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. </p>
<p><em>Rebecca Rudman, co-founder of the Windsor Essex Sewing Force and member of McMaster’s Cloth Mask Knowledge Exchange, co-authored this article.</em></p><img src="https://counter.theconversation.com/content/194726/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Catherine Clase is editor-in-chief of clothmasks.org and a member of the Cloth Mask Knowledge Exchange, a research and knowledge translation group that includes industry stakeholders. Industry stakeholders contribute to the Cloth Mask Knowledge Exchange by contributing to grant funding, and through in-kind contributions of time and expertise. Industry stakeholders make masks and distribute polypropylene and other fabrics. They may potentially benefit from this article. She is a member of McMaster's Centre of Excellence in Protective Equipment and Materials. Catherine has received consultation, advisory board membership or research funding from the Ontario Ministry of Health, Sanofi, Pfizer, Leo Pharma, Astellas, Janssen, Amgen, Boehringer-Ingelheim and Baxter. In 2018 she co-chaired a KDIGO potassium controversies conference sponsored at arm's length by Fresenius Medical Care, AstraZeneca, Vifor Fresenius Medical Care, Relypsa, Bayer HealthCare and Boehringer Ingelheim. Catherine Clase receives funding from CIHR, and is a member of the Green Party, the American Society of Nephrology, the Canadian Society of Nephrology, the American Association of Textile Chemists and Colorists and ASTM International.</span></em></p><p class="fine-print"><em><span>Charles-Francois de Lannoy receives funding from the Natural Sciences and Engineering Research Council (NSERC) of Canada, the Global Water Futures (GWF) Research organization, Ontario Centres of Excellence (OCE), Federal Economic Development Agency for Southern Ontario (FedDev), Canadian Foundation for Innovation (CFI), the French Embassy, and McMaster University. He has received funding in partnership with Pall Water, Trojan Technologies, Hatch Ltd., and PW Fabrication. He has engaged in various research projects and testing/validation of facemasks for several private companies in Ontario. He is affiliated with the Cloth Mask Knowledge Exchange as an expert advisor.</span></em></p><p class="fine-print"><em><span>Ken G. Drouillard receives funding from Natural Sciences and Engineering Research Council (NSERC) of Canada, Environment and Climate Change Canada, Ontario Ministry of Environment, Conservation and Parks and Mitacs. He is affiliated with the WE-Spark Health Institute, Detroit River Canadian Cleanup Committee, International Association of Great Lakes Research, Editor of Bulletin of Environmental Contamination and Toxicology and science advisor for Windsor-Essex Sewing Force. </span></em></p>In 2020, with adult ICUs at risk of being overwhelmed, we wore masks and accepted restrictions. Now pediatric intensive care is at risk. Will leaders follow the evidence and tell us to mask up?Catherine Clase, Professor of Medicine, Epidemiologist, Physician, McMaster UniversityCharles-Francois de Lannoy, Associate Professor, Chemical Engineering, McMaster UniversityKen G. Drouillard, Professor, Great Lakes Institute for Environmental Research, School of the Environment, University of WindsorLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1912652022-10-23T19:02:26Z2022-10-23T19:02:26ZWhat should rich countries do with spare masks and gloves? It’s the opposite of what the WHO recommends<figure><img src="https://images.theconversation.com/files/490496/original/file-20221018-9021-5rvd4z.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C1000%2C666&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/due-shortage-medical-supplies-coronavirus-covid19-1685561587">Shutterstock</a></span></figcaption></figure><p>Most developed countries hold significant quantities of medical supplies in reserve to respond in an emergency. </p>
<p>For example, Australia has its <a href="https://www.health.gov.au/initiatives-and-programs/national-medical-stockpile">National Medical Stockpile</a>, which stocks personal protective equipment, such as masks and gloves, among other items. New Zealand has its <a href="https://www.health.govt.nz/our-work/emergency-management/national-reserve-supplies">national reserve supplies</a>.</p>
<p>If these supplies are not used in an emergency, such as a pandemic, they typically stay in the stockpile until their use-by date, then are sent to landfill. </p>
<p>Surely there’s a better way, especially with some developing nations short of medical supplies. Donating surplus stock to developing countries seems an obvious solution. </p>
<p><a href="https://onlinelibrary.wiley.com/doi/full/10.1111/poms.13828">Our study</a> looked at the likely impact of donating excess stock to developing countries – dated items close to or past their labelled use-by date. We found this a viable option, even better than donating fresh items.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/we-were-on-a-global-panel-looking-at-the-staggering-costs-of-covid-17-7m-deaths-and-counting-here-are-11-ways-to-stop-history-repeating-itself-190658">We were on a global panel looking at the staggering costs of COVID – 17.7m deaths and counting. Here are 11 ways to stop history repeating itself</a>
</strong>
</em>
</p>
<hr>
<h2>What’s in the stockpile?</h2>
<p>In 2011, Australia’s stockpile <a href="https://www.anao.gov.au/sites/default/files/AuditReport_2013-2014_53.pdf">contained about</a> 3,000 pallets of expired stock, the bulk of which was personal protective equipment, including 98 million latex gloves. </p>
<p>While some of the reserves have been used during COVID, items are being restocked. So these too will likely expire if not used. For instance, we know surgical masks in the stockpile are <a href="https://www.anao.gov.au/sites/default/files/Auditor-General_Report_2020-21_22.pdf">already expiring</a>.</p>
<p>Similar issues have been seen in other developed countries such as the <a href="https://www.oig.dhs.gov/reports/2014-08/dhs-has-not-effectively-managed-pandemic-personal-protective-equipment-and">United States</a>, <a href="https://oag.parliament.nz/2020/ppe/docs/ppe.pdf">New Zealand</a> and <a href="https://globalnews.ca/news/6651402/ontario-coronavirus-masks-medical-supplies-expired/">Canada</a>, before and during the current pandemic.</p>
<h2>Why not donate surplus stock?</h2>
<p>This expiration and waste is in sharp contrast to the situation in some developing countries. Some are forced to reuse <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4932219/">normally disposable items</a>, such as surgical gloves, masks and <a href="https://harmreductionjournal.biomedcentral.com/articles/10.1186/1477-7517-8-4">syringes</a>.</p>
<p>While donation of surplus stock seems an obvious solution, donations of dated medical supplies are <a href="https://daisi.com.au/category/dr-gary-mckay-deregistered-expired-products-will-not-be-included-in-daisi-donations/">typically discouraged</a>. </p>
<p>The World Health Organization (WHO) <a href="https://www.who.int/publications/i/item/9789241501408">recommends against it</a>. It expects donations to arrive in another country with an expiry date of:</p>
<blockquote>
<p>at least one year, or half the shelf life if the expiry date is less than one year.</p>
</blockquote>
<p>The idea is to protect recipients from degraded or faulty stock.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/wealthy-nations-starved-the-developing-world-of-vaccines-omicron-shows-the-cost-of-this-greed-172763">Wealthy nations starved the developing world of vaccines. Omicron shows the cost of this greed</a>
</strong>
</em>
</p>
<hr>
<h2>We found a pragmatic option</h2>
<p><a href="https://onlinelibrary.wiley.com/doi/full/10.1111/poms.13828">Our study</a> modelled the impact of donating stock, in particular personal protective equipment and similar low-risk products. We did not look at donating dated vaccines or medicines, which come with higher safety risks. </p>
<p>We found dated donations close to or recently past their use-by date was the best option. This benefited the recipient country the most, as it was least likely to push local suppliers out of business.</p>
<p>The next best option was donating fresh stock. The least preferable option was donating very dated stock, such as items out of date by more than a year.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/490493/original/file-20221018-16-mqo4r8.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Open cardboard box of hand sanitiser" src="https://images.theconversation.com/files/490493/original/file-20221018-16-mqo4r8.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/490493/original/file-20221018-16-mqo4r8.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/490493/original/file-20221018-16-mqo4r8.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/490493/original/file-20221018-16-mqo4r8.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/490493/original/file-20221018-16-mqo4r8.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/490493/original/file-20221018-16-mqo4r8.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/490493/original/file-20221018-16-mqo4r8.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">The best option was donating stock, such as hand sanitiser, close to or slightly past its use-by date.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/hand-sanitizer-container-box-delivery-self-1686800215">Shutterstock</a></span>
</figcaption>
</figure>
<h2>How could old stock be better?</h2>
<p>It’s easy to assume that donating large volumes of fresh, excess stock, still within its use-by date, would be the best option. But we showed how this can distort the local market.</p>
<p>Flooding the local market with free, fresh products can force local suppliers to lower their products’ market price, and make them potentially stop making or supplying these products.</p>
<p>This discourages any further attempts to develop local supply capacity, and makes the recipient country more reliant on donations. </p>
<p>This may be compounded by corruption. If corrupt officials siphon donated products and sell them on the black market, this too may force local suppliers out of business. This may also drive prices up on the black market, putting an extra strain on already stretched health-care systems.</p>
<p>Whether or not such corruption is involved, somewhat dated supplies could enable the local supplier to stay in business and supply the country’s health-care system.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/to-get-more-people-to-pay-taxes-indonesia-should-stamp-out-corruption-by-officials-at-the-top-57512">To get more people to pay taxes, Indonesia should stamp out corruption by officials at the top</a>
</strong>
</em>
</p>
<hr>
<h2>What should happen next?</h2>
<p>Some surplus medical supplies <a href="https://globallinks.org/our-programs/medical-surplus-recovery/">are being donated</a>. But
these programs are small scale and face many restrictions and challenges. These include a <a href="https://knowledge.insead.edu/operations/supply-chain-solutions-healthcare-inequality">limited and unpredictable supply</a> of donated items and relying heavily on <a href="https://naturallymodernlife.com/how-this-non-profit-health-system-is-reducing-waste/">volunteers and community partners</a> to distribute donated stock.</p>
<p>So donating surplus stock could be better coordinated at a larger scale.</p>
<p>Our evidence calls us to rethink what we do with dated donations of low-risk medical supplies.</p>
<p>Masks, respirators, syringes and hand sanitisers from national stockpiles would be a good start. Such products can continue to be useful even when dated, especially if the products are stored well.</p>
<p>Indeed, even in developed countries, personal protective equipment has been distributed past its expiration date <a href="https://www.bbc.com/news/uk-england-nottinghamshire-52025950">when needed</a> <a href="https://abcnews.go.com/Health/wireStory/mask-day-doctors-virus-epicenter-washington-69653568">during the pandemic</a>.</p>
<p>It would be prudent to run a pilot program to donate dated, surplus stock, possibly with a single product. </p>
<p>Medical suppliers could also get on board. They may be willing to pay the costs of such a donation program if it allows them to regularly restock national stockpiles and similar reserves with fresh items. </p>
<p>Many countries were <a href="https://www.cbc.ca/news/politics/ppe-pandemic-covid-coronavirus-masks-1.5645120">surprised</a> at the start of the pandemic to find how much expired stock was in their reserves. A donation program would prevent this happening again and help us better prepare for the next pandemic.</p><img src="https://counter.theconversation.com/content/191265/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The authors do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>During COVID, rich countries have used masks and gloves from their medical stockpiles. But not all countries are so fortunate. We found the best way to help. It may not be what you think.Spring Zhou, Lecturer, operations and supply chain management, University of WollongongTava Olsen, Professor of Operations and Supply Chain Management, University of Auckland, Waipapa Taumata RauLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1894362022-09-05T13:09:47Z2022-09-05T13:09:47ZThe PPE used throughout the COVID-19 pandemic is getting tangled up in wildlife<figure><img src="https://images.theconversation.com/files/481952/original/file-20220831-14-b7noe0.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C6000%2C3997&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Used masks threaten urban wildlife.</span> <span class="attribution"><span class="source">(Shutterstock)</span></span></figcaption></figure><p>Throughout the COVID-19 pandemic, masking has been one of the key public health measures put in place to combat the disease. Since March 2020, billions of disposable surgical masks have been used around the world, raising the question: What happens to all those used masks?</p>
<p>As researchers in single use plastic and microplastic pollution, the onset of a global wave of plastic debris pollution became evident to us in the early days of the pandemic — we could see the evidence even during lockdowns when exercise was limited to short daily walks in the neighbourhood. Masks and gloves were on the ground, fluttering in the wind and hanging on fencing. </p>
<p>As ecologists, we were also aware of where the debris would end up — in nests, for example, or wrapped around the legs or in the stomachs of wildlife.</p>
<p>In Canada, a team of researchers led by conservation biologist Jennifer Provencher <a href="https://doi.org/10.1139/er-2018-0079">studied how plastic debris impacts wildlife</a>. In a study conducted during a canal cleanup in The Netherlands, biologists at the Naturalis Biodiversity Center documented <a href="https://doi.org/10.1163/15707563-bja10052">that Personal Protective Equipment (PPE) debris would interact with wildlife in the same way as other plastics</a>. </p>
<h2>Effects on wildlife</h2>
<p>There’s <a href="https://www.reddit.com/r/RATS/comments/i4nv66/face_masks_for_the_win/">a cartoon circulating on the internet</a> that goes like this: a rat comes home carrying bags of groceries to see two rats laying in bunk beds made from medical grade masks. The rat in the bottom bunk exclaims, “Free hammocks, all over town. It’s like a miracle!”</p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1294320425099571202"}"></div></p>
<p>We shared this cartoon with our colleagues at the beginning of the pandemic, while we were conducting surveys of PPE litter around Toronto streets and parking lots. </p>
<p>We found that within the area that we were surveying — which covered an area of Toronto equivalent to about 45 football fields — over 14,000 disposable masks, gloves or hand wipes accumulated by the end of the year. That’s a lot of rat hammocks.</p>
<p>We set out to understand the breadth of the harm that PPE is doing to wildlife. What we learned is just how many other people were equally concerned. </p>
<h2>Jarring images</h2>
<p>We conducted a global survey using social media accounts of wildlife interactions with PPE debris. The images are jarring: A hedgehog wrapped in a face mask, the earloops tangled in its quills. A tiny bat, with the earloops of two masks wrapped around its wing. A nest, full of ivory white eggs, insulated with downy feathers and a cloth mask. </p>
<p>Many of these animals are dead, but most were alive at the time of observation. Some were released from their plastic entanglement by the people who captured the photo.</p>
<p><div data-react-class="InstagramEmbed" data-react-props="{"url":"https://www.instagram.com/p/CDAB4MQBCKO","accessToken":"127105130696839|b4b75090c9688d81dfd245afe6052f20"}"></div></p>
<p>In total, we found 114 cases of wildlife interactions with PPE debris as documented on social media by concerned people around the world. Most of the wildlife were birds (83 per cent), although mammals (11 per cent), fish (two per cent), invertebrates such as an octopus (four per cent) and sea turtles (one per cent) were also observed. </p>
<p>The majority of observations originated in the United States (29), England (16), Canada (13) and Australia (11), likely representing both the increase in access to mobile devices and our English-language search terms. Observations also came from 22 other countries, with representation from all continents except Antarctica. </p>
<h2>Weighing costs and benefits</h2>
<p>With an <a href="https://doi.org/10.1021/acs.est.0c02178">estimated 129 billion face masks</a> <a href="https://doi.org/10.1016/j.jece.2021.105222">used monthly around the world</a>, how do we, as ecologists and environmental researchers, tell a global population experiencing a global pandemic to use fewer masks? We don’t. </p>
<p>N95 masks have been essential in reducing the transmission of COVID-19 and, although they are more environmentally harmful than cloth masks, <a href="https://doi.org/10.1021/acs.chas.1c00016">the benefit to health is demonstrably superior</a>.</p>
<p>So, what could we have done better? One thing we noted during our PPE litter surveys is the abundance of discarded masks and gloves in close proximity to public garbage bins. </p>
<p>We hypothesize that a lack of clear messaging from municipalities and provinces about safe ways to dispose of PPE, along with our reluctance to gather near sources of discarded PPE, may have contributed to this global pollution event.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/481955/original/file-20220831-12-g98rae.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="a public rubbish bin filled with PPE and surgical masks to the point of overflow" src="https://images.theconversation.com/files/481955/original/file-20220831-12-g98rae.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/481955/original/file-20220831-12-g98rae.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=338&fit=crop&dpr=1 600w, https://images.theconversation.com/files/481955/original/file-20220831-12-g98rae.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=338&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/481955/original/file-20220831-12-g98rae.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=338&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/481955/original/file-20220831-12-g98rae.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=424&fit=crop&dpr=1 754w, https://images.theconversation.com/files/481955/original/file-20220831-12-g98rae.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=424&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/481955/original/file-20220831-12-g98rae.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=424&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Developing better ways for people to get rid of their PPE waste may help prevent used surgical masks from ending up in the environment.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
</figcaption>
</figure>
<p>These are lessons that can still be implemented as we continue to cycle through waves of this pandemic; the use of masks is not yet behind us. Our surveys continue as we track an accumulation of PPE debris that will likely find its way into more nests and tangled around the bodies of more animals.</p>
<p>The rise of single use plastic use due to COVID-19 may not have been avoidable. But the rise in plastic pollution could have been mitigated with some investment in public outreach and modifications to waste management infrastructure to allow for masks and other PPE to be disposed of and processed correctly with minimal leakage to the environment.</p><img src="https://counter.theconversation.com/content/189436/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The authors do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Billions of face masks and other personal protective equipment have been used throughout the pandemic. Containing plastic, these items are damaging wildlife and their environments.Shoshanah Jacobs, Associate Professor, Integrative Biology, University of GuelphJackie Saturno, Research Associate, Dalhousie UniversityJustine Ammendolia, PhD Student, Resource and Environmental Studies, Dalhousie UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1873772022-08-01T15:32:07Z2022-08-01T15:32:07ZLiving with COVID: how treating masks like umbrellas could help us weather future pandemic threats<figure><img src="https://images.theconversation.com/files/475681/original/file-20220722-18-dygv4z.jpg?ixlib=rb-1.1.0&rect=0%2C8%2C5363%2C3559&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">When cases rise, we can make small changes to our behaviour.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/rainy-day-young-man-holding-blue-452725810">Jaromir Chalabala/Shutterstock</a></span></figcaption></figure><p>Thankfully, the UK now looks to be past the peak of both the recent heatwave and the <a href="https://www.theguardian.com/commentisfree/2022/jul/22/covid-wave-prepare-new-variants-nhs-hospital-admissions-england">latest COVID wave</a>. But there will be more of both – and in future, we might think about how we protect ourselves from COVID in the same way we protect ourselves from the weather. </p>
<p>An umbrella is a useful analogy. If we look out the window or check the weather forecast and see rain, we would probably take an umbrella out with us. Similarly, if COVID cases are starting to rise or if a new wave is forecast, we might consider grabbing a face mask, for example.</p>
<p>But just as there’s no need to carry an umbrella with us when it’s sunny, we needn’t be expected to wear masks all the time. Of course, some people may choose to wear masks more consistently in certain settings, while others may forgo wearing them altogether. This is the nature of the current phase of the pandemic we’re in, a big part of which is based on personal choice and responsibility. </p>
<p>Thanks largely to the impact of vaccines, we no longer need the kind of rules-based approach to risk management we saw earlier in the pandemic. But the umbrella analogy can guide our behaviour and choices in a variety of areas of our response moving forward. Beyond masks, these include testing, ventilation and social distancing.</p>
<p>The idea is that we can pick up or step up precautions when we most need them (when COVID cases are on the rise), before relaxing them, if we want to, when infection rates and risk are lower.</p>
<h2>What might this look like in practice?</h2>
<p>Let’s say we start to see COVID cases rising again come autumn. This is a <a href="https://www.who.int/europe/news/item/19-07-2022-rapidly-escalating-covid-19-cases-amid-reduced-virus-surveillance-forecasts-a-challenging-autumn-and-winter-in-the-who-european-region">distinct possibility</a>.</p>
<p>It then becomes even more important to <a href="https://theconversation.com/i-have-covid-symptoms-should-i-do-a-test-186368">take a test</a> if we have any symptoms that might be COVID-related. This will help inform our decision of whether, and to what extent, to minimise contact with others.</p>
<p>Isolation is no longer a legal requirement, and I think this should remain the case. However, if possible, staying at home while we’re unwell is a sensible and considerate thing to do, particularly when COVID rates are high.</p>
<p>Distancing should also remain a choice. But during a wave of infections, people might wish to maintain more distance between themselves and others in shops, or may choose to avoid crowded venues.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/i-have-covid-symptoms-should-i-do-a-test-186368">I have COVID symptoms. Should I do a test?</a>
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</em>
</p>
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<p>Back on <a href="https://www.science.org/doi/10.1126/science.abg6296?keytype2=tf_ipsecsha&ijkey=d490dbfa143fcca104ba377624e90c6c8d084108">masks</a>, when cases begin to rise, the risk of contracting and transmitting COVID also rises, so masks become a more useful and reasonable precaution. They can be particularly valuable in certain circumstances – for example, if someone is unwell but can’t isolate, when visiting people who are vulnerable, or in crowded indoor spaces.</p>
<p>Opening windows even a little can increase fresh air indoors and also help <a href="https://www.gov.uk/government/publications/emg-role-of-ventilation-in-controlling-sars-cov-2-transmission-30-september-2020">reduce the likelihood</a> of transmitting the virus. </p>
<p>Finally, the number of people in the UK who have had <a href="https://coronavirus.data.gov.uk/details/vaccinations">a COVID booster vaccine</a> is considerably lower than the number who received their first and second doses. We know immunity from vaccines wanes, and boosters <a href="https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(22)00146-3/fulltext">restore vaccine effectiveness</a>. So if we start to see rising cases, or looking ahead to <a href="https://www.who.int/europe/news/item/19-07-2022-rapidly-escalating-covid-19-cases-amid-reduced-virus-surveillance-forecasts-a-challenging-autumn-and-winter-in-the-who-european-region">future waves</a>, it would make good sense for people who are behind on their vaccines to get up-to-date.</p>
<figure class="align-center ">
<img alt="A woman administers a rapid COVID test to her son on the couch." src="https://images.theconversation.com/files/475684/original/file-20220722-14-oimal7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/475684/original/file-20220722-14-oimal7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=338&fit=crop&dpr=1 600w, https://images.theconversation.com/files/475684/original/file-20220722-14-oimal7.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=338&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/475684/original/file-20220722-14-oimal7.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=338&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/475684/original/file-20220722-14-oimal7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=424&fit=crop&dpr=1 754w, https://images.theconversation.com/files/475684/original/file-20220722-14-oimal7.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=424&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/475684/original/file-20220722-14-oimal7.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=424&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Testing becomes more important during a COVID wave.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/small-boy-having-rapid-covid19-test-1895185210">Dragana Gordic/Shutterstock</a></span>
</figcaption>
</figure>
<h2>Shared responsibility</h2>
<p>It’s been a year since England’s “<a href="https://www.gov.uk/government/speeches/pm-statement-at-coronavirus-press-conference-19-july-2021">freedom day</a>”, when most legal COVID measures were removed. But <a href="https://news.un.org/en/story/2022/05/1118752">the pandemic</a> is far from over. Along with high numbers of daily infections, <a href="https://www.ons.gov.uk/peoplepopulationandcommunity/healthandsocialcare/conditionsanddiseases/bulletins/prevalenceofongoingsymptomsfollowingcoronaviruscovid19infectionintheuk/7july2022">long COVID</a> is very common, and the <a href="https://www.bma.org.uk/advice-and-support/nhs-delivery-and-workforce/pressures/an-nhs-under-pressure#:%7E:text=The%20NHS%20is%20experiencing%20some,planning%20and%20chronic%20under%2Dresourcing.">pressure on the NHS</a> is still unsustainable.</p>
<p>In a recent article in the <a href="https://www.bmj.com/content/378/bmj.o1803">British Medical Journal</a>, Professor Susan Michie and I reflected on some of the lessons we’ve learned over the past year.</p>
<p>Among these, the pandemic has shown us that behaviour is not purely down to an individual’s choice or motivation. People’s actions are also shaped by the <a href="https://www.nature.com/articles/s41591-021-01345-2">opportunities and supports</a> they’re given – or not given. For example, while some people might want to stay home if they have symptoms, they may not if neither their employer or the government provides financial support.</p>
<p>People should be encouraged and supported as much as possible to stay home when they’re sick, particularly when cases are high. Amidst a winter COVID wave, Australia has re-instated its <a href="https://www.theguardian.com/australia-news/2022/jul/15/state-and-territory-leaders-urge-labor-to-extend-pandemic-leave-payments-as-covid-case-numbers-rise">pandemic leave disaster payments</a> to enable those with COVID and without proper sick pay to stay home and not lose out financially.</p>
<p>Further, governments could ensure that free at-home tests are available during times when infections are likely to, or starting to, rise.</p>
<p>And it’s important that, to mitigate the impacts of future waves, vaccination coverage is as high as possible. Public health campaigns should target both the unvaccinated and partially vaccinated, as well as encouraging people (particularly the most vulnerable) to take up booster offers.</p>
<p>We also need more action to ensure adequate ventilation. In the US, billions of dollars are being made available for <a href="https://www.whitehouse.gov/briefing-room/statements-releases/2022/03/17/fact-sheet-biden-administration-launches-effort-to-improve-ventilation-and-reduce-the-spread-of-covid-19-in-buildings/">improving air quality</a> in schools and other public buildings.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/caught-covid-heres-what-you-should-and-shouldnt-do-when-self-isolation-isnt-mandatory-179441">Caught COVID? Here’s what you should and shouldn't do when self-isolation isn’t mandatory</a>
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<p>I’ve previously argued that the UK government puts <a href="https://blogs.bmj.com/bmj/2020/03/17/uks-coronavirus-policy-places-too-much-responsibility-in-the-hands-of-the-public/">too much responsibility</a> in the hands of the public. Just like climate change, pandemics are global problems, and addressing them requires a collective effort.</p><img src="https://counter.theconversation.com/content/187377/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Simon Nicholas Williams has received funding from Swansea University, the University of Manchester, Senedd Cymru and Public Health Wales for research on COVID-19. However, this article reflects the views of the author only and no funding bodies were involved in the writing or content of this article.</span></em></p>The latest COVID wave in the UK might be on the decline, but there will be more to come.Simon Nicholas Williams, Lecturer in Psychology, Swansea UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1871362022-07-24T12:28:51Z2022-07-24T12:28:51ZBusinesses have the responsibility to invest in health and safety when governments fail to<figure><img src="https://images.theconversation.com/files/475482/original/file-20220721-10125-b05lmy.jpg?ixlib=rb-1.1.0&rect=6%2C0%2C4456%2C2951&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">With governments seemingly giving up their responsibility to keep people safe, it is time for businesses to take the lead on health and safety. </span> <span class="attribution"><span class="source">(AP Photo/Seth Wenig)</span></span></figcaption></figure><p>With the lifting of <a href="https://doi.org/10.1038/d41586-022-00620-7">public health measures</a> all over North America and Europe, some governments seem to believe the pandemic is over. Restaurants and theatres are <a href="https://www.cp24.com/news/remaining-capacity-limits-covid-19-vaccine-passport-system-dropped-in-ontario-1.5800267?cache=%2F7.548484">operating at full capacity and without proof of vaccination</a>. <a href="https://www.cbc.ca/news/canada/edmonton/limit-pcr-testing-rapid-test-results-1.6301128">PCR testing has been scaled back</a> or nearly eliminated. Masks are gone — even in crowded and <a href="https://www.ctvnews.ca/health/coronavirus/covid-19-transmission-in-schools-experts-call-for-better-ventilation-monitoring-1.5836746">poorly ventilated school classrooms</a>.</p>
<p>This is despite many people continuing to be highly susceptible to the disease — especially as <a href="https://doi.org/10.1056/NEJMoa2118946">vaccine-derived and prior infection immunity starts to wane</a> — booster campaigns stall and <a href="https://theconversation.com/why-are-there-so-many-new-omicron-sub-variants-like-ba-4-and-ba-5-will-i-be-reinfected-is-the-virus-mutating-faster-182274">increasingly contagious variants keep emerging</a>. </p>
<p>And while medical professionals have been <a href="https://www150.statcan.gc.ca/n1/daily-quotidien/220603/dq220603a-eng.htm">driven beyond the breaking point</a> and are quitting in droves, <a href="https://coronavirus.jhu.edu/data/mortality">thousands of people continue to die</a> and the number of people living with <a href="https://www.ama-assn.org/delivering-care/public-health/what-doctors-wish-patients-knew-about-long-covid">debilitating long-term effects</a> of the disease are growing. </p>
<p>By any objective measure, it is not the pandemic that is over, but rather government efforts to minimize the human toll of the pandemic. With governments seemingly giving up their responsibility to keep people safe, it it time for businesses to take the lead on health and safety. </p>
<h2>Corporate social responsibility</h2>
<p>Protecting the health and safety of employees, customers and suppliers in the absence of government mandates is the very essence of corporate social responsibility. While <a href="https://doi.org/10.1177%2F000765039903800303">the definition of corporate social responsibility has evolved</a> over the decades, it is now known as a company’s obligation to act in service of the public good. </p>
<p>Early in the pandemic, many businesses invested in the health and safety of customers and employees by <a href="https://www.thestar.com/podcasts/thismatters/2021/04/28/how-hero-pay-came-went-and-is-pushing-business-to-be-more-responsible.html">offering “hero pay.”</a></p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/explainer-what-is-corporate-social-responsibility-or-csr-and-what-do-investors-need-to-know-169256">Explainer: what is corporate social responsibility or CSR – and what do investors need to know?</a>
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</em>
</p>
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<p>But recently, we have seen some businesses go in the opposite direction. Instead of investing in protections for workers and customers, <a href="https://www.npr.org/2022/03/24/1088669929/airlines-federal-travel-mask-mandate">airline CEOs have demanded</a> that <a href="https://edmonton.citynews.ca/2022/06/02/westjet-air-travel-restrictions/">mask mandates be ended</a> and business leaders have been <a href="https://www.insauga.com/travel-industry-calls-for-end-to-covid-19-measures-at-mississaugas-pearson-airport/">some of the most vocal advocates</a> of going “back to normal.”</p>
<figure class="align-center ">
<img alt="A worker pushing a row of shopping carts towards the entrance of a store" src="https://images.theconversation.com/files/475480/original/file-20220721-14484-kvgeej.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/475480/original/file-20220721-14484-kvgeej.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/475480/original/file-20220721-14484-kvgeej.JPG?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/475480/original/file-20220721-14484-kvgeej.JPG?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/475480/original/file-20220721-14484-kvgeej.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/475480/original/file-20220721-14484-kvgeej.JPG?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/475480/original/file-20220721-14484-kvgeej.JPG?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">At the start of the pandemic, many companies provided frontline workers with extra pay to both incentivize and thank them for putting their lives at risk for their job.</span>
<span class="attribution"><span class="source">THE CANADIAN PRESS/Sean Kilpatrick</span></span>
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<p>It appears as though businesses found it easier to be socially responsible when there was a clear social consensus about COVID-19 and governments were willing to provide clear guidance. But now, more than ever before, it is time for businesses to step up.</p>
<h2>Fighting the lonely fight</h2>
<p>We expect businesses to be more socially and environmentally responsible by minimizing greenhouse gas emissions and eliminating socially harmful business practices, such as sweatshop labour — why don’t we do the same for COVID-19? </p>
<p>We should be applying similar pressures to businesses that are unwilling to mandate masks for employees and customers during surges, thereby contributing to spread of COVID-19.</p>
<p>Similarly, we should commend the businesses that are fighting the lonely fight to protect customers and employees. Chapman’s Ice Cream, for instance, has promoted vaccination among its employees and paid for regular testing for those who refuse to be vaccinated. As a result, it has become a frequent <a href="https://www.cbc.ca/news/canada/london/chapmans-ice-cream-1.6447871">target for anti-vaxxers</a>. </p>
<p><a href="https://www.restaurantji.com/on/mississauga/the-apricot-tree-cafe-/">Apricot Tree Café</a>, a restaurant in Mississauga, Ont., has sought to ensure safety for its staff and patrons by investing in <a href="https://www.thestar.com/news/gta/2022/03/11/one-restaurants-fight-against-covid-15000-four-filters-and-a-co2-monitor.html">HEPA filters and carbon dioxide monitors</a>. These practices are <a href="https://www.canada.ca/en/public-health/services/diseases/2019-novel-coronavirus-infection/guidance-documents/guide-home-ventilation-covid-19-pandemic.html">recognized by public health experts as crucial for combating airborne pathogens</a>, such as SARS-CoV-2, the virus causing COVID-19. </p>
<p>More businesses should take inspiration from these two companies and make good on their commitment to corporate social responsibility. If companies truly care for their employees and customers, they will prioritize their safety and well-being.</p>
<h2>Business schools have a role to play</h2>
<p>There is a key voice that has been missing from this conversation — business schools. This silence might be because business schools, like any other faculty, defer to university administrators to implement government-mandated COVID-19 health and safety policies. </p>
<p>At the same time, health and safety issues have not been identified as a “business issue,” unlike forced labour or climate change, both of which have been identified as business responsibilities. This needs to change.</p>
<p>Business schools cannot remain silent in the face of society’s ongoing failure to address a crisis that is vastly disruptive, despite widespread availability of solutions, including masking in crowded spaces, improving ventilation, offering sick days to employees and encouraging or mandating up-to-date <a href="https://hbr.org/2021/09/why-business-leaders-need-to-mandate-the-covid-19-vaccine">vaccination regimens</a>. </p>
<figure class="align-center ">
<img alt="A woman giving a lecture to a room of people" src="https://images.theconversation.com/files/475481/original/file-20220721-14641-8bk6rp.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/475481/original/file-20220721-14641-8bk6rp.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/475481/original/file-20220721-14641-8bk6rp.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/475481/original/file-20220721-14641-8bk6rp.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/475481/original/file-20220721-14641-8bk6rp.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/475481/original/file-20220721-14641-8bk6rp.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/475481/original/file-20220721-14641-8bk6rp.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Business schools have the responsibility to ensure future business leaders are aware of and ready to take on current and emerging global challenges, including pandemics.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
</figcaption>
</figure>
<p>Business schools conduct cutting edge research and educate future business leaders. They have the responsibility to ensure leaders are aware of and ready to take on current and emerging “<a href="https://doi.org/10.5465/amj.2016.4007">grand challenges</a>,” like the <a href="https://health-infobase.canada.ca/covid-19/inequalities-deaths/index.html">rampant inequality</a> that has been <a href="https://www.scientificamerican.com/article/covid-has-made-global-inequality-much-worse/">exacerbated by the pandemic</a>. </p>
<p>Business schools should lead by example by modelling best business practices and equipping future business leaders with the skills to tackle the issue of health and safety as a business responsibility — even beyond the current pandemic. Speaking up and taking the lead on public health and safety will prove that the business world is ready and willing to take on other pressing issues, like climate change.</p>
<p>Carrying out voluntary actions for social good is not easy and, in our increasingly polarized society, these efforts may alienate some stakeholders. For example, customers that just want to “move on” from the pandemic might be displeased by businesses imposing mask mandates, but that is the essence of corporate social responsibility — doing the right thing, even when it’s hard.</p><img src="https://counter.theconversation.com/content/187136/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Maxim Voronov receives funding from Social Sciences and Humanities Research Council of Canada (SSHRC). </span></em></p><p class="fine-print"><em><span>Burkard Eberlein receives funding from the Social Sciences and Humanities Research Council of Canada (SSHRC).</span></em></p>We expect businesses to be more socially and environmentally responsible by minimizing greenhouse gas emissions and eliminating harmful business practices — why don’t we do the same for COVID-19?Maxim Voronov, Professor of Organization Studies and Sustainability, York University, CanadaBurkard Eberlein, Professor of Public Policy and Sustainability, York University, CanadaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1870062022-07-19T23:45:19Z2022-07-19T23:45:19ZMasks are ‘strongly suggested’ by health authorities as the winter COVID wave hits. Here’s how effective they are<p>Health departments are predicting another <a href="https://www.abc.net.au/news/2022-07-14/nsw-flu-season-reaches-peak-but-covid-hospitalisations-increase/101238304">COVID surge</a> related, in part, to more easily transmitted new variants and waning immunity. </p>
<p>Given COVID cases are rising and likely underestimated, Chief Medical Officer Paul Kelly has strongly <a href="https://www.afr.com/politics/federal/aussies-could-get-omicron-targeted-jab-earlier-than-most-20220719-p5b2m6?post=p53xv4">suggested</a> people wear masks in indoor spaces.</p>
<p>So it’s important to get across how effective they are and which type to choose. Is it worth dusting off last year’s cloth masks, using a surgical mask, or going out to buy some N95 respirators to wear over the coming weeks?</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/6-steps-to-making-a-covid-plan-before-you-get-sick-187158">6 steps to making a COVID plan, before you get sick</a>
</strong>
</em>
</p>
<hr>
<h2>COVID spread and the effects of winter</h2>
<p>The SARS-CoV-2 virus (which causes COVID) spreads mainly through breathing in <a href="https://www.cdc.gov/coronavirus/2019-ncov/science/science-briefs/sars-cov-2-transmission.html">contaminated droplets or aerosols</a> (tiny particles that are left when fine droplets dry out) <a href="https://first10em.com/aerosols-droplets-and-airborne-spread/">released into the air</a> when an infectious person breathes, talks, laughs, shouts, coughs or sneezes. This can happen even when they don’t have any symptoms. </p>
<p>Larger droplets fall to the ground quickly, so distancing yourself from others gives you some protection. Aerosols, though, can hang in the air for hours and travel all around a room. </p>
<p>So you can be infected by aerosols indoors even at a distance from an infectious person or after they have left the room. </p>
<p>COVID case numbers tend to increase during winter. This may be because: </p>
<ul>
<li><p>the virus remains viable (able to cause an infection) for longer in <a href="https://www-ncbi-nlm-nih-gov.libraryproxy.griffith.edu.au/pmc/articles/PMC7500589/">cool and less humid conditions</a></p></li>
<li><p>we tend to remain indoors when it’s cold, and sharing <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7798940/">indoor spaces</a> with others increases the risk of contracting COVID. </p></li>
</ul>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/covid-hospitalisations-and-deaths-are-rising-faster-than-cases-but-that-doesnt-mean-more-severe-disease-187163">COVID hospitalisations and deaths are rising faster than cases – but that doesn't mean more severe disease</a>
</strong>
</em>
</p>
<hr>
<h2>Which indoor spaces are the most risky?</h2>
<p>The most risky indoor settings are:</p>
<ul>
<li><p>places where people are <a href="https://www.nature.com/articles/s41598-019-38808-z">talking loudly</a>, laughing, singing or shouting, because <a href="https://www.nature.com/articles/s41598-019-38808-z">more</a> droplets and aerosols are released</p></li>
<li><p>rooms where ventilation is poor, as the contaminated particles are not being quickly removed</p></li>
<li><p>spaces that are <a href="https://www.epa.gov/coronavirus/indoor-air-and-coronavirus-covid-19">crowded</a> or where you are exposed for a <a href="https://www.epa.gov/coronavirus/indoor-air-and-coronavirus-covid-19">longer period</a>, as the risk goes up with extended contact. </p></li>
</ul>
<p>In other words, spending two minutes in a small shop with an open door and one other person present is less risky than sitting in a crowded indoor bar for hours where everyone is talking loudly to be heard over the background noise. </p>
<h2>What can I do?</h2>
<p>Wearing a mask or respirator can protect you and others in the community from COVID infection. Some people are at greater risk of severe illness due to old age or poorly functioning immune systems.</p>
<p>As the <a href="https://www.cidrap.umn.edu/news-perspective/2021/10/commentary-what-can-masks-do-part-1-science-behind-covid-19-protection">table below</a> shows, when both the infected and uninfected person wear a mask or respirator, the protection is greater than if just one of them wears one. </p>
<hr>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/475058/original/file-20220720-12-ohf0p0.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/475058/original/file-20220720-12-ohf0p0.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=506&fit=crop&dpr=1 600w, https://images.theconversation.com/files/475058/original/file-20220720-12-ohf0p0.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=506&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/475058/original/file-20220720-12-ohf0p0.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=506&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/475058/original/file-20220720-12-ohf0p0.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=637&fit=crop&dpr=1 754w, https://images.theconversation.com/files/475058/original/file-20220720-12-ohf0p0.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=637&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/475058/original/file-20220720-12-ohf0p0.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=637&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption"></span>
<span class="attribution"><a class="license" href="http://creativecommons.org/licenses/by-nd/4.0/">CC BY-ND</a></span>
</figcaption>
</figure>
<hr>
<h2>What is the difference between a mask and respirator?</h2>
<p>Respirators are specifically designed to a <a href="https://www.fda.gov/medical-devices/personal-protective-equipment-infection-control/n95-respirators-surgical-masks-face-masks-and-barrier-face-coverings#s3">standard</a> that prevents 95% of particles from getting through them. So they drastically reduce airborne spread. </p>
<p>Surgical masks are designed primarily to prevent spread of large droplets, so they can stop an infected person spreading disease. This is called <a href="https://www.fda.gov/medical-devices/coronavirus-covid-19-and-medical-devices/face-masks-barrier-face-coverings-surgical-masks-and-respirators-covid-19#using">source control</a>. </p>
<p>Cloth and surgical masks filter out viral particles by having multiple layers. Respirators (N95s, also called P2s) are more effective at filtering very small particles, because not only do they have multiple fibres, but are made of a type of plastic mesh with a charge that attracts and traps viruses and other particles. </p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/eAdanPfQdCA?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">The highly charged physics of respirators.</span></figcaption>
</figure>
<p>Unlike masks, respirators are also designed to have a tight fit to the face so air enters the lungs only after passing through the respirator. Cloth or surgical masks allow some air entry around the edges because they are not so tightly fitted. </p>
<h2>How well do masks and respirators work?</h2>
<p>To assess COVID risk and masks, we have to rely on studies in which we are unable to control exactly what people’s exposure to the virus is. This is because we can’t deliberately put people in risky settings. But that means the results are less clear-cut than if we could control the duration and concentration of disease around each subject. </p>
<p>One <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8769935/">meta-analysis</a> (pooled results from multiple studies) of the performance of surgical masks versus respirators in healthcare workers found respirators tended to provide better protection than surgical masks, but the difference was not statistically significant. However, staff were more likely to wear respirators when they were working in high-risk areas with greater exposure to COVID, so the results were biased against respirators.</p>
<p>A recent <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8830622/">community</a> study compared the effectiveness of masks or respirators with no masks. People who had received a positive COVID PCR result were matched by age, gender and locality, with people who had a negative result. They were surveyed about their mask or respirator use in indoor public settings two weeks before the test. </p>
<p>Those who always wore any type of mask or respirator in indoor public spaces were 56% less likely to test positive than those that never wore one. There was an 83% reduction in the odds of getting a positive test in those who wore a respirator, compared with a 66% reduction in those wearing surgical masks. Those wearing a cloth mask had lower odds of having a positive PCR test result than those wearing no mask, but the difference was not statistically significant. </p>
<p>Those who wore any mask or respirator most of the time had better outcomes than those who wore them some of the time or not at all. </p>
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<h2>OK, so you’re reaching for a respirator. But which one?</h2>
<p>If you are using an N95/P2 respirator, find a brand that fits snugly to your face. Try a few to find one that is most comfortable for you. Note they are not designed for children. And they don’t work well for people with beards, as the hair affects the seal. </p>
<p>Once worn, the respirator is considered contaminated so sanitise your hands before and after handling it, and store it in a paper bag between uses so it can dry out. Don’t reuse the device if it gets dirty, if the straps break or become loose, or if the strip over the nose breaks. </p>
<p>And remember: your mask or respirator is useless if you wear it under your nose. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/time-to-upgrade-from-cloth-and-surgical-masks-to-respirators-your-questions-answered-174877">Time to upgrade from cloth and surgical masks to respirators? Your questions answered</a>
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<hr>
<img src="https://counter.theconversation.com/content/187006/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Thea van de Mortel teaches into the Griffith University postgraduate Infection Prevention and Control programs. </span></em></p>They’ve stopped short of mandates, but authorities and experts are strongly suggesting it’s time to cover our mouths and noses again to prevent COVID infection. This time, reach for a respirator.Thea van de Mortel, Professor, Nursing and Deputy Head (Learning & Teaching), School of Nursing and Midwifery, Griffith UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1869142022-07-15T03:40:53Z2022-07-15T03:40:53ZMask mandates – will we only act on public health advice if someone makes us?<p>Back in mid 2020, it was <a href="https://www.bbc.com/future/article/20200902-why-people-object-to-laws-that-save-lives">suggested</a> mask use was similar to seat belt wearing in cars. Not everyone wore a seat belt start straight away, but now it’s unheard of to get into a car and not put it on. </p>
<p>In reality, it took seven years for seat belt compliance to <a href="https://pubmed.ncbi.nlm.nih.gov/466050/#:%7E:text=In%201970%20the%20Government%20of,90%20per%20cent%20in%201977">reach 90%</a>. </p>
<p>Now we are about <a href="https://www.ajmc.com/view/a-timeline-of-covid19-developments-in-2020">900 days</a> into the pandemic, we are certainly not seeing 90% of people wearing masks. In my local area, it is probably more like one in ten people wearing a mask in the local shops. And others on <a href="https://twitter.com/mjrowland68/status/1545193740637450240">social media</a> report low compliance on public transport. </p>
<p>So is the answer to reintroduce rules for mask use in certain settings or a more general mandate around their use? </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/time-to-upgrade-from-cloth-and-surgical-masks-to-respirators-your-questions-answered-174877">Time to upgrade from cloth and surgical masks to respirators? Your questions answered</a>
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</em>
</p>
<hr>
<h2>Listening to advice</h2>
<p>Already Victoria’s Health Minister Mary-Anne Thomas has <a href="https://www.abc.net.au/news/2022-07-12/victoria-health-minister-dismisses-cho-mask-advice/101229884">dismissed</a> recommendations from the state’s chief health officer to mandate mask wearing in retail and early education settings in response to rising case numbers. (People are still required to wear masks in <a href="https://www.coronavirus.vic.gov.au/face-masks">some Victorian settings</a> including public transport, aircraft, courts, prison, if they have COVID or are a close contact.) </p>
<p>Mandates were not the most effective way of getting the message out about the importance of mask wearing, the minister said. The government instead wants to focus on empowering Victorians to make their own choice. </p>
<p>Doctors are not happy. Australian Medical Association of Victoria president, Roderick McRae <a href="https://www.9news.com.au/national/doctor-calls-on-victorian-government-to-act-urgently-with-hospital-system-at-crisis-point/5d087792-78d8-4f73-90ba-dced84d02289">said it was “very disappointing”</a> the health minister had ignored recommendations to mandate masks in schools, child care, retail and hospitality. </p>
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<h2>How does mask compliance track with and without a mandate?</h2>
<p>One <a href="https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0253510">study</a> tracked mask use based on newspaper photos published in Victoria during one month in mid-2020. It found prior to the mandatory mask policy announcement, 43% of the people in the photos were wearing masks. </p>
<p>During the period when the mask policy had been announced but not formally enacted, 74% were wearing masks. Lastly, during the period when mask wearing was mandatory, 98% were wearing masks. </p>
<p>Obviously, there are limitations to this work. Only a small number of photos were reviewed and the photographers may have been purposely taking photos of people who were not complying (prior to policy introduction) or were following the rules (once the policy was in place). </p>
<p>However, the study authors also surveyed the community and found a rapid change in self-reported mask wearing, from just over 40% of participants reporting always or often wearing a mask on July 20, to 100% reporting always wearing a mask on 26 July. </p>
<p>Based on case numbers, the authors concluded masks were effective at reducing transmission and though they were “somewhat inconvenient” for the individual, they were “less likely to have unintended negative impacts on the broader community than policies restricting movement, social engagement and the operations of business, schools and childcare”. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/politics-with-michelle-grattan-health-minister-mark-butler-warns-covid-wave-will-worsen-186915">Politics with Michelle Grattan: Health Minister Mark Butler warns COVID wave will worsen</a>
</strong>
</em>
</p>
<hr>
<h2>Will empowerment promote mask use?</h2>
<p>Probably not. Community empowerment refers to the process of enabling communities to increase control over their lives. But that doesn’t mean everyone will feel empowered to do the safest thing.</p>
<p>“Empowerment” refers to the process by which people gain control over the factors and decisions that shape their lives. It can prompt <a href="https://www.researchgate.net/publication/273150413_Empowerment_in_the_Process_of_Health_Messaging_for_Rural_Low-Income_Mothers_An_Exploratory_Message_Design_Project">innovation</a> in health messaging and engagement. </p>
<p>In times of uncertainty, such as a pandemic which doesn’t yet appear to be nearing its end and new subvariants emerging, the simple act of not wearing a mask may give people a feeling of control over an unfamiliar situation. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/we-lost-the-plot-on-covid-messaging-now-governments-will-have-to-be-bold-to-get-us-back-on-track-186732">We lost the plot on COVID messaging – now governments will have to be bold to get us back on track</a>
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</em>
</p>
<hr>
<h2>What about a nudge in the right direction?</h2>
<p>Early in the pandemic, it was suggested that promoting social norms (the values within the community) such as the widespread use of masks (through strategic communication and community engagement) could be just as effective as enforcement. </p>
<p>Some suggested strategies included sharing evidence of widespread adherence and encouraging news stories about positive trends in mask-wearing. <a href="https://publications.iadb.org/en/are-behaviorally-informed-text-messages-effective-promoting-compliance-covid-19-preventive-measures">Research</a> from Sao Paulo showed individuals who received a text message referring to COVID restrictions as a “civic duty” were over 12% more likely to report keeping an appropriate distance from others and 3% more likely always to wear masks. </p>
<p>Successful use of messages to increase mask-wearing intentions were also reported in another <a href="https://onlinelibrary.wiley.com/doi/10.1002/acp.3793">study</a>, when individuals were encouraged to “rely on their reasoning” instead of “relying on their emotions” to make the decision.</p>
<p><a href="https://www.sciencedirect.com/science/article/pii/S0167268121001475?casa_token=S3PUd8IlomgAAAAA:4UxZrcD-LQUpnqo4dWhX2Go_-l6jMFGvZeFW0TQYhkbg5qnFyh6dLHBm6DlkbsH6OxXnU74Sfg#bib0018">A United States study</a> from 2021 showed exposure to a message about mask use from the president or the Centres for Disease Control increased the stated likelihood of wearing a mask, particularly among then President Trump’s supporters. </p>
<p>Lastly, they found if a person tested negative, they were more likely to support mask use. Testing positive to COVID had no affect on mask support and in some cases reduced support. </p>
<p>This far into the pandemic though, role modelling by leaders, highlighting the benefits masks can have on reducing risk and the possible knock-on financial gains might not have the same nudging effects.</p>
<h2>Misunderstandings around masks and vaccines</h2>
<p>Waning immunity from vaccines and the emergence of new variants, only increases the value of wearing face masks. However, the current low levels of mask use suggest many members of the public still believe using masks in certain situations is unnecessary. </p>
<p>A <a href="https://www.sciencedirect.com/science/article/pii/S2590061722000023">study</a> of people surveyed in mid 2021 showed many thought widespread COVID vaccination would ease the burden of wearing masks. But the <a href="https://theconversation.com/how-soon-can-i-get-covid-again-experts-now-say-28-days-but-you-can-protect-yourself-185491">risk of reinfection</a> means that’s not necessarily the case. </p>
<p>Health experts and government officials need to continuously communicate with people to explain how effective face masks are at preventing infection, even after getting vaccinated. Decreasing individuals’ uncertainty about the role of masks and vaccines could improve their judgement. </p>
<p>It is important we continue to draw on the learnings so far and the behavioural nudges that have been shown to have an impact on mask use. However we also need to be realistic given the point we are in the pandemic. These nudges may not be enough and if there are any other shifts in severe COVID cases due to new variants, it is important to prime the community that mandates may be needed again.</p>
<p>In the words of Batman, a caped and masked crusader since 1939: </p>
<blockquote>
<p>I wear a mask. And that mask, it’s not to hide who I am, but to create what I am.</p>
</blockquote><img src="https://counter.theconversation.com/content/186914/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Holly Seale is an investigator on research studies funded by NHMRC and has previously received funding for investigator driven research from NSW Ministry of Health, as well as from Sanofi Pasteur and Seqirus. </span></em></p>If our immunity from COVID vaccines is waning, then wearing a mask to prevent infection is even more valuable. But not many people seem to be thinking that way when they’re out and about.Holly Seale, Associate professor, UNSW SydneyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1870202022-07-15T02:24:32Z2022-07-15T02:24:32ZHow are Australia and NZ managing the rising COVID winter wave – and is either getting it right?<p>New Zealand, Australia and many countries are experiencing a further Omicron wave driven by the latest BA.4/BA.5 subvariants. Our response to this threat is remarkably laissez-faire compared with past approaches, as society has pivoted more to “living with the virus”. </p>
<p>But in both New Zealand and Australia, there’s a real risk current policy settings will be insufficient to prevent health services being <a href="https://7news.com.au/news/public-health/elective-surgeries-cut-amid-covid-surge-in-victoria-c-7520025">overwhelmed</a> – and more will need to be done in coming weeks. </p>
<p>We might squeak through under current policy settings if many more of us get vaccinated, wear masks, and isolate well when sick. </p>
<p>So, how do New Zealand and Australia compare on key policy settings?</p>
<h2>Free masks? And what kind?</h2>
<p><strong>New Zealand:</strong> <a href="https://www.beehive.govt.nz/release/new-measures-tackle-covid-19-and-flu">Free masks</a> for all in Aotearoa – available from testing centres, <a href="https://www.theguardian.com/world/2022/jul/14/new-zealand-free-masks-covid-rapid-antigen-tests-omicron-wave">marae</a> (Māori communal meeting ground) and community centres, and provided directly to <a href="https://www.beehive.govt.nz/release/new-measures-tackle-covid-19-and-flu">schools</a>. Some <a href="https://www.beehive.govt.nz/release/new-measures-tackle-covid-19-and-flu">16 million</a> surgical masks have been distributed in the last two months, as well as <a href="https://www.beehive.govt.nz/release/new-measures-tackle-covid-19-and-flu">3 million</a> N95 masks (the latter to high risk and vulnerable people). </p>
<p><strong>Australia:</strong> free masks are occasionally distributed to certain groups (for example, some schools might have them). But access is extremely variable. (Also, one of us – Tony Blakely – has been in both Australia and New Zealand in last ten days, and can report mask wearing is much higher in New Zealand.)</p>
<h2>Free Rapid Antigen Tests (RATs)?</h2>
<p><strong>New Zealand:</strong> access is similar to masks. <a href="https://www.beehive.govt.nz/release/new-measures-tackle-covid-19-and-flu">10.4 million</a> free RATs distributed in last two months. </p>
<p><strong>Australia:</strong> the federal government will <a href="https://www.theguardian.com/australia-news/2022/jul/13/free-covid-rapid-tests-rat-scheme-anthony-albanese-urges-concession-card-holders-to-stock-up">not extend</a> free rapid antigen tests for concession card holders past July 31. <a href="https://cdn.theconversation.com/static_files/files/2183/Dominic_Perrottet_Mark_Coure_Natasha_Maclaren-Jones_med_rel_-_NSW_Government_steps_up_COVID-19_support_for_vulnerable_communities.pdf?1657848923">New South Wales</a> and Victoria make RATs available for free for some under <a href="https://www.coronavirus.vic.gov.au/about-rapid-antigen-tests">certain</a> <a href="https://www.coronavirus.vic.gov.au/rapid-antigen-testing-schools">circumstances</a>. But nationwide, access to free RATs is variable and limited. (One of us – Tony Blakely – received four free RATs on arrival in New Zealand, and zero on arrival in Australia.)</p>
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<h2>Accessing antivirals (and do you need to go to the GP)?</h2>
<p>There are two oral antivirals available in both countries: <a href="https://theconversation.com/i-have-mild-covid-should-i-take-the-antiviral-paxlovid-183913">Paxlovid</a> and <a href="https://theconversation.com/australia-approves-two-new-medicines-in-the-fight-against-covid-how-can-you-get-them-and-are-they-effective-against-omicron-175321">Lagevrio</a>. </p>
<p>Both are effective at preventing disease progression (for example, stopping you ending up in hospital) if taken within five days of symptom onset. </p>
<p><strong>New Zealand:</strong> available to higher risk groups – access has been expanded from 2% to <a href="https://www.beehive.govt.nz/release/new-measures-tackle-covid-19-and-flu">10% of cases</a>. Available by prescription from GP and directly from pharmacist. No cost if you’re eligible. </p>
<p><strong>Australia:</strong> <a href="https://www.health.gov.au/health-alerts/covid-19/treatments/eligibility">available</a> to certain higher risk groups. Prescription needed from GP. Co-payment of <a href="https://theconversation.com/i-have-mild-covid-should-i-take-the-antiviral-paxlovid-183913">A$42.50 ($6.80 if concession card)</a>.</p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1547393409811357696"}"></div></p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/australia-approves-two-new-medicines-in-the-fight-against-covid-how-can-you-get-them-and-are-they-effective-against-omicron-175321">Australia approves two new medicines in the fight against COVID. How can you get them and are they effective against Omicron?</a>
</strong>
</em>
</p>
<hr>
<h2>Vaccines?</h2>
<p>Both countries are gradually widening access. Differences in one point in time may not be present in a few weeks. That said, as of mid-July 2022:</p>
<p><strong>New Zealand:</strong> primary course (that is, the first two vaccines) <a href="https://covid19.govt.nz/covid-19-vaccines/get-your-covid-19-vaccination/">available</a> for all people five years and older. First booster available to all 16+ year olds. Second booster (that is, the fourth dose) available to all 50+ year olds (but targeted more to 65+ year olds, unless Māori or Pasifika, in which case all 50+ year olds prioritised). Free. Vaccines <a href="https://www.health.govt.nz/covid-19-novel-coronavirus/covid-19-response-planning/covid-19-mandatory-vaccinations">mandatory for health and disability sector workers</a>.</p>
<p><strong>Australia:</strong> <a href="https://www.health.gov.au/initiatives-and-programs/covid-19-vaccines/who-can-get-vaccinated">primary course</a> and first booster eligibility the same as in New Zealand. However, second booster encouraged for immunocompromised and all 50+ year olds, and available to 30-49 year olds if they wish. Free. Vaccines mandatory for some workers in some settings.</p>
<h2>Income support for people who test positive?</h2>
<p><strong>New Zealand:</strong> several forms of assistance, including <a href="https://covid19.govt.nz/isolation-and-care/financial-support/">COVID-19 Leave Support Scheme</a> for people who need to self-isolate. </p>
<p><strong>Australia:</strong> very restricted <a href="https://www.coronavirus.vic.gov.au/financial-support-and-emergency-relief">availability</a>.</p>
<h2>Mask mandates?</h2>
<p><strong>New Zealand:</strong> <a href="https://covid19.govt.nz/prepare-and-stay-safe/keep-up-healthy-habits/face-masks/when-to-wear-a-face-mask/">mandatory</a> for public transport, retail, visiting health care and aged care facilities, and public venues. </p>
<p><strong>Australia:</strong> <a href="https://www.9news.com.au/national/coronavirus-mask-restrictions-australia-update-state-by-state-guide-mandates-explainer/d6ff7601-9cf7-4ab6-b2dc-a91b81f16284">mandatory</a> in aged and health care settings, on public transport and some other settings (but compliance is low). </p>
<p>Actual mask wearing is higher in indoor environments in New Zealand, based on direct observation in both New Zealand and Victoria by one of us – Tony Blakely – during July. </p>
<h2>Mandatory self-isolation?</h2>
<p><strong>New Zealand:</strong> mandatory seven days <a href="https://covid19.govt.nz/isolation-and-care/if-you-have-covid-19/">self-isolation</a> following positive test result. <a href="https://covid19.govt.nz/testing-and-tracing/contact-tracing/household-contacts/">Household contacts</a> also need to isolate for seven days, unless they have had COVID-19 in the last three months.</p>
<p><strong>Australia:</strong> if you test positive for COVID-19 you <a href="https://www.health.gov.au/health-alerts/covid-19/testing-positive?gclid=CjwKCAjw_b6WBhAQEiwAp4HyIMuDQWWpIYgs1cHp4I6NOE2M4QRPsn2tbkG0CBSNczVMYeZEXO5U0BoCpR8QAvD_BwE&gclsrc=aw.ds">must immediately isolate</a>. However, the circumstances under which you can leave isolation may depend on <a href="https://www.health.gov.au/health-alerts/covid-19/testing-positive?gclid=CjwKCAjw_b6WBhAQEiwAp4HyIMuDQWWpIYgs1cHp4I6NOE2M4QRPsn2tbkG0CBSNczVMYeZEXO5U0BoCpR8QAvD_BwE&gclsrc=aw.ds">which state</a> you’re in. Household members in many places don’t have to isolate, as long as they have no symptoms.</p>
<h2>Is either country getting it right?</h2>
<p>Based on the above criteria, New Zealand is clearly “winning”. But getting policy settings right over the long haul is about more than just having the most favourable assessment on some selected (but important) criteria. </p>
<p>If the goal is to minimise hospitalisations, deaths and long-term illness, there is an argument for minimising infections by shifting from mitigation towards a <a href="https://www.bmj.com/content/371/bmj.m4907">suppression strategy</a>. </p>
<p>Longitudinal studies are increasingly showing high rates of reinfection, which carry many of the same <a href="https://assets.researchsquare.com/files/rs-1749502/v1/499445df-ebaf-4ab3-b30f-3028dff81fca.pdf?c=1655499468">health consequences</a> as the initial infection. </p>
<p>As the pandemic goes on (and on and on) we need to increasingly consider <a href="https://www.nejm.org/doi/full/10.1056/NEJMp2202828">cost-effectiveness</a>.</p>
<p>Giving out free RATs to all is a cost to governments, and carries sustainability consequences. Such interventions need to be effective and compared with alternative approaches.</p>
<p>These are complex decisions – and hard to quantify. We do not have a good enough crystal ball to know what is “right” now; we will, unfortunately, only know with the benefit of hindsight.</p><img src="https://counter.theconversation.com/content/187020/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Tony Blakely is contracted to Moderna for provision of vaccine effectiveness estimates for Victoria, and in discussions with MSD for evaluation of Molnupiravir effectiveness in the Victorian population.</span></em></p><p class="fine-print"><em><span>Michael Baker receives funding from the Health Research Council of New Zealand to conduct research on infectious diseases, including Covid-19</span></em></p>Based on certain criteria, New Zealand is clearly ‘winning’. But getting policy settings right over the long haul is about more than just having the most favourable assessment on selected criteria.Tony Blakely, Professor of Epidemiology, Population Interventions Unit, Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of MelbourneMichael Baker, Professor of Public Health, University of OtagoLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1867322022-07-13T20:03:32Z2022-07-13T20:03:32ZWe lost the plot on COVID messaging – now governments will have to be bold to get us back on track<p>Overall, Australian governments managed the first two years of the COVID pandemic well. Border closures and state actions such as lockdowns <a href="https://doi.org/10.1016/S0140-6736(21)02796-3">averted 18,000 deaths</a> in 2020 and 2021. </p>
<p>This came at a cost in terms of <a href="https://www.tandfonline.com/doi/abs/10.1080/13642987.2022.2058496">separation of families and friends because of border closures</a>, <a href="https://grattan.edu.au/news/learning-the-lessons-from-the-long-school-lockdowns/">disruption to schooling</a> and <a href="https://www.abs.gov.au/articles/effects-covid-19-strains-australian-economy">economic activity</a>, and <a href="https://mentalhealththinktank.org.au/wp-content/uploads/2021/10/AustraliasMentalHealthThinkTank-EvidenceSummary-COVID-MentalHealth.pdf">individual stress</a>.</p>
<p>The public supported these measures and thought <a href="https://essentialreport.com.au/reports/23-november-2021">state governments had managed the pandemic well</a>. Support for the Commonwealth government was also <a href="https://essentialreport.com.au/reports/23-november-2021">high until mid-2021</a>, when the bungled vaccine rollout caused support to plummet.</p>
<p>Now, we are in the grip of a fresh COVID wave. Hospital systems and ambulance services are under severe strain, not just because of an increase in patients, but because the virus has decimated their own workforces. Governments now appear to be much more reluctant to introduce measures to curb its spread, a big difference from the start of the pandemic in 2020.</p>
<p>So, how did it come to this?</p>
<h2>Contest of values and rhetoric</h2>
<p>Despite the much-vaunted national cabinet, for most of 2020 and 2021 there was no coherent national leadership of COVID-19 response. Then-Prime Minister Scott Morrison and other federal ministers downplayed COVID risks and undermined state public health measures. They <a href="https://www.theguardian.com/australia-news/2020/may/19/state-leaders-resist-morrison-government-push-to-reopen-borders-closed-by-coronavirus">attacked lockdowns</a>, <a href="https://thewest.com.au/news/coronavirus/coronavirus-crisis-mark-mcgowan-hits-back-at-scott-morrisons-attack-on-plan-to-keep-border-closed-until-2022-c-4476266">state border closures</a> and <a href="https://www.abc.net.au/news/2020-04-29/schools-offered-three-billion-to-have-students-back-in-class/12196094">school shutdowns</a>, while <a href="https://www.theguardian.com/australia-news/2021/nov/19/had-a-gutful-scott-morrison-denies-double-speaking-to-extremists-but-says-he-feels-for-frustrated-australians">dog-whistling to anti-vaxxers</a>.</p>
<p>This weakened the states’ social licence to pursue effective public health measures.</p>
<p>The differences between the Commonwealth and state governments were in part due to different weighing of the risks of COVID. In 2020 and for the first half of 2021, there was either no vaccine or not enough vaccines, and the prevalent virus strain was quite virulent. As a result, other public health measures were key to controlling the pandemic and minimising hospitalisations and deaths.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/473752/original/file-20220713-26-u56z33.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/473752/original/file-20220713-26-u56z33.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/473752/original/file-20220713-26-u56z33.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/473752/original/file-20220713-26-u56z33.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/473752/original/file-20220713-26-u56z33.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/473752/original/file-20220713-26-u56z33.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/473752/original/file-20220713-26-u56z33.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">In the earlier stages of the pandemic, the federal and state governments took very different approaches.</span>
<span class="attribution"><span class="source">Mick Tsikas/AAP</span></span>
</figcaption>
</figure>
<p>But from the middle of 2021, the rhetoric and messaging changed. Led by the Commonwealth government, there was increasing talk of “<a href="https://www.reuters.com/world/asia-pacific/australia-nears-living-with-covid-like-flu-pm-morrison-2022-03-12/">living with COVID</a>”, reducing restrictions and reopening borders, with the underlying assumption being that, with vaccines, the pandemic was under control. Even the advent of the Omicron wave in late 2021 didn’t lead to a reset, as it was dismissed as “<a href="https://www.health.gov.au/ministers/the-hon-greg-hunt-mp/media/canberra-press-conference-on-9-january-2022-on-omicron-covid-19-vaccines-and-mrff-rare-cancers-funding">mild</a>”.</p>
<p>There have also been ideological differences throughout the pandemic. Morrison preferred “personal responsibility” to mandates, the latter of which was viewed pejoratively. Individual responsibility is a comfortable position for conservative politicians who tend to minimise the role for government.</p>
<p>In contrast, the very essence of public health is that it is <a href="https://www.mja.com.au/journal/2011/194/1/public-health-and-health-reform-australia#0_i1095908">an organised response by society</a>, to quote a standard definition of the field. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/how-has-covid-affected-australians-health-new-report-shows-where-weve-failed-and-done-well-186461">How has COVID affected Australians' health? New report shows where we've failed and done well</a>
</strong>
</em>
</p>
<hr>
<h2>The federal electoral context</h2>
<p>By early 2022, the effect of undermining the social licence was increasingly prevalent. The public, especially those that who had borne the brunt of the more extensive public health measures, were tired of lockdowns. The evidence about vaccine waning had not yet become apparent, so reliance on vaccines was seen as the appropriate principal public health response. “Living with COVID” was becoming the dominant narrative. </p>
<p>Around the same time, anti-vaxxers had begun to get organised and protested against any public health measures. States sniffed the wind and began to roll back their restrictions.</p>
<p>A Melbourne joke from 2021 went like this:</p>
<blockquote>
<p>Question: what is the hardest part of a one-week snap lockdown?
Answer: Week five.</p>
</blockquote>
<p>The federal Coalition attempted to paint Labor as the party that would <a href="https://thenewdaily.com.au/news/politics/australian-politics/2022/01/10/scott-morrison-freedom-let-it-rip/">reintroduce lockdowns and border closures</a>. The Labor opposition did not want to talk about the pandemic to avoid that bullet.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/473753/original/file-20220713-22-u56z33.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/473753/original/file-20220713-22-u56z33.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/473753/original/file-20220713-22-u56z33.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/473753/original/file-20220713-22-u56z33.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/473753/original/file-20220713-22-u56z33.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/473753/original/file-20220713-22-u56z33.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/473753/original/file-20220713-22-u56z33.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">By 2021, anti-vaccination rallies were making loud protests about public health measures.</span>
<span class="attribution"><span class="source">Bianca de Marchi/AAP</span></span>
</figcaption>
</figure>
<h2>Post-election politics</h2>
<p>This long history is necessary context for the confusion we see today. Despite its defeat at the election, the Morrison government’s pandemic legacy is hindering Australia’s ability to manage the pandemic because of the weakening of the social licence to regulate. </p>
<p>Labelling the more transmissible Omicron variant as mild hasn’t helped, as low average severity coupled with high incidence still leads to overburdened hospitals. The <a href="https://www.sbs.com.au/news/article/scott-morrison-urges-personal-responsibility-instead-of-mask-mandates-and-lockdown/h2tlrp5k2">Morrison rhetoric of personal responsibility</a> has proved hard to shift as well. It is certainly seductive – “it is your job to protect yourself and if you don’t, tough luck, you will wear the consequences”.</p>
<p>Of course, that position assumes we are all perfectly rational decision-makers and we bear the full cost of our decisions. Neither is true. We tend to discount future consequences of our decisions, and we are unrealistically optimistic about the chances of getting COVID and its consequences. </p>
<p>Just one person’s infection can have a big impact on others – for example, if they are hospitalised, that impedes access to hospital beds for others – so the cost of poor choices by one person potentially falls on others too. </p>
<p>The public health messaging is also confusing. If I have had only two doses, am I “fully vaccinated”? Does “individual responsibility” involve my lugging a very heavy HEPA filter to ensure clean air in any room I go into? Is the Omicron variant genuinely mild? If so, why do we see all those stories about hospital problems? </p>
<p>And what is the right thing to do about masks? Are cloth masks any good? Or should we all have N95s? And should they then be subsidised? And if masks are “strongly recommended”, why are they not mandated? </p>
<p>It all comes back to the COVID social licence. What proportion of the public will <a href="https://essentialreport.com.au/questions/living-with-covid-19">accept a mask mandate</a>? If the public is not convinced of the threat or benefit to themselves and others, compliance will be low. This means public health leaders need to talk up collective responsibility and collective benefit, the antithesis of the individual responsibility mantra. This has been missing from the national response. </p>
<p>Talking up individual responsibility means leaders don’t have to <a href="https://www.bmj.com/content/371/bmj.m4171">lead or shape collective behaviour</a>. Media hype about regulatory fatigue, a <a href="https://www.bmj.com/content/372/bmj.n137.long">fraught</a> <a href="https://papers.ssrn.com/sol3/papers.cfm?abstract_id=3774252">catch-all</a> concept where the evidence <a href="https://www.medrxiv.org/content/10.1101/2021.04.13.21255336v2">is still developing</a>, hasn’t helped either.</p>
<p>Both New South Wales and Victoria face elections in the next 12 months. Neither government wants to be attacked as the government of lockdowns and mandates when the risks of not acting have been downplayed for so long.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/how-the-pandemic-has-brought-out-the-worst-and-the-best-in-australians-and-their-governments-161745">How the pandemic has brought out the worst — and the best — in Australians and their governments</a>
</strong>
</em>
</p>
<hr>
<p>So where to from here? </p>
<p>Public health messaging over the past six months has been woeful. Political leaders are sometimes seen in masks, but mostly not. There has been little messaging about third and fourth doses, and so we have poor third-dose rates, despite what we now know about vaccine waning. The “Omicron is mild” message has led to a “no worries mate” insouciance among the public.</p>
<p>But political and public health leaders must now exercise leadership. Public health requires collective action, not simply a reliance on the easy cop-out of individual responsibility. This will require a carefully planned transition from the discredited positions that have made a public response so much harder now than it was a year ago, and consistent positions across party lines that put the public’s health ahead of cheap political shots. </p>
<p>Leaders need to adopt a more nuanced approach to responding to COVID, jettisoning the simplistic all-or-none dichotomy. </p>
<p>Finally, the mainstream media also need to resile from their knee-jerk rejection of any public health action as akin to lockdowns and economic catastrophe.</p><img src="https://counter.theconversation.com/content/186732/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The authors do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Despite its defeat at the election, the Morrison government’s pandemic legacy is hindering Australia’s ability to manage the pandemic.Stephen Duckett, Honorary Enterprise Professor, School of Population and Global Health, and Department of General Practice, The University of MelbourneSarah Duckett, PhD Candidate in Risk and Society, King's College LondonLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1851962022-06-26T12:11:51Z2022-06-26T12:11:51ZCanada’s trust divide is growing, and that could spell bad news for the future<figure><img src="https://images.theconversation.com/files/470290/original/file-20220622-7584-rre1y6.JPG?ixlib=rb-1.1.0&rect=0%2C0%2C7067%2C4687&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Anti-mask protesters hold signs during a demonstration against measures taken by public health authorities to curb the spread of COVID-19 in St. Thomas, Ont., in 2020.
</span> <span class="attribution"><span class="source">THE CANADIAN PRESS/Geoff Robins</span></span></figcaption></figure><p>Social relationships can fall apart in times of crisis. Canadians were among the world’s <a href="https://www.pewresearch.org/fact-tank/2020/12/03/social-trust-in-advanced-economies-is-lower-among-young-people-and-those-with-less-education/">most trusting people prior to the pandemic</a>. But have they remained trustful during the pandemic?</p>
<p>Our <a href="https://doi.org/10.1016/j.ssresearch.2022.102750">recent research</a> shows the pandemic has created greater socioeconomic divisions when it comes to trust among Canadians. </p>
<p>Canadians at the high end of socioeconomic status have become even more trusting. But trust is declining among people who are economically vulnerable.</p>
<h2>Social trust and how it matters</h2>
<p>Trust reflects a belief in the goodness of human nature. Those who have trust in others think that most people in society are honest and reliable. Those with little trust may have doubts about other people’ intentions even when it comes to saying good morning with a smile in an elevator.</p>
<p>Generalized social trust is trust in people we don’t know. </p>
<p>Societies with more trust often <a href="https://doi.org/10.1093/oxfordhb/9780190274801.001.0001">perform better economically and politically and have rich and healthy citizens</a>. In times of crisis, trust helps facilitate collective action. Lack of trust, on the other hand, often causes disruptions of community interactions, public panic and fragmentation.</p>
<p>Growing research suggests that people who trust have been essential to a successful pandemic response. Trusters are more likely to <a href="https://magazine.yorku.ca/issues/fall-2020/leap-of-faith/">wear masks and get themselves vaccinated</a>. Communities with more trust <a href="https://doi.org/10.1371/journal.pone.0245135">have lower infections and lower deaths</a>.</p>
<p>Trust also helps <a href="https://doi.org/10.1177/0022146520970190">prevent the negative effect of the pandemic on people’s mental health</a>. This is because trusters tend to have more friends and feel more connected with others. An elevated sense of social support helps trusters better cope with the stress.</p>
<figure class="align-center ">
<img alt="A woman wearing a mask walks through a public plaze with lights overhead." src="https://images.theconversation.com/files/470291/original/file-20220622-13-vg4lk8.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/470291/original/file-20220622-13-vg4lk8.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/470291/original/file-20220622-13-vg4lk8.JPG?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/470291/original/file-20220622-13-vg4lk8.JPG?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/470291/original/file-20220622-13-vg4lk8.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/470291/original/file-20220622-13-vg4lk8.JPG?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/470291/original/file-20220622-13-vg4lk8.JPG?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">A woman wearing a face mask to curb the spread of COVID-19 walks through a public plaza as strings of lights are hung overhead in Vancouver in December 2021.</span>
<span class="attribution"><span class="source">THE CANADIAN PRESS/Darryl Dyck</span></span>
</figcaption>
</figure>
<h2>Still trusting during COVID-19?</h2>
<p>Canadians were among the <a href="https://www.britishcouncil.org/contact/press/canada-most-attractive-and-trusted-country-g20">world’s most trusting people prior to the pandemic</a>. The commonly used measure of trust asks respondents:</p>
<blockquote>
<p>“Generally speaking, would you say that most people can be trusted, or that you can’t be too careful in dealing with people?” </p>
</blockquote>
<p>Surveys before the pandemic <a href="https://doi.org/10.1007/s11205-020-02484-8">consistently showed that over half of Canadians said most people can be trusted</a>. This compared to the U.S., where <a href="https://doi.org/10.1016/j.ssresearch.2021.102537">only about 30 per cent of Americans were trusting</a>. </p>
<p>But the pandemic may have sapped Canadians’ sense of trust. They were warned to maintain social distance in the event their friends and co-workers posed a health threat. <a href="https://policyoptions.irpp.org/magazines/january-2022/anti-lockdown-mobilization-far-right-canada/">Increasing numbers of protests</a> and <a href="https://theconversation.com/the-occupation-of-ottawa-by-the-freedom-convoy-has-the-potential-for-an-urban-siege-176681">the trucker occupation of Ottawa</a> further signalled Canadians’ potential loss of trust.</p>
<h2>Two years of surveys</h2>
<p>Our research <a href="https://doi.org/10.1016/j.ssresearch.2022.102750">tracked Canadians’ trust before and during the COVID-19 pandemic</a>. </p>
<p>Since 2019, and throughout the pandemic, we <a href="https://workandhealth.ca/2020/09/22/c-qwels/">have repeatedly surveyed thousands of Canadians</a> about their trust in others. The first survey was conducted in September 2019 with 2,500 workers. We’ve surveyed the same workers another 10 times, from April 2020 to October 2021. Following the same people over time has let us look at how their sense of trust in others has changed. </p>
<p>There wasn’t one type of change in people’s trust. Instead, there were three different types of change. </p>
<p>About 22 per cent of our sample lost trust during the pandemic. Their trust never recovered. </p>
<p>Most Canadians actually gained trust during the pandemic or maintained the trust they had before the pandemic.</p>
<p>What seemed to be critical in differentiating these groups was how trusting they were before the pandemic. People who were low in trust before the pandemic lost more trust. People who were highly trusting became even more trusting. </p>
<figure class="align-center ">
<img alt="Hockey fans take in a game, some wearing masks and others maskless." src="https://images.theconversation.com/files/470294/original/file-20220622-14-2z50t1.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/470294/original/file-20220622-14-2z50t1.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/470294/original/file-20220622-14-2z50t1.JPG?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/470294/original/file-20220622-14-2z50t1.JPG?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/470294/original/file-20220622-14-2z50t1.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/470294/original/file-20220622-14-2z50t1.JPG?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/470294/original/file-20220622-14-2z50t1.JPG?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Some hockey fans wear masks while others do not as the Boston Bruins take on the Edmonton Oilers in Edmonton, Alta., in December 2021.</span>
<span class="attribution"><span class="source">THE CANADIAN PRESS/Amber Bracken</span></span>
</figcaption>
</figure>
<h2>Socioeconomic divisions in trust</h2>
<p>It may seem like the solution is to ensure people have trust before a crisis, but it’s not that simple. </p>
<p>We looked at different markers of people’s socioeconomic status before the pandemic. We combined measures like income and how much trouble people had paying bills into one overall indicator of how well-off people were. </p>
<p>The importance of socioeconomic status was clear — when people are well off, they are far more likely be in the group that’s become more trusting. People at the low end of socioeconomic status tended to be the ones who lost trust.</p>
<p>What this pattern shows is how trust has become more divided in Canada. People who are economically advantaged before the pandemic had more trust to build on. People who were in financially precarious positions lost what little trust they had.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/income-inequality-and-covid-19-we-are-in-the-same-storm-but-not-in-the-same-boat-173400">Income inequality and COVID-19: We are in the same storm, but not in the same boat</a>
</strong>
</em>
</p>
<hr>
<h2>Growing trust gap can be harmful</h2>
<p>Canada needs trust to survive. We’ve already seen how this loss of trust can harm Canada. </p>
<p>The occupation of Ottawa and <a href="https://www.cbc.ca/news/canada/calgary/blockade-coutts-alberta-trucker-covid-convoy-1.6333957">the shutdown of the border in Alberta</a> <a href="https://www.cbc.ca/news/canada/windsor/ambassador-bridge-protest-cost-1.6351312">and Ontario</a> are about a loss of trust. People lost trust in political leaders and others who supported pandemic responses like masking and vaccine requirements. </p>
<figure class="align-center ">
<img alt="A line of trucks travels down a highway, with the lead one carrying a banner that reads End All Mandates." src="https://images.theconversation.com/files/470295/original/file-20220622-7816-otoqaf.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/470295/original/file-20220622-7816-otoqaf.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=320&fit=crop&dpr=1 600w, https://images.theconversation.com/files/470295/original/file-20220622-7816-otoqaf.JPG?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=320&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/470295/original/file-20220622-7816-otoqaf.JPG?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=320&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/470295/original/file-20220622-7816-otoqaf.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=402&fit=crop&dpr=1 754w, https://images.theconversation.com/files/470295/original/file-20220622-7816-otoqaf.JPG?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=402&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/470295/original/file-20220622-7816-otoqaf.JPG?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=402&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Anti-vaccine mandate demonstrators leave in a truck convoy after blocking the highway at the busy U.S. border crossing in Coutts, Alta., in February 2022.</span>
<span class="attribution"><span class="source">THE CANADIAN PRESS/Jeff McIntosh</span></span>
</figcaption>
</figure>
<p>The result was the grinding halt of the economic and political levers necessary for a healthy society. International trade was slowed, and the seat of national politics was frozen.</p>
<p>If we don’t address this trust gap, Canada may be in for more chaos. People who are distrustful are at risk of even greater losses in trust. Further losses in trust are likely to weaken fundamental political economic and political institutions, undermining the basic stability of the nation.</p>
<p>Whether the loss of trust can be regained is an open question. But what is clear is that simply trying to convince people to trust the basic institutions of Canada and each other is not enough. Economic divisions create a trust divide that threatens Canadians’ way of life. </p>
<p>Canada is facing <a href="https://www.cbc.ca/news/business/canada-inflation-1.6424388">a historic rise in inflation</a> that is further putting financial well-being at risk for many people. These financial precarities may not simply mean more economic hardship. They may also mean further <a href="https://www.thestar.com/opinion/contributors/2022/03/16/why-are-low-trust-nations-more-prone-to-war-building-social-trust-is-key-to-global-peace.html">losses of trust that can undermine national stability</a>.</p><img src="https://counter.theconversation.com/content/185196/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Cary Wu receives funding from the Canadian Institutes of Health Research and the Social Sciences and Humanities Research Council.</span></em></p><p class="fine-print"><em><span>Alex Bierman has received funding from SSHRC and the CIHR. He is a member of the American Sociological Association, Association for the Sociology of Religion, Religious Research Association, Society for the Scientific Study of Religion,and Inter-University Seminar on the Armed Forces.</span></em></p><p class="fine-print"><em><span>Scott Schieman receives funding from the Social Sciences and Humanities Research Council. </span></em></p>Trying to convince people to trust the basic institutions of Canada and each other is not enough. Economic divisions create a trust divide that threatens Canadians’ way of life.Cary Wu, Assistant Professor, Department of Sociology, York University, CanadaAlex Bierman, Associate Professor, Department of Sociology, University of CalgaryScott Schieman, Professor of Sociology and Canada Research Chair, University of TorontoLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1838372022-05-30T12:46:41Z2022-05-30T12:46:41ZLong social distancing: how young adults’ habits have changed since COVID<figure><img src="https://images.theconversation.com/files/465732/original/file-20220527-23-7d3pzb.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C5176%2C3453&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/friends-sitting-on-grass-eating-music-298773782">Monkey Business Images/Shutterstock</a></span></figcaption></figure><p>After two long, difficult years of the pandemic, life has started to return to normal – or at least something resembling normal – for many people. </p>
<p>With all major COVID restrictions now removed in the UK, <a href="https://coronavirus.data.gov.uk/details/cases?areaType=nation&areaName=England">recorded cases</a> at their lowest rate in about a year, and vaccines and booster coverage <a href="https://coronavirus.data.gov.uk/details/vaccinations">relatively high</a>, many people are keenly settling back into <a href="https://theconversation.com/two-years-into-the-pandemic-which-of-our-newly-formed-habits-are-here-to-stay-178204">old habits</a>. Mobility <a href="https://www.google.com/covid19/mobility/">data suggests that</a> – with the exception of travel on public transport and travel to workplaces, which are still below average – we are starting to get out and about as much as we did before the pandemic.</p>
<hr>
<figure class="align-right ">
<img alt="Quarter life, a series by The Conversation" src="https://images.theconversation.com/files/451343/original/file-20220310-13-1bj6csd.png?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/451343/original/file-20220310-13-1bj6csd.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=600&fit=crop&dpr=1 600w, https://images.theconversation.com/files/451343/original/file-20220310-13-1bj6csd.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=600&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/451343/original/file-20220310-13-1bj6csd.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=600&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/451343/original/file-20220310-13-1bj6csd.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=754&fit=crop&dpr=1 754w, https://images.theconversation.com/files/451343/original/file-20220310-13-1bj6csd.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=754&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/451343/original/file-20220310-13-1bj6csd.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=754&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption"></span>
</figcaption>
</figure>
<p><em><strong><a href="https://theconversation.com/uk/topics/quarter-life-117947?utm_source=TCUK&utm_medium=linkback&utm_campaign=UK+YP2022&utm_content=InArticleTop">This article is part of Quarter Life</a></strong>, a series about issues affecting those of us in our twenties and thirties. From the challenges of beginning a career and taking care of our mental health, to the excitement of starting a family, adopting a pet or just making friends as an adult. The articles in this series explore the questions and bring answers as we navigate this turbulent period of life.</em></p>
<p><em>You may be interested in:</em></p>
<p><em><a href="https://theconversation.com/five-tips-for-young-people-dealing-with-long-covid-from-a-gp-180464?utm_source=TCUK&utm_medium=linkback&utm_campaign=UK+YP2022&utm_content=InArticleTop">Five tips for young people dealing with long COVID – from a GP</a></em></p>
<p><em><a href="https://theconversation.com/covid-vaccines-why-second-boosters-are-being-offered-to-vulnerable-people-in-the-uk-but-not-young-and-healthy-people-yet-180215?utm_source=TCUK&utm_medium=linkback&utm_campaign=UK+YP2022&utm_content=InArticleTop">COVID vaccines: why second boosters are being offered to vulnerable people in the UK – but not young and healthy people yet</a></em></p>
<p><em><a href="https://theconversation.com/goblin-mode-a-gothic-expert-explains-the-trends-mythical-origins-and-why-we-should-all-go-vampire-mode-instead-180282?utm_source=TCUK&utm_medium=linkback&utm_campaign=UK+YP2022&utm_content=InArticleTop">Goblin mode: a gothic expert explains the trend’s mythical origins, and why we should all go ‘vampire mode’ instead</a></em></p>
<hr>
<p>But for a significant number of people, the habits that were picked up during the pandemic are still very much a part of life. For example, recent data suggests that just under one-third of people in the UK are continuing to <a href="https://yougov.co.uk/topics/international/articles-reports/2020/03/17/personal-measures-taken-avoid-covid-19">avoid crowded places</a>, while about one-third say they’re maintaining social distancing when meeting up with people from <a href="https://www.ons.gov.uk/peoplepopulationandcommunity/wellbeing/datasets/publicopinionsandsocialtrendsgreatbritaincoronaviruscovid19andotherillnesses">outside their household</a>. More than half of people (54%) report still wearing face masks at least sometimes.</p>
<p>This phenomenon – which has been called “<a href="https://www.nytimes.com/2022/03/19/world/researchers-find-an-ongoing-commitment-to-pandemic-behaviors-they-call-it-long-social-distancing.html">long social distancing</a>” – is not unique to the UK. For example, in many countries, including France, Spain, Italy and Germany, <a href="https://yougov.co.uk/topics/international/articles-reports/2020/03/17/personal-measures-taken-avoid-covid-19">more than four in ten people</a> have reported they’re still avoiding crowds.</p>
<p>Meanwhile, <a href="https://wfhresearch.com/wp-content/uploads/2022/04/LongSocialDistance_v11_forwebsite.pdf">US research</a> has found that 13% of Americans say they plan to continue to socially distance after the pandemic is over, with another 46% saying they plan on only a partial return to normal activities.</p>
<p>But who is practising long social distancing, and why? And where do young people fit in? </p>
<h2>Let’s take a look</h2>
<p>One obvious group is those who are clinically vulnerable. For example, people with disabilities – many of whom, depending on the nature of their disability, might be at higher risk of serious outcomes from COVID – are <a href="https://www.ons.gov.uk/peoplepopulationandcommunity/wellbeing/articles/coronaviruscovid19disabledpeoplearemorelikelytofeellifewillneverreturntonormal/2022-03-16">more likely</a> to believe that their lives will never return to normal. Similarly, adults aged over 70, also at higher risk of serious illness from COVID, are <a href="https://www.ons.gov.uk/peoplepopulationandcommunity/wellbeing/datasets/publicopinionsandsocialtrendsgreatbritaincoronaviruscovid19andotherillnesses">more likely</a> to still be wearing face masks.</p>
<p>There are certainly differences in behaviour by age. Data from the UK finds that younger adults are <a href="https://www.ons.gov.uk/peoplepopulationandcommunity/wellbeing/bulletins/publicopinionsandsocialtrendsgreatbritain/latest">less likely</a> than older adults to either be still socially distancing or wearing face masks. Research <a href="https://wfhresearch.com/wp-content/uploads/2022/04/LongSocialDistance_v11_forwebsite.pdf">from the US</a> meanwhile finds that younger people are less likely to continue socially distancing after the pandemic is over.</p>
<p>Younger people may have been quicker to return to social activities, compared to older adults. Recent <a href="https://www.covidsocialstudy.org/_files/ugd/064c8b_c525505ffa6b432f96dc41d6b6a985ea.pdf">UK data</a> suggests that over the first few months of 2022, during and just after the initial omicron wave, more than 80% of 18 to 29-year-olds said they had met up with friends during the previous week, compared to around 60% to 70% of people in older age groups.</p>
<p>Even so, <a href="https://www.ons.gov.uk/peoplepopulationandcommunity/wellbeing/datasets/publicopinionsandsocialtrendsgreatbritaincoronaviruscovid19andotherillnesses">data shows that</a> 16% of those aged 16-29 are still socially distancing, and 40% are still wearing masks outside of their homes at least sometimes.</p>
<figure class="align-center ">
<img alt="A young woman on a bus wearing a mask." src="https://images.theconversation.com/files/465739/original/file-20220527-19-7bdndc.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/465739/original/file-20220527-19-7bdndc.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/465739/original/file-20220527-19-7bdndc.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/465739/original/file-20220527-19-7bdndc.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/465739/original/file-20220527-19-7bdndc.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/465739/original/file-20220527-19-7bdndc.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/465739/original/file-20220527-19-7bdndc.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Some young people are continuing to wear masks when they go out.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/girl-medical-mask-bus-period-mandatory-1796776639">wasilisa/Shutterstock</a></span>
</figcaption>
</figure>
<h2>The pandemic has been hard on young adults</h2>
<p>Young adults have tended to get a bad rap during the pandemic, often unfairly. Although some surveys have suggested that rule-breaking was <a href="https://www.ipsos.com/en-uk/young-britons-most-likely-break-coronavirus-rules-pursuit-romance-0">higher among younger adults</a>, others have found that compliance in this group was as high, or at certain points <a href="https://www.sciencedirect.com/science/article/pii/S0016328721001920?via%3Dihub">even higher</a>, than it was among older adults.</p>
<p>Notably, young adults have been one of the groups who have found the pandemic, and the policies designed to contain COVID, most difficult. General life satisfaction has been <a href="https://www.covidsocialstudy.org/_files/ugd/064c8b_c525505ffa6b432f96dc41d6b6a985ea.pdf">significantly lower</a> among younger compared to older adults throughout the past two years. It’s possible that the “<a href="https://bmjopen.bmj.com/content/10/7/e039334">social losses</a>” experienced during the pandemic have been more challenging for younger adults, for whom we know socialising <a href="https://pubmed.ncbi.nlm.nih.gov/10842426/">is crucial</a> for development and wellbeing.</p>
<p>Young adults have been among the most likely to experience <a href="https://pubmed.ncbi.nlm.nih.gov/33308420/">mental health problems</a>, and not to look after their <a href="https://bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-021-11140-w">physical health</a> – for example having a poor diet, drinking a lot of alcohol, or not doing enough exercise. As we continue to emerge from the pandemic, problems such as anxiety and depression tend to remain <a href="https://www.covidsocialstudy.org/_files/ugd/064c8b_c525505ffa6b432f96dc41d6b6a985ea.pdf">higher among younger adults</a>.</p>
<h2>Why a return to ‘normal’ won’t be uniform</h2>
<p>Behaviour is complex and often if not always the result of many factors. Research has invariably shown how everything from <a href="https://www.sciencedirect.com/science/article/pii/S0033350620303772">political affiliation</a> to <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8259055/#bb0265">personality traits</a> affects how people have been behaving during the pandemic. <a href="https://iaap-journals.onlinelibrary.wiley.com/doi/full/10.1111/aphw.12284">Conscientiousness</a> and <a href="https://doi.apa.org/fulltext/2020-76208-001.html">neuroticism</a>, for example, have both been associated with greater adherence to infection-reducing behaviour. </p>
<p>Similarly, these sorts of factors are likely to affect the extent to which different people return to their <a href="https://theconversation.com/two-years-into-the-pandemic-which-of-our-newly-formed-habits-are-here-to-stay-178204">pre-pandemic social habits</a>. Certainly there’s a significant minority of the population who remain at least somewhat worried about the effect of COVID on their lives – <a href="https://www.ons.gov.uk/peoplepopulationandcommunity/wellbeing/bulletins/publicopinionsandsocialtrendsgreatbritain/latest">four in ten</a> according to recent UK data. </p>
<p>Interestingly, <a href="https://wfhresearch.com/wp-content/uploads/2022/04/LongSocialDistance_v11_forwebsite.pdf">US data</a> suggests people on lower incomes, and with less formal education, are the least likely to feel as though they will return to normal pre-pandemic activities.</p>
<p>Further research is needed to explore why this is the case. One possible explanation is that people from <a href="https://jech.bmj.com/content/75/11/1050">more deprived communities</a> have been at greater risk of more serious outcomes from COVID. They have also been most affected by the economic and social impacts of pandemic policies. So for them it’s perhaps unsurprising that getting back to “normal” seems like a distant, if not impossible, goal.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/two-years-into-the-pandemic-which-of-our-newly-formed-habits-are-here-to-stay-178204">Two years into the pandemic, which of our newly formed habits are here to stay?</a>
</strong>
</em>
</p>
<hr>
<p>In our <a href="https://www.swansea.ac.uk/research/research-highlights/health-innovation/public-during-pandemic/">Public Views During the COVID Pandemic</a> project, we have been following people using a combination of focus groups and surveys since March 2020. One of our aims is to continue to explore some of the reasons behind why, and for how long, social distancing might be a part of some people’s lives.</p><img src="https://counter.theconversation.com/content/183837/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Simon Nicholas Williams has received funding from Swansea University, the University of Manchester, Senedd Cymru and Public Health Wales for research on COVID-19. However, this opinion article reflects the views of the author only and no funding bodies were involved in the writing or content of this article.</span></em></p>Some young adults are hanging onto COVID habits – but less so than older people.Simon Nicholas Williams, Senior Lecturer in People and Organisation, Swansea UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1834262022-05-19T09:42:11Z2022-05-19T09:42:11ZReducing COVID transmission by 20% could save 2,000 Australian lives this year<p>Australia’s <a href="https://www.health.gov.au/sites/default/files/documents/2022/05/coronavirus-covid-19-at-a-glance-9-may-2022.pdf">COVID death toll</a> is rising, yet public health measures to reduce transmission such as mask mandates are largely a thing of the past. </p>
<p>It’s time for governments and the community to consider what measures can be reintroduced to reduce COVID transmission and deaths, particularly during waves of infection. </p>
<p>Cutting COVID transmission by 20% could avert more than one million infections and 500 COVID deaths in Victoria this year, our new modelling shows. </p>
<p>Given Victoria makes up around 25% of Australia’s population, if extrapolated, these results suggest a 20% reduction in transmission could save up to 2,000 lives nationally.</p>
<p>Even if reintroducing public health measures cut COVID transmission by 10%, this could save between 198 and 314 Victorian lives between now and the end of 2022. Again, this would translate to many more lives saved nationally.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/covid-has-killed-5-600-australians-this-year-and-the-pandemic-isnt-over-ethics-can-shape-our-response-182765">COVID has killed 5,600 Australians this year and the pandemic isn't over. Ethics can shape our response</a>
</strong>
</em>
</p>
<hr>
<h2>COVID isn’t ‘just like the flu’</h2>
<p>The prevailing view in Australia is we can now treat COVID “like the flu”. However, the dramatic and sustained increase in COVID-related deaths in 2022 tells a very different story. There have been <a href="https://www.health.gov.au/sites/default/files/documents/2022/05/coronavirus-covid-19-at-a-glance-9-may-2022.pdf">5,687 COVID deaths reported</a> in Australia since January 1.</p>
<p>During the Omicron wave in January 2022, COVID was the second most common cause of death nationwide, with <a href="https://www.abs.gov.au/statistics/health/causes-death/provisional-mortality-statistics/latest-release">2,865 more people dying</a> in that month than is normally expected. That’s a 22% increase. </p>
<p>Critically, COVID deaths have not stopped since the January peak: our current <a href="https://www.covid19data.com.au/deaths">seven-day average</a> sits at about 45 deaths per day, or 315 deaths each week. </p>
<p>In comparison, our most recent severe influenza season (2017) caused <a href="https://www.abs.gov.au/ausstats/abs@.nsf/Lookup/by%20Subject/3303.0%7E2017%7EMain%20Features%7EDeaths%20due%20to%20influenza%7E5">1,255 deaths</a> across the entire year.</p>
<h2>We have vaccines, so why are there so many deaths?</h2>
<p>There are still so many deaths because we have let the virus run. By scaling back public health measures and delivering an “it’s over” message, we have allowed almost unfettered transmission. </p>
<p>Currently, <a href="https://www.health.gov.au/sites/default/files/documents/2022/05/coronavirus-covid-19-at-a-glance-18-may-2022.pdf">381,000 Australians</a> are known to be infected with SARS-CoV-2, the virus that causes COVID. With high case numbers comes a high death toll, even with a reduced case fatality rate (the proportion of those infected who die).</p>
<p>This relaxed policy stance – combined with emerging variants (three new Omicron strains have entered Australia), winter encouraging more time indoors, and waning immunity – suggest high caseloads will continue for some time yet.</p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1522441592266964992"}"></div></p>
<h2>Who is dying of COVID?</h2>
<p>In order to reduce COVID deaths, it’s important to understand who is dying and why. While some basic information on deaths is available for some states, additional data – for example, whether those who die are eligible for antiviral treatment – is needed. Such data could enable targeted public health action such as improving treatment access. </p>
<p>Nevertheless, with the data we have we know older people continue to be at greatest risk. Last week in NSW, <a href="https://www.health.nsw.gov.au/Infectious/covid-19/Documents/weekly-covid-overview-20220514.pdf">41% of all COVID deaths</a> were in aged care residents, despite very high rates of vaccination. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/australia-is-failing-marginalised-people-and-it-shows-in-covid-death-rates-177224">Australia is failing marginalised people, and it shows in COVID death rates</a>
</strong>
</em>
</p>
<hr>
<p>We often hear those who die from COVID have pre-existing medical conditions. This is true – <a href="https://www.abs.gov.au/articles/covid-19-mortality-australia-deaths-registered-31-january-2022#deaths-due-to-covid-19-associated-causes-of-death">about 70% of deaths</a> due to COVID were in people with chronic conditions.</p>
<p>But note that <a href="https://www.aihw.gov.au/reports/australias-health/chronic-conditions-and-multimorbidity">half of all Australians</a> have a chronic condition, as do 80% of those aged 65 and older. Given most of those who have died due to COVID are aged over 65, it’s not surprising most also have an underlying condition.</p>
<h2>Are people dying ‘with’ rather than ‘of’ COVID?</h2>
<p><a href="https://www.theguardian.com/australia-news/2022/may/18/pm-dismisses-need-for-more-measures-to-limit-covid-deaths-suggests-australians-dying-with-not-of-the-virus">Some argue</a> the high rates of COVID deaths isn’t as worrying as it seems because people are dying “with” COVID rather than “from” COVID. </p>
<p>But the majority (89.8%) of <a href="https://www.abs.gov.au/articles/covid-19-mortality-australia-deaths-registered-until-30-april-2022">COVID deaths</a> are “from” COVID. </p>
<p>For those defined as dying “with” COVID, this means COVID has possibly or probably “contributed” to those deaths. </p>
<p>For example, a person is infected with COVID which weakens their immune system and leads to a bloodstream infection (sepsis). They’re hospitalised and die three weeks after their COVID diagnosis. Although their death is directly “due to” sepsis, it is also “with” COVID because COVID caused the decline in their health which ultimately led to their death. COVID is not incidental in these deaths.</p>
<p>COVID is also killing young people – even children. Eight children aged nine and under have <a href="https://www.health.gov.au/health-alerts/covid-19/case-numbers-and-statistics#cases-and-deaths-by-age-and-sex">died in Australia from COVID</a> since the pandemic began, as well as five people aged ten to 19 years, 22 in their twenties, and 65 in their thirties. </p>
<p>It’s impossible to know if COVID will cause significant numbers of premature death in coming years. Given the damage the SARS-CoV-2 virus causes to the heart, brain, kidneys and lungs, we have reason enough to be seriously concerned. </p>
<h2>What could reduce the COVID death toll?</h2>
<p>Vaccination continues to be hugely important, and the main reason we can even contemplate our current open lifestyle. But vaccination alone is not enough. </p>
<p>Improving air quality and/or wearing a high-quality N95/P2 mask in indoor spaces cause minimal disruption to the community but interrupt COVID transmission effectively. </p>
<p>To illustrate the benefit of interventions, we used <a href="https://www.burnet.edu.au/covid-19/129_modelling">our model</a> to simulate three hypothetical scenarios for the state of Victoria for the remainder of 2022. </p>
<p>We first modelled a scenario with no additional interventions (the light blue line). We compared this with two scenarios where, from May 20, hypothetical interventions were introduced that could reduce the risk of transmission per contact by 10% (the dark blue line) or 20% (the red line). </p>
<p>We didn’t specify which specific interventions should be adopted to make up the 10% or 20% reduction. It could be a single intervention a or combination that make up the 10% to 20% reduction. </p>
<p>Between May 20 and the end of 2022, the outcomes from the “no additional intervention” scenario were an extra 2.22-2.38 million infections or reinfections and 1,060-1,450 deaths in Victoria. </p>
<p>With interventions reducing transmission by 10%, 596,000-614,000 infections and 198–314 deaths could be averted (a 16-25% reduction) over this period.</p>
<p>With interventions reducing transmission by 20%, 1.08-1.10 million infections and 462-502 deaths could be averted (a 37-40% reduction). As outlined above, this translates to up to 2000 lives nationally.</p>
<p>These are likely to underestimate the impact of interventions because the analysis was deliberately conservative and didn’t consider new COVID variants or sub-variants (only omicron BA.1 and BA.2). </p>
<p>The simple message is a small reduction in transmission has a big impact on mortality.</p>
<h2>How do we do this modelling?</h2>
<p>The model used for this work was <a href="https://github.com/institutefordiseasemodeling/covasim">COVASIM</a>, a model that can assess the impact of different policies and behaviours on COVID transmission, hospitalisations and deaths. The model has been used to assist policy decisions in Australia, the United States and the United Kingdom. </p>
<p>People in the model are assigned an age (which affects their susceptibility to infection and their disease prognosis), a household, a school (for people aged five to 17) or a workplace (for people over 18, up to 65), and they participate in a number of community activities that may include attending restaurants, pubs, places of worship, community sport, and social gatherings. </p>
<p>The model includes:</p>
<ul>
<li>vaccination (including individual dosing schedules, vaccine types and waning immunity)</li>
<li>testing (PCR or rapid antigen tests)</li>
<li>contact tracing (self-tracing)</li>
<li>quarantine of close contacts</li>
<li>isolation of confirmed cases</li>
<li>masks</li>
<li>a variety of policy restrictions to prevent or reduce transmission in different settings (such as closing schools or workplaces, density limits in hospitality and retail settings, restrictions on social gathering sizes).</li>
</ul>
<figure class="align-center ">
<img alt="Woman in a mask shops for clothes." src="https://images.theconversation.com/files/464178/original/file-20220519-25-t0w2ie.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/464178/original/file-20220519-25-t0w2ie.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/464178/original/file-20220519-25-t0w2ie.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/464178/original/file-20220519-25-t0w2ie.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/464178/original/file-20220519-25-t0w2ie.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/464178/original/file-20220519-25-t0w2ie.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/464178/original/file-20220519-25-t0w2ie.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">The COVASIM model assesses the impact of different policies on behaviours and COVID transmission.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/">Shutterstock</a></span>
</figcaption>
</figure>
<h2>It’s not just about the economy</h2>
<p>Australia successfully mitigated the direct impact of COVID in the first two years of the pandemic. However, recently Australia has made little effort to reduce the impact of COVID. We are quietly, perhaps unknowingly, approving a trade-off between COVID deaths, and economic and social well-being more generally. </p>
<p>Many people seem unaware of the high death numbers, and that simple interventions can make a meaningful difference. </p>
<p>But the value of the current trade-off is unclear. The economic and social benefits of winding back key public health measures, when tens of thousands of COVID cases occur each day, have not been established. Indeed, stories of major COVID-driven disruption are common, suggesting the opposite is true. </p>
<p>Australia must find a middle road, centred around slowing transmission, reinvigorating vaccine roll-out and scaling-up treatment options for people with COVID infections. Otherwise, 10,000 or more COVID deaths per year could well be our new – previously unthinkable – normal.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/im-at-home-with-covid-when-do-i-need-to-see-a-doctor-and-what-treatments-are-available-176884">I’m at home with COVID. When do I need to see a doctor? And what treatments are available?</a>
</strong>
</em>
</p>
<hr>
<img src="https://counter.theconversation.com/content/183426/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Margaret Hellard has received funding receives funding from the Victorian Government, the Federal Government, the New South Wales Government, the Macquarie Foundation and the Minderoo Foundation for COVID-19 related research. None provided support for this specific work. She also receives funding from the National Health and Medical Research Council of Australia for other research, and Gilead Science and Abbvie for investigator initiated non COVID-19 related research.
</span></em></p><p class="fine-print"><em><span>Brendan Crabb and the Institute he leads receives research grant funding from the National Health & Medical Research Council of Australia, & other Australian federal and Victorian State Government bodies.</span></em></p><p class="fine-print"><em><span>Dominic Delport has received funding from the NSW government in 2021 and continues to receive funding from the Victorian government for COVID-19 modelling work.</span></em></p><p class="fine-print"><em><span>Nick Scott receives funding from the Victorian Government for COVID-19 related work, and has previously received funding from the New South Wales Government and Federal Government for COVID-19 related work. No government funding was received for this specific work. He also receives funding from the National Health and Medical Research Council of Australia for research on other diseases. </span></em></p>We modelled the impact small reductions in transmission would have on COVID deaths. We found a 20% drop could save the lives of 500 Victorians this year, or 2,000 people nationally.Margaret Hellard, Deputy Director (Programs), Burnet InstituteBrendan Crabb, Director and CEO, Burnet InstituteDominic Delport, Health modeller, Burnet InstituteNick Scott, Econometrician, Burnet InstituteLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1803332022-04-26T19:56:19Z2022-04-26T19:56:19ZWant to cut your chance of catching COVID on a plane? Wear a mask and avoid business class<figure><img src="https://images.theconversation.com/files/458758/original/file-20220420-25-4z0ccn.jpg?ixlib=rb-1.1.0&rect=4%2C4%2C994%2C681&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/facemask-on-plane-airport-travel-wearing-1905906799">Shutterstock</a></span></figcaption></figure><p>A Florida court recently <a href="https://www.abc.net.au/news/2022-04-19/florida-judge-voids-us-mask-mandate-for-planes-other-travel/100998116">overturned mask mandates</a> on planes in the United States, saying the directive was unlawful. That decision is now <a href="https://www.9news.com.au/world/covid19-masks-on-us-flights-justice-department-appeals-easing-of-rules/a960d39c-dff4-4198-935c-c5b5c5b40551">under appeal</a>.</p>
<p>Before that, Australian comedian Celeste Barber
<a href="https://twitter.com/djokaymegamixer/status/1514836909620572162">told her social media followers</a> a passenger sitting next to her on a recent flight took off her mask to sneeze.</p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1514836909620572162"}"></div></p>
<p>So wearing masks on planes to limit the spread of COVID is clearly a hot-button issue.</p>
<p>As we return to the skies more than two years into the pandemic, what is the risk of catching COVID on a plane? And does it really matter where on the plane you are?</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/worried-about-covid-risk-on-a-flight-heres-what-you-can-do-to-protect-yourself-and-how-airlines-can-step-up-150735">Worried about COVID risk on a flight? Here's what you can do to protect yourself — and how airlines can step up</a>
</strong>
</em>
</p>
<hr>
<h2>So many variables</h2>
<p>It’s impossible to give a precise answer about your risk of catching COVID on a plane as there are so many variables.</p>
<p>For instance, not all countries and <a href="https://twitter.com/British_Airways/status/1503729049050353665">airlines</a> require passengers to wear masks or <a href="https://www.nationalworld.com/lifestyle/travel/where-can-i-travel-without-a-vaccine-countries-that-allow-unvaccinated-passengers-and-entry-requirements-3528913">be vaccinated</a>.</p>
<p>Some countries and airlines require a negative COVID test within a certain timeframe before flying, others have <a href="https://www.homeaffairs.gov.au/covid19/vaccinated-travellers/temporary-visa-holders/leaving-australia">scrapped that requirement</a> entirely. </p>
<p>Then there are different rules that may apply if you’re flying domestically or internationally, or <a href="https://www.health.gov.au/health-alerts/covid-19/international-travel/proof-of-vaccination">leaving or entering</a> a country.</p>
<p>That’s before we start talking about the virus itself. We know more recent variants have emerged (Omicron and the sub-variant BA.2, for example), that are <a href="https://aci.health.nsw.gov.au/covid-19/critical-intelligence-unit/sars-cov-2-variants">much more easily transmitted</a> than the original virus or the Delta variant. We don’t know how transmissible future variants or sub-variants will be.</p>
<p>So we can only talk in general terms about the risk of catching COVID on a plane. All up, your risk <a href="https://www.sciencedirect.com/science/article/pii/S1477893921001745">is very low</a>, but the measures airlines put in place help achieve that. You can also reduce your personal risk further in a number of ways.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/the-next-covid-wave-is-here-why-for-some-of-us-its-omg-and-for-others-its-meh-180338">The next COVID wave is here. Why for some of us it's OMG and for others it's meh</a>
</strong>
</em>
</p>
<hr>
<h2>Air flow and HEPA filters</h2>
<p>Air flow is designed to largely <a href="https://www.sciencedirect.com/science/article/pii/S1477893920304117">travel vertically</a>, from the ceiling to the floor, to reduce the potential spread of contaminated air through the plane. </p>
<p>The height of the seats acts as a <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8013760/">partial barrier</a> to air movement from rows in front and behind you. </p>
<p>Cabin air is also replaced <a href="https://cdn1.sph.harvard.edu/wp-content/uploads/sites/2443/2020/10/HSPH-APHI-Phase-One-Report.pdf">every two to three minutes</a> with a half-half mix of recycled and fresh air.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/458744/original/file-20220420-24670-q5yz3z.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Air flows from top to bottom on a plane" src="https://images.theconversation.com/files/458744/original/file-20220420-24670-q5yz3z.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/458744/original/file-20220420-24670-q5yz3z.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=487&fit=crop&dpr=1 600w, https://images.theconversation.com/files/458744/original/file-20220420-24670-q5yz3z.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=487&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/458744/original/file-20220420-24670-q5yz3z.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=487&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/458744/original/file-20220420-24670-q5yz3z.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=611&fit=crop&dpr=1 754w, https://images.theconversation.com/files/458744/original/file-20220420-24670-q5yz3z.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=611&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/458744/original/file-20220420-24670-q5yz3z.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=611&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Air largely travels from the ceiling to the floor.</span>
<span class="attribution"><a class="source" href="https://www.sciencedirect.com/science/article/pii/S1477893920304117">Travel Medicine and Infectious Disease</a></span>
</figcaption>
</figure>
<p>To see <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7588538/">how this works in real life</a>, researchers looked at how the virus spread on a long-haul flight when an infected person (the index case) sat in business class. </p>
<p>Twelve of 16 people who were infected on the plane sat within a few rows of this person; another was a flight attendant. This suggests limited spread of contaminated air through the rest of the plane.</p>
<p>Recycled air is also filtered through high-efficiency particulate air (or HEPA) filters. These remove <a href="https://cdn1.sph.harvard.edu/wp-content/uploads/sites/2443/2020/10/HSPH-APHI-Phase-One-Report.pdf">more than 99%</a> of viral particles, further reducing the risk of droplet or airborne transmission. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/we-should-install-air-purifiers-with-hepa-filters-in-every-classroom-it-could-help-with-covid-bushfire-smoke-and-asthma-166332">We should install air purifiers with HEPA filters in every classroom. It could help with COVID, bushfire smoke and asthma</a>
</strong>
</em>
</p>
<hr>
<h2>Masks</h2>
<p>Well fitted masks or respirators (worn properly) can reduce your risk of contracting COVID on a flight. That’s why many airlines say wearing a mask is a condition of flying.</p>
<p>For example, <a href="https://onlinelibrary.wiley.com/doi/10.1111/ina.12979">modelling</a> of several known transmission events on planes demonstrates an advantage if both the infected person and others around them wear masks.</p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1496681764705955845"}"></div></p>
<h2>Vaccination</h2>
<p>Some countries, such as Australia, require entering travellers to be <a href="https://www.health.gov.au/health-alerts/covid-19/international-travel/proof-of-vaccination">fully vaccinated</a>. This <a href="https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(21)00648-4/fulltext">lowers the risk</a> of someone becoming sick with COVID.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/your-unvaccinated-friend-is-roughly-20-times-more-likely-to-give-you-covid-170448">Your unvaccinated friend is roughly 20 times more likely to give you COVID</a>
</strong>
</em>
</p>
<hr>
<h2>Pre-flight COVID testing</h2>
<p>Not all flights require a negative COVID test before boarding. For those that do, the time frame before a flight varies, as does the type of test required. </p>
<p>However, we know tests do not detect every single COVID case. A range of factors can influence test sensitivity (ability to detect COVID). These include the type and <a href="https://www.tga.gov.au/covid-19-rapid-antigen-self-tests-are-approved-australia">brand</a> of test you take, whether you have <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8761676/">symptoms</a>, your <a href="https://ebm.bmj.com/content/early/2022/01/04/bmjebm-2021-111828">age</a>, and the <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8761676/">viral variant</a>.</p>
<p>You can also still test negative two days before a flight and catch COVID in the meantime.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/15-things-not-to-do-when-using-a-rapid-antigen-test-from-storing-in-the-freezer-to-sampling-snot-176364">15 things not to do when using a rapid antigen test, from storing in the freezer to sampling snot</a>
</strong>
</em>
</p>
<hr>
<h2>Sanitisation</h2>
<p>Airlines may do additional cleaning of high-touch areas, and overnight disinfection, to reduce the spread of COVID through touching contaminated surfaces. </p>
<p>However, the risk of transmission by this route is <a href="https://cdn1.sph.harvard.edu/wp-content/uploads/sites/2443/2020/10/HSPH-APHI-Phase-One-Report.pdf">low</a> compared to the risk of catching COVID through breathing in infectious droplets and aerosols.</p>
<h2>When and where are you most at risk?</h2>
<p><strong>The closer you are to the infected person</strong></p>
<p>Most transmission occurs within <a href="https://www.sciencedirect.com/science/article/pii/S1477893920304117">two to three rows</a> of an infected person. If you sit next to someone who is coughing or has other symptoms you might ask to <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7665738/">move seats</a> if spare seats are available. </p>
<p><a href="https://cdn1.sph.harvard.edu/wp-content/uploads/sites/2443/2020/10/HSPH-APHI-Phase-One-Report.pdf">Distance</a> yourself from others if you can, particularly when getting on and off the plane. </p>
<p>You might also avoid sitting close to the toilets as passengers will hang about in the aisles waiting to use them, particularly on long flights.</p>
<p><strong>The longer the flight</strong> </p>
<p>The risk increases with long- versus <a href="https://pubmed.ncbi.nlm.nih.gov/33650201/">short- or medium-haul</a> flights. During long-haul flights passengers are also more likely to <a href="https://onlinelibrary.wiley.com/doi/10.1111/ina.12979">recline their seats</a>. This somewhat reduces the <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8013760/">protection upright seats</a> provide in reducing air movement between rows. </p>
<p><strong>If you or others are not wearing a mask or wearing it properly</strong></p>
<p>You can breathe infectious particles in and out via your nose as well as your mouth, so don’t wear your mask under your chin or nose.</p>
<p>The risk also increases when everyone takes off their masks during food service. You might choose not to eat or drink on short flights to avoid this. Alternatively you might bring a snack to eat before food service begins, or <a href="https://cdn1.sph.harvard.edu/wp-content/uploads/sites/2443/2020/10/HSPH-APHI-Phase-One-Report.pdf">eat after</a> those around you. </p>
<p><strong>If you contaminate your food or your face</strong></p>
<p>You can catch COVID through touching your food or face with contaminated fingers. Sanitise your hands regularly and <a href="https://ieeexplore.ieee.org/document/9176589">train yourself</a> to not touch your face.</p>
<p><strong>If you are in business class</strong> </p>
<p>Based on limited reports, the transmission risk appears higher in business class. This is possibly because of <a href="https://globalizationandhealth.biomedcentral.com/articles/10.1186/s12992-021-00749-6">more interruptions to mask wearing</a> due to greater service of food and drinks.</p><img src="https://counter.theconversation.com/content/180333/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Thea van de Mortel teaches into the Graduate Infection Prevention and Control program at Griffith University. </span></em></p>All up, your risk of catching COVID on a flight is very low. But there are things you can do to lower that risk even further.Thea van de Mortel, Professor, Nursing and Deputy Head (Learning & Teaching), School of Nursing and Midwifery, Griffith UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1815822022-04-20T19:36:25Z2022-04-20T19:36:25ZShould you wear a mask on a plane, bus or train when there’s no mandate? 4 essential reads to help you decide<figure><img src="https://images.theconversation.com/files/458911/original/file-20220420-25-qleeh8.jpg?ixlib=rb-1.1.0&rect=187%2C130%2C5120%2C3082&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">It is now up to individuals whether to wear masks in airports and other mass transit areas.</span> <span class="attribution"><a class="source" href="https://newsroom.ap.org/detail/TravelMaskMandate/28ce57b3790b493190c8409bf0cd06d0/photo?Query=mask%20plane&mediaType=photo&sortBy=&dateRange=Anytime&totalCount=469&currentItemNo=22">AP Photo/Evan Vucci</a></span></figcaption></figure><p>On April 18, 2022, a judge in Florida <a href="https://www.cnn.com/us/live-news/federal-mask-mandate-airlines-04-19-22/index.html">struck down the federal mandate requiring passengers on mass transit to wear masks</a>. While the U.S. Centers for Disease Control and Prevention still recommends that passengers mask up while on planes, trains or buses, it is no longer a requirement. When asked whether people should wear masks on planes, President Joe Biden replied: “<a href="https://www.cnn.com/us/live-news/federal-mask-mandate-airlines-04-19-22/index.html">That’s up to them</a>.”</p>
<p>The Conversation has been covering the science of masks since the beginning of the pandemic. Masking may no longer be required on mass transit, but you can always choose to still wear a mask. For those worried about being exposed to SARS-CoV-2 or developing COVID-19, below are highlights from four articles exploring the benefits of wearing a mask and how to get the most protection from wearing one. </p>
<h2>1. Masks can protect the person wearing them</h2>
<p>A lot of the reason for wearing a mask is to protect others. But early on in the pandemic, <a href="https://profiles.ucsf.edu/monica.gandhi">Monica Gandhi, a professor of medicine</a> at the University of California, San Francisco, explained how masks can protect the wearer, too.</p>
<p>“When you wear a mask – even a cloth mask – you typically are <a href="https://dx.doi.org/10.7326%2FM20-2567">exposed to a lower dose of the coronavirus</a> than if you didn’t,” Gandhi writes. “Both <a href="https://doi.org/10.1073/pnas.2009799117">recent experiments in animal models</a> using coronavirus and nearly a <a href="https://doi.org/10.1038/nri2802">hundred years of viral research</a> show that <a href="https://theconversation.com/cloth-masks-do-protect-the-wearer-breathing-in-less-coronavirus-means-you-get-less-sick-143726">lower viral doses usually mean less severe disease.</a>”</p>
<p>Though it’s only one of many factors, “the amount of virus that you’re exposed to – called the viral inoculum, or dose – has <a href="https://doi.org/10.1038/nri2802">a lot to do with how sick you get</a>. If the exposure dose is very high, the immune response can become overwhelmed,” explains Gandhi. “On the other hand, if the initial dose of the virus is small, the immune system is able to contain the virus.”</p>
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<em>
<strong>
Read more:
<a href="https://theconversation.com/cloth-masks-do-protect-the-wearer-breathing-in-less-coronavirus-means-you-get-less-sick-143726">Cloth masks do protect the wearer – breathing in less coronavirus means you get less sick</a>
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<p>The better the mask, the lower the exposure dose. And in the many months since Gandhi wrote that story, a lot of work has been done to determine which kinds of masks are most effective. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/458910/original/file-20220420-18-nanbe4.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="An N95, surgical and cloth mask." src="https://images.theconversation.com/files/458910/original/file-20220420-18-nanbe4.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/458910/original/file-20220420-18-nanbe4.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=413&fit=crop&dpr=1 600w, https://images.theconversation.com/files/458910/original/file-20220420-18-nanbe4.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=413&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/458910/original/file-20220420-18-nanbe4.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=413&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/458910/original/file-20220420-18-nanbe4.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=519&fit=crop&dpr=1 754w, https://images.theconversation.com/files/458910/original/file-20220420-18-nanbe4.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=519&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/458910/original/file-20220420-18-nanbe4.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=519&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">Not all masks offer the same amount of filtration.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/protective-face-masks-commonly-used-during-2020-royalty-free-image/1248294245?adppopup=true">Gaelle Beller Studio/Moment via Getty Images</a></span>
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<h2>2. What makes for a good mask?</h2>
<p>The first thing to consider when wearing a mask is whether it’s a good one. <a href="https://scholar.google.com/citations?hl=en&user=MaEhNkQAAAAJ">Christian L'Orange is a professor of mechanical engineering</a> and has been testing different masks for the state of Colorado since the pandemic started. He explains that there are two things that make for a protective mask. “First, there’s the ability of the material to capture particles. The second factor is the fraction of inhaled or exhaled air leaking out from around the mask – essentially, how well a mask fits.”</p>
<p>When it comes to these two attributes, L'Orange says, “<a href="https://theconversation.com/what-is-the-best-mask-for-covid-19-a-mechanical-engineer-explains-the-science-after-2-years-of-testing-masks-in-his-lab-175481">the N95 and KN95 masks are the best option</a>.” This performance has a lot to do with the materials they are made from. “These fibers are very tightly packed together so the gaps a particle must navigate through are very small. This results in a high probability that particles will end up touching and sticking to a fiber as they pass through a mask. These polypropylene materials also often <a href="https://www.thomasnet.com/articles/machinery-tools-supplies/what-is-melt-blown-extrusion/">have a static charge</a> that can help attract and catch particles.”</p>
<p>Fit is the second important factor for a mask. As L'Orange writes, “a mask can offer protection only if it doesn’t leak.” N95s and KN95s are stiff and seal much better than other masks.</p>
<p>If you don’t have access to an N95 or KN95, surgical masks should be your second choice. They are made of densely woven material, but they don’t seal perfectly. Cloth masks should be your last choice because of their generally loose weave and bad fit. But there are ways to improve the performance of surgical and cloth masks. </p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/what-is-the-best-mask-for-covid-19-a-mechanical-engineer-explains-the-science-after-2-years-of-testing-masks-in-his-lab-175481">What is the best mask for COVID-19? A mechanical engineer explains the science after 2 years of testing masks in his lab</a>
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<h2>3. How to make a mask fit well</h2>
<p>“No matter how good a mask’s material is, it won’t work well if it doesn’t fit well,” writes <a href="https://scholar.google.com/citations?user=fZJWmF8AAAAJ&hl=en&oi=ao">Scott Schiffres, a mechanical engineer</a> at Binghamton University.</p>
<p>There are <a href="https://theconversation.com/cdc-says-masks-must-fit-tightly-and-two-are-better-than-one-153778">two ways to improve the fit and performance of surgical and cloth masks</a>. The first, explains Schiffres, is simply wearing two masks. “Double-masking is wearing a cotton mask over a medical-procedure mask.” This can greatly improve the fit and add a little bit more filtration. The second approach is to knot and tuck a surgical mask so that it fits better. </p>
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<iframe width="440" height="260" src="https://www.youtube.com/embed/OD-jy7M6tEc?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">Knotting and tucking a surgical mask can make it fit much better.</span></figcaption>
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<p>As Schiffres explains in his article, “Knotting and tucking entails tying a knot in the elastic loops that go over your ears, close to where they attach to the mask. Then, you tuck the extra mask fabric into the gap that is often present where the ear loops attach to the mask, and flatten that part as much as possible. Both of these tricks make a better fit and <a href="https://www.cdc.gov/mmwr/volumes/70/wr/mm7007e1.htm?s_cid=mm7007e1_w">decrease the mask-wearers’ exposure to potentially infectious aerosols by 95%</a> as compared with wearing no mask at all. That’s a <a href="https://doi.org/10.1017/dmp.2013.43">15% improvement over the 80% efficiency found when using a single surgical mask</a>.</p>
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<p>
<em>
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Read more:
<a href="https://theconversation.com/cdc-says-masks-must-fit-tightly-and-two-are-better-than-one-153778">CDC says masks must fit tightly – and two are better than one</a>
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<h2>4. Breakthrough cases and new variants</h2>
<p>The final consideration when deciding to wear a mask isn’t about you. Doing so can protect others. </p>
<p><a href="https://scholar.google.com/citations?user=XY7DNtgAAAAJ&hl=en&oi=ao">Sara Sawyer</a>, <a href="https://www.colorado.edu/pac/arturo-barbachano-guerrero">Arturo Barbachano-Guerrero</a> and <a href="https://scholar.google.com/citations?user=l2lpnYkAAAAJ&hl=en&oi=ao">Cody Warren</a> are virologists and biologists at the University of Colorado Boulder. In <a href="https://theconversation.com/alpha-then-delta-and-now-omicron-6-questions-answered-as-covid-19-cases-once-again-surge-across-the-globe-174703">a recent story</a>, they write that omicron "is often able <a href="https://doi.org/10.1038/s41586-021-04385-3">to evade existing immunity</a> long enough to start an infection, cause symptoms and transmit onward to the next person.” “This explains why reinfections and vaccine <a href="https://www.cdc.gov/coronavirus/2019-ncov/vaccines/effectiveness/why-measure-effectiveness/breakthrough-cases.html">breakthrough infections</a> seem to be more common with omicron.”</p>
<p>Case numbers are low for now, and therefore so is the risk of catching or transmitting the coronavirus. But it is not zero; some places have higher risk than others, and new variants can come on quickly. As the team writes, all new variants that spread widely – so-called <a href="https://www.cdc.gov/coronavirus/2019-ncov/variants/variant-classifications.html#anchor_1632154493691">variants of concern</a> – are likely to be highly transmissible.</p>
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<em>
<strong>
Read more:
<a href="https://theconversation.com/alpha-then-delta-and-now-omicron-6-questions-answered-as-covid-19-cases-once-again-surge-across-the-globe-174703">Alpha then delta and now omicron – 6 questions answered as COVID-19 cases once again surge across the globe</a>
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<p>The person next to you on the plane might not be wearing a mask and, as it stands, that is their choice to make. If you want to lower your own chances of catching or spreading the coronavirus, there are still a number of reasons to wear a well-fitting, high-quality mask. </p>
<p><em>Editor’s note: This story is a roundup of articles from The Conversation’s archives.</em></p><img src="https://counter.theconversation.com/content/181582/count.gif" alt="The Conversation" width="1" height="1" />
Despite the halt to the federal mask mandate for mass transit, people may still choose to protect themselves. For those who do, the type of mask and how well it fits matter.Daniel Merino, Associate Breaking News Editor and Co-Host of The Conversation Weekly PodcastLicensed as Creative Commons – attribution, no derivatives.