Copy
View this email in your browser
COVID CONWAY COMMUNICATIONS REBOOT #4
Q&A JANUARY 2022
Hi Colleagues and Community! I’m Dr. Kate Conway (she/her) and I have been writing CCC since Summer 2020. I now have a team with me ready and excited to bring you answers to your questions every month. I am a Family Physician specializing in Global Health and Medical Education. I have been working hard during the pandemic to take care of my family, my patients, my coworkers, and my students. I believe in the power of relationships and sharing our stories to empower positive change in this world. I will share my own personal reflections along with introducing our monthly Q&A topics. Stay Well, Stay Safe, Stay Smart!
In this January edition we will be answering questions on My test just came back positive for COVID – now what?, What is long Covid?, What is natural immunity and why do I need the vaccine or a booster?, Why do viruses have variants and can we stop them?, What kind of mask is best and why?, and What is going on with vaccines for children under five?. Each question is first answered with Take Home Points for quick and easy reference. This is followed by More of the Story when our writers have provided a deeper dive on the topic and then Resources Used to Answer this Question with the primary references listed, including links to take you there. We hope to include infographics and other visual aids along the way and will make sure to highlight multi-media resources when we can.

We will always strive to answer the question with the best information available. It is our goal to provide information from trusted sources and balanced perspectives. We will also be honest when a question can’t fully be answered because science is still trying to answer it and may only have partial data available for review and interpretation. I am humbled by how much we have learned in such a short amount of time. Asking questions is one important way we all stay tuned in together. Please continue to submit COVID questions here:
Google Form COVID Q&A. You can also reach me if you have any questions or need clarifications on material published here katharine.conway@wright.edu.

Please share this with others and be on the lookout for ways we will continue sharing with you via our social media and website links coming soon.

In this new year, we hope to continue working together to build back our communities’ health, safety, knowledge, and informed engagement with trusted connections.
~ The BSOM CCC Reboot Team
Team Member Introduction: Who am I and Why do I COVID Care?
Matt Huston (he/him): I’m a first-year medical student at the Boonshoft School of Medicine and am interested in Emergency Medicine, health equity, and global public health. I grew up in Northeast Ohio and received my Bachelor of Science in Biochemistry and Molecular Biology from Otterbein University. I am passionate about these issues because of the impact I’ve seen Covid have on patients and their loved ones.

Question I am answering: “My test just came back positive for COVID – now what?”
Take Home Points:
● First, contact your doctor, and let them know that you tested positive for COVID. Your primary care doctor knows you and your medical history. They can better inform you of your specific risks with COVID as well as what might best help you manage your symptoms.
● Contact anybody that you have recently had close contact with. Those people should get tested a few days after the contact or as soon as they develop symptoms of COVID-19.
● Prepare yourself to isolate. If you live with other people, figure out how you will isolate yourself from them. Know who you will call for help if need be and who might be able to bring you supplies like groceries, a thermometer, a pulse oximeter, etc.
● Monitor yourself throughout the day. Check your temperature, oxygen levels, and make sure that you are getting plenty of fluids.
● Use an at-home pulse oximeter if available. A pulse oximeter measures the oxygen saturation of your blood, which for healthy individuals is usually between 98-100%. The device can be placed on any finger and may give slightly different readings on each finger. Long nails or dark nail polish may interfere with the device getting an accurate reading. An article in the New England Journal of Medicine showed that at-home pulse oximeters are 3 times more likely to not detect hypoxemia (low blood oxygen levels) in people of color so if you are feeling out of breath it is more important to seek care no matter the number on the machine. For most people if your oxygen level drops below 90% contact your doctor immediately and consider going to the nearest emergency department.
● Know when to utilize emergency services. Testing positive for COVID is not a reason to go to the emergency department. Symptoms that may indicate a medical emergency include but are not limited to: difficulty breathing, shortness of breath, persistent chest pain, confusion or changes in mental status, inability to wake or stay awake, severe or persistent vomiting or diarrhea.
● Some high-risk people will qualify for COVID-specific medications. You can talk to your doctor about these options that include antiviral pills and monoclonal antibody infusions. For mild illness you can treat symptoms with over-the-counter medications that help with fever, muscle aches, and cough/cold like Tylenol, ibuprofen, throat lozenges, and mucinex if ok’d by your doc.
When to seek emergency medical attention, look for emergency warning signs* for COVID-19. If someone is showing any of these signs, seek emergency medical care immediately:
  • Trouble breathing
  • Persistent pain or pressure in the chest
  • New confusion
  • Inability to wake or stay awake
  • Pale, gray, or blue-colored skin, lips, or nail beds, depending on skin tone
*This list is not all possible systems. Please call your medical provider for any other symptoms that are severe or concerning to you.
Call 911 or call ahead to your local emergency facility: Notify the operator that you are seeking care for someone who has or may have COVID-19.
Resources used to answer this question:
Website. University of Michigan Health, Using a Pulse Oximeter at Home When You Have COVID-19, accessed 01/09/22, Pulse Oximeter
Website. University of Maryland Medical System, When to Go to The Hospital, accessed 01/09/22, Hospital
Website. New England Journal of Medicine, Racial Bias in Pulse Oximetry Measurement, accessed 01/13/22, NEJM
Image. CDC, What to Do If You Are Sick, accessed 01/09/22, Image
Image. New York Times, What’s a Pulse Oximeter, and Do I Really Need One at Home?, accessed 01/09/22 NYT Image
Team Member Introduction: Who am I and Why do I COVID Care?
Hi! My name is Maneesh Chidambaram and I am a first year medical student. I am writing for this publication because in the past year I have witnessed how misinformation has affected our community and the lives of people we care about. I believe the best way to combat this misinformation is through evidence-based information which I hope to share.

Question I am answering: What is Long COVID?
A 59 year old woman with no medical history and her family find themselves in an unfortunate circumstance all too familiar with many families these past two years. One way or another, COVID-19 was brought into the household and as a result, she and each of her family members came in contact with it and became infected. Over the course of the following days, they each developed various symptoms indicative of a COVID-19 infection. After 4 weeks, thankfully her family seems to have fully recovered, but she alone continues to experience lasting symptoms including persistent cough, low grade fever, breathlessness, and fatigue.

Take home points
● Long COVID is diagnosed when symptoms last longer than 4 weeks from onset.
● Data indicates that greater than 50% of people infected with COVID will experience long COVID.
● Common symptoms include fatigue, breathlessness, cardiovascular abnormalities, cognitive and mental health deficits, and prolonged abnormalities of taste and smell.
● Long COVID symptoms do not mean a person still has active viral infection. People who had an initial asymptomatic COVID infection can also go on to develop long COVID symptoms. COVID PCR testing and COVID antibody testing are sometimes used to help evaluate new symptoms but can be hard to interpret depending on what testing is done and what testing is available.
● The mechanisms that cause people to recover from acute COVID but go on to develop long COVID are still being proposed and studied.
● Long COVID is treated through gradual achievable goals towards individual symptom improvement.
● Long COVID can be avoided by preventing initial acute COVID infection. This includes vaccinations, booster shots, and wearing masks in public places.

More of the story:

What is Long COVID?
Long COVID (also has been called Post-COVID syndrome and patients as “Long-Haulers”) is formally recognized as symptoms persisting beyond 4 weeks from initial COVID infection and cannot be explained by alternative diagnoses1.

Epidemiology
The current limited data indicates that risk factors for long COVID include older age, female sex, obesity, comorbidities like existing heart and lung disease, severe initial acute infection, hospital admission for initial acute infection, and oxygen needed during the acute phase of infection1.
Studies have shown that over 50% of people have experienced at least one symptom 6 months or longer. Regardless, most people indicated a functional recovery 1 year after onset. Mild cases of COVID-19 can also go on to develop long-COVID as 12% to 15% of mild cases indicated mild symptoms persisting 8 months after onset. It seems that people who had more symptoms and/or more intense symptoms during acute infection were at risk for symptoms persisting into long-COVID syndrome.1

Symptoms
Although symptoms vary greatly from person to person, some of the most common symptoms of long- COVID include fatigue, breathlessness, cardiovascular abnormalities, cognitive and mental health deficits and abnormalities of taste and smell.2 Cardiovascular symptoms and conditions include palpitations and chest pain or more serious things like heart attacks, stroke, pulmonary embolism. Neurological symptoms and cognitive/mental health deficits can include numbness/tingling, tinnitus, trouble with focus and memory, depression/anxiety, and PTSD especially in those who have been hospitalized in the ICU requiring mechanical ventilation (ventilator). Prolonged periods of reduced smell and taste are also common symptoms that fall into the long COVID syndrome category.

Are Long-COVID Patient’s still contagious?
No. Recovery from mild acute illness usually occurs within 7-10 days from onset of symptoms, with the most contagious days being Days 1-5. Recovery from more severe illness can take up to 3 weeks and yet still the most contagious days are in that first week of symptom onset. When people have symptoms that persist past 4 weeks, their symptoms are not a direct cause of the virus still being present in their body, but rather a response to what the virus did to their bodies in the acute illness phase and what the body is doing in the recovery phase. The vast majority of long COVID patients will test negative even with persisting symptoms3.

Underlying Mechanism
The biological process for how the SARS CoV2 virus and the COVID-19 illness it causes goes on to develop long COVID is largely unknown, but studies have developed various proposed mechanisms.
Regarding long lasting neurological symptoms, inflammation has been proposed as the dominating factor. During the COVID infection, levels of cytokines increase including C reactive protein as well as levels of IL-6, which can cross the blood brain barrier. It is hypothesized that these marked elevations may contribute to central nervous system complications. Additionally, the Hippocampus has been observed to be a relatively more vulnerable part of the brain to COVID infection and may also contribute to neurological deficits. Finally, it is also hypothesized that damage to the olfactory sensors affects the outflow of cerebrospinal fluid through the cribriform plate resulting in congestion of lymphatics and toxic buildup within the CNS4.
Aside from inflammation, another hypothesis proposes that prolonged fatigue may stem from lung dysfunction. A prospective observational study of 76 patients found that serum troponin-I levels were significantly associated with fatigue after discharge and lymphopenia was also significantly associated with chest tightness4.
Although much is still unknown about the exact causes of long COVID, it is clear that it is both multifactorial and different from patient to patient as symptoms can be the result of comorbidities (like people with underlying heart disease, lung disease, and diabetes), varying time required for recovery based on the organ system, post-intensive care syndrome, and other factors as outlined in figure 1 below5.

Treatment/Management
In order to manage long COVID, identify any patterns that bring on or exacerbate symptoms and try to avoid them. The recovery process should be a story of gradual improvement6. Patients should be managed holistically. Long COVID will need to be managed in conjunction with comorbidities and patient social/financial circumstances7. Working with the patient to create a self-management plan can also provide the patient with a sense of control. These plans would include attention to general health, proper rest, self-pacing for exercise, and achievable goals7. As patients follow up with their physicians, recovery time will vary patient to patient, but the long COVID management process can remain relatively constant.

How to Avoid Long-COVID
The best way to avoid long COVID is through fundamental practices used to avoid any COVID-19 infection:
● COVID-19 vaccinations
● vaccine boosters after 6 months of vaccination
● wearing masks in public places
Figure 1
Outline of potential underlying causes of Long-COVID taken from BMJ Best Practice Coronavirus disease

Resources used to answer this question:
1. BMJ Best Practice Coronavirus disease 2019. Straight to the point of care. Accessed December 29, 2021, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8056514/
2. Crook H, Raza S, Nowell J, Young M, Edison P. Long covid—mechanisms, risk factors, and management. BMJ. 2021;374. doi:10.1136/BMJ.N1648
3. What It Means to Be a Coronavirus “Long-Hauler” – Cleveland Clinic. Accessed January 6, 2022. https://health.clevelandclinic.org/what-it-means-to-be-a-coronavirus-long-hauler/
4. Maltezou HC, Pavli A, Tsakris A. Post-COVID Syndrome: An Insight on Its Pathogenesis. Vaccines. 2021;9(5). doi:10.3390/VACCINES9050497
5. Raveendran A v., Jayadevan R, Sashidharan S. Long COVID: An overview. Diabetes & Metabolic Syndrome. 2021;15(3):869. doi:10.1016/J.DSX.2021.04.007
6. Nabavi N. Long covid: How to define it and how to manage it. BMJ. 2020;370:m3489. doi:10.1136/BMJ.M3489
7. Greenhalgh T, Knight M, A’Court C, Buxton M, Husain L. Management of post-acute covid-19 in primary care. BMJ. 2020;370. doi:10.1136/BMJ.M3026
Team Member Introduction: Who am I and Why do I COVID Care?
I’m Dr. Courtney Sulentic (she/her) and I am an Associate Professor in the Department of Pharmacology & Toxicology at Wright State University. I care about COVID because I am an Immunotoxicologist, which means that I study how chemicals, whether natural or man-made, damage the immune system. My research focuses on understanding how our environment such as diet, chemical exposures, and pharmaceuticals can either decrease or increase the production of antibodies. Antibodies and the cells that make them, which are called B cells or B lymphocytes, have become an important topic during the pandemic. They play a major role in protecting us against COVID and the current COVID vaccines do a very good job in increasing our body’s natural ability to fight infection. B cells and antibodies rock! They captured my interest in graduate school over 25 years ago and continue to do so.

Question I am answering: What is natural immunity and why do I need the vaccine or a booster?

Take Home Point:
● A vaccine booster increases the protection against COVID in those previously infected with COVID and those previously vaccinated.

More of the Story:
What is natural immunity? Natural immunity is when your body’s immune system successfully fights off a pathogen (a disease-causing bacteria, virus, or other microorganism) and develops immune cells (B cells and T cells) that will have memory of that pathogen. These cells will be able to respond more quickly and strongly when re-exposed to the same pathogen. However, the effectiveness of the immune response to re-exposure may vary depending on the pathogen.

Why can’t we count on natural immunity to protect us? The problem with relying on the development of natural immunity is that you must get infected and survive the infection first. Unfortunately, getting COVID is like Russian roulette. You may dodge the bullet with no symptoms at all or experience minor to severe symptoms, including long COVID or death. How people react is not predictable nor is it always consistent with having pre-existing conditions. An additional problem is that having COVID more than 6-months before re-exposure does not prevent a reinfection, particularly against variants of COVID.
Fortunately, we have very effective and safe vaccines that have been shown to offer protection against severe illness from COVID. This allows us to be protected without experiencing the varying degrees of illness and potential long-term effects that so many have experienced when sick with COVID. Let’s not forget the more than 826,000 friends and family members who have perished from COVID in the United States alone.

How does the vaccine protect us? The mRNA vaccines introduce a small, non-infectious piece of the virus (the spike protein) to the immune system and essentially wakes it up to the potential threat. The immune system then initiates defensive maneuvers to protect against a potential future infection if the COVID virus enters your body. These defensive maneuvers include the expansion of cells that could recognize the spike protein on COVID and the production of antibodies that can bind the spike protein and prevent COVID from infecting the cells of our body.

Why do I need the COVID vaccine if I have already had COVID? Shouldn’t I have natural immunity and isn’t that better? It has become clear that having COVID previously does not guarantee that you won’t be reinfected with COVID. You may still experience sickness and have the potential to spread COVID to unvaccinated or immunocompromised individuals. Why is this? First, we need to understand how the immune system works. It cannot block inhalation of COVID into the body. What the immune system tries to do is block the virus from infecting cells. It does this by antibodies binding and helping remove the virus from the body. If the virus is still able to infect some of the cells, the immune system tries to limit the spread of the infection and eventually gets rid of infected cells, which is part of the reason for quarantining for a few days to allow the body to resolve the infection and prevent passing it on to others. Second, there are individual differences in the ability of the immune system to reactivate a defensive and protective state. In other words, some people have more responsive immune cells and higher levels of antibodies against COVID than others. The number of antibodies is referred to as the antibody titer. A higher titer means more antibodies available to bind COVID and help remove it before it can infect the cells of the body. However, the antibody titers following COVID infection and also following vaccination alone do decrease over time, which does decrease the natural and vaccine-induced protection. Third, the variants of COVID, such as Omicron, may be different enough to result in a less effective immune response.

Vaccines help to boost the natural immunity that was started with a previous COVID infection. One of the most amazing qualities of antibodies is that their ability to bind and trigger the removal of COVID from the body is improved with a vaccine booster. However, this improvement process takes about two weeks so getting the vaccine allows for this to happen without getting sick. This improvement in antibody function with the vaccine booster likely also explains why getting a booster is showing greatly improved protection against the Omicron variant of COVID in those previously infected or vaccinated.

Therefore, no matter the starting point of immunity against COVID (i.e. none, previous infection, or previously vaccinated), immunity will be improved with a COVID vaccine booster. It’s like exercising or practicing to improve a skill. You get better with practice, but your skill level may be better or weaker than your neighbor’s. Regardless, you improved. Antibodies improve with repeated exposure (i.e. practice) and higher antibody titers result in more immediate protection.

What does it mean if I get sick with the vaccine or booster? It means your immune system is responding! Not everyone gets sick, which doesn’t necessarily mean that their immune system isn’t reacting. We all just respond differently and those that do feel ill only feel ill for a day or two, which is generally much shorter and less intense than being sick with COVID.
Vaccines reproduce a natural infection with fewer complications. - WHO Vaccine Safety Basics
Helpful Resources
Basics about antibodies and pathogens: https://youtu.be/qCRwuxDpthY
How antibodies get better at binding pathogens: https://youtu.be/kkewDUuBwFI
How COVID spreads in a droplet from a cough or sneeze: https://amarolab.ucsd.edu/news.php
Vaccines increase protection in those previously infected with COVID: https://www.cdc.gov/coronavirus/2019-ncov/science/science-briefs/vaccine-induced-immunity.html
https://www.cdc.gov/coronavirus/2019-ncov/science/science-briefs/vaccine-induced-immunity.html#anchor_1635540493225
Myths and facts about COVID vaccines: https://www.cdc.gov/coronavirus/2019-ncov/vaccines/facts.html
How to evaluate health information resources: https://vaccineinformation.org/internet-immunization-info/
Team Member Introduction: Who am I and Why do I COVID Care?
Clayton Allex-Buckner (He/Him/They/Them)
I am a fourth-year PhD candidate in the Biomedical Sciences program here at Wright State. My research focus is on immunology and bioinformatics. Specifically, I study B-cell biology with the use of emergent sequencing technologies, machine learning, and deep learning algorithms. As someone who has a love for biology, computer science, and statistics, I find it my obligation to make sure that science is accessible and understandable to all people. Better science communication to our communities and the public helps inform the public and combat mis- and dis-information. Science community outreach is a long-term practice I hope to continue in my future career.

Question I am answering: Why do viruses have variants and can we stop them?

Take Home Points:
● All viruses have the chance to make variants when replicating in the hosts (i.e. humans).
● Mutations in the viral genome during replication result in new viral variants.
● New variants may have an increase, decrease, or no change in infectivity and lethality.
● Stopping the emergence of new variants can be achieved by preventing infections through proper safety precautions including vaccination, masks, and social distancing.

More of the Story:
What are viruses? Viruses are pathogens that are defined as non-living, obligate intracellular parasites. They are classified as non-living because they cannot create their own energy to live. Almost all viruses must infect cells to replicate, killing the host’s cells and even damaging organs in the process. Submicroscopic viruses are generally comprised of only a few molecular components. Their genomes are either DNA or RNA, which are surrounded by a protein coat, and even some have a lipid membrane that envelops them. Viral genomes can be single-stranded or double-stranded, which influences the overall stability of the genomes during replication. COVID-19, for example, is a single-stranded RNA virus with a spike protein coat that is able to infect the upper respiratory tract.

How do viruses replicate? As previously stated, viruses cannot replicate on their own so therefore require the infected host cells to replicate. Mammalian cells have all of the machinery required for independent cell work like DNA replication, RNA transcription, and protein synthesis. Viruses hijack this machinery to replicate their genetic material and make proteins essential for packaging the genetic material into new virus particles.

But where do viral variants come from? When our own cells replicate, there is always the chance for a mistake to occur. This could be a mutation in the DNA that alters or stops the function of a particular gene. This may result in disease or cancer formation. However, our cells have multiple ways to correct errors in DNA replication . Viruses, on the other hand, do not have the ability to correct errors during replication. Mutations that occur during replication will be carried over to the next cell that the newly made virus infects. These mutations may result in three possible outcomes for the new variant: increased infectivity and/or severity, decreased infectivity and/or severity, or no changes. In this image, the genetic mutations that produced the COVID variants Delta and Omicron are shown, with Delta having around 13 mutations and Omicron 50. Delta and Omicron cause slightly different symptom profiles, with Delta having a higher severity and Omicron a higher infectivity.

How do we stop new variants? Stopping the formation of new variants world-wide is essential for the safety of the public and ending the pandemic. New variants threaten to undo the progress made by current vaccines and further overload our healthcare system. The best method to stop new variants is by stopping the spread of COVID. Mutations that cause new variants occur during replication of the virus in human cells. Reducing the spread of COVID-19 halts infections and ultimately viral replication. Social distancing, masking in public, and vaccination reduce the spread of COVID-19, which reduces the chances of new, potentially more infectious and/or lethal variants from emerging. The public can aid in the effort to reduce transmission and halt the emergence of new variants.
Resources.
Team Member Introduction: Who am I and Why do I COVID Care?
Hi! My name is Kehinde ‘Kenny’ Agoro, and I am an M1 at Boonshoft School of Medicine. I unfortunately dealt firsthand with COVID-19 and have also lost many loved ones due to negligence centered around extreme misinformation and outright mistrust of both public health and health care officials. I am in support of the GREAT and passionate work that has been done, especially as it pertains to education, transparency and a thorough plan of action set in place to address this current crisis. I find it a personal obligation to stand alongside those willing to combat misinformation around the COVID-19 pandemic by assisting with the dispensing of quality resources and reliable information to answer the questions of our community as best I can. I want to continue learning, to become a better voice/advocate, and to ensure that the concerns of the community I serve are met with answers worth trusting.

Question I am answering: What kind of mask is best and why?

Take Home Points:
  • The most important thing is that everyone should wear a mask. It is better to wear any mask than no mask; however, the kind of mask you choose to wear is worth consideration.
  • With remarkable increases in the Omicron surge, there have been recommendations to consider higher quality mask guidance. The CDC has since updated its masking guidance to encourage use of higher quality options.
  • To protect yourself and others, consistently wear the most protective mask that you can get your hands on. Make sure that it fits.
  • N95 masks are the “gold standard”, offering the best filtration of 95% of airborne particles. This is why it is recommended especially for high-risk people in higher-risk exposures.
  • KN95 masks are a popular alternative to the N95 mask and also filter out at least 95% of airborne particles.
  • Surgical masks are the next best option, but they do not seal as tightly around the nose and mouth as the N95 or KN95 masks do.
  • Cloth masks only block 10-30% of aerosol-sized/airborne particles.
  • Cloth masks, which are better than using no mask at all, have improved efficacy when worn with a surgical mask underneath. When cloth + surgical masks are worn together there is increased filtration efficacy of up to 91%.
  • Cloth masks can catch large droplets expelled with sneezing or when talking but miss the fine droplets that linger in a room for up to hours even after a person has gone.
  • Do not rely on a cloth mask alone. These are only good at protecting others from your respiratory droplets but do not protect you against others as much.
  • The higher the filtration of the mask and the tighter the seal with proper fit on the face, nose and mouth, the higher the protection a mask can provide when worn correctly and consistently.
More of the Story:
Are you confused about masks? Well, you are not alone. All masks are not created equal.

Scientists, health care officials and medical professionals maintain that any mask is better than no mask. However with many kinds of masks at our disposal, there has been much confusion around the topic of which one to use. Overall, it is of importance to consider the level of protection for yourself and those around you when picking a mask. Currently everyone should wear a mask when in public. When you sneeze or cough, you want these germs to stay with you. The greatest increase in protection has been in transitioning from no mask to use of any mask. The second noted increase is when everyone wears a mask. This is when all people contribute to the effort in keeping germs to themselves.

Current COVID-19 infection and hospitalization rates have surpassed pandemic records, with the Omicron variant making up approximately 98% of all new cases. With such an increase in cases and the mutation of the virus into more contagious variants, the CDC has recommended use of more protective facial coverings.

Concern for single layer cloth coverings is warranted, given they do not provide adequate protection against COVID-19. Experts say cloth masks have proven ineffective against filtering particles. Such findings have led to a need to address current guidelines to consider recommendations for use of more protective masks such as the N95, KN95 and surgical masks.
Image 1: Bloomberg, Confused About Masking? It's Time to Get Tactical, accessed 1/14/2022
Why are cloth masks ineffective?
The effectiveness of a cloth mask lies around 10-30%. In an analysis of 200 different cloth masks with pore sizes ranging from 80-500 micrometers, the tiny 0.12 micrometer droplets of the coronavirus are inhaled through gaps near the nose and cheeks because the pore sizes in these masks are larger than the airborne particle diameter. As a result, it is noted that cloth masks have poorer filtering efficiency due to the larger and more open pores. A surgical mask has smaller pores than a cloth mask and when worn under a cloth mask, effectiveness increases to about 91%, a close second to the N95 and KN95, hence the recommendation to double mask with the two.

Per CNN Medical Analyst, Dr. Leana Wen, an Emergency Medicine physician and visiting professor of health policy and management at the George Washington University Milken Institute School of Public Health, “Cloth masks are little more than facial decorations. There's no place for them in light of Omicron."
N95 masks have been considered the “gold standard” in masking, ranked the topmost protective face covering by the National Institute for Occupational Safety and Health (NIOSH), with KN95 and surgical masks following. The

N95 masks are most common in the health care setting and were initially only recommended for such use. Providing the least amount of protection were cloth products.

Issues do arise. There are many counterfeit versions of the N95 and KN95 masks, so it is important to be able to distinguish between counterfeit and authentic versions. Per the CDC, more than 60% of KN95 masks sold on the market are counterfeit. Tips on how to avoid counterfeit masks and ensure usage of masks that meet standards can be found here.

There are some downsides to KN95 use.
  • These masks are rather uncomfortable, especially after being worn for long periods of time. They more easily retain heat and apply pressure on the face.
  • Some people find it difficult to breathe when using these masks and so they are not recommended for individuals with both respiratory and/or cardiac history.
  • Though more accessible now than at the start of the pandemic, the cost of these masks makes them not so accessible for some. It is much cheaper and easier to find a surgical mask.
So, what then is a good mask?
Masks capable of higher filtering efficiency are best at protection against COVID-19 but considering the fit of your mask is of most importance. Multi-layer cloth masks have also been shown to have similar filtration efficiency as a KN95 mask. Good masks fit close to the face and do not have gaps. You should feel comfortable wearing the mask of your choice for long periods of time and doing so consistently. Even removing your mask for a few seconds is enough time for transmission of particles and possible infection. Whether you choose to wear an N95, KN95 or double layer with a surgical mask and cloth mask on top, all options are only as effective as their fit. These masks all present with adjustable nose wires to ensure a better fit. Per the Department of Public Health Commissioner, Dr. Allison Awardy, the most protection one can offer themselves and others is to either double up with a surgical and cloth mask or use a KN95 mask alone.
Image 2: Bloomberg, Confused About Masking? It's Time to Get Tactical, accessed 1/14/2022
History:
Back in May of 2021, the CDC said that immunized people no longer needed to wear masks in most settings but rises in the Delta variant reinstated the initial recommendation for overall mask use, vaccinated or not. Prior to the most recent update from the CDC this January, and emergence of the Omicron variant in November, it was previously advised that all individuals ages 2 and up regardless of vaccination status wear masks while indoors or in public spaces. In an interview on January 12, 2022, Director of the CDC, Rochelle Walensky said that the agency would update its masking guidance to better reflect the options of masking available and their different levels of protection. On January 14, 2022, the consumer webpage was updated with descriptions of the different types of masks to prevent transmission, noting that some masks provide better protection than others.

Do keep in mind that with new findings and consistent research, recommendations from the CDC, health care officials and medical professionals at large will change. The CDC itself provides recommendations but enforcement of such advice is completely up to state and local governments, employers and local business.

“Safety doesn’t happen by accident”. If we all do our part to mask up in the most effective ways, hopefully we can soon put this pandemic behind us.

“Safety is not an intellectual exercise to keep us in work. It is a matter of life and death. It is the sum of our contributions to safety management that determines whether the people we work with live or die.” – Sir Brian Appleton
Image 3: Bloomberg, Confused About Masking? It's Time to Get Tactical, accessed 1/14/2022
Resources used to answer this question:
Article: Omicron SARS-CoV-2 variant: a new chapter in the COVID-19 pandemic [published correction appears in Lancet. 2022 Jan 8;399(10320):142]. Lancet. 2021;398(10317):2126-2128. doi:10.1016/S0140-6736(21)02758-6, accessed 1/14/2022, www.thelancet.com
Article: Face masks effectively limit the probability of SARS-CoV-2 transmission [published online ahead of print, 2021 May 20]. Science. 2021;eabg6296. doi:10.1126/science.abg6296, accessed 1/14/2022, https://pubmed.ncbi
Article: Optical microscopic study of surface morphology and filtering efficiency of face masks. PeerJ. 2019;7:e7142. Published 2019 Jun 26. doi:10.7717/peerj.7142, accessed 1/14/2022, https://pubmed.ncbi
Webpage: NBC Chicago, CDC Updates Mask Guidance: Here’s Which Best Protect From COVID-19, accessed 1/14/2022, https://www.nbcchicago.com
Webpage: Bloomberg, Confused About Masking? It’s Time to Get Tactical, accessed 1/14/2022, https://www.bloomberg.com Webpage: CDC, Your Guide to Masks, accessed 1/14/2022, https://www.cdc.gov
Webpage: CDC, Types of Masks and Respirators, accessed 1/14/2022, https://www.cdc.gov
Webpage: CDC, Improve How Your Mask Protects You, accessed 1/14/2022, https://www.cdc.gov
Webpage: FDA, N95 Respirators, Surgical Masks, Face Masks, and Barrier Face Coverings, accessed 1/14/2022, https://www.fda.gov
Webpage: CNN, Why Experts Recommend a N95 Mask to Stop COVID Spread, accessed 1/14/2022, https://www.cnn.com Webpage: Cnet, Busting 8 COVID-19 Mask Myths That Are Putting Americans At Risk, accessed 1/14/2022, https://www.cnet.com
Webpage: Bloomberg: Should I Be Wearing an N95 or KN95? Understanding the Evolving Advice on Masks, accessed 1/14/2022, https://www.bloomberg.com\
Webpage: TIME, An N95 is the Best Mask for Omicron. Here’s Why, accessed 1/14/2022, https://time.com
Team Member Introduction: Who am I and Why do I COVID Care?
My name is Shay Guthrie, I am an M1 at Wright State Boonshoft School of Medicine. I was pregnant with my son when the Covid Vaccine was made available and I could not get it fast enough. Though I was nervous because pregnant people were left out of the vaccine trials, I trusted the scientists and my physicians who recommended I get the vaccine to protect my life and to pass antibodies to my unborn child. I wanted to take part in this because I have seen how the spread of mis-information and dis-information can negatively impact people’s health and I wanted to do what I could to combat the problem. My goal now and as a future physician is to be a safe/non-judgmental person that patients can ask all of their questions to and to provide them accurate and trustworthy information.

Question I am answering: What is going on with Vaccines for children under Five?
Take Home Points:
  • Pfizer is now testing a third dose of the series for kids under 5 yrs.
  • Moderna hopes to release their data for kids 2-5 in March 2022.
  • Most kids still have milder symptoms than adults but that is not guaranteed. Use masks (both kids and adults) and make sure people around your kids are vaccinated.
  • It is critical to keep children up to date on all of their vaccinations from newborn-5 years old.
More of the Story:
In December 2021 parents of children under 5 yrs old got some disappointing news regarding the fight against COVID. Pfizer released data stating the 3μg 2-dose series did not provide high enough levels of protection for kids aged 2-5, but non-inferiority (product is not worse than the comparator by more than a small pre-specified amount) was met for kids 6 months-2 years. Pfizer has changed the trial to test a third 3μg dose and hopes to submit for an Emergency Use Authorization in the first half of 2022.

Moderna is expected to release their data for children 2-5 years old in March of 2022, and if indicated they will move forward with regulatory filings.

Pfizer’s news was devastating to hear for me as a parent of two kids in this age group, especially with how contagious the Omicron variant is. While children have mild infections, there are many that end up in the hospital due to COVID. The scary thing is there is no way to tell if your child will have a mild or severe illness. So what can parents of kids this age do to protect their kids?
1. Make sure you and everyone in close contact with your children are vaccinated.
2. Stay home when possible and if it is not possible, continue to wear masks.
3. When out and about, practice hand hygiene and try to keep your children from touching hi-touch surfaces. (I know, easier said than done).
4. Continue making sure our children are up to date on ALL their vaccinations! This pandemic has disrupted a lot of standard preventative care and we need to catch everybody up on other vaccine-preventable diseases too!
Image from National Foundation for Infectious Diseases nfid.org/KeepUpTheRates
Resources used to answer this question:
News Release: Pfizer; Pfizer and Biontech Provide Update On Ongoing Studies Of Covid-19 Vaccine, accessed 1/15/2022, https://www.pfizer.com/news/press-release/press-release-detail/pfizer-and-biontech-provide-update-ongoing-studies-covid-19
News Release: Moderna; Statement On Covid-19 Vaccine Clinical Studies In Children & Adolescents, accessed 1/15/2022, https://investors.modernatx.com/Statements--Perspectives/Statements--Perspectives-Details/2022/Statement-on-COVID-19-Vaccine-Clinical-Studies-in-Children--Adolescents/default.aspx
Article: Dayton Children’s Hospital, Omicron Covid And Children Under 5 - What Should Parents Do?, accessed 1/15/2022, https://www.childrensdayton.org/the-hub/omicron-covid-and-children-under-5-what-should-parents-do
Website: CDC Vaccines for your Children, The Journey of Your Child’s Vaccine, accessed 1/23/22. https://www.cdc.gov/vaccines/parents/infographics/journey-of-child-vaccine.html
Website
Facebook
Instagram
Email
Copyright © 2022 Wright State University Boonshoft School of Medicine Global Health Scholars Program, All rights reserved.


Want to change how you receive these emails?
You can update your preferences or unsubscribe from this list.

Email Marketing Powered by Mailchimp