Covid: You Again?
November 9, 2020
As predicted, the second wave of Covid-19 infections has come to the Untied States and Europe, mostly due to pandemic fatigue rather than any epidemiological phenomenon. While Japan is seeing a modest resurgence of the virus, the rest of Asia has been able to avoid the same fate, largely because of a more homogeneous adherence to anti-Covid public health protocols and advanced contact tracing.
Here in the West, the illogical, prejudicial and unscientific public health strategies that were strangling small businesses and personal freedoms were finally abandoned by a growing segment of the populace. Rather than cooperate in the development of safe and workable solutions for schools, businesses, and gatherings, our political leaders (at all levels) either opened their economies without regard to upgrading viral transmission management or attempted to maintain an unnecessary choke-hold on the small businesses that are the lifeblood of the economy.
In the nine months of the US Covid pandemic, much has been learned about how Covid is spread, some has been learned about how to treat the virus, and virtually nothing has been learned by the World’s leaders on how to use the emerging data to keep people safe.
Since the pandemic’s beginning, my office has safely stayed open and has successfully treated hundreds of Covid patients using ‘Bedside Medicine’. Bedside Medicine is a treatment strategy that offers personalized medicine to individual patients based on three guiding principles: (1) Safety; (2) Plausibility; (3) Limited scientific evidence. As with Covid-19, in the absence of sufficient or effective, regulatory-approved therapeutics, a treating physician can offer a patient access to a safe therapeutic in which the downside risks are outweighed by the upside potential. Additionally, there should be a plausible mechanism of action that explains why this unconventional treatment could work. And, finally, there should be some indirect scientific evidence that the therapy has a reasonable chance of working as hoped.
Contrary to ‘Bedside Medicine’, ‘Academic Medicine’ is a practice that waits for a consensus of validated scientific evidence before taking action or making recommendations. Developing a consensus takes time as rigorous studies are initiated, conducted, completed and digested. In a fast moving disease process like Covid, many patients were allowed to die while waiting for this consensus, which as of this writing, still has precious little to offer Covid patients. ‘Academic Medicine’ is important for the long term advancement of medical practice and represents the gold standard of medical care. But in the setting of a rapidly advancing pandemic, the best ‘standard’ is the one that can save the patient in front of you.
The choice has always been clear: allow and encourage physicians to make safe, plausible, scientific bets to save lives or helplessly watch the world bury its victims while waiting for a consensus. By definition, ‘progress’ is never conventional. When we allow the labeling of unconventional as ‘misinformation’ and allow the cancelling of those who are unconventional, we should not be surprised that progress stops and people die. Instead, we should collectively ask ourselves to whom are we giving away our power to decide between ‘misinformation’ and ‘progress’? Your life and those of your loved ones may depend on the answer.
As it is said: those who say it cannot be so, should step aside for those who are already doing it.
Some five months ago, I developed Covid conjunctivitis after taking a respiratory droplet to the eye when treating a Covid patient with a cough. When examining my patient, I was wearing a proper mask, but not eye protection which was entirely my oversight. Fortunately, the same multi-dimensional anti-Covid ‘Bedside Medicine’ that I use for my patients worked the same for me. Now, I have my Covid-19 antibodies and the protection that these immune proteins afford.
At my office, this anti-Covid strategy has been 100% successful in treating all of our infected patients. I do not share this with you to impress you, but rather to impress upon you that Covid-19 is treatable. Covid is easiest to treat when patients with first symptoms get tested and treated early. As with most things, the timing is as important as the therapy itself, and none more so than Covid-19.
From the very beginning of this pandemic, I stated that Covid-19 was preventable, containable, and treatable. After nine months, I can report that this is still accurate, and the readers of these frontline reports know this to be true as well. What follows are my latest observations and recommendations on how to stay safe for the duration of this pandemic…which is going to be awhile.
As I said in March, follow my advice on how to survive this pandemic, and I assure you that you will be around for the next one.
Unlike the two prior corona virus pandemics, SARS1 and MERS, Covid-19 is far more contagious. Not since measles, has medicine experienced a virus this contagious. But every person who is infected, provides this virus the opportunity to mutate, to genetically try something different. Sometimes these mutations are bad for the virus, and sometimes these mutations are bad for the patient. According to the latest research, Covid-19 is mutating about every two weeks.
From the frontlines, I can report that Covid-19 does appear to becoming even more contagious, but less virulent. For the past two months, I am seeing more cases but patients are generally less ill. Hospitalization rates and deaths remain lower than expected for the number of people getting infected. Part of this success is also due to our improved therapeutics and a healthier population becoming infected. I said early on that it was generally not as important how many people get infected but who gets infected. If you fall into one of the three ‘O’ categories. (Older, Overweight, Other medical problems), then you are still at significant risk with this virus, and must take greater precautions than the general population of healthy people.
As Covid-19 rapidly mutates, there are concerns that Covid-19 may not fade like SARS1 and MERS, but rather transition to become a persistent viral threat like the seasonal flu. Typically influenza travels the globe each year, starting in Asia, working its way across the US, then onto Europe, and back to Asia. By the time the seasonal flu makes it back to your home town one year later, it is no longer the same virus, and the antibodies you developed against last year’s strain (from a vaccine or infection) will not stop you from getting the flu this year. We all know that last year’s flu shot will not protect us against this year’s strain.
An important clue as to whether Covid-19 will become a perennial threat are the numbers of patients who are getting Covid-19 for a second time. A patient who contracts Covid a second time has either picked up a second strain or never developed a persistent antibody response to protect them from future exposures.
Two weeks ago, I saw my first patient get a second case of Covid-19. I helped this patient through a Covid-19 infection in March, then after traveling, my patient picked up another case of Covid-19. This patient did not develop antibodies after the first infection in March. While anti-Covid antibodies are known to be important in defending patients from recurrent infections, scientists also thought that other back-up immune responses (such as immune ‘memory’ cells as opposed to protein antibodies) could protect patients from a second infection. Well, maybe not.
Boomerang Covid infections still seem to be quite rare, though as the pandemic drags on and Covid mutates, we may start to see more of these cases soon. Repeat Covid infections would be an unwelcome harbinger of Covid becoming a perennial virus, and cast doubt as to whether a vaccine against Covid-19 would protect the populace from Covid-20, 21, etc.
So far in the scientific literature, there are only a handful of documented cases of Covid reinfections. Most of these have occurred in persons that were intercontinental travelers and picked up a genetically distinct strain of Covid during their travels to other countries. Fortunately, the majority of these boomerang Covid cases were either mild or asymptomatic. Two required hospitalization. All survived.
Even though I still have my coveted Covid antibodies, seeing a patient with a boomerang Covid infection gave me pause and redoubled my efforts to be more careful and less cavalier with the virus. For all of us worldwide on the Covid frontlines who are treating Covid patients on a daily basis, there have been no reports of any of us contracting the virus a second time. Since we assist patients without knowing which Covid strain they have, the lack of boomerang infections in healthcare workers suggests that these reinfections remain uncommon in the general populace as well.
Let’s say that the car industry had a shortage of the nylon material necessary to make seatbelts. What if they told you not to worry, that anything resembling a seatbelt would be just fine. What if they asked you to just look around your house; maybe you have some extra cardboard lying around. Why don’t you simply cut it into 2 1/2 inch ribbons. Then, use some tape or staples, and build yourself something that looks like a seatbelt. As long as it has the shape of a seatbelt, you would be considered as having fulfilled the mandate to always wear your seatbelt when driving.
How safe would you feel driving that car on a freeway?
Well, the same analogy applies to masks as PPE. We have been told (and mandated) to wear masks, and that any face covering, made of any material will do. As long as we cannot see your nose and lips, you are officially fulfilling your civic duty, protecting yourself and those around you.
I have warned from the beginning that cloth masks will not protect the wearer or the public from Covid. The virus is so small that it can easily sail right through the open weave of a cloth mask. Cloth masks are no more effective at keeping Covid in your mouth than a chain link fence is effective at keeping ticks out of a yard.
So, what does ‘science’ say about cloth masks and nylon neck gaiters? As late as 2015, scientific reports studying the effectiveness of cloth masks in protecting hospital workers from the respiratory infections of their patients found that cloth masks were worse than wearing no mask at all. Yes, worse than no mask at all. Turns out that the cloth masks get moist and dirty which is a fantastic breeding ground and shelter for all kinds of viruses and bacteria.
In September 2020, the Centers for Disease Control (CDC) published a report documenting that over 70% of patients who contracted Covid-19 acknowledged always using a cloth mask or face covering when in public spaces in the 14 days leading up to their infection. The CDC report goes on to say that ‘direction, ventilation and intensity of airflow might affect virus transmission, even if social distancing measures and mask use are implemented according to current guidance.’
Ok, so cloth masks don’t work (or worse, increase likelihood of infectious diseases transmission). But what about surgical masks?
Traditional medical masks are constructed very differently from cloth masks. A medical mask is composed of three layers: two outer, synthetic woven layers and a center panel made of melt-blown polymers. These polymer panels filter out particles that are the size of viruses. This means that they greatly reduce the forward spread of infectious material and can reduce viral throughput by about 40%.
Nylon gaiters are also worse than wearing no mask at all. Rather than trap large respiratory droplets on the inside of the gaiter, studies show that the material in these facial coverings break up large droplets into smaller, more contagious droplets that can travel farther and infect people at a greater distance. Nice.
If any old face covering worked, then we would not be seeing spiking cases in France, England, Spain, Germany and Italy all of whom have had nationwide mask mandates since Summer 2020. The same is true of states like California which have had ineffective mask mandates in place for months. Would the spiking be worse without cloth masks? Not according to the science.
Seatbelts save lives. Masks can also save lives, but the materials you use to build seatbelts and masks really do matter.
In the era of PPE shortages, science has also taught us how to build a better mask, one that is or is nearly equivalent to the N-95 standard that protects frontline healthcare workers.
To create a mask that is 90% as good as an N-95 mask, do the following:
- Place a dried (unused, please) baby wipe between two cloth masks that are secured to your face. Baby wipes are made of similar melt-blown polymers that are found in medical masks.
- Use a nylon gaiter to press the two masks and dried baby wipe to your face, reducing any gaps between your facial skin and the masks. Any significant facial hair that keeps the masks from securely sealing to your face will significantly reduce the effectiveness of any PPE.
To create a mask that is 100% as good as an N-95 mask, do the following:
- Place a piece of surgical sterile wrap between two cloth masks that are secured to your face. The material used to wrap surgical equipment before it is placed in an autoclave is also made of similar melt-blown polymers that are found in medical masks. However, sterile medical wrap is thicker and even more effective at filtering particles which are the size of viruses and bacteria as compared with a dried baby wipe. Medical wrap is widely available online.
- Again, use a nylon gaiter to press the two masks separated by the sterile medical wrap to your face, reducing any gaps between your facial skin and the mask assembly. Once again, any significant facial hair that keeps the masks from securely sealing to your face will significantly reduce the effectiveness of any PPE.
Cost estimates for making a mask using only medical wrap are about thirty cents per mask. That’s pretty cheap insurance that nearly everyone can afford.
Telling the world that any mask is better than no mask is simply not following the science that has been available for at least five years. Ineffective masks also give wearers the false security that they have some magical protection from getting and giving the virus.
You should no sooner drive in a car with cardboard seatbelts than leave your home wearing an equally ineffective mask. It is long past time of pretending that any facial covering will do, and time to teach people how to D-I-Y a truly effective PPE solution…that’s backed by science.
Clearing the Air
Before Covid reached the US, I anticipated the need to control indoor air contagion and placed fifteen, medical grade air scrubbers throughout my office. Honestly, I saw these air filters as a backup solution to good hand washing which I thought was paramount in defending myself, my staff, and my patients from contracting Covid-19. I underestimated the contagious potential of viral spread through the air, thinking instead that we could be mostly protected from the virus by never touching our faces or food without well sanitized hands.
Despite this over reliance on the importance of hand washing, the presence of air scrubbers in my office has been of equal or greater value in keeping my staff and my patients safe from Covid. To date, none of my staff nor any of my patients have contracted Covid from my office. Stand nearly anywhere in my office and you can feel the indoor breezes of purified air blowing past you.
Since early April, I have been vigorously promoting the effectiveness of air filters as a primary public health tool. After our US manufacturing complex stopped making ventilators, they should have immediately switched to making medical grade air scrubbers. These could then have been privately purchased and installed by the millions of small businesses, office buildings, restaurants, and retail shops to keep their indoor spaces as safe as the outdoors.
In previous writings, I have illustrated the scientific papers documenting the effectiveness of air purifiers at removing Covid-19 from indoor spaces, particularly hospital settings where viral contagion levels are higher than anything a small business or office complex would likely encounter.
Controlling indoor air quality is especially important as we get deeper into fall and approach the holidays. The need to spend more time indoors and the intense longing for connection with friends and family are driving the narrative on how to do both safely, given that Covid is currently more infectious and pervasive than ever.
Here are the Bottom Line safety recommendations from the real scientists and those of us on the frontlines:
- We must still arduously protect those of the Three O’s (Older, Overweight, Other medical problems – diabetes, severe lung disease, heart disease, immune compromise).
- What grandma really needs for Christmas this year is a roll of sterile medical wrap (I’m told they make great stocking stuffers). And leave one for Santa, next to the cookies; he’s good for at least two of three of the O’s.
- Build better masks for those who are most vulnerable and for those who visit the vulnerable. The vulnerable should also wear face shields or protective goggles when venturing out or letting others into their bubble.
- At your gatherings, have some extra dried baby wipes, sterile medical wrap, masks and gaiters so that everyone can have proper PPE to protect themselves and those around them. Wear these better masks anytime you are going somewhere and are concerned about the safety and cleanliness of the indoor air quality. America now knows how to wash her hands of Covid-19, but needs to put the same attention on breathing virus-free air.
- When someone asks a holiday host what to bring to the gathering, tell them to skip the jello-mold and instead bring over their home air filter. If everyone brought at least one air scrubber (with a brand new filter), there would likely be enough units to clean the indoor air of any viral contagion. Don’t forget about the guest bathroom, kitchen, hallways, and other tight spaces with limited air circulation.
Sadly, the threat of Covid is not lower, only our collective resolve to keep fighting it. However, working together, we are stronger than this virus.
Intelligently applied, science can help keep you safe.
Freely expressed, Bedside Medicine can help keep you alive.
Michael Hirt, MD