COVID-19: A musing for the detractors of masking and vaccination (9 April 2021)
There is a popular trend on social media in which people who refuse to wear masks or get the COVID vaccine portray themselves as brave non-conformists and denigrate those of us who do these things as timid, gullible sheep being manipulated by a would be puppet master with nefarious intent. Although I understand that people may have become confused and skeptical because of shifting guidelines during the pandemic (vis-à-vis the virus’s route of transmission and the utility of various preventatives and therapeutics) or that they may have reservations about an expedited novel vaccine, the fact of the matter is we are essentially building an airplane in mid-flight, and conforming guidelines as data emerges is the very nature of applied science (As Jules Verne wrote: “Science, my boy, is made up of mistakes, but they are mistakes which it is useful to make, because they lead little by little to the truth”). Would that we could have known from the beginning whether or not the virus is spread as an aerosol, whether hydroxychloroquine is effective, and whether masking is protective. However, the answers to such scientific questions are rarely readily apparent. Hypotheses must be formulated and tested; results must be interpreted and reconciled; and conclusions must withstand the tincture of time. We know far more about this virus now than we did a year ago and presumably, we will know still more one year hence. Nous sommes au bord des mystères et le voile s’amincit de plus en plus.
On the matter of COVID vaccines, detractors claim that the constructs were rushed, and corners were cut, and that anyone who gets vaccinated is a guinea pig. Some also invoke a conspiracy à la Montgomery Burns to implant tracking devices or change the composition of our genetic code. To be clear, although vaccine development was expedited, none of the critical steps were omitted. Each of the vaccine candidates was vetted through clinical trials involving tens of thousands of volunteer participants before being granted Emergency Use Authorization by the Food and Drug Administration; and as with any medical preventative or therapeutic, post-marketing surveillance is ongoing. There are several factors that contributed to the rapid development of the COVID vaccines, none of which have to do with safety or efficacy. Among these is the Accelerating COVID-19 Therapeutic Interventions and Vaccines (ACTIV) initiative of the National Institutes of Health (NIH). Confronted with myriad pre-clinical and clinical studies, all of which were competing for volunteer participants, and most of which would not advance to market, ACTIV intended to bring the NIH together with other agencies in the Department of Health and Human Services as well as the Department of Defense (DOD), Department of Veterans Affairs (VA), the European Medicines Agency (EMA), and representatives from academia, philanthropic organizations, and more than 15 bio-pharmaceutical companies in order to: 1) develop a collaborative, streamlined forum to identify pre-clinical treatments; 2) accelerate clinical testing of the most promising vaccines and treatments; 3) improve clinical trial capacity and effectiveness; and 4) accelerate the evaluation of vaccine candidates to enable rapid authorization or approval. In short, ACTIV aimed to “establish a collaborative framework for prioritizing vaccine and therapeutic candidates, to streamline clinical trials and tap into existing clinical trial networks, and to coordinate regulatory processes and leverage assets among all partners”.
As for Bill Gates, who is popularly implicated in conspiratorial theories surrounding the COVID vaccines, I will say that while I don’t know him personally, I have no reason to question his motives or to impugn his character. Moreover, I do know that the Bill and Melinda Gates Foundation has donated billions of dollars to fund research combatting infectious diseases such as malaria, onchocerciasis, and dracunculiasis (over $50 billion since 1994 and $589 million in 2019 alone). My impression is that he recognizes that he has an ethical responsibility to leverage his wealth towards improving the Human condition; and in my opinion, for this he should be lauded, not vilified.
With regard to masks, people are understandably confused by shifting recommendations and frankly, tired of wearing them; and many are asking why, if the vaccines are indeed effective, we need to continue masking. There are several reasons why masking is still recommended. For one, full protection isn’t achieved until two weeks after the vaccination regimen is complete. Thus, individuals who are status post only one shot of either the Pfizer or Moderna construct and even immediately status post the second are not yet fully protected. Additionally, most of the studies that measured protection looked at clinical COVID, and not infection. Thus, while we assume that vaccinated individuals are also protected against asymptomatic infection, it is an assumption, and the definitive studies are still pending. Another reason for continued masking is that once people begin doffing their masks, for whatever reason (e.g. vaccination), everyone will follow suit, making it impossible to discern who still needs to mask and also making it impossible to enforce the masking requirement for unvaccinated individuals. Moreover, the significance of the emergence of variant strains has yet to be determined. If a vaccine-resistant variant (such as the South African variant) becomes prevalent, the protection conferred by the vaccines will be diminished. Lastly, think of the mask as a layer of swiss cheese. Alone, it is porous; however, when stacked against other layers (here, vaccinating and social distancing), the block of cheese becomes impermeable. Frankly, until enough people have been vaccinated, it is prudent not to rely solely on a single intervention. Indeed, the recent uptick in the incidence of COVID-19 nationally is being attributed to loosening restrictions and wholesale relaxed compliance with pandemic precautions. For whatever it’s worth, as an infectious diseases physician, I was wearing surgical masks long before this pandemic began and will no doubt be doing so long after it abates.
Lastly, I would inform the COVID skeptics that I didn’t get vaccinated for myself; nor do I wear a mask for myself, as I’ve already had COVID-19. Rather, I do these things for my elderly parents and for your parents, and for my patients, and for others who might not be as resilient as I am. If the vaccines and the masks are truly ineffective, then at worst, I’ve been inconvenienced. However, if they confer even a modicum of protection, then I’ve contributed something to the welfare of others. Perhaps it’s worth recalling the words of former vice president Hubert Humphrey at the dedication of the Hubert Humphrey Building on 1 November 1977 in Washington, D.C.: “The moral test of government is how that government treats those who are in the dawn of life, the children; those who are in the twilight of life, the elderly; those who are in the shadows of life, the sick, the needy and the handicapped.”
As with my prior COVID-19-themed posts, my intention here is not to politicize, sensationalize, or trivialize the pandemic, but only to provide information and thoughtful commentary.
Until my next update — regards.
Michael Zapor, MD, PhD, CTropMed, FACP, FIDSA
(9 April 2021)
