Dr. Bow Tie
COVID-19: Nails In Coffins (Not All Figuratively)
Last week we discussed the politicization of healthcare and how that has contributed to the extended duration of the pandemic. A few studies and stories have come out recently that shoot off that topic. Some of these really ought to be the final word on some topics that keep cropping up, but...I also thought those topics ought to have been put to rest months ago. So let's dive in: IVERMECTIN...AGAIN A study published in JAMA last week looked at ivermectin in early/mild COVID-19. It is one of many, MANY studies that have been conducted on ivermectin because despite what conspiracy theorists and disinformation-mongers keep trying to say, we in the healthcare community would LOVE to be able to repurpose an already-available and inexpensive medication against the worst pandemic of our lifetime. However, as with all of the better-designed trials with ivermectin (and hydroxychloroquine before it), no benefit was shown. There were increased adverse effects, though. This really ought to close the door on the ivermectin question. Still, I get it. Most families asking for ivermectin (those that aren’t threatening healthcare workers over it) are, as my colleague Mark Shapiro puts it on Explore the Space, asking out of desperation; their loved one is dying and they seek any glimmer of hope possible. But the question of “so what’s the harm in giving it” overlooks the fact that ivermectin is not a benign medication when used in anything but the small doses required for treatment of parasitic infections for which it actually works. It can cause significant harmful effects that can worsen an already rough situation. The catchy memes and snake oil salesmen (some of whom misuse their medical degrees to seize on desperation) don’t mention that, though.
PFIZER ADVERSE EVENT DOCUMENT
Pfizer has responded to FOIA requests to release data on adverse events from its initial trials (so adverse events that occurred in both vaccine and placebo groups). Ed Nirenberg of Deplatform Disease did an amazing Tweet thread/article putting it into context. Long story short, anti-vaccine advocates are trying to tout it as a victory but when you examine the documents:
Most of the adverse events are self-reported, and they are reported without proof of causation (Similar to VAERS).
Some of the lists/tables being touted as adverse drug reactions by anti-vaccine advocates are not actually reported at all, they were just cited as examples of what to watch for!
People tried to claim that this was some tell-all document, and they tried to claim that it was a "gotcha" moment by taking things out of context. Really, it proves that there were a remarkably low number of serious adverse events amid literal MILLIONS of doses. The risk of vaccines remains far lower than the risk of COVID-19 itself on health, the economy, schools, and society.
This is a small summary, but I'll link to Nuremberg’s in-depth analysis below.
MASKS IN SCHOOLS
I talked last week about how frustrated I was with the CDC’s new guidelines and how it was a repeat of Spring 2020, abandoning masks prematurely without enough other preventative measures in place, such as air filters in crowded workplaces/schools/public transport, vaccine requirements outside of healthcare, and vaccines for kids under 5, to name a few. Even now, two years into this pandemic, I still have people in my comment sections claiming masks don’t work, usually based on an all-or-nothing nirvana fallacy.
The answer, of course, is that masks absolutely do work, but like any other intervention, pharmaceutical and not, against COVID-19, they are not 100% effective, but a layer of protection. Two studies just came out further proving that point:
The first, a study published by the American Academy of Pediatrics, looked at over 1 million students and >150,000 school staff in 61 school districts (K-12) across 9 states - an impressive group! They compared universal masking vs. partial and/or optional masking policies. From the paper: "Districts that optionally masked throughout the study period had 3.6 times the rate of secondary transmission as universally masked districts...Universal masking was associated with a 72% reduction in secondary transmission compared with optional masking."
The next, published in CDC's regular Morbidity & Mortality Weekly Report (MMWR), looked at school districts across Arkansas, with similar variation in mask policies. Districts with full mask policies saw 23% lower incidence of COVID-19 cases compared to districts without a mask policy. Many of the no-mask-policy districts adopted a mask policy partway through the time of the study, and case incidence decreased significantly!
Now, both studies acknowledge some limitations, and both took place during peak Delta time, pre-Omicron, but these are still another layer of evidence among the many studies I have shared proving the importance of masking during this pandemic. Mileage may vary, but the principle is soon: consistent and collective masking WORKS.
We are rapidly approaching one million American deaths due to COVID-19. That death rate has slowed down somewhat, but not nearly enough. Of those, 1,300 have been children. The children who, supposedly, are not affected by this virus, have died in numbers enough that COVID has climbed to one of the leading causes of death among children in the USA. To continue the allegory in this piece’s title, that is 1,300 small coffins, many of which could have been avoided if more people had gotten vaccinated and worn masks more consistently. That's a TERRIBLE image and every parent I know hated reading that sentence, but that's honestly how bad this pandemic is, and that does not get into the many adults and children surviving with persistent effects of long COVID.
(And if you’re still asking if they died “from“ or “with” COVID or focusing on comorbidities (which weren’t present in 63% of pediatric COVID hospitalizations), you need to go back and read my previous posts, or stop being disingenuous.)
We are not at the end of the pandemic. BA.2 is causing increased cases in the UK and Hong Kong (the latter of which has had low vaccination uptake and is suffering terribly), which means the US is probably not far behind. Vaccines and masks remain a part of our lives and until serious protective changes are made to our society's structure (because COVID-19 should change us and our culture), they will continue to be that way. Contribute to public health if you want to safely use public spaces. I welcome your questions.
What really ought to be the final Ivermectin-in-COVID-19 study:
Ed Nirenberg’s thread:
Masks In Schools: https://publications.aap.org/pediatrics/article/doi/10.1542/peds.2022-056687/185379/School-Masking-Policies-and-Secondary-SARS-CoV-2
AAP News discussing that paper: https://publications.aap.org/aapnews/news/19741/Study-In-school-COVID-spread-reduced-by-72-with
CDC MMWR: https://www.cdc.gov/mmwr/volumes/71/wr/mm7110e1.htm