This is an excerpt from Second Opinion, a weekly roundup of eclectic and under-the-radar health and medical science news emailed to subscribers every Saturday morning. If you haven’t subscribed yet, you can do that by clicking here.
A growing chorus of experts is calling for the widespread use of masks to slow the spread of COVID-19 and suggesting it may be a key factor in why some countries seemingly have their outbreaks under control while others are completely overwhelmed.
The World Health Organization does not officially recommend the general public use masks as a way to reduce spreading the virus, only saying that if they do decide to use masks, they should do so “safely and properly.”
“We encourage countries that are considering the use of masks for the general population to study their effectiveness, so we can all learn from their experience,” a spokesperson for WHO said in a statement to CBC News.
“Currently, there is insufficient evidence for or against the use of any type of mask among healthy people in public settings. As new information and evidence about masks and non-medical masks emerges, WHO will update existing guidance.”
WHO does recommend medical masks, respirators and other personal protective equipment (PPE) in health care settings, but says only people who are sick or caring for a sick person at home should use them in the community.
WATCH | An epidemiologist explains why masks are effective for asymptomatic carriers
‘The point of the mask,’ says Christopher Labos, ‘is to protect others from you,’ especially if you are an asymptomatic carrier of the virus. 2:58
“Masks alone cannot stop the pandemic. Countries must continue to find, test, isolate and treat every case and trace every contact,” WHO Director-General Tedros Adhanom Ghebreyesus said earlier this month.
“Mask or no mask, there are proven things all of us can do to protect ourselves and others: keep your distance, clean your hands, cough or sneeze into your elbow, and avoid touching your face.”
WHO’s recommendations on masks not ‘logical’
But the specific language WHO uses has come under fire from experts who suggest that even non-medical masks could be beneficial in curbing the spread of the virus — or, at the very least, couldn’t hurt.
Babak Javid, a professor at the Tsinghua University School of Medicine in Beijing and a consultant in infectious diseases at Cambridge University Hospitals in the U.K., thinks there’s a double standard in WHO’s messaging.
Yes, he says, “there’s no direct evidence that masks can prevent transmission.”
“But there’s no direct evidence that hand-washing can prevent the transmission of COVID or lockdowns can prevent the transmission of COVID because none of those trials have ever been done in the context of COVID.”
One infectious disease expert says WHO’s recommendation on masks doesn’t take into account the significant number of asymptomatic or pre-symptomatic carriers of the virus in the general population. (Evan Mitsui/CBC)
Javid said there is a “logical gap” in WHO’s recommendation, because it doesn’t take into account the significant number of asymptomatic or pre-symptomatic carriers of the virus in the general population, also known as “silent spreaders.”
Asymptomatic carriers are those who show no symptoms, while pre-symptomatic carriers are people who have not yet displayed symptoms — usually in the first few days of infection.
“What I think is indisputable is that the face covering can reduce the amount of both droplets and virus that we can transmit,” he said.
Research on virus’s spread suggests masks could help
Emerging research has revealed more about how the virus spreads from person to person, suggesting it doesn’t just transmit through coughing but also through simply talking.
A U.S. National Institutes of Health study published as a research letter in the New England Journal of Medicine this week provided visual evidence that “speech-generated droplets” can become suspended in the air and inhaled by other people, potentially exposing them to viruses like the one responsible for COVID-19.
That provides some preliminary evidence that the potentially deadly coronavirus, also known as SARS-CoV-2, could be transmitted between people just by speaking normally.
Emerging research has revealed more about how the virus spreads from person to person, suggesting it doesn’t just transmit through coughing but also through simply talking. (Evan Mitsui/CBC)
“There’s plenty of research showing that even just when we talk and breathe, we release these very small respiratory droplets, smaller than we can see,” said Dr. Linsey Marr, an expert in the transmission of viruses by aerosol at Virginia Tech in Blacksburg, Virginia.
“Masks really could help make a difference because they will — if you are sick without knowing it — block those droplets from flying into the air and then staying in the air or contaminating surfaces.”
A paper by researchers in China set to be published in July in the U.S. Centers for Disease Control and Prevention’s journal Emerging Infectious Diseases, found an infected individual without symptoms was apparently able to spread the virus to nine others at a restaurant in Guangzhou, China.
The direction the air-conditioning system was blowing may have helped transport the virus particles to other diners, who otherwise had no contact with one another, while those elsewhere in the restaurant who weren’t near the airflow didn’t get sick.
The study has limitations because the findings were not corroborated with experiments to simulate the airborne transmission. Still, the research is raising concern.
“That was pretty strong evidence for the potential that transmission is happening through these microscopic respiratory droplets that can stay floating in the air for a long enough time to kind of go back and forth over the tables,” Marr said.
Should masks be mandatory in public?
Last week, Transport Canada made it mandatory for all air passengers to wear non-medical masks or face coverings over their mouth and nose during travel.
Passengers on boats are “encouraged to wear non-medical masks or face coverings whenever possible,” while train or bus riders are also “strongly encouraged” to do the same.
The Public Health Agency of Canada says non-medical masks are ‘not a substitute for physical distancing and hand-washing,’ but can protect those nearby ‘even if you have no symptoms.’ (Evan Mitsui/CBC)
But the Public Health Agency of Canada only recently changed course on its recommendations to Canadians on the effectiveness of non-medical masks, previously saying masks should only be worn by health care workers.
“Wearing a non-medical mask is an additional measure that you can take to protect others around you,” Canada’s Chief Public Health Officer Dr. Theresa Tam said on April 6 — while warning that a non-medical mask doesn’t necessarily protect the person wearing it.
“A non-medical mask can reduce the chance of your respiratory droplets coming into contact with others or landing on surfaces,” Tam said. “The science is not certain, but we need to do everything that we can and it seems a sensible thing to do.”
PHAC also says non-medical masks are “not a substitute for physical distancing and hand-washing,” but can protect those nearby “even if you have no symptoms.”
Last week, Transport Canada made it mandatory for all air passengers to wear non-medical masks or face coverings during travel and ‘strongly encouraged’ passengers on boats, trains and buses to do the same. (Ben Nelms/CBC)
But some experts say that given that significant role asymptomatic and pre-symptomatic carriers of the virus play in the spread of the virus, Canada should be mandating the use of non-medical masks in public, the way other countries have.
“Public health officials are saying there’s no evidence that the mask is going to keep you from getting the disease, but I also think it’s important to recognize that absence of evidence is not evidence of absence,” said Dr. Joe Vipond, a Calgary emergency department physician.
“Even a small decrease in the risk of me getting the disease is still really important from a population level.”
Evidence from other countries
Asian countries that have successfully dropped their curve of new COVID-19 cases, like South Korea, Taiwan and China, all have widespread mask usage, while the Czech Republic recently implemented mandatory mask measures and saw case fatality rates drop, Vipond wrote in a recent op-ed for Maclean’s magazine.
There are numerous factors as to why a given country can become overwhelmed by the virus, including the onset of outbreaks, the accuracy of reporting, backlogs in testing, the age of the population and the effectiveness of containment measures.
But Javid said that while this is still just correlative evidence, it could be one reason why countries like Taiwan, which doesn’t have total lockdown measures in place but does have widespread mask usage, has a much lower incidence of COVID-19 than other countries like Sweden, for example, where masks are less commonly used.
Jeremy Howard, a University of San Francisco researcher and the co-founder of Masks 4 All, said Japan is another example of a densely populated region with widespread public mask wearing and low levels of COVID-19 despite not prioritizing physical distancing or testing compared with a place like New York.
“There’s all this evidence, which strongly suggests, as part of the suite of tools we have available, wearing a mask appears to be astonishingly powerful, and the cost is nearly zero,” he said.
“And when we compare the level of evidence we have to something like washing hands, it’s vastly, vastly, vastly, vastly higher.”
While masks are not a “magic bullet” in curbing the spread of the virus and more research still needs to be done on their effectiveness, Javid said they can be used in conjunction with other measures like physical distancing and widespread testing to slow the spread.
“To get over the COVID problem we’re going to need a multi-pronged approach. To me, what’s attractive about masks is that they’re cheap, they’re probably effective and they allow economic activity,” he said.
“We can’t stay in lockdown forever, so to me, the downsides are so minimal compared to the potential upsides.”
Some Ontario doctors have started offering a free shot that can protect babies from respiratory syncytial virus while Quebec will begin its immunization program next month.
The new shot called Nirsevimab gives babies antibodies that provide passive immunity to RSV, a major cause of serious lower respiratory tract infections for infants and seniors, which can cause bronchiolitis or pneumonia.
Ontario’s ministry of health says the shot is already available at some doctor’s offices in Ontario with the province’s remaining supply set to arrive by the end of the month.
Quebec will begin administering the shots on Nov. 4 to babies born in hospitals and delivery centers.
Parents in Quebec with babies under six months or those who are older but more vulnerable to infection can also book immunization appointments online.
The injection will be available in Nunavut and Yukon this fall and winter, though administration start dates have not yet been announced.
This report by The Canadian Press was first published Oct. 21, 2024.
-With files from Nicole Ireland
Canadian Press health coverage receives support through a partnership with the Canadian Medical Association. CP is solely responsible for this content.
ISLAMABAD (AP) — Polio cases are rising ahead of a new vaccination campaign in Pakistan, where violence targeting health workers and the police protecting them has hampered years of efforts toward making the country polio-free.
Since January, health officials have confirmed 39 new polio cases in Pakistan, compared to only six last year, said Anwarul Haq of the National Emergency Operation Center for Polio Eradication.
The new nationwide drive starts Oct. 28 with the aim to vaccinate at least 32 million children. “The whole purpose of these campaigns is to achieve the target of making Pakistan a polio-free state,” he said.
Pakistan regularly launches campaigns against polio despite attacks on the workers and police assigned to the inoculation drives. Militants falsely claim the vaccination campaigns are a Western conspiracy to sterilize children.
Most of the new polio cases were reported in the southwestern Balochistan and southern Sindh province, following by Khyber Pakhtunkhwa province and eastern Punjab province.
The locations are worrying authorities since previous cases were from the restive northwest bordering Afghanistan, where the Taliban government in September suddenly stopped a door-to-door vaccination campaign.
Afghanistan and Pakistan are the two countries in which the spread of the potentially fatal, paralyzing disease has never been stopped. Authorities in Pakistan have said that the Taliban’s decision will have major repercussions beyond the Afghan border, as people from both sides frequently travel to each other’s country.
The World Health Organization has confirmed 18 polio cases in Afghanistan this year, all but two in the south of the country. That’s up from six cases in 2023. Afghanistan used a house-to-house vaccination strategy this June for the first time in five years, a tactic that helped to reach the majority of children targeted, according to WHO.
Health officials in Pakistan say they want the both sides to conduct anti-polio drives simultaneously.
WASHINGTON (AP) — Millions of people with private health insurance would be able to pick up over-the-counter methods like condoms, the “morning after” pill and birth control pills for free under a new rule the White House proposed on Monday.
Right now, health insurers must cover the cost of prescribed contraception, including prescription birth control or even condoms that doctors have issued a prescription for. But the new rule would expand that coverage, allowing millions of people on private health insurance to pick up free condoms, birth control pills, or “morning after” pills from local storefronts without a prescription.
The proposal comes days before Election Day, as Vice President Kamala Harris affixes her presidential campaign to a promise of expanding women’s health care access in the wake of the U.S. Supreme Court’s decision to undo nationwide abortion rights two years ago. Harris has sought to craft a distinct contrast from her Republican challenger, Donald Trump, who appointed some of the judges who issued that ruling.
“The proposed rule we announce today would expand access to birth control at no additional cost for millions of consumers,” Health and Human Services Secretary Xavier Becerra said in a statement. “Bottom line: women should have control over their personal health care decisions. And issuers and providers have an obligation to comply with the law.”
The emergency contraceptives that people on private insurance would be able to access without costs include levonorgestrel, a pill that needs to be taken immediately after sex to prevent pregnancy and is more commonly known by the brand name “Plan B.”
Without a doctor’s prescription, women may pay as much as $50 for a pack of the pills. And women who delay buying the medication in order to get a doctor’s prescription could jeopardize the pill’s effectiveness, since it is most likely to prevent a pregnancy within 72 hours after sex.
If implemented, the new rule would also require insurers to fully bear the cost of the once-a-day Opill, a new over-the-counter birth control pill that the U.S. Food and Drug Administration approved last year. A one-month supply of the pills costs $20.
Federal mandates for private health insurance to cover contraceptive care were first introduced with the Affordable Care Act, which required plans to pick up the cost of FDA-approved birth control that had been prescribed by a doctor as a preventative service.
The proposed rule would not impact those on Medicaid, the insurance program for the poorest Americans. States are largely left to design their own rules around Medicaid coverage for contraception, and few cover over-the-counter methods like Plan B or condoms.
