Kansas Confirms Mask Mandates Don’t Do Much To Prevent the Spread of COVID-19

Comparison of COVID-19 cases in Kansas Counties that adopted a mask mandate on July 3 and those that did not. (click for higher resolution)

My previous post discussed two studies that seem to indicate masks have little effect when it comes to stopping the spread of COVID-19. I had several Facebook commenters who disagreed with my interpretation of the studies, which is not surprising. One commenter linked a recent study promoted by the CDC, which makes the remarkable conclusion that in Kansas, counties that adopted a mask mandate saw a 6% decrease in new cases, while those that did not adopt the mandate saw a 100% increase. If true, that indicates masks have a strong effect when it comes to stopping the spread of COVID-19. After reading the study and doing my own analysis of the numbers, I have to say that unfortunately, it is not true.

Once again, let me preface this by saying that I am not anti-mask. I wear a mask whenever I am in public, and I did so even before my state made it mandatory. In addition, I am not telling people to stop wearing masks. As I said in my first post, any mask not made specifically for viruses will be pretty much worthless in protecting the wearer. However, a mask does reduce the number of water droplets that the wearer spews into the air, and since those droplets can contain viruses, it probably does protect the people around the wearer, albeit to a small extent. Thus, you should wear a mask. At the same time, however, you need to have a realistic idea of what kind of protection it provides. So far, the data say it offers only a little protection.

With that out of the way, let’s look at the study. It examined various counties in Kansas that adopted a mask mandate on July 3, 2020 and compared them to the other counties that did not adopt a mask mandate. It developed a seven-day rolling average of new COVID-19 cases for both sets of counties and compared the numbers before July 3 and After July 3. The graph (shown near the bottom of the study) shows that while the 7-day rolling average continued to climb for those counties that did not adopt a mask mandate, it fell a bit for those counties that did. Thus, the mask mandate actually reduced COVID-19 cases, while lack of a mandate resulted in a steady increase in cases.

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Mask Recommendations Make Little to No Difference

A surgical mask like the ones used in the study being discussed (click for credit)

In the midst of this pandemic, most governments are requiring people to wear mask in public. I will start this by saying that I began wearing a mask early on in the pandemic, long before any mandates were made. I didn’t wear one because I thought it would be effective. Even a basic understanding of science tells us that standard masks provide little protection against the spread of a virus. Protecting yourself against a virus using a mask that is not made specifically for viruses is roughly equivalent to protecting your yard against mosquitoes by installing a chain-link fence.

However, a mask does reduce how many water droplets you spew into the air, and since those droplets can carry viruses, there is probably some small protective effect for those with whom you come into contact. I wore a mask early on simply to put others at ease. Now I wear one because I think people must follow a society’s rules (unless they are immoral) in order to be a functional member of that society. If the mandates were lifted, however, I would still wear a mask in public until the pandemic dies out, simply because some people think it protects them, and I want to put such people at ease.

Having said that, there has been one study that concluded mask mandates reduced the rise of COVID-19 infections by a tiny amount. However, the study couldn’t conclude that the masks were the cause of the tiny decline. Most likely, when a mask mandate is instituted, people become naturally more cautious, limiting their social interactions, being more aware of social distancing, etc. Thus, it’s possible that the masks had nothing to do with the small reduction in COVID-19 cases.

My publisher sent me a recent study that tries to address the question a bit more effectively than the study linked above. It didn’t test masks directly, because it would be impractical to follow people around making sure they were wearing their masks. However, the study gave 3,030 people a set of recommendations for protecting themselves against COVID-19. They included things like social distancing, etc., as well as the recommendation to wear a mask, 50 surgical masks, and instructions on how to use them. The study also gave 2,994 people the same set of recommenstions, minus the mask recommendation, the masks, and their instructions. After 1 month, they tested people for COVID-19 antiboides. This was all during a time when their communites did not issue any mask recommendations or mandates.

The results showed that slighly fewer people in the mask group contracted COVID-19 than those in the no-mask group. However, because the number of people who contracted COVID-19 during the study was small, the difference between the groups could have been the result of random chance. In the end, the authors use basic statistics to conclude that the mask group was somewhere between 46% less likely to get the disease and 23% more likely to get the disease. As they say:

The recommendation to wear surgical masks to supplement other public health measures did not reduce the SARS-CoV-2 infection rate among wearers by more than 50% in a community with modest infection rates, some degree of social distancing, and uncommon general mask use. The data were compatible with lesser degrees of self-protection.

Now, of course, we have no idea what percentage of the people in the mask group actually followed the recommendation, but the study made it pretty easy to do so. Combined with the study I linked at the beginning of the post, I think we can conclusively say that if the typically-used masks provide protection against COVID-19, it is small. Thus, when “experts” say nonsense like this:

If we could get everybody to wear a mask right now, I really think in the next four, six, eight weeks, we could bring this epidemic under control.

We know they are not using science to inform their opinion.

A New Kind of Vaccine for COVID-19

Pfizer’s description of how an mRNA vaccine works (click for larger version)
There has been a lot of talk about Pfizer’s COVID-19 vaccine, and a reader asked me to comment on it. The company claims it is more than 90% effective at preventing the disease, which is better than what most health-care experts were expecting. If true, that news is exciting enough. To add to the excitement, it is a new kind of vaccine that has great potential, if it works the way it is supposed to. There is another company trying to produce a similar vaccine, but it looks like Pfizer is in the lead, so for the purpose of this article, I will focus on its version.

Let me start by saying that I have no connection to Pfizer or any other pharmaceutical company. I am a science educator who writes about science issues like this one. I am also not a medical doctor or medical researcher. I am simply a nuclear chemist who has broadened my knowledge base by writing (or co-writing) a series of textbooks used by home educators and teachers in Christian schools. Thus, I am no expert on these matters. However, I get most of my information by reading the scientific literature, which allows me to avoid a lot of the misinformation found in the standard media outlets and (even worse) social media.

Before I talk about Pfizer’s vaccine in particular, I want to explain how this kind of vaccine works. To understand that, remember that a traditional vaccine uses a weakened/inactivated form of the pathogen whose infection it wants to prevent (or a chemical mimic of that pathogen). This causes your body to react as if it is being infected by the real thing. As a result, it mounts a defense that is specific to that pathogen and remembers how to fight it. That way, if you get infected by the real thing, it can mount a swift immune response. This process takes advantage of your acquired immune system. However, you also have an innate immune system, and the active ingredient of the vaccine does not stimulate it. As a result, traditional vaccines have additives, called adjuvants, which are designed to stimulate your innate immune system. That way, everything in your immune system works the way it is designed to work.

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Regardless of What You Have Heard, the COVID-19 Deaths in the U.S. are Real

The purple bars are the deaths in the U.S. each week since2017. The yellow line represents the maximum number of deaths that were projected for those weeks. (graph by The Conversation, data from the CDC)

I have referenced this article in some comments I made previously, but I want to highlight it in a separate post, because the graph it contains (also shown above) makes it clear that the COVID-19 deaths are not some manipulation of the data. They are real. Very real. The purple bars in the graph represent all deaths recorded in the U.S. each week since 2017. The yellow line represents a projection of the maximum number of deaths that should have happened each week. The projection is based on historical data, and it fluctuates with the season. That’s because there are usually more deaths in the winter and fewer deaths in the summer, and as you can see, the actual deaths show that same fluctuation.

Notice that for most weeks, the actual deaths were lower than the maximum number of projected deaths. That’s expected. If the projection is done well, there should rarely be a time when the actual number of deaths meets or exceeds the maximum projection. However, there were some weeks in December of 2017 and January of 2018 when that happened, because there was a particularly virulent strain of the flu that season. As a result, more people died than were expected.

But those excess deaths are dwarfed by the ones that start showing up the last week of March in 2020. In that week, about 4,000 more than the maximum projected deaths occurred. Since then, the actual deaths have exceeded the maximum projected deaths by a considerable margin every week. All of this is discussed in the article from which I took the graph. However, I want to make a couple of additional points.

First, look at the shape of the excess deaths. There appear to be two peaks – one very large one the second week of April, and a smaller one at the end of July. This is important, because it looks very, very similar to the COVID-19 deaths reported over the same time span:

When the excess deaths have essentially the same time profile as the COVID-19 deaths, you know that the COVID-19 deaths make up most of the excess deaths. This tells us that the vast majority of COVID-19 deaths are real and most certainly represent people who would not have died had there not been the COVID-19 pandemic.

Second, some friends have asked me why they don’t know anyone who got the disease or died from it. After all, if there really have been more than 180,000 people who died from the disease and more than 6 million confirmed cases, shouldn’t everyone know someone who has suffered from it? Of course not! There are 328.2 million people who live in the U.S. That means about 2% of the population has contracted COVID-19, and about 0.05% have died from it. Thus, your chance of knowing someone who died from it is ridiculously low. While your chance of knowing someone who contracted it but didn’t die from it is significantly higher, remember that for most cases, the disease is mild. Thus, you would have to know someone well enough that you track his or her common illnesses to be aware that he or she had the disease!

It disturbs me that there are so many people (many of whom are Christians) who think this pandemic has been made up. The data clearly say that it hasn’t been. Lots of people died because of the disease, and misinformation will only increase the number of deaths. Now please understand that I am not saying that I support any of the measures that governments have taken to slow the spread. We don’t know enough about the disease or the consequences of the actions that have been taken to know whether or not they are a good idea. I said this before, and I will say it again:

As a scientist, let me assure you that no one really knows what we should be doing. There are a lot of experts saying a lot of different things, and you should listen to all of them. Then, you should decide what works best for you and your family, and you should start doing it. But once you decide what you and your family should be doing, please please please show grace to those who choose to do something different. Since the experts can’t agree on a proper course of action, there is no reason to expect your neighbor to agree with your course of action.

In addition to showing grace to others, please please please stop spreading the false idea that the COVID-19 deaths are few in number or not real at all. They are real, and there are a huge number of them. There is simply no other way to understand the data.

Please Stop Spreading False Information About COVID-19

Falsehoods meant to downplay the seriousness of COVID-19 (click for an enlarged image)
On Saturday, I received the image on the left from a well-meaning individual. She wanted me to see that we have been fooled regarding the severity of the virus that causes COVID-19. By Sunday, this image (or one like it) was all over my Facebook feed. Please understand that the statement starts out as completely false and then uses true statements to imply something else that is completely false. Unfortunately, it tends to resonate with people who do not understand medical science and who have not been personally affected by the pandemic. As I watched this lie literally spread around the world, I couldn’t help but think of Jonathan Swift’s famous statement1

Falsehood flies, and the Truth comes limping after it.

Here is my attempt to get the truth to come limping after this falsehood.

Let’s start with the first lie. The CDC has not “quietly updated” the numbers to “admit” something. The CDC has been regularly updating the numbers in the same place since the pandemic began. In addition, they have been saying that 94% of COVID-19 deaths were in patients with underlying conditions since at least April 3rd. That’s nothing new to anyone who has done even a little investigation into the matter.

More importantly, this image is meant to imply that COVID-19 is not dangerous because the vast majority of people who die from it have some other illness. Once again, that is simply 100% false. If you look at the underlying conditions that are included in the 94% (table 3 in the link above), you find things like high blood pressure (hypertensive diseases), diabetes, obesity, etc. The image tries to categorize them as “serious illnesses,” and depending on the person, they might be. However, they are present in a large percentage of the population. 45 percent of adults in the U.S. have a hypertensive disease, 10 percent of the U.S. population have diabetes, and 42 percent have obesity. Thus, a huge number of people in the U.S. have at least one of the “serious illnesses” that make you likely to die from COVID-19. In other words, there are many, many people at risk of death from COVID-19.

But how can we say that these people died of COVID-19 when they had some other condition? Because most of these conditions are completely treatable and will not generally kill a person. However, when that person gets an infection, the underlying condition makes it harder for his or her body to fight off the infection, leading to death. The more serious the infection, the more likely the person is to die. In fact, the majority of people who die of an infection like influenza, pneumonia, tuberculosis, etc. have an underlying condition that makes it more difficult for them to fight off the infection. Thus, it is not even remotely unusual that 94% of people who die from COVID-19 had one or more underlying conditions. It is common for many serious infectious diseases, especially in the developed world.

There is one more issue in the image above that I must address. It says that the overwhelming majority of people who died from COVID-19 were of advanced age. That’s true, but it’s true for all deaths in the developed world, not just COVID-19 deaths. Indeed, a recent study compared the ages of people who died from COVID-19 to those who died from all causes. Guess what? They were quite similar:

In fact, the age distribution of deaths attributed to COVID-19 is quite similar to that of all-cause mortality, which tends to increase by about 10% every year of age after age 30 y.

We don’t know a lot about COVID-19, and there is no way to scientifically state the best cause of action against the disease at this time. However, we do know that it is a very serious disease, and it is being downplayed by some using falsehoods like the image above. Please stop the misinformation! If you want to share something about COVID-19, at least make sure it doesn’t communicate something blatantly false, like the image above does.

ADDENDUM (added 9/4/2020): Someone on a friend’s Facebook feed wrote an incredibly insightful comment that I must share. She said that if you really think that the only COVID-19 deaths are the ones that had COVID-19 as the sole cause, then you must think that AIDS has a mortality rate of zero!

REFERENCES

1. The Examiner, Number 15 November 2 to November 9, 1710, (Article by Jonathan Swift), Page 2, Column 1, Printed for John Morphew, near Stationers-Hall, London.
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What Have Government Restrictions Accomplished with COVID-19?

Cumulative COVID-19 cases (left) and deaths (right) per million in Sweden and Denmark
(click for a larger view)

In a previous post, I compared COVID-19 cases and deaths in Sweden and Denmark. As I said then, it’s because they are very similar countries in the same basic region of the world, but they have remarkably different responses to the disease. Sweden has avoided lockdowns and tried to target their social restrictions, while Denmark has followed the practices of most other countries, strongly limiting what their citizens can do during the pandemic. While no comparison of two different countries is conclusive, I think the results are very interesting. The data come from the European Centre for Disease Prevention and Control, and while it may very well be a biased source of data, at least it is equally biased for both countries.

The graph on the left shows the cumulative COVID-19 cases per million. That means each day on the graph shows the total cases that were reported by that date, divided by the population in millions. Initially, Denmark had more cases (probably because initially they were testing more), but as you can see, Sweden quickly surpassed Denmark in cases per million, and the difference between the two countries has continued to grow. Since the death rate of COVID-19 is low (but higher than most infectious respiratory diseases), many people (including myself) think that death rate is a better indicator of the severity of the pandemic. Thus, the graph on the right shows the cumulative deaths per million. Notice that Sweden has more than 5 times the deaths per million as Denmark.

If the comparison between these two countries is legitimate, then, government restrictions did reduce the number of COVID-19 deaths per million in Denmark. However, there are those who suggest that this might be okay, since Sweden will reach herd immunity faster than Denmark. In the long term, then, Sweden will have fewer COVID-19 deaths because the spread of the disease will stop sooner.

Based on my evaluation of the data, I don’t think Sweden is significantly closer to herd immunity than Denmark. Take a look at the graph below, which records cases per day per million. Rather than adding all the cases reported by a given date (as is done in the graph on the left above), this shows the daily reports of COVID-19 cases per million.

If Sweden were closer to herd immunity than Denmark, the recent cases per million per day in Sweden should be lower than the cases per million per day in Denmark. However, they are not. For most of August, Sweden and Denmark have roughly equivalent cases per million per day. That tells me the disease is spreading roughly the same in the two countries right now, but Sweden has lost five times the people (per capita) as Denmark. As a result, my analysis indicates that Denmark’s restrictions kept a lot of people from dying of COVID-19, and that will continue to be the case in the long run.

Now please understand that this analysis considers only deaths from COVID-19. We know that government restrictions have also caused deaths. There are those who say that the government restrictions will cause more deaths than the ones that were saved from COVID-19. Others say that overall, the restrictions have saved lives. I think the data are insufficient to make that determination, but I do agree that most countries are ignoring the devastating death toll caused by the restrictions themselves. Nevertheless, I think the data are now clear that Sweden’s strategy has not accomplished what the country had hoped it would.

Another Possible COVID-19 Treatment

The three components of blood (click for credit)
So far, there are no widely-accepted treatments for COVID-19. Hydroxychloroquine, often mixed with other things like azithromycin, was initially thought to be promising, but the data so far are inconclusive. While there are some indications that it is effective (and some physicians are convinced it works very well), the controlled studies that have been done so far see no significant benefit to its use. The antiviral drug remdesivir shows some promise, as does the corticosteroid drug dexamethasone. However, there are not enough data yet to make a firm decision on either of them.

Yesterday, President Trump held a press conference to announce a new possible treatment: convalescent plasma. Based on an analysis of several different studies, it seems to be the best candidate yet (in my non-medical-doctor opinion). I say this because of the kinds of studies that have been done. First, there have been three randomized clinical trials. This means patients were assigned to either get the treatment or not get the treatment based on random chance. The group that got the treatment was compared to the group that didn’t (called the control group). In the three studies, the death rate in the treatment group was half that of the control group. There were also five matched-control studies, where the treated patients were compared to a control group specifically selected to closely match them. The results of those studies were similar to those of the randomized clinical trials. There were also four case-series studies, where patients were given the treatment and their progress was tracked. While that kind of study has practical uses for physicians, its ability to determine the effectiveness of a treatment is extremely limited. However, the case-series studies seem to support the other two kinds of studies. All of the studies were done on patients with severe or life-threatening cases of COVID-19.

Taken all together, then, the treatment looks very promising. However, I do have to say that each study was very small, so even when all the patients were analyzed, the total number was only 804. Phase three clinical trials that determine whether or not a drug should be widely used typically involve a few thousand patients. Thus, this is still a limited data set. Also, many of the studies (as well as the analysis linked above) are not peer-reviewed. As a result, there could be major flaws that have not been noticed. A recent analysis (once again not peer reviewed) of more than 35,000 patients seems to support the small studies, but since it has no control group, it cannot be used to draw any real conclusions. Nevertheless, the FDA has approved emergency use of the treatment, and it is asking those who have recovered from the disease to help in determining whether or not it is truly effective.

How can someone who has recovered from COVID-19 help determine the effectiveness of the treatment? To understand that, you need to learn a bit about the wonderful mixture that is running through your circulatory system.

Continue reading “Another Possible COVID-19 Treatment”

Another Exciting Development in COVID-19 Prevention

AeroNabs could be delivered as a nasal spray. (click for credit)
Scientists are pursuing several different strategies to protect people from the virus that causes COVID-19, and a recent paper that hasn’t been peer reviewed reports on a strategy I haven’t seen before. It makes use of the fact that the virus starts the infection process by employing specific chemicals called spike proteins to bind to an enzyme (ACE2) in human cells. The idea is simple: Block the virus’s ability to bind to that enzyme, and it will be unable to start the infection process. But how can that be accomplished? In the paper, the researchers report on making a small molecule, called a nanobody, that binds to the spike proteins on the virus. Once the nanobody binds to them, the spike proteins can no longer bind to the ACE2 enzyme.

First found in alpacas, nanobodies are like antibodies, but they are smaller, simpler molecules. Because of that, they are easy to make and manipulate. Essentially, scientists can build a small gene that produces the nanobody, insert it into certain microorganisms, and let the microorganisms churn out the nanobodies. As a result, there have been many, many different kinds of nanobodies produced over the years. The researchers searched a database that contained more than two billion nanobody genes, and they found 21 that should be able to bind to the virus’s spike proteins in some way. They put those genes into yeast, extracted the nanobodies that were produced, and studied them.

Based on their analysis, they found the three most promising candidates and tested them against the virus itself. One of the nanobodies was particularly effective, so they focused on it. They mutated the gene multiple times to make slight changes to the nanobody and tested the result against the virus. They then produced a gene that could take the three most effective nanobodies and chain them together. The result was a chemical that basically shut down the virus’s ability to infect human cells.

Continue reading “Another Exciting Development in COVID-19 Prevention”

Why Are Children Less Susceptible to COVID-19?

Children make up less than 2% of all identified COVID-19 cases. This is unusual, since they make up 20-30% of influenza cases. Why is COVID-19 so much rarer in children? A study from the Icahn School of Medicine at Mount Sinai Hospital in New York might have found the answer. Cells found in the nose, lungs, veins, and other parts of the body sometimes have an enzyme called ACE2 in their membranes. The enzyme is important, because it can participate in a process that lowers blood pressure when necessary. Studies show that the virus which causes COVID-19 (SARS-CoV-2) attacks cells by attaching to that enzyme.

The researchers examined nasal tissue from people between the ages of 4 and 60. The tissue collection had already been done between 2015 and 2018 for a research study on asthma. The researchers specifically looked at how much the gene that makes ACE2 was expressed. The more the gene is expressed, the more ACE2 is made. They found that the youngest children expressed the gene the least, older children expressed it more, young adults even more, and older adults even more. Thus, the younger you are, the fewer ACE2 proteins in the cells that line your nasal cavity, so the fewer places the virus has from which to attack. As a result, the less likely you are to be infected.

Because of the nature of the original study for which the tissue was collected, nearly half of the people from whom the tissue came had asthma. Also, they didn’t have tissue from anyone over 60 years of age. Thus, the sample is not truly representative of the nation as a whole. Nevertheless, the results are very intriguing, and they seem to explain why this respiratory virus affects children differently from most common respiratory viruses.

Please DO NOT Get Your COVID-19 Information from Social Media!

So far, I have written three articles about how horrible social media is as a source of scientific information (see here, here, and here). Facebook might be a great way to find out what your friends are eating, but it is one of the worst places you can go to learn about science, especially the COVID-19 pandemic. That’s because lots of people (left, right, and center) have decided to politicize the pandemic, and the unscrupulous among them have transformed science from its true nature (a very imperfect mode of inquiry) into a weapon. Unfortunately, many people don’t recognize weaponized science, and as a result, they tend to share things that fit their political views, regardless of whether or not they are accurate.

Consider, for example, the statement shown above. I have seen it on my Facebook feed at least a dozen times. While the statement is factually accurate, it supports a false narrative. Yes, there have been roughly 4 million cases of COVID-19 in the U.S. so far, and there were estimated to be 60 million cases of H1N1 during the 2009 pandemic. So the H1N1 pandemic of 2009 was “worse” than the COVID-19 pandemic today. Therefore, all the precautions we are taking against COVID-19 (shutting down schools, wearing masks, etc.) are just a result of politicians trying to use the current pandemic to their advantage. Of course, that’s simply not true. The reason we are taking precautions against COVID-19 is that it is significantly more deadly than H1N1. Out of the estimated 60 million cases of H1N1 in 2009, there were only about 12,500 deaths. Out of the roughly 4 million cases of COVID-19, there have been almost 150,000 deaths. Since 15 times fewer cases have produced more than 10 times as many deaths, it is easy to understand why we are taking more precautions against this virus!

Just to give you one more example, yesterday I saw this statement on my Facebook feed:

The COVID-19 death rate without a vaccine is lower than the flu death rate with a vaccine.

As far as I can tell, there is no way you can massage the data to make that statement even factually correct. For the 2018-2019 flu season, there were estimated to be more than 35.5 million cases and 34,200 deaths. Once again, for the current COVID-19 pandemic, there have been roughly 9 times fewer cases, but about 5 times as many deaths.

Now please understand that I am certain the number of COVID-19 deaths are being overreported. But they aren’t being overreported to the point where you can conceivably compare this current pandemic with the H1N1 pandemic of 2009 or the seasonal flu. In the same way, I know that politicians are using this pandemic to their advantage, but that doesn’t mean it isn’t real and isn’t serious.

So when it comes to getting information about the pandemic, choose your sources wisely, and do not include social media on the list!