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Looking backward and forward at COVID-19 mitigation strategies

Looking backward and forward at COVID-19 mitigation strategies

Dr. John Livingston
August 23, 2021
Dr. John Livingston
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August 23, 2021

Some 20 months into the pandemic, America is still having heated debates about appropriate and wise virus mitigation strategies. The disease like AIDS has become politicized, and the agenda and narrative are overshadowing evidence and logic.  Conclusions regarding masks, vaccines, and the opening of schools and churches have been tainted by economic and political agendas that only confuse the collection and evaluation of the data. 

The line separating collective and individual risk has been blurred. The homogenization of groups of people into the collective whole has resulted in thousands of people being harmed and even the death of large groups of people in hospitals and nursing homes. Clinicians have taken a back seat to the public health specialists, who themselves are far removed from patient care responsibilities. Clinicians are busy taking care of patients rather than being interviewed in the media. 

Our ability to take care of sick COVID-19 patients has been a great untold story. Passive immunity — which includes convalescent antibodies, monoclonal therapy, new techniques and strategies in ventilation and vaccination — is being communicated via email and various social media sites. Professionals aren’t waiting months for “peer-reviewed” articles in the traditional medical literature, and they’ve saved more lives than masks and Type 2 mitigation strategies. Ask the thousands of healthcare workers in New York State and New Jersey who prophylaxed themselves during the height of the pandemic or ask your own doctor or PA if they have on hand any “hydroxy.”  Or ask (as I did today) your pharmacist in Boise if there has been a run on hydroxy over the past 18 months.

I have written about COVID-19 since March of 2020 for Gem State Patriot, Redoubt News, and the Idaho Freedom Foundation. My positions regarding social distancing, masks, handwashing, and vaccines have not changed. What has changed is my understanding of the extremes that individuals will go regarding risk avoidance when they don’t understand the context of the risk they are trying to avoid. 

As of July 30, not a single person under age 18 has died from the virus. The new delta variant is more easily transmissible but less lethal across all age groups than the original COVID-19. This is very consistent with previous seasonal viruses — as the virus mutates and evolves, the R0 factor goes up and becomes more easily transmissible and less virulent. A child is more likely to die in a car accident in Idaho than they are from COVID-19. A child living in Idaho in 2019 was more likely to die from the seasonal flu than from COVID-19 in Idaho in 2021.

Where do we stand today in Idaho with the delta strain of COVID-19? Doctors Marty Makary, Jay Bhattacharya, and Scott Atlas addressed some of the more contemporaneous issues with the delta variant in a recent article in The Wall Street Journal, citing studies from Sweden, Iceland, and Ireland. 

Schools are actually safer places for children to be than enclosed areas with adults. Masking is fourth on the list of mitigation strategies for children at school behind proper ventilation, including open windows and exposure to sunlight, distancing, dividing, and separating students. Only then is masking recognized as an effective mitigation strategy. It should be acknowledged, though, that only properly fitted N-95 masks protect wearers from the virus. Popular cloth masks are basically worthless in protecting kids from COVID-19. 

Citing studies from the University of North Carolina and Brown University, the doctors point out that the risk of infection was statistically the same in classrooms with unmasked and masked kids.

Unlike my friend Dr. Ryan Cole, I have decided that the vaccine makes sense for me. The risk of a severe adverse reaction is less than the risk of the disease. The math changes for the elderly and those with comorbid conditions. Infants and children are more likely to have adverse reactions to the vaccine than young adults and preadolescents because of the naturally “revved up” state of their immune systems. People who have had previous infections or vaccinations and have positive antibodies are at higher risk for complications including thrombotic and immune complex and antibody mediated reactions.

“The jab” has become so politicized as to be almost comical. I saw a clip from MSNBC last week about the “recalcitrant Trump supporters” who refused to take the vaccine and were putting their neighbors at risk for selfish, childish reasons. Here are some facts that may surprise everyone: People ages 18-35 are the least vaccinated group. Sumpter County in Florida, where the largest senior living facility The Villages in our country is located, has a vaccination rate today of over 80%, and it voted 90% for Trump. 

Looking at level of education as a marker for conforming to vaccination recommendations shows those with less than a high school education have a slightly higher rate of vaccination than those with a PhD, which have the lowest rates of all groups. Those in STEM fields have the lowest vaccination rate when compared to those in the humanities. And in New York City, the two groups that are resisting vaccinations the most are Black men, with a vaccination rate less than 40%. In Williamsburg, New York, Hassidic Jews have a vaccination rate of 35%. In Alaska, the highest rates of the vaccinated are in the indigenous native populations.

In Idaho, I would recommend that schools stay open and follow the mitigation techniques described above. Masks should be optional because they really don’t work unless student have a medical-grade face-covering. Anyone that tells you otherwise is either misinformed or lying or trying to make themselves feel better. If you want to wear a mask, go ahead. It is a “long run for a short slide” at best.

Children should not be vaccinated if they are under 12 years old, and many experts say even those who are under 18 shouldn’t get the jab. If you don’t want to be vaccinated, don’t get vaccinated. If you have already had the disease and have antibodies, or have been vaccinated and have antibodies, what do you care? If I get the disease, it will probably be worse than if you get the disease, but it is my choice to suffer from the ramifications of my own decisions — not yours.

Teachers over 35 should be vaccinated, if they want. Those with comorbid conditions or over 65 should get vaccinated, if they want. These remain recommendations based on science, not mandates based on a political narrative.

Finally, let’s stop being little “Chicken Littles.” Idahoans are fully capable of making our own decisions about what is best for ourselves and our families. Talk to your family doctor. Many share almost all of my feelings, but those employed by large hospital systems are afraid to speak out publicly and are reluctant to advise their patients in such a way privately. Ask them what they are doing with their own families.

As my former chief of surgery used to say to patients who weren’t working hard enough to make themselves better: “The time has come to either start living or start dying. The choice is yours.”

View Comments
  • Al says:

    I have not checked across the U.S. but in Mississippi alone, 4 chikdren are reported to have died from the virus, per July 28 Sun Times article.

    And i for one am not surprised, as you suggest, regarding the low number of vaccinated among young adults compared to older population. Its quite expected. We have consistently been told younger people are not at risk. While weve consistently quite aware feom reality that older population is far more vulnerable. Why would younger people be incentivized toward innoculation?

  • Al says:

    You made an important distinction about masks in one part of your article but not later on. The distinction is about the function of cloth masks: do they protect the wearer, others in close proximity to the wearer, or neither?

    I won't disagree about effectiveness of cloth masks in protecting the wearer from contracting the virus. But your article notes some effectiveness in the "community" approach - it ranks 4th in your list of mitigation techniques in schools but at least it's on the list.

    But later in your article you state masks don't work and if people say they do they're either misinformed or lying - but you don't make the distinction in that comment whether you're talking about protection to the wearer or to people close to the wearer. I ask if you'd clarify and ask your reaction to comments I have below regarding efficacy of the "community" approach.

    First, I'll reiterate I'm only discussing masks as a mitigation factor, not a self-protection factor.

    Then I'll start with perhaps the weakest point of an argument on this: my personal experience. In my profession, I've been next to a number of mentally ill patients or persons high on drugs whom police have forced a "spit hood" on. The loose mesh allows the wearer to speak and facial features are quite clearly visible through the hood. The mesh is FAR less interwoven than a cloth mask. Yet they're remarkably effective in preventing spittle from escaping through the hood. Some spittle might escape, but the quantity is greatly reduced and the distance is greatly reduced. It's an effective mitigation device, even against intentional, high-speed spitting.

    Which leads to your noted mitigation strategy in schools of dividing, separating and creating distance between students. That is, from what I've read, the function of masks against COVID. Like the spit hood, a cloth mask may not block ALL spittle (and, thus, the virus carried on the spittle), but the quantity and distance are mitigated.

    The "social distancing" our schools enforced this past year, by the way, led to a remarkable rise in attendance, as colds, influenza and other matters were reduced in Idaho. Masks were a part of that social distancing effort, as it mitigated the spread of ALL virus/germs in our schools.

    Next, is deference to experts such as yourself. Keeping in mind that I'm only speaking about masks as a social-distancing tool to contain spread, I give deference to experts from Johns Hopkins University: https://www.hopkinsmedicine.org/health/conditions-and-diseases/coronavirus/coronavirus-face-masks-what-you-need-to-know;

    the CDC: https://www.cdc.gov/coronavirus/2019-ncov/science/science-briefs/masking-science-sars-cov2.html,

    and others too numerous to list here. They support the "community masking" approach.

    Next there are videos abound such as this one that demonstrates the containing abilities of cloth masks. This is not as "official" as some as seen from universities, such as University of California, but it's still of some value: https://www.youtube.com/watch?v=DNeYfUTA11s

    So, to my question: Are you saying cloth masks are useless for BOTH functions of self-protection as well as the "community approach"? If useless for self-protection, then I'm with IFF and others who say it's a personal choice and wear them if it makes you feel good - your choice. But most readers don't acknowledge that distinction, so when you call masks useless and people who say otherwise, I'm concerned, in the minds of the readers, they believe Johns Hopkins University, CDC, and numerous other sources, are liars, per your comments.

    But if there's SOME mitigation value to the community, the personal choice issue is an altogether, more complex, legal issue. If we're talking about community protection rather than self-protection, well...now we're dealing with health restrictions that may, or may not, be constitutionally permissible.

    The question, both legally and morally, perhaps, is what is the tradeoff of just HOW MUCH is the effectiveness of cloth masks in preventing spread vs. the harmful effects of wearing cloth masks. If there's SOME mitigation value, we're no longer talking about "uselessness"; we're talking about HOW USEFUL is a mask and comparing it to the harmful effects.

    • john livingston says:

      Thanks Al for your considerate and considered response. The only masks that work for mitigation and for personal protection is the N-95. Studies regarding the mask poor size and the efficacy of protecting the person wearing the mask and protecting those around a person wearing a mask can be found in the medical, nursing and occupational health literature dating back to 1915. These can be accesed on the CDC web site or on Medline or Mescape or the OSHA website. Isolation---protecting me from you the way people with TB were treated years ago (and still today in Cuba), and reverse isolation-- protecting you from me the way we treat suprressed cancer patients after some forms of chemotherapy and transplant patients who are immuno suppressed all use N-95 masks. In sterile operative procedures especially with orthopedic implants, open heart surgery, or neurosurgery non rebreathing masks are required because of the loss of efficacy and effectivness of any other type of mask. In all the cases mentioned above rapid turnover ventalation, high grade filtering techniques, and exposure to UV and even sunlight are also important. Thank you for you comments jml

      • Al says:

        Thanks for the quick response. So, to be clear, you contradict sources such as the CDC weblink (with multiple test studies referenced therein) that I supplied?
        If Johns Hopkins, which is inarguably either the top or nearly-top medical hospital in the U.S., and the CDC cannot be believed (or, as you say, liars or misinformed), then at what point do we just simply say "I give up - they're ALL liars or ALL misinformed? Including yourself, whom I don't know personally and, although qualified to give an opinion on this subject, at best, you just cancel-out the contrary opinion from other experts who are likewise qualified.

        And when you say the only masks that work for mitigation (I don't care about arguing about self-protection here) are N-95, are you saying cloth masks have NO value in mitigation or simply not enough to be worth it? Your statement, quoted here, indicates value in community masking, when performed with other social-distancing mitigation strategies:

        "Only then is masking recognized as an effective mitigation strategy. It should be acknowledged, though, that only properly fitted N-95 masks protect wearers from the virus."

        Who's lying here? Why should I be swayed one way or the other with, for example, a CDC report that references several studies on the subject matter vs. your experience and opinion?

        You can certainly understand the predicament we're in. Why should we believe your opinion about vaccines, either, then?

        • al says:

          That came across snarkier than intended, by the way. I was not intending to call you a liar but, rather, since you would rule that out, then what is the solution to my questions?

  • Al says:

    Whether it's lies, or misinformation, or truth, Dr. Livingston, i dont know, but I'm finding reports of death of children from the virus. Three in Shelby County, TN in a month and many ("hundreds") in Indonesia. "From" COVID, or "with" COVID may be debated in these reports, i suppose, but its concerning that the more robust immune systems of kids are shiwing more vulnerability to the delta variant. More in Mississippi.

  • john livingston says:

    Al I want to continue to engage you but only after your present to me 3 articles demonstrating the limitations of masks other than the N-95. I want you to present evidence to me of my position. That way I can know that you have exposed yourself to both sides of the issue. I will even give you a "freebee"----read the disclaimer on the blue cotton masks being dispensed in drug stores, medical clinics, and in our schools. It says the masks will not protect the person wearing the masks from bacterial infections and that the masks should not be worn for over 4 hours. Again interegate the CDC web page and find articles dating back to 1915 showing the limitation of masks.

    • Al says:

      Fair enough, and i would expect you would likewise read the studies referenced in the CDC report and update whether you believe there is truth to news articles that children have died from COVID. Havent heard from you on that yet.
      I will, though, remind you that i am not engaging on the self-protection aspect of masks. I think i made that position clear. I dont believe i understand your position on what i keep asking about: the protection of others around the wearer.

    • al says:

      Ok, I’ve completed my task from you. Here are three articles that support the opinion that masks are “useless”, along with my comments:

      1. Here is an abstract from University of Louisville, not yet peer-reviewed which concludes there is no significant difference of COVID case growth between states that mandate masks vs. states that don’t mandate masks. https://www.medrxiv.org/content/10.1101/2021.05.18.21257385v1

      I would note that it poses the same problem as I indicated regarding the New York Intelligencer article: it doesn’t “prove” whether masks are effective or not because it doesn’t track compliance with mask mandates. At best, this report gives a conclusion as to the effectiveness of government policies, but not about the effectiveness of masks themselves.

      2. Here’s something from the MacIver Institute of Wisconsin. This is cited by various mask adversaries. It quotes the Wisconsin Department of Health Services statistics: 934 COVID related deaths from March 15th to July 31st, averaging 6.7 deaths per day. In the first 139 days of mask mandate (August 1st through Dec 17th) there were a total of 3,321 deaths for an average of 23.9 deaths per day. The authors admit seasonal variation between those periods of time, like normal changes in influenza. But still concluded a state-wide mask mandate did not stem the spread.

      I would say again this is not “proof” of the ineffectiveness of masks. ala the New York Intelligencer article you referred me to . For example, if I want o lose weight by exercising daily but nonetheless order at McDonalds every lunch, and gain weight over a month, does that mean exercise is useless in trying to lose weight? It is just as logical to say that, if not for the wearing of masks, the spread might have been worse.


      3. Here is a third often cited for the position that masks are useless. It’s pre-COVID but influential on this topic, as it concludes masks don't help. This one is more convincing, and even goes so far as to make me question the effectiveness of N95 respirators to some degree. My caveat is that this study is of influenza. It is beyond the scope of my knowledge, but from what I’ve heard about the vastly greater transmission rate of COVID is largely due to its differing molecular structure. Is that accurate? So, I would say this article should not automatically be transferred to being applicable to COVID. I would defer to experts on that one.

      And here’s my request for you – to consider amending your statement that no children have died from the virus after reading these articles for your convenience:
      1. Governor Edwards officially states a child under the age of 1 died from the Delta Variant: https://gov.louisiana.gov/index.cfm/newsroom/detail/3363
      2. Statistics from Ohio’s Department of Health shows 7 deaths of children in Ohio from COVID complications; 8 if you include an out-of-state Ohio resident: https://coronavirus.ohio.gov/wps/portal/gov/covid-19/dashboards/schools-and-children/children
      3. Mortality rate is still extremely low in children (0.00% to 0.03% of all child COVID cases) but not nonexistent as your article states. See American Academy of Pediatrics: https://www.aap.org/en/pages/2019-novel-coronavirus-covid-19-infections/children-and-covid-19-state-level-data-report

      These are in addition to my previous references to children dying in Mississippi and Tennessee. I haven’t looked anywhere else for additional data.

  • john livingston says:

    Al Let me help you. From Jason Riley in today's WSJ
    A New York magazine article last week reported on the findings of a “mostly ignored, large-scale study of COVID transmission in American schools” that was published in May by the Centers for Disease Control and Prevention. The study matter-of-factly called into question the efficacy of face coverings for children in schools. “These findings cast doubt on the impact of many of the most common mitigation measures in American schools,” the magazine reported. “Distancing, hybrid models, classroom barriers, HEPA filters, and, most notably, requiring student masking were each found to not have a statistically significant benefit. In other words, these measures could not be said to be effective.”

    The article also noted that many European countries—including Britain, Italy, France, Switzerland and all of Scandinavia—“have exempted kids, with varying age cutoffs, from wearing masks in classrooms,” yet “there’s no evidence of more outbreaks in schools in those countries relative to schools in the U.S., where the solid majority of kids wore masks for an entire academic year and will continue to do so for the foreseeable future.”

    Your welcome Al---not to be "snarky" jml

    • al says:

      Are we limiting our "engagement" only to schools? I've just started reading your sources and they seem limited to that subject. I started out this discussion asking your opinion on masking to benefit the "community"; wasn't considering only schools. But I'll read on.

    • al says:

      I read the article from New York Intelligencer. I don't have enough cash to subscribe to news sources like WSJ, so couldn't read the op-ed you referred me to. But if it's available via another method, I'll read it. I did, however, read the New York Intelligencer argicle. Here's my understated summary.

      It makes a fair point that there is no "proof" that masks are effective in schools. But that's limited because in the scientific method, you form a hypothesis and test it, changing one variable at a time, replicating the experiment to prove or disprove the hypothesis.

      Or something like that....I've never been a scientist, but I believe I'm on the right track with that at least, right?

      And the author makes the point that there are multiple variables in a school, such as social distancing, hygiene, etc. So there can be no "proof". Granted. I agree.

      But libertarians, and other capitalists like myself, have to admit there's no "proof" of effectiveness of capitalism, since we have always had variables of social welfare and never a "true" capitalistic society. Yet, it's the cornerstone of fervent political, economic and even religious beliefs these days...

      With that as an aside, even without "proof", there are reasonable inferences and mechanical demonstrations such as the video I sent to you (I've seen a number of them) and logic that a looser mesh spit hood effectively mitigating the distance and volume of spittle gives us a fair idea that a cloth mask, with tighter mesh, ought to do SOME good. How much good? Therein lies the heart of the article. The article doesn't debunk masks, it really just says we can't "prove" effectiveness of masks. Big difference.

      As you have seemingly favored Professor Digory Kirke in a prior post, seeking readers to use logic, I submit that what I've just said seems logical, even if not capable of being "proven".

      Then again, C.S. Lewis also submitted that the same kind of scientific "proof" cannot be found when trying to determine if God is real. Logic got him there, and he was firmly convicted thereafter.

      But back to the article you directed me to. It describes negative aspects of wearing a mask in school and I completely agree with them. Actually, so does every single teacher I am acquainted with. And being a former teacher as a temporary period of my professional career, as well as working in courts, working with mental patients and teaching Sunday School for over a decade, I agree with them.

      The ability to read social cues from facial expressions is eminently important. Ammon Bundy, of all people, argued this in court to try to force masks of jurors and witnesses. And no one disputes that. As I said above, we have to trade off negatives vs. positives when deciding whether to wear masks. And that's difficult for laymen like myself to figure when scientists are all over the board on effectiveness of masks. And at times using bad logic to come to a predetermined conclusion.

      I would say there is an unintended benefit of masks that the article doesn't account for: the greatly reduced "facial touchings" of mask wearers. That alone gives a self-protection benefit, especially among children. Though, of course, hopefully there'd be another way to gain that benefit.

      Fair enough, the article you sent me doesn't surprise me, I know there are arguments against effectiveness of masks and this doesn't really say conclusively there is NO benefit, its essence is that there is no way to know.

      So...you can give me some follow-up questions and I'd be happy to oblige. I did my share of the engagement and thank you for getting me to an article I hadn't read. I really do try to ensure I don't read articles that favor my ideas - I try to force myself to read alternative opinions. Might change my mind. Might reinforce my idea. But always good exercise.

      I would conclude with the concluding paragraph from the Intelligencer article: "Several of the experts I spoke with said that given the lack of evidence of a substantial benefit from a student-masking requirement, it’s not at all clear this measure will be effective against a more transmissible variant. One of the costs of an intervention that lacks clear benefit, said the immunologist, is distraction from the tools that we know protect people — in the case of schools, vaccination and ventilation."

      Would you get Wayne Hoffman to read this article as well, since you reference it as authoritative: It supports the proposition that kids should be vaccinated. Ok, other tools (i.e. masks) are a "distraction" and vaccination and ventilation are keys. I don't disagree. I agree with you. But in doing so, I disagree with IFF.

      • john livingston says:

        Thanks again Al. I have presented to you my opinions with my documentation of the CDC and medical evidence from the articles listed. I have nothing more to add and I rest my case. If you can in any way refute my premise or the medical evidence I will rengage. Again today in the engineering literature there is another article about the inefficiency and lack of protection from any mask but the N-95---exactly my position since March11th 2020. Nothing new. I'll let you find it. So far I have provided all the research for our discussion. Get to work Warmest regards.

        • Al says:

          I dont think you upheld your end of the bargain here, Dr. You led me to believe you would engage if i read 3 articles that support your position. I did. You haven't responded in kind. That's not engagement. I read those articles in good faith. Even had a PhD in chemistry review the Intelligencer article with me to ensure i was on the right track with my thoughts. You didnt respond to my comments, you just stated a "last word" and terminated the conversation.
          I would hope some readers would look at my sources indicating that your statement that no children have died from COVID appears to be in error, as you dont seem to seek truth on that. You never even cited your source about how no kids have died.

          • DB says:

            Mr. Livingston doesn't seem to understand how humans breath. He's only concerns with air ingressing his mouth, which I'm sure is allows open, and not air egressing his mouth. Al is pointing out how, if a person is infected, the hot moist air laden with virus can be suppressed to some degree by using a mask. Children are taught to cover their mouths when they sneeze, why Mr. Livingston can't understand this is beyond me.

            By the way, this article has aged like milk.

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