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According to a new Monmouth University poll, 7 out of 10 Americans agree that COVID-19 is here to stay, and “that we need to get on with our lives.” Science has given us vaccines, boosters, and evolving best practices for staying safe over the past two years, but the poll shows that although many Americans still express concern about the virus, only one-third feel that the country will get it under control by the end of the year, as compared to 6% who felt that way one year ago. As COVID-19 continues to be present in our lives, two USJ experts help us understand how to do that: USJ Assistant Professor of Biology Chadene Tremaglio, a virologist, and USJ’s Director of Health Services Janet Flink.
Asked to comment on the COVID-19 virus and whether the recent Omicron variant might get us to herd immunity, Dr. Tremaglio said, “the trouble is that infection with or vaccination against one strain of the virus does not always lead to protection against other strains, which is what we saw with the emergence of the Omicron variant and breakthrough infections.” She continued, “what makes viruses like the coronaviruses so devastating is that they do not exist as just one homogenous group of identical viruses, they exist as a “cloud” of slightly different mutants, what we call a “Quasi species.” Some of these mutations are bad for the viruses, and those strains are not successful at replicating and die off. But other mutations are good for viruses and make them more fit. Mutations that help the virus get into cells more efficiently, that help the virus to replicate faster, or to evade our immune system, will all lead to viruses that are poised to cause greater infection in humans, and these become what we know as the dominant circulating strains (such as Delta or Omicron).”
Dr. Tremaglio went on to explain. “While infection is thought to lead to some level of immunity in healthy individuals, this protection isn’t lifelong, in fact, it wanes anywhere from 3-6 months afterward, which means you can be reinfected. Even with very high vaccination rates (or very high infection rates) in a population, herd immunity may not be achievable for this virus. I think what could be more likely is that over time we end up seeing a seasonal surge in SARS-CoV-2, like influenza, and we all need to get boosted against the latest variant similarly to how we all go and get our annual flu shots.”
But Dr. Tremaglio emphasized how important it is that people work together to limit transmission and spread. “We achieve this through multiple means, including masking, practicing good hand hygiene, social distancing, staying home when sick, testing and tracing, and getting vaccinated. While none of these practices are perfect alone, together they help to significantly reduce the spread of the virus.”
There is a good infographic illustrating this, called the Swiss Cheese Model of Respiratory Pandemic Defense, created by a virologist called Ian Mackay and covered in the NYTimes here.
Does the history of the 1918 Great Influenza pandemic, where we learned to live with the flu, yearly vaccines, and individual decisions about living with the seasonal virus, have anything to teach us as a culture of how we accept a virus as staying with us? According to Dr. Tremaglio, the 1918 flu pandemic is an interesting comparison because “there are many parallels in the darker aspects of our social response- anti-mask campaigns, for example. What is that old saying about not learning from history and being doomed to repeat it? We were amid World War I, which I think probably had an outsized impact on the response to the pandemic.” While admitting she is not a historian or social scientist, Dr. Tremaglio continued, “Similar to what we have seen in this pandemic, race and socioeconomic status were major risk factors, and urban areas suffered the most. But we were also only just grasping the importance of proper sanitation and hygiene in healthcare, and viruses had only recently been discovered about 30 years before the pandemic (and would not be visualized until ten years later!). We did not have a vaccine to help us get through the 1918 pandemic either. The first flu vaccine was not widely available until the 1940’s, and we didn’t really start pushing for an annual flu vaccine until the swine flu scare of the 70’s. So, there are similarities there, but also crucial differences.” Dr. Tremaglio noted that there are more tools and knowledge now and that more people appreciate how connected we are as a global society.
Dr. Tremaglio came back to a virology lesson. “Influenza viruses are a very different beast and much more genetically nimble than coronaviruses. Flu viruses carry all their genetic material on eight different pieces of RNA (called “gene segments”), rather than one like coronaviruses. This allows them to mix and match these segments with other strains of flu, a process called “reassortment,” which is why we have new strains circulating every year and must create an entirely new vaccine to combat it. I think with SARS-CoV-2, we may not need a new vaccine every year, since its rate of mutation is much slower than influenza. But a booster, which is designed to sort of “wake up” our immune system might be necessary every few years, with slight tweaks to the formula to ensure it covers any mutations that have cropped up in the dominant strain during that time.”
Speaking of USJ’s community response to the pandemic, USJ’s Director of Health Services Janet Flink is proud of the way USJ faculty, staff, and students have navigated the pandemic. “The COVID-19 positivity rate of our campus community has been, and continues to be, significantly lower than the positivity rates reported for the towns surrounding our campuses and for Connecticut overall.” Her practical guidance for now and the future as we encounter need for protection? “Masks remain one of the single most effective measures against the spread of respiratory viruses, including SARS-CoV-2 and the most effective mask will be the one you actually wear. Wearing a procedural or surgical mask properly and consistently is more effective than wearing an N95 mask that you fidget with or remove often.” She acknowledged that higher quality masks offer the most protection and are especially important for those who are immunocompromised or otherwise at risk of severe illness.
Student Health Services, located on the first floor of the O’Connell Center, is available as a resource for students with questions or concerns about COVID-19 or other health concerns at [email protected] or at 860.231.5530.
We asked Dr. Tremaglio to talk about masks–the differences between different types of masks, the changing guidance, layering masks and spotting knockoffs.
Cloth masks, which we are all very familiar with, are made with multiple layers of fabric and are designed to cover your mouth and nose. Some also feature a nose wire and adjustable ear loops to improve the fit. Surgical masks are made from layers of synthetic material and have an electrostatic charge (kind of like static electricity) that is designed to trap particles that come in contact with the fibers in the mask. Cloth masks and surgical masks are similar in that neither are designed to fit tightly or create a seal around your face but serve to block respiratory droplets from the mouth and nose and some particles in the air. So, what are N95s, KN95s, and KF94s, and why should you aim to upgrade your mask to one of these? These masks are medical-grade respirators and are held to specific governmental standards of filtration. N95s are regulated by the US government and must meet the ‘National Institute for Occupational Safety and Health” (NIOSH) standard for filtering 95% of particles from the air. KN95s are the Chinese equivalent of these, and KF94s are made in South Korea (and filter 94% of particles). All of these are designed to create a tight seal around your mouth and nose for maximum air filtration. They are disposable but can be reworn a few times. (See answer to question 5 below).
2. Why have different types of masks been recommended at different junctures of the pandemic?
Early in the pandemic, hospitals were experiencing shortages of N95s and surgical masks, so there was concern that advising the public to wear these would exacerbate the situation. At that point in the pandemic when we didn’t yet have the vaccines, it was critical to ensure that healthcare workers in high exposure, high-risk situations had access to PPE. But supply has improved significantly since then, and President Biden recently announced that he is increasing production of higher quality masks to make them even more accessible to the public. So now the recommendation is that everyone should purchase the highest quality mask they have access to. From a scientific perspective, the virus and what we know about it has also changed during the pandemic. The Omicron variant is thought to replicate (make more copies of itself inside your cells) much faster than previous variants did, which means that people infected with Omicron expel a lot more infectious virus into the air when they cough or sneeze, making the virus far more transmissible than the previous strains in circulation. So, with more virus in the air, you want better filtration from your mask.
3. Are layering of surgical masks as effective as KN95 masks?
No, layering of surgical masks is not as effective as wearing an N95 or KN95 masks because they are not designed to seal to your face. However, surgical masks have been shown to be more effective than cloth masks, and layering a cloth mask on top of a surgical mask can improve the fit and filtration of the mask.
4. How can you spot a knockoff?
Here are a few tips: as with most things on Amazon, if a deal looks too good to be true, it probably is! Check the product listing for misspellings and grammatical errors or language that sounds like it’s trying to sell you something (for example, be wary of words like “genuine”, or “authentic”). If purchasing an N95, it should have straps that go around your head, not ear loops, and it should bear the “NIOSH” mark on the mask. If purchasing a KN95, these often have ear loops, so no red flags there, but a real KN95 should have a “GB” mark on it. This will be “GB” followed by 8 numbers and indicates the mask was made to Chinese government standards. Any masks you purchase should come in tamper-evident packaging and sealed bags, and the box should have an expiration date on it.
5. Can you rewear N95s/KN95s?
Yes! Even though these are designed to be single-use, disposable masks, you can get a few wears out of them. The key here though is to make sure you give your mask a chance to air out between uses, so it’s a good idea to rotate a few masks. You want your mask to sit for 24-48 hours in order to dry out and give any germs it may have come into contact with a chance to be inactivated. Toss a mask when it looks visibly soiled. Of course, use your best judgement- if you are going to exercise and get sweaty in a mask, you may not want to reuse it. It all depends on how heavy the usage is.
6. Other important notes:
If upgrading to an N95, KN95, or KF94, keep in mind that fit is important! These masks are designed to seal to your face, and things like facial hair can impede getting a good seal. You shouldn’t have any gaps where air can leak, so test this by putting your mask on and placing your hands on either side of your face as you breathe in and out. You should feel the mask “breathe” with you. If the fit isn’t great, try adjusting it by tying the ear loops or purchasing an extender that hooks the loops behind the back of your head. If you plan to stick with a surgical mask, you can improve the fit and filtration of these by wearing a cloth mask on top of it, or by purchasing a mask brace that is designed to minimize air leakage.