It’s not over

Despite all the fannying around by politicians indicating that the Covid-19 pandemic is over and that we are in a post-Covid-19 time^{1, 2}, and despite all the prognostications, by some people like Fabio Codswallop (i.e. Nick Coatsworth), who should know better, that the Covid-19 pandemic would end last year³, it is not over, not by a long chalk.

At the time of writing there have been 674 million Covid-19 cases across the globe, and 6,751,754 deaths. The current rate of new cases is about 215,000 per day, far below its peak of 3.4 million per day from late January, 2022. Similarly, the current number of deaths is about 1,413 per day⁴.

In Australia, at the time of writing, there have been 11,231,866 cases⁵, and 17,742 deaths. Up until the end of 2021 there had been 2206 deaths in Australia, then the nation opened up and the various governments let the pandemic rip. Since that happened there have been over 15,000 deaths, almost 7 times the number of deaths in the previous 2 years of the pandemic⁶.

The World Health Organisation (WHO) has released its latest set of guidelines for dealing with Covid-19, especially mask-wearing, and also treatment and clinical management. 

It recommends the use of masks irrespective of the local epidemiological situation, given the current spread of the COVID-19 globally. Masks are recommended: 

• Following a recent exposure to COVID-19;
• When someone has or suspects they have COVID-19; 
• When someone is at high-risk of severe COVID-19; 
• For anyone in a crowded, enclosed, or poorly ventilated space⁷. 

Although treatments have improved as time has passed, people still die, with well over 200 people dying in Australia every week⁶. In the supermarket today, only a small proportion (5-10%) of people were wearing masks. I always wear a KN95 mask when in public indoor settings. Although I have never been accosted by halfwits telling me that I don’t need to wear one ‘cos it’s over’, I know people that have been so acosted. I wear a mask because of what Covid-19 can do to you:

1. Long Covid. While I wrote an essay about Long Covid not long after it first appeared, much more research has been undertaken subsequently⁸. Some 18 months after that first essay, I wrote a second, when more became known about it⁹. A recent long term study found that Long Covid is a multisystemic illness encompassing Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS), dysautonomia*, impacts on multiple organ systems, and vascular and clotting abnormalities. It has already debilitated millions of individuals worldwide, and that number is increasing. On the basis of more than 2 years of research this study found a significant proportion of individuals with Long Covid may have lifelong disabilities. Diagnostic and treatment options are currently insufficient in addressing underlying biological mechanisms, including viral persistence, neuroinflammation, excessive blood clotting and autoimmunity¹⁰.
2. I have grandchildren and if they get Covid-19 from me or anyone else, they run the risk of contracting Multisystem Inflammatory Syndrome in Children (MIS-C). It is a rare condition associated with Covid-19 that usually occurs 2-6 weeks after a child is infected. The infection may be very mild or have no symptoms at all and therefore may go unrecognised. MIS-C causes different internal and external body parts to become inflamed, including the heart, lungs, kidneys, brain, skin, eyes, or gastrointestinal tract. While MIS-C can be serious, even deadly, most children with this condition get better with medical care¹¹.
3. Covid-19 infections can lead to long-term brain problems. A recent study found that COVID negatively impacts working memory function, but only in adults aged 25 and over. It is likely that memory function can recover over time after a COVID infection, but people with ongoing symptoms (Long Covid) may continue to have difficulty with their working memory. Working memory is a form of short-term memory, that allows us to store and retrieve information while performing tasks such as problem solving, reading or having a conversation¹², or in my case, writing essays such as this one or writing my research papers. So, impaired working memory function can have a significant impact on a person’s daily life.
4. The pandemic has caused a surge of fatal cardiac arrests in Australia, as delayed care and COVID’s damaging effect on the heart drives a major increase in serious heart problems. More than 10,200 Australians died of ischemic heart disease in the first eight months of 2022 – that is about 17 per cent higher than would be expected in a normal year¹³. A recent Australian study also found hospitalisations from myocarditis (inflammation of the heart muscle) and pericarditis (swelling of the membrane surrounding the heart), pulmonary embolism (blood clotting on the lungs), heart attack and stroke were significantly more frequent after COVID‐19^{14, 15}.

So, apart from the above, why do I wear a mask? Additional factors may explain why. Almost as many Australians have died so far in the first 20 days of 2023 (703), than died in the whole of 2020 (909)⁶. This is a consequence of all Australian governments of all persuasions seemingly throwing up their hands in surrender to the virus.

Recommendations for mask wearing exist; the federal Department of Health “recommends the use of surgical masks or well-fitting, triple-layered cloth masks for the general public to reduce transmission of COVID-19 and its variants”¹⁶  (KN95 masks tend to be reserved for health professionals). The New South Wales government is even more insistent, telling readers of their website “it is strongly recommended to wear a face mask in indoor public spaces and when you can’t physically distance from others”¹⁷. However, I do not remember any politician mentioning anything about such recommendations for mask wearing. The reader may say that recommendations such as those on the two websites above obviate the need for politicians to mention them. Given the lack of ability of all sorts of conspiracy theorists, halfwits and other people to find credible information online, while believing any misinformation they read in the newspaper, politicians need to spread the word.

How effective are masks in preventing transmission of the virus? A recent huge study of 20 million people in most continents which looked at ‘voluntary’ mask wearing (rather than mandated mask wearing). This study found that such mask wearing significantly reduced transmission of the virus. They found that the average mask-wearing levels decreased the R number** by about 19%¹⁸. Given that the current R number in New South Wales is at 1.05¹⁹, such a drop (0.19) is something that should be welcomed.

Why do you never get a mention from politicians about mask wearing? Is it because they have all agreed that a few thousand deaths of generally older people is a small price to pay for the convenience of not wearing masks or the government not having to pay for them? Is it because they are afraid of what the cookers and the Murdoch media will say about freedom, government control, carbon dioxide poisoning, or any other bovine ordure? Is it because they do not understand the long-term effects of Covid-19 infection, particularly multiple infections? For whatever reason, their lack of action is reprehensible. 

Whenever you go into indoor public spaces, for your own sake and the sake of others, wear a decent mask. If you don’t, that just shows that convenience and comfort are more important to you than the lives of others.

*Dysautonomia: Dysautonomia is a disorder of the functioning of the autonomic nervous system (ANS). The ANS is charge of involuntary functions—things that happen without thinking—like breathing. Dysautonomia usually involves failure of the sympathetic and parasympathetic parts of the ANS. Dysautonomia can be localised, as in reflex sympathetic dystrophy, which causes lasting pain typically in an arm or leg. It can be generalised throughout the body, as in pure autonomic failure. This can manifest itself as what is termed sympathetic failure which can cause impotence in men and a drop in blood pressure when standing. It can manifest itself also as too much sympathetic activity with high blood pressure or a rapid pulse rate. It can also be severe but reversible, or chronic and worsening over time²⁰.

**R: The ‘R number’ is a measure of a disease’s ability to spread. R is the number of people, on average to which one infected person will pass on a virus. It is impossible to know he moment people are infected. Instead, scientists work backwards from other data, such as the number of people dying, admitted to hospital or testing positive for the virus over time. This allows an estimate how easily the virus spreads and therefore allows an estimate of the R number to be made. An R number less than 1 will see the disease eventually fizzle out because not enough new people are being infected to sustain the outbreak, while an R number greater than 1 will see the number of cases constantly increasing²¹. Currently, in Australia the R number (usually referred to in Australia as the effective R number or Reff) ranges from 0.74 in Tasmania up to 1.04 for Queensland and 1.05 for New South Wales. All other states and territories are below 1.0¹⁹.

Sources

1. https://www.theguardian.com/australia-news/2022/apr/08/scott-morrison-spruiks-australias-post-covid-jobs-recovery-we-factcheck-him
2. https://theconversation.com/morrisons-new-deal-for-a-return-to-post-covid-normal-is-not-the-deal-most-australians-want-163889
3. https://www.smh.com.au/national/welcome-to-2022-the-year-this-pandemic-ends-20211230-p59kzf.html
4. https://www.worldometers.info/coronavirus/
5. https://www.covid19data.com.au/states-and-territories
6. https://www.covid19data.com.au/deaths
7. https://www.who.int/news/item/13-01-2023-who-updates-covid-19-guidelines-on-masks–treatments-and-patient-care
8. https://blotreport.com/2021/07/26/long-covid/
9. https://blotreport.com/2022/12/29/even-longer-covid/
10. https://www.nature.com/articles/s41579-022-00846-2
11. https://www.cdc.gov/mis/mis-c.html
12. https://theconversation.com/feeling-forgetful-after-covid-study-shows-the-virus-can-affect-short-term-memory-195302
13. https://www.smh.com.au/national/fatal-heart-attacks-have-surged-in-australia-here-s-why-20230117-p5cd22.html
14. https://www.mja.com.au/journal/2023/218/1/associations-between-covid-19-and-hospitalisation-respiratory-and-non
15. https://www.nature.com/articles/d41586-022-00403-0
16. https://www.health.gov.au/sites/default/files/2022-12/coronavirus-covid-19-guidance-on-community-face-mask-use.pdf
17. https://www.nsw.gov.au/covid-19/stay-safe/guidance-on-wearing-face-masks
18. https://www.pnas.org/doi/10.1073/pnas.2119266119
19. https://www.health.gov.au/sites/default/files/2023-01/coronavirus-covid-19-common-operating-picture-13-january-2023.pdf
20. https://www.ninds.nih.gov/health-information/disorders/dysautonomia#:~:text=Dysautonomia%20is%20a%20disorder%20of,parasympathetic%20parts%20of%20the%20ANS.
21. https://www.bbc.com/news/health-52473523