Links in the chain

As the new COVID wave, most likely driven by the Omicron variant, continues to bring hardship across our nation and much of the world, it’s all the more important to go over the basics and what we’ve learned about the virus that has brought about this pandemic. A lot of the information that we remember most clearly was seared into us by the trauma of the early days of the pandemic, but not all of these still hold true. In part this is because our understanding of the virus has evolved, in part because people or society have made adjustments because of the pandemic and in part because each variant of the virus has its own characteristics. It’s important that we not only keep ourselves informed from trustworthy sources, but that we continue to update that information as the days go by.

Last week I wrote about how public health demands nothing less than a public response, and how the pandemic cannot be resolved solely by personal choices. This does not mean, however, that our personal choices have no role to play. In a column about his decision-making process when cancelling a celebration in light of Omicron, journalist Ed Yong wrote: “Failed systems constrain us, but we still have agency, and our small choices matter immensely. The infectious nature of a virus means that a tiny bad decision can cause exponential harm, but also that a tiny wise decision can do exponential good.”

What is the good that we are aiming for? Protection of ourselves, our loved ones and the most vulnerable members of society. When it comes to the pandemic, we are all potential links in a chain… but unlike in that old game show, this time we want to be the weakest link, the one that breaks the connection between someone infected and someone susceptible.

The way we do that, as Dr. Elle Murray has laid out, is by reducing the frequency of contact we have, and by reducing the probability of infection per contact.

Most of us have already drastically reduced our face-to-face interactions with other people, particularly once the case numbers started to climb. That this entails sacrifice is a given, but the alternative is harsh consequences, and we may not be the ones to bear those consequences. Not everyone can stay home or away from other people, but it’s important that those who can, do. Even when we cannot do so entirely, then reducing the number to the bare minimum can also do a lot to help. And right now, every little bit helps.

Reducing the probability of infection per contact can be done in several ways. COVID, based on the latest understanding of the WHO, is spread primarily through not just droplet transmission but through short-range airborne transmission as well, which can become long-range airborne transmission in poorly ventilated and/or crowded indoor settings where people tend to spend longer periods of time. This means that the best protection against infection is to filter the air that we breathe.

The most obvious way we do this is through masks. But it isn’t as simple as placing any barrier in front of our nose and mouth. The two factors to consider when it comes to masks (aside from price and availability) are filtration and fit. For filtration, considering the transmissibility of the Omicron variant, I believe we should all try to use the best masks possible, which are the N95 or KN95 types which not only use mechanical means to filter out particles, but also use electrostatic charge to attract and intercept them.

The advice to the public not to get these masks was given at the start of the pandemic because there was a shortage of such masks and they were more urgently needed by healthcare workers, but in many areas these supply issues have already been addressed. Unless there is once again a shortage, the best advice for protection would be to buy the best available masks (but do keep an eye out for fakes). Cloth masks alone will not do much against Omicron, nor any masks that have an exhalation vent. Surgical masks are the next best thing to N95 and KN95 masks if they are three-ply and made to fit well.

That issue of fit is also important to consider, and it’s one of the advantages of how N95 and KN95 masks are designed (with features such as a nose wire), but fit needs to be considered on an individual basis. Most N95 masks are not made to fit children and are thus not recommended for them, because even the best mask will not help if it doesn’t fit well (St. Jude Children’s Research Hospital has recommended children wear the white, duck-bill N95 masks).

A good fit means the mask completely covers the nose and mouth, is flush against the skin with as little gap as possible (particularly at the sides), doesn’t fall off and is breathable. This is one of the reasons why double masking with a surgical mask underneath (for filtration) and a cloth mask on top (for fit) is a good option. Experts do not recommend double masking using two surgical masks, or when your mask is an N95 or KN95.

Another important way to clean the air we breathe is through ventilation. Even if everyone is wearing the best possible masks, staying in an unventilated area will allow infected particles to accumulate and exposure to increase. The easiest way to ensure ventilation is to do our activities outdoors. If indoors, open the windows and try to use tools such as exhaust fans or HEPA filters… anything that can maximize airflow will help. For schools and establishments, ventilation must be a top priority.

Of course, as the recent surge has shown, even these methods may not be enough. I’m sure we know people who seemed to have done everything right and yet who fell ill to COVID. We may be one of these people ourselves, and it’s important not to fall into the trap of thinking that we must have failed if we get sick, that we have contributed to this pandemic or committed a sin or crime. All we can do is do our best, and do so with an eye towards not only minimizing our own risk but that of our community as well.