Expert reflects on the importance of masks and other COVID-19 updates

As my COVID-19 recovery continues, I have questions. So I called public health expert Frank James, MD, to help me.

James is active in teaching, research and medical practice. He is the health worker for San Juan County and the Nooksack Indian Nation in Washington State. He is a clinical assistant professor at the University of Washington School of Public Health and an assistant professor of global health at the National Yang-Ming University School of Medicine in Taipei, Taiwan.

Excerpts from our conversation follow.

JL: I was vaccinated and boosted but still got COVID-19. What happened? I feel like my vaccines let me down.

FJ: We must remember that the purpose of the vaccine is to prevent serious illness and death. The vaccine will not prevent the initial infection, but it will prevent it from getting worse. The vaccine prevents the virus from replicating in your body. If you are not hospitalized and you are not dead, it is a success. Vaccines help prevent serious infections and deaths that overwhelmed hospital systems early on.

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My rapid COVID-19 test is still positive after 12 days. Am I still contagious? The US Centers for Disease Control’s five-day quarantine rule doesn’t make sense to me.

The five-day rule was a business decision to get workers back to work. If workers are forced to stay out of the labor market for 10 days, this has a huge economic impact. In my jurisdiction, infected people test on day six with rapid tests and, if negative, return to work. If the test is positive on the sixth day, they remain absent until the tenth day.

It also depends on the test. The PCR test is much more sensitive, and after an infection you will be positive for three weeks to 90 days. The rapid antigen [home test] is correlated with infectiousness, so, yes, you can still be infectious if your rapid test is positive, but expect your PCR to stay positive. Masking will help prevent the spread [the virus].

the importance of masks |  Hemophilia News Today |  A photo shows Dr Frank James smiling, wearing glasses and green shorts.  A text caption next to it reads,

(Courtesy of Dr. Frank James, graphic by Jennifer Lynne)

Where do you think we are going?

It’s not going to go away. Our selfishness is our weakness. 80% of Africa did not receive a single dose [of COVID-19 vaccines].

My biggest fear is the virus chasing innovation. We must remember that our vaccines were developed against earlier variants. As new variants emerge, vaccines become less and less effective. As new variants develop and improve contagiousness, the virus bypasses the antibodies we have already developed.

The new BA.4 and BA.5 versions of omicron are a good example of this. They are an example of immune evasion; the vaccine won’t work as well, monoclonal treatments don’t work as well, and even a previous infection offers significantly less protection. They bypass our defenses. The new variants will replace the old variants in a few weeks.

Right now, the public doesn’t care, because for the most part infections aren’t life-threatening because omicron affects the upper respiratory tract and not your lungs. But the other half of that is even a mild COVID-19 infection that affects any tissue with an ACE receptor. This includes your pancreas. We see 38% increase in diabetes in the general population. The increase is very impactful for those who lose the critical function of their pancreas.

Mortality then increases due to diabetes or problems with the kidneys, brain, heart, pulmonary fibrosis or vascular system. Autopsies show that all tissues containing ACE receptors are infected and can be affected by infection, not just the lungs and upper respiratory tract.

A recent post study found that anyone infected with COVID-19 is at higher risk for heart problems – clots, inflammation and arrhythmias – long after the illness has passed. Many of the manifestations we describe are chronic conditions that will affect people throughout their lives and will require care for a long time. People, health systems and governments need to be prepared for this.

Remember that a virus survives by reproducing and evolving. It’s a bad idea to kill your host. We are only just beginning to understand the role of COVID-19 in long-term illness. We really have no idea. Long-term studies of COVID-19 are needed to understand morbidity. The next question is whether we can do something about it.

Are masks still necessary?

Yes. It is still very important not to get infected! You should always wear a mask – N95 or KN95 – indoors when around people you don’t live with. Masks keep viral load low to prevent infection, which prevents transmission. It’s a big problem.

To note: Hemophilia news today is strictly a disease news and information site. It does not provide medical advice, diagnosis or treatment. This content is not intended to replace professional medical advice, diagnosis or treatment. Always seek the advice of your physician or other qualified health care provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay seeking it because of anything you read on this website. The opinions expressed in this column are not those of Hemophilia news today or its parent company, BioNews, and are intended to spark discussion on issues relating to haemophilia.

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