Bill Gates wrote a book talking about how to prevent the next pandemic. His advice is valuable, but I want to add my additional notes and suggestions to the advice in his book. This article will focus on what parts we can do better in the current pandemic and the next pandemic if such an outbreak happens again. Please note that this article is not about a summarization of Bill Gates’s book or a book review; it’s about what I described above. If you are interested in what Bill Gates suggests, you may purchase his book.
1. Transmission Of Virus After Vaccination: Why You Should Wear Mask And How Long Does It Take Until You Can Take Off Masks
Six months after the vaccines became available in the U.S in December, 2020 [1]https://www.bbc.com/news/world-us-canada-55305720 , 164 million Americans are fully vaccinated in July 2021 [2] … Continue reading, that’s roughly 49% of Americans who are fully vaccinated, while the figure of people who have received at least one dose isn’t far away from this – 67% of adults in the U.S received at least one dose in July 2021 [3]https://news.yale.edu/2021/07/08/us-vaccination-campaign-prevented-279000-covid-19-deaths .
Before the vaccines became available, many Western people protested claiming they are against the mask mandate.
After the vaccines have become available, in Apr 2021, Tucker Carlson, a Fox News host, asked “If we get vaccinated, why should we wear a mask?” In one interview, Dr.Dorian made a great and easy-to-understand answer by explaining “We still have a good population that is not vaccinated, so for us to decrease the chance of variant, the better off we are going to be. We need to get to herd immunity before the virus beats us. We know that if you are vaccinated, you can still get sick from COVID. The idea is you get a mild cold nothing major, but does that mean you can spread the mild illness to somebody who is not vaccinated? We don’t want to give it an opportunity [4]https://www.youtube.com/watch?v=GfEaP8KPmww .”
Still, the mask mandate has continued to be a concern in many Western people’s minds, the major claim is about whether wearing a mask or not is people’s freedom. I will answer this claim, but before that, let’s dig deeper into what Dr.Dorian means regarding “decrease the chance of variant”.
1. (1) What We Know – Virus Transmission After Vaccination
In Bill Gates’s book, he quoted the word of the head of the Chinese CDC (*which Bill Gates agrees), “The biggest mistake in the U.S and Europe is that people aren’t wearing masks.” While this statement was made in early 2020, before the vaccines became available, I want to add that this is still true even after the massive inoculation began in the Western world. Why?
Short answer: First, vaccination doesn’t guarantee you from infection of coronavirus. Second, just as the word of Dr. Dorian I quoted earlier states,” for us to decrease the chance of variant….we need to get to the herd immunity”, but eventually we didn’t get to the herd immunity before the next variant, Omicron, emerged. What do the two points mean? They mean there are breakthrough cases and variants, and many people have still not worn masks after new cases and variants were reported by the media. Therefore, part of the reason that there are still many infectious cases right now may be because many people have been not wearing masks after vaccination.
Long answer: Many people probably already know what the breakthrough case is after the variant came out. According to CDC, “COVID-19 vaccines also help protect against infection. People who are vaccinated may still get COVID-19. When people who have been vaccinated get COVID-19, they are much less likely to experience severe symptoms than unvaccinated people” [5]https://www.cdc.gov/coronavirus/2019-ncov/vaccines/effectiveness/why-measure-effectiveness/breakthrough-cases.html . Further, CDC also explains that “When someone who is vaccinated with a COVID-19 vaccine gets infected with the virus that causes COVID-19, it is referred to as a “vaccine breakthrough infection.” [6]https://www.cdc.gov/coronavirus/2019-ncov/vaccines/effectiveness/why-measure-effectiveness/breakthrough-cases.html . In Bill Gates’s book, he also mentions the same point, “Just as the rise of variants wasn’t a surprise, neither were so-called breakthrough cases, in which people who have been vaccinated end up getting infected anyway. Until vaccines or drugs can block infections perfectly, some vaccinated people will still become infected.”
So what does it mean in detail to explain why there is still coronavirus when most people in the Western world are vaccinated?
First, what most people know is that people who get vaccine breakthrough infections can spread COVID-19 to other people, just as Dr.Dorain said. CDC explains these transmissions mean more virus is circulating. When more virus is circulating, more breakthrough infections will occur even when vaccination rates are high. Even if you are vaccinated, if you live in a county with a high COVID-19 Community Level, you and others in your community, whether vaccinated or not, should take more steps to protect yourself and others, like wearing a mask in indoor public places [7]https://www.cdc.gov/coronavirus/2019-ncov/vaccines/effectiveness/why-measure-effectiveness/breakthrough-cases.html . According to the New York state government’s data, there are more than 2 million breakthrough cases of COVID-19 among fully-vaccinated people in New York State – this is just the number in New York[8]https://coronavirus.health.ny.gov/covid-19-breakthrough-data . This means many vaccinated people didn’t wear masks thus becoming breakthrough cases. So yes, part of the current mistake is people are not wearing masks.
Second, are you less likely to infect people if you are vaccinated? According to Dr. Katherine O’Brien from WHO, “if you happen to get infected, the amount of virus that you have in your nose, in the back of your throat that you are shedding and potentially transmitting to somebody is less of the virus. There’s less density of the virus in you and so less risk that you transmit it to somebody else.” [9]https://www.who.int/emergencies/diseases/novel-coronavirus-2019/media-resources/science-in-5/episode-49-can-i-get-infected-after-vaccination The view is actually not consistent with many scientific studies. One study in 2021 which examined the same topic indicated there is no statistically significant difference in transmission potential between completely vaccinated people and those who were not fully vaccinated [10]https://www.news-medical.net/news/20211124/Markers-of-SARS-CoV-2-shedding-in-vaccinated-and-unvaccinated-individuals.aspx . Although there is another study indicates that for Omicron BA.1 breakthrough cases, reduced infectious VL was observed only in boosted individuals with three shots but not in fully vaccinated individuals with two shots compared to unvaccinated individuals, and the study concludes that vaccines may lower transmission risk [11]https://www.nature.com/articles/s41591-022-01816-0 , that’s for only the Omicron cases, while the study conducted in 2021 was probably focused on original COVID-19 and the Delta variant – this means there is no significant difference in potentially transmitting original COVID-19 and the Delta variant between completely vaccinated people and those who were not fully vaccinated. In addition, the second study which focuses on the Omicron variant states that, unlike the Delta variant, mechanisms other than the metric of increased infectious VL contribute to the high infectiousness of Omicron BA.1. Yet, even if a vaccinated individual is less likely to infect people, still do notice the word “less likely”, this means less possibility, but doesn’t mean no possibility. So a vaccinated individual can still infect other people. Some people might ignore this fact. Since you can still get infected and infect other people after vaccination, yes, part of the current mistake is people are not wearing masks.
Third, a U.S study shows, “Persons with infection who never develop symptoms may account for approximately 24% of all transmission. In this base case, 59% of all transmission came from the asymptomatic transmission, comprising 35% from presymptomatic individuals and 24% from individuals who never develop symptoms (asymptomatic). ” To distinguish the difference between asymptomatic and presymptomatic, you may read Medical News Today‘s explanation: “Transmission by persons who are infected but do not have any symptoms can arise from 2 different infection states: presymptomatic individuals (who are infectious before developing symptoms) and individuals who never experience symptoms (asymptomatic infections, which we will refer to as never symptomatic)…An asymptomatic person has tested positive for COVID-19 but never exhibits any signs or symptoms of the disease.” [12]https://www.medicalnewstoday.com/articles/what-is-asymptomatic#identification . Ok, back to the topic. Although the above quoted study states the exact proportions of presymptomatic and never symptomatic transmission are not known, it concludes, “transmission from asymptomatic individuals was estimated to account for more than half of all transmissions. In addition to the identification and isolation of persons with symptomatic COVID-19, effective control of spread will require reducing the risk of transmission from people with infection who do not have symptoms. These findings suggest that measures such as wearing masks, hand hygiene, social distancing, and strategic testing of people who are not ill will be foundational to slowing the spread of COVID-19 until safe and effective vaccines are available and widely used” [13]https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2774707 . Since the study said “transmission from asymptomatic individuals was estimated to account for more than half of all transmissions”, there could be many cases where vaccinated people get infected but are asymptomatic cases, then infect other people unknowingly. In my view, part of these cases is probably because asymptomatic individuals didn’t wear masks as they thought they are vaccinated. So yes, part of the current mistake is people are not wearing masks.
Fourth, In Bill Gates’ book, he talks about children’s cases. “There were fewer COVID cases among children, and a study in Norway found that there wasn’t much transmission in schools, leading many people (including me) to conclude that kids weren’t as susceptible as adults are…..The initial view was probably affected by the fact that many schools were closed.” Indeed, many people think children only get mild symptoms. Here’s what you probably didn’t know, one TheConversation article pointed out in 2020, “Children, who may not experience any symptoms or only very mild symptoms, may also be able to spread the infection” [14]https://theconversation.com/coronavirus-faqs-can-people-without-symptoms-spread-covid-19-how-long-does-it-live-on-surfaces-what-cleaning-products-kill-the-virus-134945. What you may not know is, that since children who do not experience any symptoms can infect other people, I think people should wear a mask and be more cautious about preventing getting the virus even if they are vaccinated in 2021, but people didn’t. In the early time of 2021, there weren’t available vaccines for children, and since children only got mild symptoms around that time, people thought it was ok for not to be cautious as long as parents and teachers get vaccinated, so I think that children who hadn’t vaccinated around early 2021, is probably also one of the reasons why more and more virus are circulating in 2021 (Other reasons are explained as the above points in earlier paragraphs). The transmission chain would probably be “Adults not wearing a mask get breakthrough and transmit the virus to children”, “Children hadn’t got vaccinated so get infected then infect vaccinated adults”, or both ways. Governments and people should be cautious at that time but didn’t. Around March 2021, when there was no vaccine for children, some states in the U.S such as Florida and Iowa issued orders to reopen schools [15]https://edition.cnn.com/interactive/2020/health/coronavirus-schools-reopening/ . In the meantime, many parents and kids are against the mask mandate at schools because of reasons such as personal freedom or religious belief. So yes, part of the current mistake is people are not wearing masks.
1.(1).1 Other factors which possibly contributing to the non-ended pandemic
In addition to the most possible four factors of why there is still coronavirus everywhere when the majority of people are already vaccinated, I want to discuss two relatively minor possibilities: Viruses can survive in the environment for a longer time than people expect or airborne transmission and recombination of viruses.
1.(1).1.1 Viruses survival in an environment & Airborne (Aerosol) transmission
Vaccines have relaxed many people’s minds. Just as in the breakthrough cases I explained in earlier paragraphs, many people didn’t know you can still get infected and transmit viruses to other people. Part of this unawareness is that many people would think of the past smallpox case and think vaccines could eradicate COVID-19, too. People stop being cautious about wearing masks and preventing infections after inoculation. However, COVID-19 is different from smallpox in some ways. This article explains the difference. One of the differences that I want to point out is the third point in this article: smallpox, which is primarily transmitted through respiratory droplets and close contact, is less transmissible than SARS-CoV-2, which can spread through aerosols [16]https://publichealth.jhu.edu/2022/qa-why-cant-covid-19-be-eradicated-and-other-lingering-questions
Here airborne / aerosols transmission is a transmission of infectious disease through a small participle suspended in the air [17]https://en.wikipedia.org/wiki/Airborne_transmission . Bill Gates describes aerosol transmission in his book, “Once it was known that COVID spread mainly through the air, most experts thought it did so via droplets. This would have meant that anyone more than a few feet away, or sharing the same air space just a few seconds later, would’ve been safe. But further research showed that aerosols also contribute significantly to the transmission…Because they weigh much less than droplets, they can travel farther and linger in the air longer. And for a time, the virus was evolving to spread even more via aerosols.” He points out a COVID-19 case of aerosol transmission, “In Sydney, Australia, an eighteen-year-old man singing in a church loft passed the virus to twelve others who were sitting fifty feet away.” UK Research and Innovation states, ”the COVID-19 virus chiefly transmits through liquid droplets containing viruses. There is currently no robust scientific evidence to support the airborne transmission of SARS-CoV-2, but a study conducted in Wuhan suggests that SARS-CoV-2 has the potential to be transmitted via aerosols.” [18]https://coronavirusexplained.ukri.org/en/article/pub0008/ . So simply put, the virus can transmit to people in the air when there is no infectious human being physically close to you, though the percentage of the infected cases through this type of transmission is unknown, it’s possible.
In fact, coronaviruses stay in an environment or transmit via aerosols are no news before the COVID-19 pandemic. One study examining ways of virus transmission by Professor Gustavo Fermin which is published in 2018 wrote, “Viruses are often shed into the environment from infected hosts or carrier hosts…….They are carried by urine, feces, blood, serum, and saliva as well as in the air. It is not an exaggeration to say that viruses are everywhere. While outside of their cellular hosts and in the environment, viruses have the potential to survive, persist, and be transported by various routes to other susceptible hosts.“ Although the study does emphasize, “Not all viruses released into the environment are, however, successful in maintaining an infectious status and reaching new susceptible hosts; persistence or survival can vary greatly with virus type and environmental conditions”, it also points out, “a study investigating enveloped surrogates of coronaviruses (transmissible gastroenteritis and mouse hepatitis) demonstrated that these enveloped viruses remained infectious in wastewater for weeks[19]https://www.sciencedirect.com/science/article/pii/B978012811257100005X?via%3Dihub .”
In conclusion, despite that the possibility of transmission of COVID-19 through the air is unknown and perhaps small, it is still possible. As it’s possible and you still can get infected and transmit viruses to other people, you need to wear a mask even if you are fully vaccinated.
1.(1).1.2 Recombination of viruses
According to WebMD, “mutation is not the only concern. Viruses have another mechanism that produces new strains: Recombination, which can occur when a person is infected with two different strains of the same virus, altogether producing a different strain of the virus.” It quotes Professor Ray’s words “In the early days of SARS-CoV-2, there was so little diversity that recombination did not matter. However, there are now distinct lineages of the virus circulating globally.” Ray further says, “The more diverse the strains that are circulating, the bigger a possibility this is [20]https://www.webmd.com/vaccines/covid-19-vaccine/news/20210730/threat-of-vaccine-proof-covid-variant ”. So if you don’t wear a mask and get infected, it’s possible that there are two strains of the virus in your body and produces a new different strain, then the new different strain of the virus transmits to other people via you. As a result, there are many different strains of virus circulating in the world, and the current vaccine may not be able to tackle them all. At that time, we may need another shot of the current vaccine or a new vaccine. The pandemic has thus become an endless pandemic, as is the case with people who don’t wear masks and get infected that cause the virus to mutate.
1.(2) What Went Wrong Making This Pandemic Still Be Going On
1.(2).1 Not Wearing Masks
One of the major reasons that make this pandemic still going on, just as I said in an earlier paragraph, is the situation that many people, especially Western people, have not been wearing masks after the massive vaccination began. Before the vaccines became available, part of the reasons that people didn’t wear masks is attributed to the governments and WHO, because many Western governments and the WHO didn’t suggest uninfected people put on masks [21]https://www.cdc.gov/media/releases/2020/t0212-cdc-telebriefing-transcript.html [22]https://edition.cnn.com/2020/03/30/world/coronavirus-who-masks-recommendation-trnd/index.html – this is something that Taiwan government, the majority of Taiwanese, and China already knew. Bill Gates also agrees with that fact by quoting the head of the Chinese CDC in 2020, “The biggest mistake in the U.S and Europe is that people aren’t wearing masks” in his book. I would like to repeat what I said in the earlier paragraph: This is still true after the vaccine became available. In Bill Gates’s book, he notes several CDCs of the U.S’s responses to COVID in 2021, which is the time vaccines became available. The following are some of them that I think are worth noting:
“April 27, 2021: The CDC announces that people do not need to wear masks outdoors when they walk, bike, or run alone or with members of their household regardless of vaccination status.”
May 13, 2021: The CDC announces that fully vaccinated people no longer need to wear a mask or physically distance inside. Some states, like Washington and California, continue to mask mandates through some or all of June.
July 27, 2021: The CDC recommends that fully vaccinated people resume wearing masks indoors in parts of the country where case counts are surging.
Bill Gates expresses in his book that the CDC was wrong in May 2021 when it said that “vaccinated people didn’t need to wear masks”, which I agree with. I want to particularly point out that the word of Dr.Dorian which I quote at the beginning of this article was spoken in April 2021, which is earlier than May 2021. Since some scientists in the U.S already knew about the fact that there is a possibility that there could be more new variants coming out if people don’t wear masks, I wonder why the U.S CDC at that time didn’t care about the mask mandate to avoid variants before reaching herd immunity? 2021 is a year in which Biden is the U.S president, not Trump (the former president who didn’t take scientists’ suggestions of COVID), so it’s not another Trump’s fault. I think this is something the U.S government should examine during this pandemic.
1.(2).2 Not Enough Vaccination Globally
In Bill Gates’s book, he wrote, “The ability of new waves of COVID to spread through a population depends a lot on how many people have been vaccinated, infected, both, or neither. ” One article in Scientific American talking about how to end the pandemic wrote, “The question of how the pandemic plays out is at least 50 percent social and political. The other 50 percent will probably come from science…Unless a vaccine is administered to all of the world’s eight billion inhabitants who are not currently sick or recovered, COVID-19 is likely to become endemic.”[23]https://www.scientificamerican.com/article/how-the-covid-19-pandemic-could-end1/ . Vaccine distribution is definitely a concern. I will talk about this topic in Point 4 of this article. Here I want to focus on the mistakes many people made because many people don’t know the facts resulting from this unequal distribution: There could be new variants which the current vaccines won’t help. Unknowing this fact, many people especially in the Western world didn’t wear masks after vaccination. Thus, Delta variants and Omicron variants infect some of them, and there have been more and more infectious cases. Part of the Pandemic seems to keep going on because people didn’t wear masks and thus infected these variants.
1.(2).3 Relaxing The Regulations Too Soon
Bill Gates wrote in the book, “You also have to be careful about relaxing all NPIs (Non-Pharmaceutical Interventions: Measures such as closing schools) too soon. When the most effective public measures are relaxed—such as restrictions on large gatherings—case numbers tend to go back up. The problem with relaxing these measures early is that you have large numbers of people who are what experts call “immune naïve”: They’ve never been exposed to the virus—and they’re susceptible to infection…In some cases, we need to keep some NPIs going until we can develop medical tools that protect you from infection and keep you out of the hospital if you do get sick.” While what Bill Gates said is true – We need to be careful about relaxing regulations, he didn’t talk about what measure was relaxed too soon by which government during this pandemic in the book. Here I want to point out that we did make some mistakes in terms of relaxing the regulations. What mistake?
First, reinfection is possible was already a known fact to the WHO (so that means the whole world knew that) in 2020 [24]https://www.who.int/news-room/questions-and-answers/item/herd-immunity-lockdowns-and-covid-19#:~:text=We%20are%20still%20learning%20about,people%20to%20get%20infected. . Second, in 2020, Dr. Faucipredicted that 70 to 85% of the United States population may need to be vaccinated to achieve “herd immunity” against SARS-CoV-2 [25]https://www.pnas.org/doi/10.1073/pnas.2107692118 [26]https://www.self.com/story/dr-fauci-covid-19-vaccine-herd-immunity . In my view, the two things indicate governments should be more cautious in terms of relaxing the regulations, but they didn’t. Let me explain the detail.
For example, in March 2021, CNN analyzed that 70% of the US population could be fully vaccinated around the end of July and 85% by mid-September at the pace of that time. But CNN also points out that the CDC estimated that more than a quarter of the population may have been infected by Covid-19, bumping the share of the population already protected up to nearly a third. Assuming there’s no overlap between people with natural immunity and those protected through vaccination, herd immunity could be reached as early as June. [27]https://edition.cnn.com/2021/03/05/health/herd-immunity-usa-vaccines-alone/index.html California cancel mask mandate in June 15, 2021 [28]https://calmatters.org/newsletters/whatmatters/2021/05/california-end-mask-mandate/ . However, according to an article in LA Times in March 2021, some rural counties in Northern California are falling further behind in COVID-19 vaccination rates compared with the rest of the state, causing cases to remain flat or, in some cases, to rise. For example, in June 2021, in Shasta County – one of the counties in California – only 36% of residents had received at least one dose while more than 67% of residents had done so in San Francisco [29]https://www.latimes.com/california/story/2021-06-02/70-of-california-adults-have-at-least-one-shot-but-vaccine-rates-in-the-north-are-low . The result? As of July 19, 2021, California’s statewide case rate more than quadrupled from a low in May of 1.9 cases/100,000/day to at least 9.5 cases/100,000 [30]https://www.gov.ca.gov/2021/07/26/california-implements-first-in-the-nation-measures-to-encourage-state-employees-and-health-care-workers-to-get-vaccinated/ .
Some scientists will want to consider other factors, while it’s good in many other cases, I couldn’t think of what are the factors that can contribute to breakthrough cases (reinfection – infect after vaccination) and normal cases (infect without vaccination) other than not wearing masks whether you are vaccinated or not. Why? Because wearing a mask is the most effective and scientific-proved way to protect you from getting infected at the moment [31]https://www.ucsf.edu/news/2020/06/417906/still-confused-about-masks-heres-science-behind-how-face-masks-prevent . Although there are two other factors – wash hands frequently, and keep a social distance, a mask still represents a major way to protect you. Let me further explain why.
First, Infectious disease specialist Chin-Hong said “Of the three (Mask, Wash hands, Social distance), the most important thing is wearing a mask. Compared to wearing a mask, cleaning your iPhone or wiping down your groceries are ‘just distractors.’ There’s little evidence that fomites (contaminated surfaces) are a major source of transmission”. I agree with his words; however, I want to note that this doesn’t mean washing hands doesn’t important. It’s simply that wearing masks is more important as it can protect you from the major infection pathway. You still need to be cautious by washing your hands and disinfecting your items frequently.
Second, answering the question of whether social distance can replace masks, epidemiologist Rutherford said, “You should always wear masks and social distance. I would be hesitant to try to parse it apart. But, yes, I think mask wearing is more important.” I agree with his words but I think it’s not complete as to why wearing mask is more important – probably because this is difficult to explain. So why? It’s true that while a surgical mask may be effective in blocking splashes and large-particle droplets, it does not filter or block very small particles in the air [32]https://www.fda.gov/medical-devices/personal-protective-equipment-infection-control/n95-respirators-surgical-masks-face-masks-and-barrier-face-coverings – this means wearing masks can be still not enough to protect you from the airborne transmission; nevertheless, a study states “surgical masks and N95 masks protect humans from the transmission of COVID-19 droplets/aerosols, however, medical masks (surgical masks and even N95 masks) could not completely block the transmission of virus droplets/aerosols even when sealed [33]https://www.researchgate.net/publication/346331575_Effectiveness_of_Face_Masks_in_Preventing_Airborne_Transmission_of_SARS-CoV-2 .” Notice the word “could not completely”, this means masks could still provide a level of protection – simply the protection level is not 100%. In that study, under a specific circumstance, cotton and surgical masks blocked more than 50% of the virus transmission, whereas the block rate of the N95 mask is even higher.Another study shows the same finding: Face masks reduce the distance airborne pathogens could travel (airborne transmission), when speaking or coughing, by more than half compared to not wearing a mask. More importantly, that study provides clear evidence and guidelines that 3 feet of distancing with face coverings are better than 6 feet of distancing without face coverings [34]https://www.sciencedaily.com/releases/2022/01/220112121559.htm . So the above study statements are why that mask can protect you from both the major infection pathway – droplet – and the not-major infection pathway – air, while social distancing probably protects you from the droplet. In addition to the above, when you are in a public space, sometimes it’s difficult to keep a social distance. So yes, wearing a mask is more important than social distance. Therefore, since breakthrough ( infection after vaccination) is possible, a mask is the major way to protect you from viruses no matter you are vaccinated or not.
The example I take is California, one of the U.S states led by Democratic. Notice it’s a Democratic state – the situation even happened in a Democratic state. The situation is worse in Republican states in the U.S. For example, in June 2021, fewer than 35% of eligible people are fully vaccinated against COVID-19 in each East Texas county [35]https://www.kltv.com/2021/06/02/east-texas-covid-19-vaccination-rate-lags-behind-other-areas-of-state/ , which is far lower than 70% of Texas’s total population – the vaccination rate we need to get herd immunity statewide if Texas closes its border to prevent infectors enter into Texas (But the average vaccination rate across the whole U.S is actually higher – 56.2%). On May 18, 2021, which was a time before July 2021 thus the vaccination rate in Texas was even lower, Texas Governor Brad Little Greg Abbott issued an executive order that will bar public schools and most other government entities from requiring masks[36]https://www.cbsnews.com/news/texas-mask-mandate-abbott-bans/ . The result? The statewide confirmed cases in Texas rised, going from a seven-day average of 11,300 on June 23, to about 23,600 a day on June, according to Johns Hopkins University data [37]https://spectrumlocalnews.com/tx/south-texas-el-paso/news/2021/07/14/new-cases-of-covid-19-tick-up-in-texas-as-delta-variant-proliferates- . The vast majority of confirmed cases are probably unvaccinated people, as the vaccination rate in parts of Texas was low [38]https://www.kwtx.com/2021/07/22/covid-cases-are-rising-vaccination-rates-are-low-so-texas-decides-put-show/. Many people will argue that it’s because people are not vaccinated, not that they didn’t wear masks. I would say that the low vaccination rate is definitely the major reason in Texas’s case. Nevertheless, if many people in Texas are unvaccinated – the unvaccinated rate in Texas was even higher than in California, people should wear masks and be more cautious at that time. If people in Texas wear masks, the number of infectious cases will be lower, even if people are not vaccinated – because they are protected by masks. Yet, people in Texas didn’t do that. In July 2021, when more than 10,000 cases were confirmed, a Texas doctor warned that children, who are not eligible for a vaccine until age 12, are increasingly falling victim to the delta variant[39]https://thehill.com/changing-america/well-being/longevity/565323-texas-doctor-warns-covid-cases-are-rising-among/ . If children wore masks in school, the number of infectious cases of children would be lower.
The fact that masks reduce infectious cases had already been validated in 2021, even before 2021. In 2021, a study concludes that in countries with cultural norms or government policies supporting public mask-wearing, for example, Thailand, Japan, South Korea, and Taiwan, per-capita coronavirus mortality increased on average by just 5.4% each week, as compared with 48% each week in remaining countries [40]https://www.researchgate.net/publication/341639009_Association_of_country-wide_coronavirus_mortality_with_demographics_testing_lockdowns_and_public_wearing_of_masks . Another study in Germany in 2020 concludes that face masks considerably reduce the daily growth rate of reported infections by around 47% in Germany [41]https://www.pnas.org/doi/10.1073/pnas.2015954117 . Therefore, we can see the U.S still made mistakes in terms of relaxing one of the regulations too soon – the mask mandate.
What about other countries? In the study which I quoted earlier, all of the 11 countries in which governments and people supporting masks have lower mortality rates are in Asia. Nevertheless, in Europe, it’s a different story. On July 19, 2021, the U.K lifted most of its coronavirus restrictions, including face masks and social distancing, while still recommending wearing masks – Masks become voluntary, not mandatory [42]https://www.ndtv.com/world-news/england-set-to-lift-facemask-social-distancing-rules-on-july-19-2479949 . At the same time – in July 2021, U.K Opposition politicians and some doctors urged the government not to remove the mask mandate [43]https://apnews.com/article/joe-biden-europe-health-government-and-politics-coronavirus-pandemic-105efe9f913055d7b60cd2c1fd5e8adb . Some ordinary U.K citizens who completed two jabs also conveyed they would keep wearing masks as cases were soaring, while some citizens decided they would take off masks once the restriction is lifted [44]https://www.theguardian.com/world/2021/jun/23/mask-off-is-england-ready-to-ditch-face-coverings-post-covid . Anyway, the mask mandate was lifted. The result is that over the three months from July to October 2021, there had been rough as many confirmed cases as there were over the three months in 2020 when there was no vaccine, though vaccinations relieved the symptoms thus making fewer cases end up in hospital[45]https://www.bbc.com/news/health-58954793 . Just as the U.K did, many Europe countries also lifted mask mandates around the same period, such as France, Spain, and some states in Germany[46]https://www.efe.com/efe/english/portada/european-countries-look-to-end-face-mask-rule/50000260-4564852 [47]https://www.reuters.com/world/europe/spain-scrap-mandatory-outdoor-masks-june-26-2021-06-18/ [48]https://www.thelocal.de/20210615/explained-the-new-rules-on-masks-that-come-into-force-next-week/ . China, a country in Asia but not in the list of the 11 Asia countries in the study I quoted, also went mask-free [49]https://www.dnaindia.com/lifestyle/photo-gallery-list-of-mask-free-countries-mask-wearing-not-mandatory-covid19-2892481/china-2892487 . Eventually, during a specific period in late of 2021, 56 countries from all regions, reported an increase in deaths of more than 10 percent. According to WHO’s Regional Director, there are two reasons for this surge: insufficient vaccination coverage, and relaxation of public health and social measures [50]https://news.un.org/en/story/2021/11/1104912 . You may say just as what WHO said, insufficient vaccination coverage is also one of the reasons, and several measures came into play in this surge, not only canceling the mask mandate. Indeed, the relaxation of measures such as travel restrictions or border control is one of the factors of this surge. However, the mask is still the major factor, because the mask is the crucial way to protect you from a possible breakthrough infection, and if everyone wore masks, the virus wouldn’t be transmitted that much among the community when there were some infected travelers came into your country
How about now? In March 2022, France relaxed most of the restrictions, mask free is okay in almost every place except for hospitals and public transportation; you don’t need to show your vaccine passport when you go to a restaurant or bar, either. But the case number was soaring in Europe in March, and there has been a new variant BA.2 [51]https://today.line.me/tw/v2/article/nX9xDXo?utm_source=copyshare . In one of the weeks in June, the number of new cases in France jumped by nearly 50% [52]https://www.lemonde.fr/en/environment/article/2022/06/22/covid-19-cases-are-on-the-rise-in-europe-yet-again_5987619_114.html .
Bill Gates said in his book, “A more dangerous variant may emerge—one that spreads more easily, causes more severe symptoms, or evades immunity better than previous variants.” The current Omicron variants are potentially a good case of the breakthrough case. In November 2021, the Omicron variant was first reported. Professor Andrew Stanley said, “This family of omicron subvariants transmits more effectively than any other variant we’ve seen so far. They evade a large portion of the vaccine-induced immunity; you’re protected from the severe disease, but can get infected” [53]https://publichealth.jhu.edu/2022/an-omicron-vaccine-may-help-curb-the-spread-of-this-game-changing-variant . A study also shows that the Omicron variant is markedly resistant to neutralization by serum not only from patients who recovered from COVID-19 but also from individuals who were vaccinated with one of the four widely used COVID-19 vaccines [54]https://www.nature.com/articles/s41586-021-04388-0 . The Omicron variant is a good example of the virus evolving to an extent that current vaccines don’t do much help in being against it; we become in need of a new vaccine to protect us from the Omicron variant. In addition, we need not only a new vaccine but also a new antibody drug to cure these new variants. For example, another variant: Beta. Bill Gates said in the book, “The Beta variant of the virus, which was especially prevalent in Africa, had changed its shape enough that the antibodies we had supported no longer grabbed onto it enough to help.”
Since there is a possibility that there will be a virus outsmarting the current vaccine, we need to be more cautious. I said the Omicron variant is a good example of how virus evolution can be, but we are also lucky that the Omicron variant, though more transmissible, does not cause so many severe symptoms in most humans as the original coronavirus is. Just as Bill Gates said: A variant that causes more severe symptoms or evades immunity better may emerge, we may not be as lucky as this time that encountering a variant that though escapes much of vaccine-induced immunity, but doesn’t cause severe symptoms on most of the humans. We must be cautious in relaxing restrictions such as mask mandates – this certainly should be accompanied by distributing vaccines globally.
Read Part 2
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Chrissy Slora
The articles published in this website are all written by Chrissy Slora. Chrissy Slora aims to make people learn about how the world can be better and provide her intelligent and wise insight by writing about various topics from technology to issues happening in the world. Follow her on social media: Facebook | Twitter | Linkedin