Thursday, November 30, 2023

No proof face masks ever worked against Covid, claims UKHSA

There is no solid proof masks ever slowed the spread of Covid, England's former deputy chief medical officer said today.

Professor Dame Jenny Harries, who now heads up the UK Health Security Agency, said the evidence that coverings reduced transmission is 'uncertain' because it is difficult to separate their effect from other Covid curbs.

She also told the UK's Covid inquiry that government advice on how to make a mask using two pieces of cloth was 'ineffective'.

Studies showed at least three were needed for even a small effect on the spread of viruses, Dame Jenny said.

Meanwhile, she warned advice for the public to wear masks during the pandemic may even have given people a 'false sense of security' that they could reduce their risk of becoming infected if they wore one while mixing with others.

Dame Jenny wrote in her witness statement that the evidence base for using face masks in the community 'was, and still is to some degree, uncertain'.

She noted that the evidence for mask wearing varied depending on what materials it was made from. For example, a 'one or two layer cloth covering' is 'not particularly effective', she said.

And if someone doesn't wear it properly – fully covering the mouth and nose – 'it won't work', Dame Jenny added.

The inquiry was shown guidance on how people can make their own face masks from the first wave of the pandemic.

In response to the proposals in May 2020, Dame Jenny wrote that advice to use one or two pieces of fabric was 'ineffective'.

She told the inquiry that the evidence at the time said at least three layers were needed 'to give a positive impact' but even this finding 'was not very strong', so the advice was not effective.

Dame Jenny also warned that encouraging people to wear face masks led to a 'false sense of security' that people could mix more closely without risk.

Asked about a Government document recommending the use of face masks in May 2020, Dame Jenny said: 'We've got all sorts of safety issues here as well.

'One of the problems in May was when there were a lot of discussions about coming out of lockdown and opening up the economy and various other things – and the two metre, one metre (social distancing guidance).

'I think this was landing just about the same time as the "one metre plus" issue.

'The problem we had there was that there appeared to be a view permeating through, and a real concern and risk, that it was being conceived that if you did one metre and you wore a face covering slung round your cheek, or whatever it might be, that was fine.

'So, there was a risk that in encouraging face (masks) people would stop doing the thing that was really important, which was distancing and all the other things.'

Asked by inquiry chair Baroness Heather Hallett whether this led to a risk of a 'false sense of security', Dame Jenny replied: 'Yes, a false sense of security.

'But it was actually also overlapping with what was economically-driven policy, I think, to try and remove some of the distancing rules.'

She said, at the time, she and Professor Sir Jonathan Van Tam, England's former deputy chief medical officer, were 'really trying to highlight what we thought about the two metre and one metre rule discussions'.

Dame Jenny added: 'What was being conceived was if you wear a face covering and reduce everything to a metre, the face covering will make up for the difference, and the answer was no, it won't, and it definitely won't if it's ever not evidence based.'

Dame Jenny also revealed that she wrote to cabinet secretary Simon Case in May 2020, when he was No10 permeant secretary, expressing concern that people may believe they 'could go back to normal' wearing face coverings made from t-shirts, when there was no evidence base around the measure.

She told the inquiry: 'The first question was, shouldn't you be encouraging this? There's no harm'. 'The issue for me at that time, and I think Professor Van Tam shared it, was we definitely shouldn't be supporting something which was not evidence-based if it was going to promote a risk compensation.

'Of course, face coverings, as I know you'll be aware, is a wholly polarised debate and it's quite difficult to maintain a central position, if I'd said: "don't do any of this", somebody would have challenged back and said: "Well, surely there's no harm".

'My main concern was it would have been conceived as a safer way of moving about just when we got through the first tragic wave of a pandemic.'

Asked if she did anything about the concern, she added: 'Yes, well on the one metre, two metre (social distancing suggestion).

'I think this is very much around the same time that the CMO (chief medical officer), CSA (chief science adviser) and the two deputy CMOs wrote to Simon Case, because it was around lifting all the different industries and businesses and sectors at the same time.

'The anxiety was that if people just thought they could get a bit of t-shirt, put it around the face and that would solve all the problems and we could go back to normal, that was not going to be a good public health intervention.


What's the latest on COVID antiviral drugs, and who is eligible?

Australia is experiencing a fresh wave of COVID, seeing increasing cases, more hospitalisations and a greater number of prescriptions for COVID antivirals dispensed over recent months.

In the early days of the pandemic, the only medicines available were those that treated the symptoms of the virus. These included steroids and analgesics such as paracetamol and ibuprofen to treat pain and fever.

We now have two drugs called Paxlovid and Lagevrio that treat the virus itself.

But are these drugs effective against current variants? And who is eligible to receive them? Here's what to know about COVID antivirals as we navigate this eighth COVID wave.

What antivirals are available?

Paxlovid is a combination of two different drug molecules, nirmatrelvir and ritonavir. The nirmatrelvir works by blocking an enzyme called a protease that the virus needs to replicate. The ritonavir is included in the medicine to protect the nirmatrelvir, stopping the body from breaking it down.

Molnupiravir, marketed as Lagevrio, works by forcing errors into the RNA of SARS-CoV-2 (the virus that causes COVID) as it replicates. As these errors build up, the virus becomes less effective.

This year in Australia, the XBB COVID strains have dominated, and acquired a couple of key mutations. When COVID mutates into new variants, it doesn't affect the ability of either Paxlovid or Lagevrio to work because the parts of the virus that change from the mutations aren't those targeted by these two drugs.

This is different to the monoclonal antibody-based medicines that were developed against specific strains of the virus. These drugs are not thought to be effective for any variant of the virus from omicron XBB.1.5 onwards, which includes the current wave. This is because these drugs recognise certain proteins expressed on the surface of SARS-CoV-2, which have changed over time.

What does the evidence say?
As Lagevrio and Paxlovid are relatively new medicines, we're still learning how well they work and which patients should use them.

The latest evidence suggests Paxlovid decreases the risk of hospitalisation if taken early by those at highest risk of severe disease.

Results from a previous trial suggested Lagevrio might reduce COVID deaths. But a more recent, larger trial indicated Lagevrio doesn't significantly reduce hospitalisations or deaths from the virus.

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However, few people at highest risk from COVID were included in this trial. So it could offer some benefit for patients in this group.

In Australia, Lagevrio is not routinely recommended and Paxlovid is preferred. However, not all patients can take Paxlovid. For example, people with medical conditions such as severe kidney or liver impairment shouldn't take it because these issues can affect how well the body metabolises the medication, which increases the risk of side effects.

Paxlovid also can't be taken alongside some other medications such as those for certain heart conditions, mental health conditions and cancers. For high-risk patients in these cases, Lagevrio can be considered.

Some people who take COVID antivirals will experience side effects. Mostly these are not serious and will go away with time.

Both Paxlovid and Lagevrio can cause diarrhoea, nausea and dizziness. Paxlovid can also cause side effects including muscle aches and weakness, changes in taste, loss of appetite and abdominal pain. If you experience any of these, you should contact your doctor.

More serious side effects of both medicines are allergic reactions, such as shortness of breath, swelling of the face, lips or tongue and a severe rash, itching or hives. If you experience any of these, call 000 immediately or go straight to the nearest emergency department.

Be prepared

Most people will be able to manage COVID safely at home without needing antivirals. However, those at higher risk of severe COVID and therefore eligible for antivirals should seek them. This includes people aged 70 or older, people aged 50 or older or Aboriginal people aged 30 or older with one additional risk factor for severe illness, and people 18 or older who are immunocompromised.

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If you are in any of these groups, it's important you plan ahead. Speak to your health-care team now so you know what to do if you get COVID symptoms.

If needed, this will ensure you can start treatment as soon as possible. It's important antivirals are started within five days of symptom onset.

If you're a high-risk patient and you test positive, contact your doctor straight away. If you are eligible for antivirals, your doctor will organise a prescription (either an electronic or paper script).

These medicines are available under the Pharmaceutical Benefits Scheme (PBS) and subsidised for people with a Medicare card. The cost for each course is the standard PBS co-payment amount: $30 for general patients and $7.30 for people with a concession card.

So you can rest and reduce the risk of spreading the virus to others, ask your pharmacy to deliver the medication to your home, or ask someone to collect it for you.




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