Mask thread, from someone that has had the virus

[ACMEeventing]

I know exactly when I was exposed.

My colleague and I were on the Covid response team that day and we were called to exchange the endotracheal tube of a very sick ICU patient. We were fully garbed in our facilitie’s PPE (which included an n95 mask under a surgical mask and a face shield). The ETT exchange went smoothly, but the patient was exceptionally fragile and a nearly 2 hr resuscitation ensued. We were able to successfully intervene, but unfortunately he succumbed to his illness about 5 days later.

Because of the enormous viral load and the fact that I was positioned over his airway for so long, it was not surprising when I developed symptoms 4 days later (as did my colleague).

I had a normal course of illness for the first 9 days, woke up on day 10 feeling great and made plans to return to work, and on day 11 after an uneventful morning I went into Acute Respiratory Distress around noon.

My heart rate catapulted into the 150’s ( my normal resting HR is 55) and the work of breathing became absolutely terrifying. My pulse oximeter reading at home was 74% and I went to the hospital to be admitted. For my healthcare friends, I was admitted in Acute Respiratory Distress with hypoxemia, elevated D Dimer, and a CT would reveal ground glass opacities in the RUL. My sats dipped down into the 70’s and 80’s several more times.

It was absolutely frightening, to the point that I updated my healthcare POA and texted my daughter to be 2nd in command in my husband was unable or unwilling to make the difficult decisions. I was petrified, exhausted, and mentally worn from the hypoxia.

For the next month I would struggle with Tachycardia and Sats that would dip to 90% with very mild exertion, such as taking a shower.

Now, nearly 10 weeks later, I still have to monitor my HR and keep up with my exertion. Part of it is simply reconditioning, part of it is residual disease process.

Now, masks:

I firmly believe that as a whole we need to start developing some herd immunity. This is a novel virus so we don’t have any endogenous means to defend against it. Our best defense is a strong offense which involves trickling in some exposure to build antibodies. The outdoor setting of an event is a good opportunity for this. It DOES NOT mean that you go against the protocols set forth, and it is NEVER ok to be rude to a volunteer.

But does everyone need to be in a mask at all times, I don’t think so. The people that are most vulnerable of a severe infection need to stay masked for their own protection. People absolutely have to respect the 6 foot rule. “Pods” of people that are usually together will likely stay unmasked together and I don’t see a problem with that.

If we isolate ourselves too much more, we risk a severe illness if ever exposed. Yes the numbers will go up. But the ICU admissions and death rate have been declining (at least in my local area)

Volunteers have the right to forego their position if they feel their safety is in jeopardy. It is not their position to feel like they have to police every group of people and defend the protocols of the facility. If you feel unsafe, leave. Competitors will get the hint quite quickly when there is no-one organizing the warm up.

There will always be the dissidents, you can’t change them, but you can walk away.

My experience so far has been that most people are more than willing to follow the rules if it means having an event. Those that don’t, you have to tell them to keep their 6 feet and if they give you guff, call the TD.

As for me, there is such conflicting literature. Some say that I’m immune from the same strain, some say that I risk a more severe progression if exposed again. So I write this as someone that has a lot to lose, yet I still stand behind it.

Discuss . . .

[pony_grandma]

I sure appreciate your viewpoint. Myself I have always had a strong immune system and good health, just not so with my family members. So I am divided on my choices.

[JER]

ACMEeventing, you forgot to mention one very important detail of your illness: you never lost your sense of humor.

(So glad you’ve recovered and thanks so much for posting on this topic.)

[ACMEeventing]

I should add that I’m a tad pushing the “older” side at 53, but no other risk factors to speak of. I do have hypertension that is well controlled and my baseline fitness is really good.

[omare]

I am glad you are recovering , it sounds like a horrific experience.and thank you for your courage and professionalism.

I understand herd immunity would require 70 percent of the population to get covid and there is no certainty you cannot get it again. I dont understand the resistance to masks as a public health measure myself, to lower the virus load being dispersed by a masked covid positive person. I also understand a mask can cut up to 50 to 95 percent viral exposure to the person wearing one depending on the type. But its most important function is to reduce how much is propelled into the air by an unknowing covid pos wearer.

i dont know about your suggestion that outdoor events allows an opportunity for building in some herd immunity unless there is a correlation that exposure to a more dispersed viral load being outside will result in a milder case. (Edited to add, of course you are then a carrier to your family etc.) I thought being outside just lessens or disperses the virus droplets better and hence lowers your risk of getting it. How serious a case you get, once you get it, seems a combination of luck and/or no preexisting health factors from what i have read. But i have seen younger health care workers like yourself getting the worse of it because you were totally subsumed in a high environment load of covid, i guess i can see how it ups the chances it will end up in the lungs? Or is it just bad luck when it does not stay localize in nose etc?

[bornfreenowexpensive]

My concern with the herd immunity concept is they haven’t proven there is such a thing with this virus. I’m not personally willing to gamble. Wearing a mask doesn’t protect 100% but if does make a big difference in the context of normal social contact (such as Eventing). It’s not hard to do.

So common sense safety is my vote. Wear a damn mask (doesn’t need to be a n95), try and maintain social distancing, wash your hands…and use common sense AND be considerate. It’s not a big deal to exercise a small bit of caution like wearing a mask. Can’t breath in one…try a different one. I had to try a few to find one that was comfortable for me. For riding…I found a great cooling gaiter from mission that you wear around your neck and can easily pull up to wear as a mask. Works great for events in hot weather. https://www.mission.com

This sort of mask wearing is what I think can reduce the spread of this virus (as well as others) and just is not a big deal to do and considerate of others around you.

[IFG]

ACME Eventing. Glad you are recovering. I am an Epidemiologist. Sadly, I do not agree that herd immunity is the way to go with this virus. Right now, if we aim to attain herd immunity with this virus, we will lose a lot of people along the way. As you say, it can be highly unpredictable and virulent. You probably had a such a severe reaction because your dose of inoculant was high. We do not understand if herd immunity will even work for this virus. Nor do we understand if this will be a virus for which a vaccine is effective. I am dismayed by the assumption that a vaccine will be effective. There are many viral diseases for which vaccines are not effective. In some cases, a vaccine can make things worse.

What do I propose? Remaining vigilant. Being masked. Practicing social distancing. I am planning to teach remotely in the fall. I will have to reshape my clinical trials class to emphasize COVID trials, but that will make is much more interesting. We have learned a great deal about the virus, but there is still so much more to learn.

[OverandOnward]

These are such good points. It was never an option to eliminate covid. Just to manage the flow so that the health system capacity is not overwhelmed.

New Zealand has done a wonderful job suppressing covid to the point that the instance is so rare, at this time statistically there is little to no risk on the island. But what have they really accomplished in a world increasingly saturated with covid? They didn’t beat it, they just delayed it. Maybe hoping for a vaccine before they have to face it. But to the degree that they need contact with the outside world to survive, they are facing a wave of more covid carriers than there were at the beginning, with a population that has no immunity.

In the community where I live the new cases are going up sharply, but the number of deaths is going down sharply. Fewer hospitalizations. Almost no nursing homes affected, whereas earlier it was mostly nursing homes. A rapidly growing number of people that have recovered from covid. One might say we are starting to normalize. But just starting.

[Eventer2483]

@IFG

ACME Eventing. Glad you are recovering. I am an Epidemiologist. Sadly, I do not agree that herd immunity is the way to go with this virus. Right now, if we aim to attain herd immunity with this virus, we will lose a lot of people along the way. As you say, it can be highly unpredictable and virulent. You probably had a such a severe reaction because your dose of inoculant was high. We do not understand if herd immunity will even work for this virus. Nor do we understand if this will be a virus for which a vaccine is effective. I am dismayed by the assumption that a vaccine will be effective. There are many viral diseases for which vaccines are not effective. In some cases, a vaccine can make things worse.

What do I propose? Remaining vigilant. Being masked. Practicing social distancing. I am planning to teach remotely in the fall. I will have to reshape my clinical trials class to emphasize COVID trials, but that will make is much more interesting. We hae leaarned a great deal about the virus, but there is still so much more to learn.

Agree completely

[Elsari]

I’ll admit I’m on the cautious side of this conversation. A cousin of mine came down with COVID and ended up on a respirator for 9 days. There was a point where I wasn’t sure he was going to make it. It was awful being at the end of a text message hoping for positive updates. He’s recovered, but almost 2 months later he’s no where near 100%. He needs to work from home about 2 days a week because working onsite tires him out too much. His lung capacity isn’t what it used to be. He was also dealing with kidney issues from both the disease and the antibiotics to try and combat the pneumonia.

If wearing a mask makes it possible to visit people that I haven’t been able to in a while and do things that were previously halted, I have no problem complying. I’d feel guilty if I didn’t take this measure and made someone sick (whether it’s a family member or a stranger).

[ACMEeventing]

Thank you for the replies, I always appreciate a meeting of minds from people way smarter than me!

@BFNE, very good points, and IFG, that is so cool that you’re an epidemiologist. Your opinion is crucial to the discussion, thank you!

Totally not saying to stop wearing masks. Rereading my OP I did not express myself as clearly as possible.

When groups are in each other’s zones, I absolutely agree to keep the 6 feet or wear a mask if closer. I don’t think it is entirely necessary to mask AND be 6 feet apart. Unless someone is coughing or sneezing in which case I’ll be grabbing for my mask ASAP!

Being outside in the fresh air is so beneficial, and if fun police are putting a bulls eye on venues because they see some rule breakers then we will all lose out.

There will always be those who think the rules don’t apply and short of instituting Marshall law, they will have to live with their choices. We can only ensure we are protecting ourselves and being assertive in asking for a safe personal space, and if they resist they should be asked to leave the grounds.

On a humorous note, here is a funny video I made about recovery (mostly so my family wouldn’t worry so much

https://www.facebook.com/10000882195…074674302/?d=n

[merrygoround]

Both “ACME” and “BFNE” thank you for speaking up. And Acme, I’m so glad you have done so well. Kick On!

Mask Believer.

[ACMEeventing]

@Elsari

I’ll admit I’m on the cautious side of this conversation. A cousin of mine came down with COVID and ended up on a respirator for 9 days. There was a point where I wasn’t sure he was going to make it. It was awful being at the end of a text message hoping for positive updates. He’s recovered, but almost 2 months later he’s no where near 100%. He needs to work from home about 2 days a week because working onsite tires him out too much. His lung capacity isn’t what it used to be. He was also dealing with kidney issues from both the disease and the antibiotics to try and combat the pneumonia.

If wearing a mask makes it possible to visit people that I haven’t been able to in a while and do things that were previously halted, I have no problem complying. I’d feel guilty if I didn’t take this measure and made someone sick (whether it’s a family member or a stranger).

My post is specific to the return of Events, and the management of mask regulations while on show grounds. I am a healthcare worker and absolutely understand the necessity of mask use.

I am absolutely not suggesting in any manner that masks should be discontinued in other situations. I am so sorry your cousin went through that, wishing him a return to full speed soon.

[gottagrey]

thanks for sharing

[eosinophil]

I am a physician scientist, where i see patients for about 10-20% of my work time, but run a basic science immunology lab for the remainder of my job responsibilities. I am so happy, ACMEeventing, that you are recovering. It’s been terrifying seeing and hearing about all these patients in the ICUs, in their prone positioning to improve oxygenation, and their various providers in their extensive PPE with elaborate hand offs to transfer samples from “dirty” to “clean”. The epidemiologists at my center have been run ragged but have done an excellent job; I attribute that we have been fortunate to have low seroconversion among our providers to their excellent guidance.

My research knowledge and experience in critically analyzing data, providing peer review of research studies and grants, and drafting manuscripts and grant submissions on my own studies, all within the fields of immunology and host defense, have led me to be hopeful both for a vaccine and for the possibility to achieve herd immunity.

However, while I hope that will be attainable, we do not have the data to know.

We do not know if infection reliably leads to robust antibody titers, how robust those titers must be to prevent reinfection, and for how long they will be sustained. We do not know if the antibodies generated following natural infection are against epitopes that are specific to COVID. We do not know if COVID has the ability to mutate rapidly, and if so, if that results in modification of epitopes to escape the adaptive immune response. Natural infection will lead to herd immunity only if there is an adequately robust and sustained specific antibody response to epitopes in COVID that are non-mutable and remain exposed for recognition by the immune system.

Even more difficult is the generation of a vaccine. An effective vaccine will need to meet all the criteria for the immune response to natural infection, but must also overcome all the difficulties associated with the development of any drug or vaccine: safety, tolerability, portability, economic viability, et cetera. Further, with an infection that is associated with ARDS and uncontrolled immune responses (“cytokine storm”, although i dislike that term), one must be concerned of the possible risk that a vaccine that is effective will have the potential to elicit a similar response as the natural infection, and thus pose a real risk of dangerous side effects.

Here’s what I’m doing. Staying home as much as i can, wearing a mask when i am out (regular surgical mask), staying at least six feet away from others, and rigorous hand hygiene. I think a vaccine is our best hope, but only time will tell if that’s going to work.

As an aside, i remember maybe 20 years ago going to a talk by Tony Fauci on vaccines and the various barriers to generating an effective vaccine, at that time with a focus on HIV and hepatitis C. That I still remember it decades later speaks to how impressive he was and eye opening the concepts were. I’ll follow whatever Dr. Fauci suggests (maybe then he’ll fund my grants, most of which go to NIAID).

[hoopoe]

some current info in circulation is that IgG antibodies many not be durable for long term immunity. This is from a news article and not from the actual peer reviewed work, so stand by for more solid info. My take away is to not allow new press and word of mouth to drive decisions which may not hold up over time.

[eosinophil]

Why wouldn’t IgG antibodies be “durable for long term immunity”? Long term humoral immunity is classically IgG. Simply put, IgM is the early response. IgE is allergic. IgA is secretory for mucosal surfaces (like the gut). IgG is generated after class switching to the same epitopes as the early IgM response but is the sustained response, and generally undergoes changes that make it have higher avidity and affinity for the given antigen.

In general, high IgM titers reflect early infection / acute infection (depending on clinical scenario), while IgG reflect later infection, history of prior infection (or vaccination).

Separately, the half life of IgG is roughly 3 weeks. Well, IgG actually refers to IgG1, IgG2, IgG3, and IgG4, but 3 weeks is pretty close. It’s the longevity of plasma cells / memory B cells that determine whether a response is sustained.

Edit to add: Memory responses are assessed year-level intervals after infection, so I can’t imagine there has been enough time or are enough data to know from human studies. Mouse studies require a genetically modified mouse that expresses the ACE II receptor to permit infection, but those mice are sold out (no surprise - almost as popular as toilet paper!) and I don’t think there’s been enough time or mouse availability to address this question in in vitro studies.

[YankeeDuchess]

   I’m interested in your reference to “trickling in some exposure” to generate antibodies. 

    I understand that exposure to a heavy viral load is more likely to lead to severe disease, and possibly exposure to a very light load may result in a mild or asymptomatic case. 

      Are you saying that occasional exposure to low load  doses such though you would get outdoors without a mask staying six feet from others has some reasonable chance of being protective in the sense of letting your system react to baby doses?  And that this might be safer than isolating severely then being exposed to a “normal” dose?  

    When your case turned dangerous, were you in cytokine storm?

[OverandOnward]

Not a scientist here …

But vaccine or not, it seems to me that we have to learn how to live in a covid world. Some way to go forward without knowing if immunity works or if a vaccine will work. Prepared to do this for a long time. How do we do that? Is hand-washing and lots of distance enough?

[SolarFlare]

@ACMEeventing

Now, masks:

I firmly believe that as a whole we need to start developing some herd immunity. This is a novel virus so we don’t have any endogenous means to defend against it. Our best defense is a strong offense which involves trickling in some exposure to build antibodies. The outdoor setting of an event is a good opportunity for this. It DOES NOT mean that you go against the protocols set forth, and it is NEVER ok to be rude to a volunteer.

But does everyone need to be in a mask at all times, I don’t think so. The people that are most vulnerable of a severe infection need to stay masked for their own protection. People absolutely have to respect the 6 foot rule. “Pods” of people that are usually together will likely stay unmasked together and I don’t see a problem with that.

If we isolate ourselves too much more, we risk a severe illness if ever exposed. Yes the numbers will go up. But the ICU admissions and death rate have been declining (at least in my local area)

Volunteers have the right to forego their position if they feel their safety is in jeopardy. It is not their position to feel like they have to police every group of people and defend the protocols of the facility. If you feel unsafe, leave. Competitors will get the hint quite quickly when there is no-one organizing the warm up.

There will always be the dissidents, you can’t change them, but you can walk away.

My experience so far has been that most people are more than willing to follow the rules if it means having an event. Those that don’t, you have to tell them to keep their 6 feet and if they give you guff, call the TD.

As for me, there is such conflicting literature. Some say that I’m immune from the same strain, some say that I risk a more severe progression if exposed again. So I write this as someone that has a lot to lose, yet I still stand behind it.

Discuss . . .

First off, I’m glad you have recovered.

I have a few comments about the portion above:

• the problem with events running and allowing groups of people to not wear masks at certain times (when you’re with your “pod”, etc) is that it is effectively impossible to enforce these rules. How is anybody (staff, volunteer, anybody) supposed to know who is actually in a pod or not? What happens when one pod comes close to another pod? What if the pod is standing near the ring? What if the pod is getting food together but not many people are around? You are relying on people doing what’s right, and I think it’s been made quite clear that there are many people who just won’t do what’s right

• if volunteers have no authority to enforce the rules, then why bother assigning them those jobs? You say it’s “not their position” and yet somebody needs to do this job…so who is it? Are you saying that only “official” paid park staff should be doing this? Is that feasible to have the event pay for this?

• your solution if competitors/spectators/whoever won’t follow the park/event rules is that the volunteers should quit? I’m struggling to understand this…you WANT volunteers to leave, when it’s the people breaking the rules who should be asked to leave? How is that going to allow a competition to run? How is that going to allow future competitions to run if you’ve lost your volunteers? How is that going to help future competitions if one event becomes a disease vector and ends up getting events shut down again? Competitors aren’t going to get the hind when nobody’s organizing warm-up, but I’m sure they’ll get it when there are no more competitions because there are no volunteers, or no more shows allowed to run this season.

• if you can’t change the dissidents, THEY should be required to leave, not your volunteers who are just doing their jobs and trying to help keep people safe and the event running smoothly, and following the protocols put in place by the governing bodies to even be allowed to hold an event

I do a lot of volunteering here in Ontario, and our first event is set to run in a couple weeks. They are taking their planning and protocols very seriously, and I have no doubt they will enforce them. They are the model by which the rest of the events will learn. I can tell you that if somehow I end up having to deal with abusive competitors, with no backing by the event hosts, that I will simply no longer be willing to volunteer my time, gas money, and effort in the future. There is no reason for me to have to risk my health to let other people show.

I am still struggling with the suggestion that the volunteers should be the ones to quit, with no support or backup from the venue, if they are being verbally abused or ignored by spectators and competitors - and how that is supposed to be beneficial in any way.