Everybody Needs to be Vaccinated and Wear a Mask

Kevin Kavanagh, MD, has been sounding the alarm about the threat COVID-19 poses to society from the very beginning of the pandemic. Kavanagh, a member of Infection Control Today^®’s Editorial Advisory Board, is still sounding the alarm, even though, as he puts it, “everybody’s in the mindset that this pandemic is over with.” It’s far from over with, Kavanagh argues. Thanks to the Delta variant, the United States battles a fourth wave of COVID-19, and some states battle a fifth wave. Fifty percent of the U.S. population is fully vaccinated according to Johns Hopkins University, and that’s just not enough to get us to herd immunity. Science can stop the COVID-19 variants (at least for now), says Kavanagh. “I’ve been told they can design a new vaccine in three days,” he tells ICT®. “And that’s great news, but you can’t make 300 million doses and get them in arms that quickly, especially when you have half of the country being anti-vaxxers and not wanting to take the vaccine.” His vision is not a bridge from where we are in this pandemic to a new normal, but rather an overhaul of our infrastructure—including installing better ventilation systems in schools—so that we can coexist with the virus, because it’s not just going to magically disappear, says Kavanagh. “There have been civilizations which have been wiped out due to infectious diseases. Species which have gone extinct. And currently what separates us is our science and our knowledge. We can handle this pandemic. But unless we take advantage of that science and knowledge, we’re no better off than a tadpole.”

Infection Control Today^®: What concerns you most about the state of play regarding the COVID-19 pandemic in the United States these days, Doctor Kavanagh?

Kevin Kavanagh, MD: Well, what’s most concerning is I think everybody’s in the mindset that this pandemic is over with. We don’t need to do anything else. And if you’re vaccinated, you have a get-out-of-jail card, and you can go on with your life as if it was normal. And with this Delta variant, nothing could be further from the truth. I feel it is imperative that everyone, even those vaccinated, start wearing masks and start following public health strategies, which were followed over the surge of the winter holidays. I can’t stress that more. This Delta variant is much more infectious, possibly two times or more infectious than the wild-type virus. There are data which indicate that it’s producing 1000 times more virions, and it is spreading like wildfire. The vaccines

that we have were made from the original wild-type virus. We are now several iterations of viruses away from that. Data out of Israel indicates that vaccine efficacy for preventing infections is around 60%. Now, the data from the public health agencies in England are much better than that. But from what I’m seeing from reports from around the nation, infections and prevention of infections by this vaccine is mirroring that of Israel. I think those that are vaccinated can still become infected. And if you’re infected, you can spread the virus to others, and the virus can mutate. I think agreement by all is that your chances of being in the hospital are less, and your chances of dying are much less, which is a huge plus, so everyone needs to get vaccinated. But as we talked about last year, even an asymptomatic infection carries risks of both lung damage and also cardiovascular and heart disease such as myocarditis. This is often asymptomatic, and this virus tends to infect everybody a little bit differently. Some people are having GI symptoms, some people are having mainly pulmonary symptoms, and others can have cardiac vascular symptoms. And these type of individuals oftentimes are asymptomatic. We need to take the virus seriously, and even those who are vaccinated need to wear masks. I am convinced this virus is about one or two iterations away from completely avoiding the vaccine. And remember, we have the lambda variant and the kappa variant which are sitting out there in the wings, waiting for immunity to drop and possibly cause another wave. We are going now through our fourth wave. And some of the states are going through their fifth wave. I can’t tell you enough that this is not characteristic of a particular type of a virus. Most viruses don’t do this. They’ll have one or two waves, and then they go away. We’re being hit by wave after wave, many times being caused by different variants. Everybody needs to follow public health advice. This is absolutely crucial.

ICT^®: How concerned are you about the lambda variant? There’s a study out of Chile that it might—might—be able to shrug off the vaccines. But it sounds like the Delta virus is what really has you worried.

Kavanagh: Well, the Delta virus is really concerning. The lambda variant may not be as an infectious. And even though the vaccines may not be efficacious, if it’s not as infectious, it still gives our immune system a jump on it. Because remember, 1000 times the soldiers landing on a beachhead can overwhelm your immune system and defenses. And that’s one of the problems we have with the Delta variant. Also in Chile, and in Peru, the major vaccine that they were using was the China vaccine. It was not the mRNA vaccine. I think the data on that, although it is still very concerning, there’s still some hope that we may be able to avoid a major surge such as what we’re seeing now. Now, I should add with this surge, because of the infectivity this virus, I would expect it to rise very quickly, come to a very high peak, and then it may fall off just as quickly. We saw that pattern in India. Unfortunately, many people who are not vaccinated, which is over half of our population—over half is not fully vaccinated—they will be susceptible to this virus. Even if you get the vaccine today, your protection will not kick in until five weeks from now. Everyone needs to follow strict public health advice.

ICT^®: As you know, there’s a lot of misinformation out there. And even last weekend, someone in my family said “Yes, viruses mutate, but they always get weaker whenever they mutate.” I said I’m just a beat reporter, but I’ve read a lot about this, and I don’t think that’s the case. Was I correct on the science of that?

Kavanagh: I think you’re correct. This virus, every time it’s mutated it becomes more infectious, and sometimes more lethal. You can look at the D614G variant, which was the first mutation. It was about a third more infections. Then we were hit with the alpha variant, or the UK variant, and that caused the Christmas surge. This was 70% more infectious. And now we’re dealing with the Delta variant which is 70% more infectious than the UK or alpha variant. And it also appears to be more lethal and causing more severe disease and causing disease in children. We’re hearing reports out of [the Oklahoma State Department of Health] and also from the [Mississippi State Department of Health] that this virus is causing severe disease in children. Mississippi reports seven children in the ICU, two on the ventilator. Oklahoma has similar warnings coming out of the university there. The idea that children are protected no longer applies with this variant. And one of the things that concerns me is this. The initial SARS virus is extremely deadly, and also spreads like wildfire. Luckily, it was snuffed out with public health strategies. But that virus also attached to the H2 receptor. And that’s what caused this virus to be so lethal. That’s the SARS virus. Well, the viruses are similar. They’re both coronaviruses. This virus that we’re currently dealing with has a lot of room to continue to mutate, and to become more infectious and more lethal. And it may do so up until it becomes similar to SARS and [the Middle East Respiratory Syndrome]. We may get hit with wave after wave. The good news is we have the science to stop this. But we cannot manufacture vaccines fast enough. I’ve been told they can design a new vaccine in three days. And that’s great news, but you can’t make 300 million doses and get them in arms that quickly, especially when you have half of the country being anti-vaxxers and not wanting to take the vaccine. It is extremely frustrating. And as I said in my recent article in Infection Control Today®, there have been civilizations which have been wiped out due to infectious diseases. Species which have gone extinct. And currently what separates us is our science and our knowledge. We can handle this pandemic. But unless we take advantage of that science and knowledge, we’re no better off than a tadpole. You can try to wish away this virus, that it will miraculously disappear, as was stated last year. Well, that’s not going to work this year either. We need to change our behavior. And we need to prepare for the next wave because it will come. We will get another wave after this one. We need to get vaccinated. We need to slow down the viral spread. Our knowledge in our manufacturing of vaccines can keep pace with the mutations.

ICT^®: You have some things to say to the vaccinated as well, right?

Kavanagh: Well, that’s correct. Because you’re seeing breakthrough infections—and even mild infections can be problematic—the vaccinated individuals need to also follow public health advice. They do not want to be spreading this virus to those who are immunocompromised, which is about 1 out of every 37 individuals in our society. Those are people who have, for example, an inflammatory disorder, rheumatoid arthritis, lupus, or have had a transplant or are on chemotherapy. There are a lot of citizens for whom the vaccine won’t work. And of course, our children are not fully vaccinated. Only half of those older than 12 years of age have taken advantage of the vaccines, and below 12 years, they’re not approved yet or even authorized for use. So yes, you need to continue to wear a mask both to protect others and to protect yourself. I think this is crucial. And in my mind, when I do the math, if you’re 30 points less protected in a virus that’s more than two times as infectious—in other words, you’re going to come across it two times more frequently—that doesn’t put you in a much better situation … maybe a little bit better, than what you were last year. And, also, decreasing viral load is absolutely critical. And this includes viral exposure. So that if you’re vaccinated, and you don’t have a mask on and you get exposed to the virus, you’ll be exposed to more virions, and you may develop a more severe infection. If you have a mask on the infection will probably be less. And what I worry about is that we’re using data from countries where people are vaccinated plus wearing masks and saying, “Well, you know, they do really well.” But if you don’t wear a mask, you go into a crowded indoor setting where there’s poor ventilation, a lot of viral particles, you may well develop a significant infection. So yes, I think these advisements need to go out for everybody. We need to wear a mask. We need to also get vaccinated. Both interventions are layers of armor. They reduce your viral exposure. And because of that, we need to do both of them. And if we don’t, as a society, we’re not going to do well through this wave or the next which will be coming. I think without a doubt, if you’re going through four or five waves of this virion with changing variants, to think that you’re not going to have another one is really magical thinking.

ICT^®: You recently wrote an article for the Infection Control Today® website in which you argue that the Centers for Disease Control and Prevention is not getting the right message out to the right people at the right time. Do you think that the CDC will be changing its method of operation soon?

Kavanagh: Well, I hope that they do. I hope today, they’ll come out with an advisement that states that masks need to be worn by everyone. But you know, by this time you already have the World Health Organization, American Academy of Pediatrics, multiple municipalities also doing the same thing of advising people to wear masks regardless of vaccination status. Now, a lot of people will say, “Well, it depends upon viral spread in the communities.” But one of the things you need to realize is that many countries have a zero tolerance for this virus. In Israel, in Jerusalem, I was reading news reports, where when the positivity rate got above 1%, they were considering enacting new and more stringent strategies such as passports. In our country, if it’s not above 5%, we don’t worry about it much. That is completely unacceptable with this type of a virus. We need to really start taking it seriously. And we need to start thinking about changing our infrastructure. One of the big items which is coming up for debate [concerns schools] for the fall. Right now, I consider ourselves in worse shape than what we were last year. Very few children vaccinated. A virus which can cause breakthrough infections and spread. A virus which is now targeting more of the younger population. And this is problematic. We need to change our infrastructure for schools with ventilation systems, increasing complete air exchanges. We need to test everyone vaccinated or not vaccinated twice a week. We need to reduce class size, to do podding. It means having hybrid options. And if someone wants to learn from home and do tele-schooling, this needs to be available. And these need to be permanent because we’re going to have another wave after this. We need to change the way that we live. We’ve been talking about this for months. I think last year we were giving these advisements. And we need to start taking them seriously. And start investing in—not a bridge to when the pandemic goes—but an infrastructure to safely live with this virus so we can get back to a more normal way of life.

ICT^®: You’re fully vaccinated. So, when you leave your house, do you often wear a mask?

Kavanagh: I wear a mask when I leave the house, I avoid indoor settings. Now, if I’m outside, when nobody’s around, I’ll be carrying a mask, not necessarily having a mask on. Certainly, when you exercise, you can’t wear a mask. But on the other hand, when you’re exercising, you’re spreading a lot of large droplet particles which won’t dissipate in the air, and you’re projecting them further. So, if you’re exercising, don’t run by someone on the sidewalk. You should be staying at least 30 feet away from people. And if you can’t do that, then don’t exercise outdoors. Get yourself a stationary bike and exercise indoors. This Delta variant, again, is much more infectious—1000 times more viral particles. We need to respect it. And we need to respect others. And that’s the key. Our society needs to start respecting others. And that means not just worrying about your rights but worrying about the safety of other people.

ICT^®: We’ve been flying at 30,000 feet here. As you know, Infection Control Today® goes out to infection preventionists, sterile processors, vascular access nurses, environmental services crews, and other professional groups. How do you translate your advisements to the people right there on the frontlines in hospitals?

Kavanagh: Well, first of all, they all need to get vaccinated. Too many health care workers are not vaccinated. There’s a lot about burnout on health care workers and frustration of people who aren’t getting vaccines. But you need to realize that one of the biggest arguments that I hear from people is, “Well, I know a health care worker who’s afraid to get the vaccine, so I am, too.” So before you expect other people to follow your advice, you need to be taking it yourself. There is no reason with these vaccines—their safety profile and the length of time that safety data has now been gathered, which is much greater than six months—that everyone in the health care setting is not vaccinated. And as we said back in April in a story [in ICT®]—I believe it was April 22—vaccinations of health care workers need to be mandatory. So that’s the first thing infection preventionists should be doing. The second is to recognize that this virus is highly infectious. Everybody needs to wear a mask. Visitation to hospitals at this point needs to be curtailed. And above all, we need to be wearing respirators or N95s. Cloth masks, surgical masks with holes on the sides—those will not work. And there should also be strong consideration of wearing goggles because that will also decrease your viral exposure. Remember, this is a numbers game. We want to decrease the number of viruses everyone is exposed to.

This interview has been edited for clarity and length.