Viewpoint: Battling COVID-19 Disinformation

I have written more than 100 articles for Infection Control Today, in addition to numerous other op-eds and 2 peer-reviewed manuscripts on COVID-19. All of this has attracted a lot of attention. Much of it is complimentary, others are threatening. Disinformation is continuing, even in the face of staggering evidence that COVID-19 is an ongoing dangerous pandemic.

Much of the denial comes from a lack of understanding of the importance of infectivity and how it increases your chances of getting a severe infection. The best example of this is the high infectivity of the Omicron variant, which resulted in a large number of deaths and hospitalizations (Figure 1). Attending an event in the United States, your chances of dying of Omicron was greater than Delta, but once infected, the opposite is true.

Many of these COVID-19 deniers do not believe interventions are needed. They feel masking is ineffective and we should rely on herd immunity as a major strategy for pandemic suppression. Here are a few examples of disinformation:

1. Disinformation: “Herd Immunity absolutely works, but was nullified by all the overblown radical mandates that kept people apart, allowing the virus time to mutate.” — At this point in the pandemic, this makes little sense. First, we should have greater than 95% of our population seropositive from either natural or vaccine-induced immunity. As of May 2021, blood donation samples found 20% of donors had SARS-CoV-2 antibodies induced by infection, with an incidence of combined infection and vaccine induced antibodies at 83%. Granted those donating blood are more likely to be vaccinated, but by February 2022, approximately 65% of the United States has received at least a 2-dose mRNA vaccine and 57.7% carried infection-induced antibodies. Since then, we have had continued infections and additional vaccinations.

Second, few mandates have been enforced since 2020. In Kentucky, mandates were lifted in the spring of 2020, but still, many blame them for the woes of the COVID-19 pandemic. And finally, keeping people apart reduces spread and mutations; it does not promote the emergence of variants.

What is actually happening is that the virus is rapidly mutating. It is also able to infect and live in several animals (rodents, deer, etc.). The most recent variants include BA.2.12.1 / BA.2, along with the new BA.4 and BA.5 variants, which appear to be on the verge of causing another surge. BA.4 and BA.5 are very concerning, since these variants appear to have an even greater potential for immune avoidance.

2. Disinformation: “Additionally, the CDC can acknowledge that 99% of us were NEVER in any danger from COVID-19 other than MAYBE feeling crummy for 4 or 5 days.” — I believe this comment is only taking into account deaths from the acute infection. It discounts that nearly just as many may be dying of delayed effects of COVID over the ensuing years. But more importantly, long-COVID or a health condition that might be related to acute COVID-19 is present in about 20% of adults who have had an infection (Figure 2). I have 2 friends in their 40s; one has significant hair loss, the other has trouble with memory after COVID-19. And then they were reinfected. I have another close relative who is in this “99%” but is waiting for a lung transplant. In addition, I have another member of our Board of Directors who is approaching a year now and still has problems with cognition and brain fog. About 70% of those who develop long-COVID have been found to have problems with their cognition. None of my friends and family members with long-COVID were immunosuppressed.

3. Disinformation: “Masks were doing more harm than good.” — With the Delta variant and beyond, the infectivity of the virus significantly decreases the effectiveness of cloth masks and an N95 face mask should be used. These are currently in abundant supply and readily available. It should be noted that our understanding of how masks work in preventing spread of viruses and bacteria has changed substantially since the beginning of the pandemic.

A virus is about 0.1 micron in size, a bacterium is about 1.0 micron in size, and N95 masks (excluding their electrostatic effect) filter down to about 5 microns. Cloth masks are less efficient. So how do masks work? The answer is that it is not a dry virus or bacteria that is floating or being projected in the air. It is water droplets containing these pathogens, which are breathed or coughed outward. The masks are effective in filtering these small and large droplets. But it is a numbers game, and the more viruses or bacteria you encounter, the more likely the protection of any mask will be defeated. Two-way masking (where everyone wears a mask) is most effective. If one mask interacts with 95% of the particles, 2-way masking will interact with more than 99% of the particles. In addition, the wearer still has a chance of becoming infected through his or her eyes. Thus, it is most effective for the asymptomatic carrier to be masking. A good review of the efficacy of different types of masks can be found in a March 2022 report produced by the Colton Foundation and Rockefeller Foundation’s Pandemic Prevention Institute, entitled: “Getting to and Sustaining the Next Normal. A Roadmap for Living with COVID.”

4. Disinformation: “All of the major surges began in 2020, only after virtually every American was wearing face masks for 2 whole months.” — It is true that in many areas of the nation (including Kentucky), major surges occurred well after most indoor mask mandates were lifted. If the virus does not completely go away, then it will resurge after the intervention is lifted. Major viral surges occurred in Dec. 2020 to Feb. 2021, and then the Delta surge in 2021 followed by the Omicron surge in the winter of 2021 and 2022. However, there are 2 important factors to consider. First, masking was not anywhere near universally followed, and when worn they were often worn incorrectly (below the nose); but above all the virus is mutating. As the virus changes it adapts to overcome our interventions (along with making natural and vaccine immunity less effective). Remember, it is a numbers game. Inhaling 1 virus particle is unlikely to make you sick. You must be exposed to several, possibly hundreds. Thus, the more infectious the virus becomes, the less effective interventions will be. But masks will still decrease the rate of spread and mutation.

Finally, we must do something for those who are at high risk for developing severe COVID-19 infection, including those who are over the age of 50 or have significant risk factors with their health. Masking on public transportation and in health care settings is not unreasonable since these settings can often not be avoided by those at high risk. And by masking, I mean an N95 mask, not a cloth mask. In addition, better air quality and improvements in ventilation are needed. This will also decrease (but not eliminate) your chances of catching the virus.

5. Disinformation: “Long-COVID is (a) biopsychosocial phenomenon and its roots are unclear.” — Although this statement could be considered true, it is all encompassing and may imply that long-COVID is not real. Brain scans have documented anatomical changes associated with COVID-19 and pathological studies have shown the long term presence of the virus can occur in many organs of the body. Long-COVID is real and recurrent surges and waves along with the potential for long-COVID is becoming a serious problem. This is not just a problem in the United States but all over the world. In the United Kingdom, approximately 2.1% of all citizens report having symptoms of long-COVID and their workforce has shrunk by 440,000 (England has about 1/5 the population as the United States).

6. Disinformation: “Free people in a representative republic have the right.” —Part of a great country is looking out for others. If our citizens do not embrace this concept, I feel our society will not be competitive and will not maintain its leadership in the world. You can be against mandates and still wear a mask.

COVID-19 deniers and misinformers can be quite vocal and forceful on the internet. All of this may be a symptom of our society and a harbinger of the increasing violent attacks that are inflicted on our brave health care workers who are battling this pandemic. I have also received some insulting passages, such as: “I'd address you as Doctor, but your continued lying about the efficacy of face masks belies your lack of medical qualifications.” As an organization we have been recommending the use of N95 masks since before the Delta surge.

One may choose to ignore disinformation, writing it off to a few uninformed individuals, but unfortunately, there are many. To make matters worse, disinformation can be highly organized, fanning flames that not only have the potential of placing health care workers in jeopardy but also weakening our nation. Hence, I would encourage all to engage in respectful conversations with those who spread disinformation to at least provide an opposing point of view. If COVID-19 waves continue, I feel more and more people will start to realize we need to be more vigilant in following public health advice.

KEVIN KAVANAGH, MD, is the founder of the patient advocacy group Health Watch USA^sm and a frequent contributor to Infection Control Today®.