'The original phrase 'a stitch in time saves nine' was used to express the idea that the prompt stitching up of a small tear in a piece of material, would save the need for more, say nine stitches, at a later date when the tear had become larger. E LaMont Gregory MSc (Oxford)
... what is the difference between no one wearing a mask, and everyone wearing a mask? ... the highest transmission rate, and the lowest transmission rate.
Contemporary interpretation, like the old saying 'a stitch in time saves nine' suggests that it is far better to solve a problem straight away, rather than wait until the problem becomes bigger, and often more challenging to address properly.
... a mask in time, saves nine
This is one of the important articles written about the COVID-19 coronavirus pandemic.
Its author, E LaMont Gregory MSc (Oxford), a decades-long clinical researcher, in a single still image, presents the primary air-borne means of transmission and the resulting relative transmission rates for all the possible interactions between those wearing a mask, and those not wearing a mask.
Surprisingly, the second highest transmission and infection rate, after no one wearing a mask, occurs when an infected person not wearing a mask, comes into contact with a healthy person wearing a mask.
Although counter intuitive, the above findings can be explained, and the explanation calls into question the efficacy of cloth face masks, which are in wide circulation. Some cloth face masks have a pocket into which a N95 grade filter may be inserted, but not all of them do. Without the N95 grade insert, cloth face masks may simply provide a means to hold a N95 grade face mask in place so that it covers both the mouth and nose, and that the perimeter of the mask fits properly.
However, unless the material from which the cloth covering is hydrophobic, moisture repelling, its use even as a means to hold a N95 grade face mask in place, is counter indicated.
Governments and health authorities must establish i.e., develop, enact and enforce meaningful standards for all face masks manufactured or sold within their respective jurisdictions, as a matter of urgency.
Pre-vaccine, the face mask can be an effective addition to disease spread containment efforts, which renders the lack of mask standards, glaring.
The implications of these findings are far-reaching.
... all knowledge is comparative ... all knowledge is comparative
The virus responsible for the disease COVID-19 bears the name SARS-CoV-2, which leads us to the inescapable, and correct conclusion that there was a SARS-CoV-1 virus. The first SARS-CoV virus led to a pandemic that spanned two years from 2002/2004.
One of the important facts about a virus that attacks humans is the amount and size of the respirable infectious material, air-borne particles it produces, when air-borne transmission is a factor. The amount of respirable infectious material produced by SARS-Covid-19 carriers will be discussed in this section, and the size of the respirable particles will be discussed in the next section in relation to what the standards ought to be for face masks.
Airborne transmission is a known factor in person-to-person transmission of the novel coronavirus virus, SARS-CoV-2.
Studies conducted in Germany, first published on the 5th of March 2020, https://doi.org/10.1101/2020.03.05.20030502, confirmed that a person, infected with the SARS-CoV-2 novel coronavirus, showing no signs of illness, is about one-thousand times more infectious than was a person with SARS-CoV-1 who was asymptomatic, in the early stages of that infection process.
These studies compared the mount of infectious material in the nasal cavity of asymptomatic coronavirus infected persons, with similar tests that had been conducted on SARS-CoV-1 patients who showed no clinical signs of illness (fever, cough, sneezing) in the early stages of that disease. And found 1000 times more infectious material in the nasal cavity of the novel coronavirus patient, than in the earlier cases of SARS-CoV-1. And furthermore, these studies found that a person infected with the coronavirus is infectious before they show signs of illness, and after signs of illness have gone away.
These studies have been replicated by other tertiary research centers, and in this regard, much attention is being given to recent studies in Maryland, which raise questions as to the efficacy of cloth masks used without a N95 grade filter inserted into the pocket of the mask, and in those cloth masks without a pocket in which to insert a filter, when they are used with a N95 grade mask beneath them.
This study is important, for anyone who is giving advice to the public or whose primary concern is infection containment.
Criteria for the development of face mask standards
The importance of wearing a mask from a clinical perspective, equates the severity of coronavirus symptoms to the number of viral particles inhaled, and whether the infection was the result of a singular or multiple exposures.
After a deluge of requests to the CDC-USA, the CDC confirmed the accuracy of the previous statement on the 21st of October 2020.
After a deluge of requests, to state whether the preceding statement was accurate or otherwise, the CDC-US, in a written statement issued on the 22 of October 2020, confirm its accuracy
There are four principal criteria to be applied to the evaluation of the efficacy and effectiveness of a face mask, especially a mask to be used to contain the spread of the SARS-CoV-2 virus i.e., breathability, fit, pore size and whether the material from which the mask is made is hydrophobic (moisture repellent), or hydrophilic (moisture attracting).
After stating the obvious, one is usually confronted with the phrase that 'it goes without saying' or other words which convey the same meaning, as is the case with our first criteria of evaluation. The first criteria concerns, breathability. The wearer of the mask must be able to breathe properly through the mask. Otherwise, its use would be counter productive, in the extreme.
The second criteria, fit, encompasses both the ability of the mask to cover both the nose and mouth, while at the same time, the mask must prevent the aerosol containing the virus particles from entering the nose and mouth area through the mask, as well as, from around the perimeter of the mask.
Pore size, the third principal criteria, takes into consideration the size of the virus-laden aerosol particles, otherwise known as droplets and spray, from passing through the mask.
The N95 surgical mask, for example, is rated by different observers as having the ability to screen between 85 to 95% of air-borne particles smaller than 300 nanometres. The nanometre is a unit of length in the metric system, equal to one billionth of a metre. One nanometre is expressed in scientific notation as 1×10⁻⁹ metre.
At the same time, as we have suggested above, the wearer must be able to breathe normally, that is, without restricting the wearer's ability to take in a sufficient amount of air to sustain life.
The size of the aerosol, droplets and spray, emitted into the air by a coronavirus disease carrier through coughs, sneezes, talking and breathing, varies between 65 to 125 nm. Therefore, a mask must be able to prevent particles of this size from flowing through it to be an effective barrier.
The aerosol, droplets and spray, that a carrier emits into the air is moist, which necessitates that the material from which the mask is made should be hydrophobic, moisture repelling.
If, the material is hydrophilic, moisture attracting, the pores of the mask material will trap virus laden particles, and make it possible for the wearer to draw virus trough the mask as the pores become increasingly saturated, clogged, with moist virus-laden particles.
A Picture Is Worth a Thousand Words
'A picture is worth a thousand words' is an English-language adage, that is, an idiomatic and proverbial expression meaning that complex and sometimes multiple ideas can be conveyed by a single still image, which conveys its meaning or essence just as effectively as a verbal description.
The author Maggie Cramer wrote that the conventional wisdom phrase 'a picture is worth a thousand words' means that an image, or graphic illustration may better convey or describe something than many written or spoken words—that it may be easier, and much faster, to just show someone something than to tell them about it.
Television is preeminently a visual medium, and yet, and in spite of a raging controversy concerning the efficacy, or otherwise of the face mask as a major tool deployed to slow, that is, curtail the spread of the coronavirus pandemic, few illustrations that can convey the efficacy of wearing face masks, like the ones presented here have been forthcoming from any of the many pundits that populate our broadcast airways, here or abroad. Well, that is about to change. Let's see how long before this rather meager attempt is broadcast, and discussed.
Upon publication, this article, is being sent to all the major cable news outlets, the premiers and territorial leaders across Canada and the governors and the mayors of the major cities of both Canada and the United States, and beyond.
Talk of a current second wave - irresponsible
In an article publish by the Globe and Mail, 21 September 2020, entitled 'Second COVID-19 Wave May Have Started in Quebec, Top Public Health Official Says' begins with the statement, "Quebec has launched into a second wave of the coronavirus pandemic ...
A myriad of such news reports, all based on interviews with clinical or health department professionals, claiming that we are in a second wave of the coronavirus pandemic have proliferated, including a recent highly toted contribution published in The Washington Post, and CNN has now joined the chorus of the dangerously ill-informed.
The graph below depicts the actual circumstances that we are in, namely the graph illustrates the sinusoidal and cosinusoidal wave forms, the peaks and throughs (surges and ebbs) as it were, associated with the first and only wave of the coronavirus pandemic that exists, thus far.
The wave forms are more indicative and a reflection of the inattention to detail that has been the principal characteristic of the response to the pandemic, than anything that is associated with the virus, inherently.
... sinusoidal (surge) and cosinusoidal (ebb) wave forms associated with first-wave of the Covid-19 pandemic.
Note, there is no sustained period of time, between 1 March and 11 October 2020, during which there were no new cases reported. Conclusion: we remain in the first wave of the COVID-19 pandemic.
The question is, by what standards of evidenced-based clinical and scientific medical practice do we establish the end of one wave of an epidemic, and subsequently determine that a second wave of the same epidemic has in fact begun?
Let us use an example that is reasonably relevant to our present circumstances. By 2003 the first SARS pandemic had circumvented the globe, after its initial recorded outbreak in 2002, and there had been no new cases reported in the City of Toronto for a period of four weeks.
At which time clinicians and public health department officials declared the pandemic, the first wave of the pandemic, and what they believed to be the only wave of the pandemic, to be at an end. And, all the rather stringent public health measures put in place to contain the spread of the SARS virus were abruptly discontinued.
By way of this historical account of SARS 2002/2003, we have introduced the primary criteria by which the end of a first wave of a pandemic is determined, that is, a sustained period of time in which there are no new cases of the disease.
However, the SARS pandemic did not end in 2003, it persisted for another year. SARS-1 like SARS-CoV-2, the virus that causes the disease Covid-19 attacks the lungs, and often results in rather severe cases of pulmonary pneumonia. Pneumonia can be countered, but it often takes a considerable amount of time in some patients. In fact, a person can be in hospital and treated for pneumonia for several months, literally.
When the high ranking clinicians of Toronto in associated with the equally high ranking members of the health department declared an end to the SARS-1 epidemic, there were scores of patients in long-term care, who were being treated for pneumonia they had contracted as a result of exposure to, and infection with the SARS-1 virus.
The frightfully premature relaxation of infectious disease control measures in Toronto hospitals and other care facilities, led to the deaths of scores of gifted and dedicated doctors, nurses, hospital workers and patients. And, the outbreak and epidemic of SARS cases sparked in Toronto resulted in a second wave of the SARS pandemic which lasted for another year, and thus, we speak of the SARS pandemic of 2002/2004.
This is the right time to begin the discussion concerning the criteria for establishing when the first wave of the Covid-19 pandemic has been brought to an end.
The first wave of the Covid-19 pandemic will have ended when we have a period of 47 days during which there are no new cases of infection with the SARS-CoV-2 virus, and the medical and health communities have ascertained reasonably that there are no reservoirs of he virus which could spark a Toronto-like second wave.
... there is always competition in nature
herd immunity v reassortment (recombination)
Let's posit that there is a competition between two natural phenomenon, herd immunity (mass infection) on the one hand, and reassortment (viral evolution) on the other.
In essence, herd immunity suggests that a state of indirect immunity to protect a population from an infectious disease can be achieved, when a sufficient number (thought to be a high percentage) of a population acquires immunity by having been infected with the infectious disease and survives, thereby reducing the chance that those who lack immunity will be infected.
If we take this concept to its logical conclusion, given our present knowledge of COVID-19 pandemic infection and survivability rates, a high percentage of the population would not survive before a sufficient level of herd immunity could be attained to protect the much smaller population that did survive.
The most obvious fallacy of this belief is the misunderstanding that associates herd immunity as a mass infection strategy, when in fact, it is a mass vaccination strategy.
Therefore, the proponents of herd immunity as a mass infection strategy fit the description of two of Kafka's three possible worldviews; monotonous senselessness and perplexing absurdity, but fall well below the third and rational worldview, that of being, ultimately meaningful.
The natural phenomenon competitor to herd immunity when it is understood erroneously as a mass infection strategy, in our example, is viral reassortment used here to include recombination mechanisms.
Reassortment and recombination are concerned with how viruses evolve, that is, how viruses produce new viral strains, including mutations. Reassortment produces new strains by replacing whole genes from a related virus, while recombination involves the incorporation of fragments of genes, often derived from the host, into a new viral strain.
The Novel Coronavirus, with which we are concerned is one of a rather large family of viruses which can attack the respiratory system within the human population. These viruses result in illnesses which include the so-called common cold, the flu, and encompass a variety of more debilitating diseases, such as, Severe Acute Respiratory Syndrome, SARS, and the Middle East Respiratory Syndrome, MERS, and novel coronavirus, COVID-19, among many many others.
As in the current circumstance, problems may arise when a person is infected by more than one of the large family of flu-like, respiratory system infecting coronaviruses at the same time, which often happens. Under these conditions, the infected cells through the process of reassortment exchange genetic material and can give rise to a new variant of the coronavirus. This is, in part, an explanation for the deaths from flu-like, yet resistant to normal flu medications, pre-COVID-19 illnesses that had infected millions in the United States alone, during the second half of the 2019/2020 flu season.
Phylogenetic analysis, the science that examines the generational relations of genes has documented the extent to which the SARS-CoV-2 virus has spawned a host of different lineages. At this writing seven new strains of the SARS-CoV-2 virus are circulating in the United States. One of which, strain WA1 (Washington one) has been isolated in COVID-19 patients on both coasts, in the Mid-west and in the Southeastern United States.
In a process analogous to the predictable decay of certain elements, altered RNA viruses mutate at a near-constant rate, which allows one to know how long ago a new strain first appeared, and often will permit scientists to identify patient zero of a new strain outbreak, with outwardly uncanny precision.
In our posited natural phenomena competition, we have the idea that if enough people get a disease and survive that will accord some indirect immunity to the rest of the population, pitted against the sure and certain situation, where the more people who get infected the greater is the opportunity for the production of more new strains of the agent causing the disease.
Thus far, through reassortment the novel coronavirus has produced several major strain types i.e., A, B, C, etc., but also variations within these major strains. Our understanding of the generational lineage of the novel coronavirus identifies Type B as derived from A, separated by two mutations, then C is in turn a 'daughter' of B.
Further, it has been established that although Type A most resembles the original human virus genome isolated in Wuhan China, Type B, not A, has been the predominant type that spread in China, while A predominates in the United States and Australia, and Type C dominates the European pandemic zone.
In a discussion of viral strains and mutations, it may prove instructive to recount that by the autumn of 1918, the virus that caused the Spanish flu had not only circumvented the globe, after the first case had been reported at a military base in the State of Kansas in the early spring of 1918, but the virus had by then mutated into a vastly more potent strain. That mutation unleashed an unremitting - second wave - of the Spanish flu pandemic that could kill even a young, healthy person, within 24 hours of the first signs of the onset of illness.
Population genetics researchers tracking the coronavirus pandemic, both in the United Kingdom, Sheffield, and the United States, New Mexico and North Carolina, have discovered and confirmed a new strain of SARS-CoV-2. And report that the new strain, a spike protein shift mutation identified as D614G, has already become the dominant strain of the SARS-CoV-2 virus infecting people, globally
In unapologetically scientific terms, the D614G mutation is a missense type genetic mutation, an alteration in a single DNA base pair, resulting in a substitution of aspartic acid, a polar amino acid with an acidic side chain, by glycine, a nonpolar amino acid containing a single hydrogen atom as its side chain. Since the discovery of the spike protein shift mutation described above, a number of respected research institutions have reported the inability to discern the functional significance of the spike D614G mutation based on population genetics studies alone.
Notwithstanding, it must be noted duly that several vaccines in development and in clinical trials were based on the initial, that is, the pre-mutation D614 spike protein sequence, and this result has important implications for the efficacy of those vaccines.
And that statement is as pure an example of British understatement, imaginable.
There is a competition between natural phenomena going on, but it is not a competition between an ethereal concept of herd immunity and viral evolution.
The clear and present natural challenge we face, is the ability of the human immune system, aided by the best forces medical science can muster, to hold at bay the relentless process and the ability of our natural competitor, the SARS-CoV-2 virus, to mutate to overcome human immune system resistance to it.
That is the battle in which we are now engaged, and success or otherwise in this specific effort, is the gold standard by which all our undertakings ought to be weighed. Experts believe the virus, called SARS-CoV-2, is mutating to overcome immune system resistance in different populations. Remember, sheltering-in-place was effective in keeping the Bay Area from being like New York City.
A Tale of Two Provinces
Several reviewers found this section "A Tale of Two Provinces' to be accurate, a subject worthy of investigation, an instrstory worthy of telling, and at the same time, rather settling. Given that the reviewers represent some of the best evidence-based medical scientific minds in our community, the unsettling characterization, naturally became the object of considerable discussion. That discussion largely accounts for the delay in the inclusion of this section into the article.
What we arrived at was a reasonably analogous situation, which places the concept of being unsettling into its proper perspective, that is, the intended meaning behind the use of the word, or concept if you will, of being unsettling.
Law, and Public Health Emergency Orders
The left column in the illustration above, represents individuals who are infected i.e., carriers of the COVID-19 disease, while the right column represents healthy, non-infected, individuals.
And, by implication, the left column also represents those who know they have been, or suspect that they have been in contact with an individual who has tested positive for the COVID-19 coronavirus.
These illustrations carry with them enormous implications as to how we go about enforcing public face mask requirements, during declared public health emergencies, and why.
In this regard, particular attention should be given to the second row from the top, which depicts a coronavirus infected person, without a mask, coming into contact with a healthy person wearing a mask.
Kindly note that this constitutes a 'high transmission rate' interface, that is, contact between a disease carrier and a healthy individual, which in many cases can result in transmission of the disease.
For example, the airways were filled recently with the story of a group of individuals, who in defiance of local requirements to wear a face mask while shopping in a store, decided to conduct a protest, by entering and running through the isles of the store not wearing masks.
On the face of it, this protest constitutes no more than a misdemeanor public order violation. However, in fact and in law, these individuals, with forethought, conspired, that is, planned and organized to commit a misdemeanor.
Conspiracy to commit a misdemeanor, is in fact a felony. The police would have come to this conclusion after even a cursory taking of statements from the boasting perpetrators. Having reasonable cause to believe a felony had been committed, the protestors would each be provided with a mask and taken into custody.
Naturally, once in custody, given that being charged, going before a judge and posting bail would take some time, each of the probable felons would be tested for the coronavirus. And, if any of them tested positive for the coronavirus, they would be in line for, at least, two additional charges, endangerment and biological assault.
In relation, to a recent Trump rally in a state where a maximum sized gathering of ten persons was in effect. The organizers of that rally with forethought, planned and organized an event in direct violation of the standing public safety order to help contain the spread of the coronavirus in that state. Again, conspiracy to violate a misdemeanor, is a felonious undertaking.
And, it is worth considering that every local, county and state police officer, who witnessed the violations and took no action, stands in breach of their sworn duty to take care that the laws be faithfully executed, which in this specific circumstance constitutes 'non-feasance' on the part of each individual police officer, that is, by definition, the failure to act where action is required—willfully or in neglect of their sworn duty.
And described in Proksch v. Bottendorf 218 Iowa 1376 (1934) as the failure to perform a duty, the omission of an act, which a person is legally obligated to carry out.
'It’s so easily transmissible, you wouldn’t even believe it.' Donald Trump, 13 April 2020
On the 28th of January 2020, national security adviser, Robert O’Brien, warned President Trump that Covid-19 would be the 'biggest national security threat' to his already crisis-ridden presidency.
Three days later, Trump announced restrictions on travel from China, although the coronavirus, by that date, was already well established in the United States.
Later, on 7 February, in a phone call with Bob Woodward, Trump stated, in uncharacteristically clear terms, what he had come to understand about just how lethal the coronavirus could be:
“It goes through the air," Trump stated. "That’s always tougher than the touch. You don’t have to touch things. Right? But the air, you just breathe the air and that’s how it’s passed. And so that’s a very tricky one."
"That’s a very delicate one," Trump continued. "It’s also more deadly than even your strenuous flus.” As damning as the Woodward tapes of his conversations with Donald Trump are, the 28th of January is by no means the first briefing Trump had received from his intelligence agencies concerning the emerging coronavirus pandemic.
It must be remembered that the so-called, gang of eight, top members of the intelligence committees of both houses of congress, had been given an intelligence briefing on the spread of the coronavirus, during the first week of January 2020.
It is customary for the president to be briefed, before the select members of congress are. We know that, at least, two members of the gang of eight, one Democrat the other a Republican, found what they were told so alarming that immediately after the intelligence briefing, sold most, if not all of their shareholdings on the stock exchange.
Therefore, it can be reasonably deduced, pending exact date verification, that Trump was briefed on the coronavirus, before the members of congress were, while the virus was raging in Central China, which would place Trump's initial briefing no later than the end of December 2019.
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Disclaimer: The illustration at the top of this page, the video and this article were developed pursuant to a grant from the Federal Government of Canada, in association with the Community League program to the Twin Brooks SIF Group. The grant exists to provide without cost to recipients, PPE materials, face masks and hand sanitizers as well as relevant multi-language information to seniors and their families, New Canadians and others, as part of the federal initiative to combat the COVID-19 pandemic. Neither the creator of the illustration, the creator of the video, or the author of this article have been compensated in any financial or material way. The illustration, video and article were contributed by volunteers of the SIF Group. The author is solely responsible for the content of the written material herein contained. Sections of this article, notably that concerned with the development of criteria for evaluating face masks and the need for face mask standards of efficacy have been submitted to a peer-reviewed medical journal for publication.