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Could a mask be a crude COVID “vaccine”?

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While we await the results of vaccine trials,  public health officials are searching for other measures that could decrease the proportion of severe symptomatic SARS-CoV-2 infections. With no clear and easy therapy, one of our main focuses in combating the virus is fewer infections and more immunity. Researchers published a recent article in the New England Journal of Medicine  introducing the idea of an age-old concept of variolation, the deliberate exposure to a pathogen to generate a protective immune response. First tried against smallpox, people who were susceptible to smallpox were inoculated with material taken from a vesicle of a person with smallpox, with the intent of causing a mild infection and subsequent immunity. Variolation was practiced only until the introduction of the variola vaccine, which ultimately eradicated smallpox.

One the researchers in the recent commentary, Dr. Monica Gandhi, an infectious disease physician at the University of California, San Francisco, states “So if you can drive up rates of asymptomatic infection with masks, maybe that becomes a way to variolate the population.” What this means is if the person wearing a mask has a mild illness and is less likely to transmit we are reducing the numbers of severe cases and increasing the number of immune people.  While this is still a theory we would need clinical trials that compare the outcomes of people who are masked in the presence of the coronavirus with those who are unmasked — an unethical experimental setup.

In this New York Times article the author writes that the coronavirus variolation theory hinges on two assumptions that are difficult to prove: that lower doses of the virus lead to less severe disease, and that mild or asymptomatic infections can spur long-term protection against subsequent bouts of sickness. Although other pathogens offer some precedent for both concepts, the evidence for the coronavirus remains sparse, in part because scientists have only had the opportunity to study the virus for a few months.

So for now, we don’t have clear evidence to support this theory but it is yet another hope as we look towards previously fought battles such as the smallpox virus to help us fight SARS-COV -2.

(Prerana Sangani, MD, September 15, 2020)