After the censors left

New CDC study shows why young people need to mask up

In mid-April, the Trump administration installed Michael Caputo as the new spokesman for the Department of Health and Human Services. Caputo, a corporate “crisis” consultant who ran Donald Trump’s communications operations at the 2016 Republican convention, immediately ordered a review of Centers for Disease Control and Prevention publications so they wouldn’t conflict with the White House’s upbeat messaging about the COVID-19 pandemic.

To act as in-house censor, Caputo hired Paul Alexander, who earned his doctorate in health research methodology in 2015 from McMasters University in Hamilton, Ontario. His Ph.D. thesis, “Clinical Practice and Public Health Guidelines,” questioned the quality of evidence behind many World Health Organization guidelines, which are used by physicians in developing countries when treating HIV/AIDS, tuberculosis and providing maternal and child healthcare.

In his thesis, Alexander accused WHO guideline writers of having financial and non-financial conflicts of interest, bowing to political pressure, and failing to give methodologists like himself a greater role in the process of writing guidelines. On May 29, shortly after he was hired, President Trump announced the U.S. would withdraw from the WHO.

Caputo’s new hire immediately began reviewing submissions to the CDC’s flagship publication, Morbidity and Mortality Weekly Report, according to a bombshell report published a month ago in Politico. While agency officials pushed back against this unprecedented interference in their work, he succeeded in changing the wording in “a few cases,” according to the report, which relied on leaked emails from inside the agency.

The story triggered an uproar among practicing clinicians, public health officials and researchers, who rely on CDC reports to get the most up-to-date analyses of epidemiological data about the COVID-19 pandemic. They feared their primary source for unbiased information about where it is spreading and what groups are most at risk had been compromised.

Less than a week later, Caputo, in a recorded Facebook Live event, accused the leakers of “sedition.” He also urged President Trump’s supporters to prepare for armed insurrection after a contested election.

When that hit the press, he was placed on a 60-day medical leave. Alexander also left the agency, but not before he told the Toronto Globe and Mail that the CDC’s 1,700 scientists were “generating pseudo-scientific reports… None of those people have my skills,” he said. “I make the judgment whether this is crap.”

With the White House’s attempts to cover up unwelcome news temporarily on hold, scientists at the CDC are continuing to pump out vital information about the pandemic. Their latest report, which, received almost no mainstream media attention, provides important insights into which age groups are largely responsible for the spread of COVID-19.

The report focused on the 767 counties deemed “hotspots” during June and July. Those counties, considered hot if they had steadily rising caseloads for seven days, house 63% of the U.S. population.

By stratifying the caseloads by age, they discovered people 24 and under began showing an increased ratio of positive COVID-19 tests 31 days on average before their counties were identified as hotspots. Increased caseloads among older populations didn’t arrive until later. For the oldest over-65 cohort, it was almost two weeks later.

When a county was designated as a hotspot, the rate at which people tested positive for the disease was 14% for the 18-24 age group, 10% for the 25-44 age group, 8% for the 45-64 age group, and 6% for seniors. All the older groups eventually reached a positive test ratio of 10-14%, but not for another three to five weeks.

The evidence shows “there is an urgent need to address transmission among young adult populations, especially given recent increases in COVID-19 incidence among young adults,” the MMWR report concluded. “These data also demonstrate the urgency of health care preparedness in hotspot counties, which are likely to experience increases in COVID-19 cases and hospitalizations among older populations in the weeks after meeting hotspot criteria.”

Addressing COVID-19 spread among the young poses a difficult challenge for local public health officials. In recent days, the media has focused public attention on the White House’s flouting of masking and social distancing protocols after the recent outbreak there led to more than two dozen infections, including the president and First Lady. It’s led most commentators and many infectious disease experts to lament the politicization of these prudent precautionary measures, the assumption being that mask-wearing is an expression of one’s political preferences.

That may be true for some. But my own observations suggest a scientific survey of mask-wearing behavior would show that non-compliance breaks down as much if not more along age lines, not political lines. The MMWR report showing hotspots begin with outbreaks among the young supports this thesis.

Whether in the park or on busy city streets, most of the people I see without masks are young. Virtually all the middle-age adults I see are wearing masks, even when they are walking alone or in couples. And I see almost no older adults without masks, and very few at restaurants that have resumed indoor dining with added space between their tables.

The scientific rationale for wearing masks and social distancing clearly hasn’t been communicated to many young people, which is not surprising given the president’s misleading comments and actions. So here’s what millions of people still need to learn:

Wearing a mask is only partially for your benefit. More importantly, it protects others from getting sprayed by aerosolized viral particles if you are sick or were recently exposed. You wear the mask so you won’t infect others. Its especially important for young people to heed that message since the young are more likely to remain symptom-less after they’ve become infected.

“Asking everyone to wear cloth masks can help reduce the spread of the virus by people who have COVID-19 but don't realize it,” the Mayo Clinic says on its website. “Countries that required face masks, testing, isolation and social distancing early in the pandemic have successfully slowed the spread of the virus.”

Are there masks that will protect older adults from the mask-less? N-95 masks, the most effective type, are designed to exclude 95% of aerosolized particles that are 0.3 micrometers or larger. According to this recent article in Nature, they are actually about 90% effective at that task.

The blue cotton surgical masks and cloth masks that most people wear are only 67% effective at screening out particles. Moreover, aerosolized droplets carrying the virus can be as small as 0.2 micrometers, and, because they’re so small, can linger in the air for longer than larger particles.

The goal, of course, isn’t to come up with the perfect mask for protecting ourselves from people who refuse to wear masks. Rather, as University of Minnesota infectious disease specialist Dr. Michael Osterholm and a colleague wrote recently in Foreign Affairs, if people would simply mask up and socially distance for two months so they don’t infect others, the pandemic could be brought under control – even without an effective vaccine, which is still many months away.

How can we convince the recalcitrant to behave responsibly? As I wrote recently in this Modern Healthcare column:

All it takes is leadership, the willingness to admit past errors, and the courage to abandon the false notion that personal liberty trumps everyone else’s right to breathe free from fear.