Covid Needs New Masked Heroes

 

It was 1919, the world was recovering from the devastations of the Great War and the Spanish flu pandemic was raging around the world when Zorro burst into the scene through a serialised novel The Curse of Capistrano. Zorro is considered a precursor of the more well-known masked saviours like Phantom (introduced in 1936) and Batman (introduced in 1939). Superman also debuted at the same time (in 1938) but Clark Kent wore thick glasses and our favourite superhero did not need any masked subterfuge to hide his super-powers.

Masked heroes have been a favourite among readers and writers to save people, cities, and countries from catastrophe. In hundreds of comic strips, novels and films they come out on top. When the enemy is defeated and the people are saved, the masked hero makes a quiet exit only to be resurrected when needed again. Exactly one hundred years from when Zorro made his screen debut through Douglas Fairbank in the Mark of Zorro, the world needs masked saviours once again. This time each one us is being called upon to save each other and the world, in a remarkable democratisation of the role of the masked saviour. This gives each one of us a chance to revel in the glory of being a superhero.

The mask is not just subterfuge, but a potent health measure known as a ‘barrier protection’. Drapes, gowns, masks are all forms of barrier protection used in every day surgical practice. Quarantine is also a form of barrier protection, and many of us are coming face to face with this measure which started in the middle ages when another pandemic, the plague was running amok in Europe in one of its many vicious cycles. Thankfully in the current situation the ‘quaranta giorni’ of 40 days has been reduced to a more reasonable 3, 7, or 12 days depending upon the wisdom of the public authorities in different places.

Probably the most well-known barrier in public health is the humble condom. Not many years ago the entire world had been brought to its knees but another pandemic AIDS. And this not so popular contraceptive was called upon as a ‘saviour’. Even though there had been many technological advances since the time of the ‘Spanish flu’, the disease agent for AIDS took some time to identify. Effective anti retrovirals (ARVs) were discovered nearly fifteen years after the virus HIV had been been identified in the early 1980’s. Nearly forty years later we still do not have a vaccine against HIV infection and condoms still continue to be a frontline preventive measure.

HIV and AIDS are not the only disease that the condom has been called upon to deal with. The modern condom is a result of the innovations of an Italian physician Gabrielle Fallopius who conducted experiments with linen sheaths and found them useful in preventing syphilis. Syphilis or the ‘great pox’, was another of the great scourges of the past. Till penicillin was discovered and its use became widespread towards the end of the 2^nd World War, condoms were the frontline against sexually transmitted diseases.    

The humble condom is also among the first known effective contraceptive, with some varieties being reported used even by the ancients in Egypt and China. Even today when many more sophisticated contraceptives are available the use of condoms is widespread. In countries like Korea and Japan it is the most prevalent contraceptive used, and has been successful in reducing the overall population growth rates drastically in the last fifty years. In China too, it is the second most prevalent method Intra Uterine Devices (IUDs).

New times call for new measures. A new pandemic, Covid 19 is sweeping across the globe. Millions have been infected and thousands are dead. A definitive treatment eludes us and many vaccines are under trial. This situation is not unprecedented. While on the one hand this situation reveals the many more mysteries of nature than we have imagined, it also brings us face to face with the limits of all our knowledge, technologies and certainties. It’s the perfect time for the appearance of the masked superhero. And from all the scientific literature that is available even the most humble mask appears to tick many boxes. Studies show that even the most simple masks are quite useful in reducing the spread of the infection.

The mask emerged as a frontline defence against Covid 19 right at the beginning. We learnt of the importance of surgical masks, three ply masks, N 95 masks and valved masks and several other varieties. There has been debate and discussion on the need for masks as well and there was a news item from the United States where there were people who claimed that wearing masks affected their constitutional rights. In the early months of the pandemic President Donald Trump refused to endorse masks and wouldn’t wear one publicly. In recent months he has changed his position. From the high offices of the US President to the person in the streets in India, there is a remarkable lack of interest in wearing masks, even though the fear of the disease has been very high with a constant focus on numbers of infected and dead.

Vaccines have been seen as the holy grail of Covid 19 prevention and numerous vaccine candidates using various technologies are being tested in different parts of the world. But some scientists have floated the idea that the mask is not just a barrier but may work as a low-tech, low-cost and readily available vaccine as well. In a commentary in the New England Journal of Medicine the authors have floated a provocative idea. Early vaccines consisted of low doses of low potency disease agents, a bacteria or virus, which were introduced into the body to stimulate a defence response. Once the body recognised the weak disease agent through the vaccine, it would be prepared to meet the ‘regular’ disease agent and mount a full-scale defence response. Thus, we had the live but attenuated (weakened) vaccines like the Measles, Mumps and Rubella (MMR) and the inactive or killed vaccines like the Whooping Cough vaccine. A third category is the toxoid vaccine where the vaccine is derived from the toxin or chemical which is responsible for the disease like the tetanus vaccine. Nowadays we are in modern times and use advance biotechnology to mimic the disease agent in different ways.

What the new article proposes is that the mask acts as a filter to reduce the dose of the virus that one is exposed to creating a vaccine like situation. We know that the infectivity of a disease is based on virulence, or ability to infect as well as the dose, or number of infecting particles a person is exposed to. Wearing a mask while one is going about their everyday life means that one’s chances of meeting another person with asymptomatic infection is high, and this provides an opportunity for multiple inoculation and thus higher protection. The authors have based this conclusion on the observation that asymptomatic infections have increased from 40% to 80% in a couple of months in settings where everyone wears masks. Asymptomatic infection could be considered as another name for being vaccinated.

A low tech and low-cost solution is exactly what India needs because we know that our vaccine delivery systems are not very robust. It took years to eradicate polio, a disease which had the simplest delivery consisting of oral drops. Injections require more elaborate mechanisms. In India we have still not succeeded in immunising all Indian children with vaccines for tuberculosis, measles, diphtheria and others which have been part of the Universal Immunisation Programmes (UIP) since 1985.    

While the search for an effective vaccine needs to continue, as a country we need to find ways to popularise the mask. And this does not require the health system, or even the government make dreary advertisements. Masks have the potential to become fashion statements and are somewhat in an advantageous position compared to its predecessor the condom. Peer pressure is known to be a powerful social incentive in current times.

Masks of different hues and designs can become a social revolution which can help to control this pandemic. And we need to find ways to send these attractive masks to all the corners of the country. It has been earlier successfully and again we have the condom as a precursor when the same company which sold and distributed torch batteries to the interiors where there was no electricity also distributed condoms.

For those of us who value our rights and our autonomy, the mask also provides an interesting benefit of privacy. Many of us are concerned about the constant electronic vigilance around us. Wearing masks as we move about may allow us to fool the elaborate facial recognition algorithms of security systems in addition to making a fashion statement.

It is probably time now for the return of the masked saviour.  All of us need to become Zorro or Batman or Spiderman, wear our masks and step out to save our world. It is a once in a lifetime opportunity and too good to miss.

Also Published in - https://timesofindia.indiatimes.com/readersblog/ponderingblues/covid-needs-new-masked-heroes-26225/ on September 19, 2020