Even if you are vaccinated, you should not remove your mask.

Although the end of this nightmare seems closer and closer, there is still some way to go.

SPAIN (El Pais) – The times when wearing a mask was the (almost) exclusive preserve of healthcare personnel seem very far away. For months now, despite the countless inconveniences (glasses fogging up, rubbers bothering the ears…), we got the idea that we couldn’t take a step beyond the door of our house without wearing one.

That little piece of cloth (or cellulose) is one of the best ways to protect ourselves against the virus that has turned our lives upside down. But just because we recognize its value doesn’t mean we’re not willing to take it off. And with the start of vaccination, we seem to be cherishing that moment. Not so fast: “Even if we have the disease under control, we will have to wear the mask for much longer,” says Francisco Alvarez, coordinator of the Vaccine Advisory Committee of the Spanish Association of Pediatrics (CAV-AEP).

There is more than one reason not to be able to hang up this garment once and for all. The first one is that the BioNTech and Pfizer vaccine that has begun to be administered requires two doses, 21 days pass. “Between one and the other, we are still at risk of acquiring the infection,” explains Ruth Figueroa, spokesperson for the vaccine group of the Spanish Society of Infectious Diseases and Clinical Microbiology (SEIMC). And, even with the two punctures, the effect is not immediate. “The vaccine has to work, like the rest of the vaccines we know, and that takes some time,” she recalls. It is estimated that seven days must pass from the second dose to be effective. In total, from the first dose, a month goes by in which we are still unprotected.

The thing does not end there. After that month, we won’t stop using it either because, although the percentage of effectiveness of this vaccine is very high, it doesn’t reach 100%.

According to Figueroa, we cannot let down our guard: “We know that the vaccine is going to protect us a lot, at least 95%, but not 100%,” he affirms and reminds us that there is no way of knowing who will be in that 5%. So we have to keep putting into practice the prevention measures: frequent hand washing, keeping social distance, and, yes, the mask.

There is a third reason. The vaccination that began last Sunday in Spain will go down in human history as the largest and fastest mass vaccination ever known. A challenge that could prevent many deaths. However, the 7.7 billion people on the planet will not be vaccinated. And as long as there are unvaccinated people, there is a risk that the virus will continue to move freely.

It is also not known if those vaccinated will be able to infect if they come into contact with the virus. “There is a possibility. The objective is that it is not transmitted and that if we suffer the disease, we are the least transmitters possible. Maybe we have such a simple cold that we don’t even realize it, precisely because we are vaccinated, but there is the uncertainty of whether we would be contagious,” explains Figueroa.

This concern comes from how the vaccine works. It is a puncture in the deltoid muscle that includes 30 millionths of a gram of tozinamerán, a molecule with the genetic information of the new coronavirus. Once it enters our body, it is our organism that is in charge of making the real vaccine through a harmless fragment of the virus, its spicule protein, with which the defenses of the organism are trained. In this way, severe forms of the disease are prevented. What is not known is “if it prevents the infection, that is if it ends up with the virus in the nasopharynx,” states the coordinator of the CAV-AEP.

Viral infections “end up being a race between the speed of the virus’ spread and the speed of the immune response. In a vaccinated person, that response should be fast and powerful enough to stop the replication of the virus, limiting both the amount of virus and the time it will be located in the nose.” Explains Luis Perez Garcia-Estañ, Professor of Virology at the University Miguel Hernandez. 

However, if the response is not very fast or very powerful, the virus can lodge in the nose and continue to infect others. “Unfortunately, until we have more data, we will have to take extreme precautions even if one is vaccinated,” says immunologist and CSIC researcher Matilde Cañelles, from the Department of Science, Technology, and Society of the Institute of Philosophy (IFS-CSIC).

The way to make sure that those who are vaccinated do not get infected either is, according to the experts, an intranasal vaccine. “Can be more effective against the contagion and transmission of the disease. They may also be better for children, who, because they have a more rudimentary immune system, rely more on ‘mucosal immunity’ that predominates in the nose and throat. For that reason, oral or nasal vaccines could potentially work better than injectable ones,” explains CSIC immunologist Matilde Cañelles. And, although we do not have it yet, it is possible that we are not far away.

In record time (less than a year), we have developed the three clinical phases of a vaccine, approve it, and start administering it. It gives hope to the experts, who do not see as a utopia the arrival of the oral and nasal versions. “There is no need to go to the future. There is already one for intranasal administration. For example, for the flu. And throughout this year, there has been some project to develop this type of vaccine for SARS-CoV-2,” says Pérez García-Estañ.

In any case, removing the mask would not be immediate either. “We cannot rely on herd immunity, as we do not yet know how long the immunity provided by the vaccine will last, or if the virus will mutate [which it already has: just a few days ago, the UK was reporting a new, even more, contagious strain] and we will have to get vaccinated every year, as is the case with influenza. Therefore, we have to continue developing vaccines of several types that reach all the segments of the population, and taking measures,” Cañelles remembers. And when our turn comes, we must take the vaccine. The more we have it, the safer we will be for all.

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