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SARS-CoV-2 and COVID-19 Prevention and Treatment Options


covid-19

Prevention

Avoiding exposure to the SARS-CoV-2 is the best way to prevent illness. Staying away from individuals who are ill or who may have been exposed to the virus can reduce your risk of contracting the virus.

Washing hands with soap and water or using an alcohol-based hand sanitizer when handwashing facilities are not available can also be effective in reducing infection risk.1

Mask Mandates and Evidence

Health officials recommend the use of masks while near others who are not family members and when in public settings.2 As of September 30, 2021, the CDC recommends that N95 respirator masks be prioritized for healthcare workers and workers who wore respirator masks prior to the pandemic; however, as supplies of these masks increase they can also be worn in other settings.3

The Centers for Disease Control and Prevention (CDC) has changed their position on the use of face coverings several times in recent months. However, as of September 30, 2021, the CDC is supporting the use of face masks despite a lack of evidence that face coverings can prevent the transmission of SARS-CoV-2.4 5 6 7

A rapid review of the available literature on the use of fabric face coverings conducted by the National Academies of Sciences, Engineering, and Medicine and published on April 8, 2020 concluded that:8

“There is little evidence regarding the transmission of small aerosolized particulates of the size potentially exhaled by asymptomatic or presymptomatic individuals with COVID-19. The extent of any protection will depend on how the masks are made and used. It will also depend on how mask use affects users’ other precautionary behaviors, including their use of better masks, when those become widely available. Those behavioral effects may undermine or enhance homemade fabric masks’ overall effect on public health. The current level of benefit, if any, is not possible to assess.”

A May 2020 published meta-analysis on the use of face masks within a community setting and their impact on reducing viral respiratory infections concluded the evidence to be equivocal at best.9

Harms associated with the use of fabric masks include the reduction of tissue and blood oxygenation and the increase in carbon dioxide levels. Detoxification is also hindered by the reduction of oxygenation which can impair the immune system and cause additional psychological and physical issues. The use of cloth masks has also been found to increase the risk of infection and the spread of viral illnesses.10 Individuals who lack the resources or the knowledge to ensure that these coverings are adequately cleaned and sanitized between uses may put themselves at risk of illness.

Former COVID-19 White House advisor Dr. Scott Atlas previously criticized the push for universal mask mandates. In an interview on Fox News's "The Ingraham Angle", Atlas stated that masking was not effective at stopping the spread of the virus. He pointed out that many U.S. states and countries worldwide which had imposed strict mask mandates were experiencing significant increases in COVID-19 infections.11

A major randomized controlled study out of Denmark that examined the efficacy of facemasks against the spread of SARS-CoV-2 concluded:

“The recommendation to wear surgical masks to supplement other public health measures did not reduce the SARS-CoV-2 infection rate among wearers by more than 50% in a community with modest infection rates, some degree of social distancing, and uncommon general mask use. The data were compatible with lesser degrees of self-protection.”12

This study, which published in November 2020 in the Annals of Internal Medicine, found that 1.8 percent of mask wearers ended up testing positive for SARS-CoV-2, compared to 2.1 percent of the controls. However, when they removed participants from the study who did not properly wear the masks, the results were identical – 1.8 percent – which suggests that mask-wearing did not alter outcomes.13

In February 2021, the CDC recommended the use of two masks to prevent the spread of SARS-CoV-2 virus.14 This recommendation was based on laboratory simulations studies conducted by the CDC, which reported that wearing a surgical mask underneath a cloth mask improved the fit and filtration. Study authors, however, reported:

“The findings in this report are subject to at least four limitations. First, these experiments were conducted with one type of medical procedure mask and one type of cloth mask among the many choices that are commercially available and were intended to provide data about their relative performance in a controlled setting. The findings of these simulations should neither be generalized to the effectiveness of all medical procedure masks or cloths masks nor interpreted as being representative of the effectiveness of these masks when worn in real-world settings. Second, these experiments did not include any other combinations of masks, such as cloth over cloth, medical procedure mask over medical procedure mask, or medical procedure mask over cloth. Third, these findings might not be generalizable to children because of their smaller size or to men with beards and other facial hair, which interfere with fit. Finally, although use of double masking or knotting and tucking are two of many options that can optimize fit and enhance mask performance for source control and for wearer protection, double masking might impede breathing or obstruct peripheral vision for some wearers, and knotting and tucking can change the shape of the mask such that it no longer covers fully both the nose and the mouth of persons with larger faces.”15

A CDC funded study, published in the JAMA Internal Medicine on April 16, 2021, offered data on double masking, and reported that wearing a procedure mask under a fabric mask improved performance on average between 66 and 81 percent.16 These conclusions, however, were questioned by experts, who expressed concerns that the study was “overly simplistic and sends the wrong message.” Lisa Brosseau, ScD, a research consultant at the University of Minnesota’s Center for Infectious Disease Research and Policy (CIDRAP) noted that the study ignored filter efficiency, an important aspect of in determining the fit.17

 “Even if double masks conferred the 81% maximum effectiveness found in the study, it is still overselling what procedure masks and cloth face coverings can do over time, Brosseau added. "No, you will not get 80% protection," she said. "A face covering will give you only minutes. Only a fitted N95 respirator will give you hours." Brosseau also noted that the study failed to address the differences in face coverings and specify the particle size used in the study, stating that "All four performance factors—filter efficiency, airflow resistance, and inward and outward leakage—need to be considered."18

In early August 2021, CIDRAP Director, Dr. Michael Osterholm, who has also served as an adviser on President Joe Biden's COVID-19 transitional advisory board, admitted that cloth masks do little to stop SARS-CoV-2 transmission. Despite publicly acknowledging that masks were not effective, Osterholm stated that he supported their use in public spaces.19

On April 2, 2021, the CDC issued new mask guidance stating that the fully vaccinated can gather with other fully vaccinated persons indoors, or with the unvaccinated from one other household, unless they live with someone with an increased risk for severe COVID-19. The fully vaccinated also do not need to stay away from others or get tested for COVID-19 after exposure to someone with COVID-19, unless they become symptomatic.20

CDC updated guidance again on April 27, 2021 and continued to recommend that, in indoor spaces, fully vaccinated individuals should continue to mask, wash hands frequently, cover sneezes and coughs, and follow any business or school guidelines. However, fully vaccinated persons could gather with other fully vaccinated people indoors without masks, or with unvaccinated people of any age, except when visiting someone with an increased risk for severe COVID-19, or who lives with someone at increased risk. Fully vaccinated individuals could also go outdoors without masks, except when gathering in large crowds but they were still advised to avoid large indoor gatherings; and to take precautions to protect themselves while traveling, to be vigilant about symptoms and to get tested when they occur.21

In May 2021, the CDC announced that fully vaccinated individuals could resume activities without masking or physically distancing, except where required by law, workplace or local requirements. Additionally, they could travel domestically without testing or self-quarantine, and travel internationally without testing unless their destination required it, and would not be required to self-quarantine on return. Vaccinated persons exposed to someone with SARS-CoV-2 were also advised that they would not need to self-quarantine or test unless symptomatic.22

After acknowledging that fully vaccinated persons could still become infected with SARS-CoV-2 and transmit the virus on to others, the CDC issued a health alert on July 27, 2021 and advised fully vaccinated people to wear a mask in indoor public settings in areas of high or substantial viral transmission.23 Public health officials report that this mask recommendation is aimed at reducing the risk of illness and transmission of the Delta variant of SARS-CoV-2.24

As of October 15, 2021, masks are federally required when traveling on buses, trains, airplanes and other forms of public transportation. All persons entering the U.S. are still required to show proof of a negative COVID-19 test completed within three days of travel or show history of recovering from illness within the previous three month and are recommended to test within five days of return.25

In addition to questions regarding the effectiveness of masks, the safety of their use, especially among children, has been called into question. In June 2021, a University of Florida laboratory analyzed six masks, five that were worn by children between 6 and 11 years of age, and one worn by an adult, and found the presence of 11 dangerous pathogens. These included bacteria that cause meningitis, diphtheria, pneumonia, as well as parasites and fungi. Of the masks analyzed, one was polyester, two were cotton, and three were surgical.26

Another June 2021 study published in the Journal of the American Medical Association's Pediatrics, found that children who wore masks were exposed to dangerous levels of carbon dioxide. The study reported that the safe limits for carbon dioxide in closed rooms is 2,000 ppm; however, researchers found that the child with the lowest carbon dioxide level was still 3- fold greater than the safe limit. Additionally, the study found that the youngest children had the highest levels of exposure, with one 7-year-old child measuring 25,000 ppm. In their conclusion, the study authors stated that they:27

“suggest that decision-makers weigh the hard evidence produced by these experimental measurements accordingly, which suggest that children should not be forced to wear face masks.”

This study, however, was retracted on July 16, 2021. The study’s lead author, Harald Walach, has publicly stated that “the retraction was political, because some people did not like our data.”28

A study on the effects of a mask mandate in Bexar County, Texas published in September 2021 concluded that:29

“There was no reduction in per-population daily mortality, hospital bed, ICU bed, or ventilator occupancy of COVID-19-positive patients attributable to the implementation of a mask-wearing mandate.”

The CDC, however, has declared that “the benefits of mask-wearing are well-established.”30 They also recommend that children two years of age and older who are not fully vaccinated wear masks in all indoor spaces. Masking is also recommended for all K-12 students, teachers, staff and visitors regardless of vaccination status.31

Vitamin D and Severe COVID-19 Illness

Individuals who are deficient in vitamin D are also at an increased risk of severe COVID-19 disease.32 33 In addition to strengthening teeth and bones, vitamin D supports nervous, brain and immune system health, lung and cardiovascular function and regulates insulin levels. Ensuring adequate vitamin D levels may prevent a person from developing serious COVID-19 illness.34 35 36 37

A large scale observational study by the University of Chicago that published in JAMA Open Network in March 2021 also revealed that high vitamin D levels may protect against COVID-19. The primary investigator noted that while the recommended dietary allowance for vitamin D is 600 to 800 international units (IUs) per day, the National Academy of Medicine states that up to 4,000 IUs per day is safe for the majority of people.38

Another study published in Scientific Reports in September 2021 found that persons with low vitamin D levels were at higher risk of serious disease, increased intensive care unit stays, and death.39

Additional Nutritional Information

A review published British Medical Journal Nutrition, Prevention & Health in May 202040 stated that while there were no published nutrition studies specific to COVID-19 and SARS-CoV-2,  and noted:

“Severe infection of the respiratory epithelium can lead to ARDS, characterised by excessive and damaging host inflammation, termed a cytokine storm. This is seen in cases of severe COVID-19. There is evidence from ARDS in other settings that the cytokine storm can be controlled by the n-3 fatty acids EPA and DHA, possibly through their metabolism to SPMs. This therapeutic approach has not been attempted in severe COVID-19 and warrants investigation.”

The review also stated that in general, vitamins A, B6, B12, C, E, folate and trace minerals such as iron, zinc, selenium, and copper are vital in reducing the risk of infections and supporting immune function. Ensuring a healthy diet containing these essential vitamins and minerals, or supplementing when dietary sources are inadequate, may be helpful in preventing illness. Gut health is also important in maintaining a healthy immune system. Consuming fermented foods and a diet rich in fiber can help to maintain a healthy gut microbiota.

Treatments

According to the CDC, for most people who become ill with COVID-19 will not require any specific treatment. Over- the-counter fever and pain reducers are advised to relieve aches and pains associated with illness. Ensuring adequate hydration and rest are also considered important for recovery.41

Early in-home treatment options have been recommended by researchers and physicians globally, however, many countries, including the U.S., have failed to recommend early home-based treatments. The “wait and see” approach has been criticized by many physicians, who believe that precious time is wasted when patients are told to monitor symptoms, instead of being provided with potential life-saving therapeutics. Multiple treatment protocols have been utilized globally, with physicians reporting positive patient outcomes.42

FDA-Approved Treatments

On October 22, 2020, the FDA approved Remdesivir, for use in COVID-19 patients 12 years of age and older and who weigh at least 88 pounds. Remdesivir, an antiviral medication administered intravenously, must be given in an acute care setting such as a hospital or similar facility. The drug initially received Emergency Use Authorization (EUA) by the FDA on May 1, 2020, and clinical studies on safety and effectiveness for use in younger populations are still ongoing.43

Developed by Gilead Sciences in conjunction with the CDC and the U.S Army Medical Research Institute of Infectious Diseases (USAMRIID), Remdesivir was initially used as a potential treatment against ebolavirus but found to be ineffective. Preliminary studies on its use in the treatment of COVID-19 report the medication to speed up recovery time by 31 percent.44

According to the FDA, one randomized, double-blind, placebo-controlled clinical trial conducted by the National Institute of Allergy and Infectious Diseases (NIAID) on recovery rates of persons hospitalized with COVID-19 reported faster recovery times in persons receiving Remdesivir when compared to the placebo group. The FDA press release noted that persons receiving the drug recovered on average in 10 days compared to 15 days for those in the placebo group.

Two additional clinical trials reported improvements in persons receiving Remdesivir when compared to the placebo, however results were not considered statistically significant. This includes one trial that looked at the drug’s effects on reducing mortality rates.

In mid-October 2020, the World Health Organization (WHO) reported that preliminary results of a larger international study found that Remdesivir “appeared to have little or no effect on hospitalized COVID-19.”45

On November 13, 2020, Jozef Kesecioglu, president of the European Society of Intensive Care Medicine, stated that “remdesivir is now classified as a drug you should not use routinely in COVID-19 patients.”46

A study published in the Journal of the American Medical Association (JAMA) in July 2021 concluded that:47

“remdesivir treatment was not associated with improved survival but was associated with longer hospital stays. Routine use of remdesivir may be associated with increased use of hospital beds while not being associated with improvements in survival.”

This was followed by a study published on September 14, 2021 in the Lancet which compared 429 patients who received Remdesivir (Veklury) plus the standard of care with 428 patients who received only the standard of care between March 2020 and January 2021. According to the study, after 15 days of beginning the treatment protocol, 46 percent of person who received Remdesivir recovered enough to return home, compared to 49 percent of those who received only the standard of care. Additionally, the Remdesivir group had a 5 percent fatality rate while the standard of care group had a 6 percent fatality rate.

Study authors concluded that:48

“No clinical benefit was observed from the use of remdesivir in patients who were admitted to hospital for COVID-19, were symptomatic for more than 7 days, and required oxygen support.”

Treatments approved under Emergency Use Authorization (EUA)

Emergency Use Authorization (EUA) is a status given to experimental products by the FDA during a public health emergency, as defined under federal law.49 50

On November 19, 2020, the FDA issued an EUA for the drug baricitinib, to be administered in combination with Remdesivir, for the treatment suspected or confirmed COVID-19 illness in hospitalized persons two years of age and older who are also receiving oxygen, extracorporeal membrane oxygenation (ECMO), or mechanical ventilation.

Baricitinib is an FDA approved medication for the treatment of moderate to severe rheumatoid arthritis. In a clinical trial involving 1,033 patients, patients who received baricitinib in combination with Remdesivir recovered on average in seven days, whereas those who received Remdesivir with a placebo recovered in eight days. Additionally, this trial reported higher survival rates in persons who received baricitinib and Remdesivir when compared to those who received only Remdesivir.51

The FDA also issued an EUA for the experimental drug bamlanivimab,52 53 which has been  developed specifically for COVID-19 illness and is a monoclonal antibody therapy. Under the EUA, bamlanivimab was authorized for use in persons 12 years of age and older considered at a high-risk for severe COVID-19 illness and/or hospitalization. According to the FDA:

“Monoclonal antibodies are laboratory-made proteins that mimic the immune system’s ability to fight off harmful antigens such as viruses. Bamlanivimab is a monoclonal antibody that is specifically directed against the spike protein of SARS-CoV-2, designed to block the virus’ attachment and entry into human cells.”

In a clinical trial involving 465 non-hospitalized adults with mild to moderate COVID-19 symptoms, only three percent of persons who received bamlanivimab required hospitalization or emergency room treatment compared to ten percent of those in the placebo arm. Bamlanivimab was not permitted for use in persons receiving oxygen or hospitalized for COVID-19 disease because use of the drug was associated with more severe outcomes. On April 16, 2021, the FDA revoked the EUA that permitted bamlanivimab to be administered alone, stating that the increase in SARS-CoV-2 variants had resulted in an increase in treatment failure. According to the press release, the FDA reported that the known and potential benefits of bamlanivimab, when administered alone, no longer outweigh the known and potential risks for its authorized use.54

Two additional experimental monoclonal antibodies, casirivimab55 and imdevimab,56  received EUA approval on November 21, 2020, to be given in combination to persons 12 years of age and older who have tested positive for SARS-CoV-2 and are considered at high-risk for severe COVID-19 illness. The use of these medications, however, is limited to persons who are not hospitalized or requiring oxygen therapy due to COVID-19. Outcomes may be worse if given to persons who are hospitalized for COVID-19 and receiving high flow oxygen or mechanical ventilation.57 This antibody cocktail, known as Regeneron, was used in mid-October to treat Former President Donald Trump even though it was not yet granted EUA approval. 58

On February 9, 2021, the FDA issued an EUA for bamlanivimab and etesevimab administered simultaneously for the treatment of mild to moderate COVID-19 in persons 12 years of age and older who test positive for SARS-CoV-2 and who are at high risk for progressing to severe COVID-19 illness.59 Etesevimab is also an experimental monoclonal antibody developed specifically to treat COVID-19 illness.60 The FDA reports that a single intravenous infusion dose of bamlanivimab and etesevimab administered together significantly reduced COVID-19-related hospitalization and death based on data collected during 29 days of follow-up when compared to placebo. The safety and effectiveness of this treatment protocol continues to be under evaluation.61

On May 26, 2021, the FDA authorized the use of the investigational monoclonal antibody therapy sotrovimab as a treatment of mild-to-moderate COVID-19 in persons 12 years and older. The treatment, however, is not authorized for use in persons who are hospitalized or receiving oxygen therapy for COVID-19 illness. The EUA authorization was based on interim results from phase 1/2/3 clinical trial involving only 583 non-hospitalized adults with mild to moderate symptoms of COVID-19 and a positive SARS-CoV-2 test. 291 patients received sotrovimab and 292 patients received a placebo within five days of symptom onset. Findings from the interim study found that 21 patients (7 percent) of placebo-recipients required hospitalization or died, compared to 3 patients (1 percent) of patients treated with sotrovimab. Reported side effects of sotrovimab include anaphylaxis, infusion-related reactions, diarrhea, and rash.62 

Additional Treatments

High doses of vitamin C given intravenously (IV) have been used to treat COVID-19. Three clinical trials and several smaller studies reported successful outcomes among patients who received IV vitamin C at doses varying from 50 to 200 milligrams per kilogram of body weight to up to 200 mg per kg per day.63

One study published in March 2020 reported:

“High-dose intravenous VC has also been successfully used in the treatment of 50 moderate to severe COVID-19 patients in China. The doses used varied between 10 g and 20 g per day, given over a period of 8–10 h. Additional VC bolus may be required among patients in critical conditions. The oxygenation index was improving in real time and all the patients eventually cured and were discharged.” 64

The Frontline COVID-19 Critical Care Alliance (FLCCC), a group comprised of highly published critical care experts, have outlined a protocol to treat hospitalized COVID-19 patients. In February 2021, the FLCCC’s clinical and scientific rational on their methylprednisolone, ascorbic acid (vitamin C), thiamine, heparin and co-interventions (MATH+) protocol was peer reviewed and published in Journal of Intensive Care Medicine.65 The protocol was reported as effective in the treatment of severe COVID-19 illness requiring hospitalization. Additional treatment co-interventions noted in the research article included the use of melatonin, famotidine, atorvastatin, vitamin D3, and the application of therapeutic plasma exchange (a treatment that replaces an individual’s blood plasma).66

The article noted that systematic use of MATH+ in two U.S. hospitals demonstrated an absolute mortality risk reduction of more than 75 percent, or 5.1 percent vs. 22.9 percent, when compared to multiple published COVID-19 hospital mortality rates in the U.S. The article concluded:

“It is exceedingly unlikely that a “magic bullet” will be found, or even a medicine which would be effective at multiple stages of the disease. The Math+ treatment protocol instead offers an inexpensive combination of medicines with a well-known safety profile based on strong physiologic rationale and an increasing clinical evidence base which potentially offers a life-saving approach to the management of COVID-19 patients.” 67

Use of Anti-Malaria Medications

In March 2020, two anti-malaria medications, hydroxychloroquine and chloroquine, received EUA authorization to treat COVID-19. The EUA was issued based on laboratory studies that showed these medications to be effective against coronaviruses. Use of these medications, however, quickly became controversial.

On May 22, 2020, The Lancet published a study reporting that hydroxychloroquine was not effective against COVID-19 and was associated with heart arrhythmias and higher death rates. As a result of this study, the World Health Organization (WHO) halted their hydroxychloroquine drug trials. The validity of this study, however, was immediately questioned and when the study data could not be obtained for independent review, The Lancet was forced to retract the study.68

Scientists affiliated with the Henry Ford Hospital System in Detroit, Michigan published research on hydroxychloroquine that reported the medication to be effective in reducing the COVID-19 death rate. No heart-related side effects were reported, and outcomes improved when treatment was initiated early.69 The study results, however, have been criticized by health officials including Dr. Anthony Fauci, Director of the National Institute of Allergy and Infectious Diseases (NIAID).70 Hydroxychloroquine administered in combination with zinc and azithromycin has also been reported to be an effective treatment for hospitalized COVID-19 patients.71

The FDA, however, revoked the EUA for hydroxychloroquine in mid-June 2020, stating that the medication was ineffective against COVID-19 and potentially harmful.72 The Association of American Physicians and Surgeons (AAPS) is currently suing the FDA due to the restrictions it placed on the use of this medication.73

A January 2021 published study in the American Journal of Medicine reported that when the medicine was administered early in the treatment stage, it was effective at halting disease progression, preventing hospitalization, and reducing mortality rates. This study also reported the effectiveness of using the hydroxychloroquine in combination with either azithromycin or doxycycline, two commonly prescribed antibiotics.74

Off-Label Use of Other Drugs

Ivermectin, a medication used to treat parasites, has been found to inhibit SARS-CoV-2, the virus that causes COVID-19, in vitro.75 Australian gastroenterologist Dr. Thomas Borody, known for developing the first peptic ulcer cure, reported that Ivermectin administered in conjunction with zinc and the antibiotic doxycycline could be a ‘potential life-saver.’76 A January 2021 published study reported that the use of Ivermectin was associated with lower rates of death, especially in patients who had severe pulmonary involvement.77 A journal study published in April 2021 concluded that:78

Meta-analyses based on 18 randomized controlled treatment trials of ivermectin in COVID-19 have found large, statistically significant reductions in mortality, time to clinical recovery, and time to viral clearance. Furthermore, results from numerous controlled prophylaxis trials report significantly reduced risks of contracting COVID-19 with the regular use of ivermectin. Finally, the many examples of ivermectin distribution campaigns leading to rapid population-wide decreases in morbidity and mortality indicate that an oral agent effective in all phases of COVID-19 has been identified.”

Despite published data to support the use of ivermectin as a treatment for COVID-19, the medication has not been granted approval or authorization by the FDA. On August 26, 2021, the CDC issued a health advisory regarding the use of ivermectin as a treatment option for COVID-19. In the health advisory, the CDC noted that the medication, while FDA-approved for use as a safe treatment option for infections caused by internal and external parasites, was not approved or authorized as a COVID-19 treatment. The CDC warned against use of the medication, and included a warning about the risk of ingesting topical formulation as well as products intended for veterinarian use.79

The corticosteroid Budesonide, commonly used to treat asthma symptoms, has also been successfully used to treat symptoms of COVID-19. According to a study conducted by the University of Oxford, budesonide significantly decreased urgent care visits and hospitalizations, and when used within seven days of symptom onset, recovery time was decreased. Fever, illness symptoms, including persistent illness symptoms, resolved quicker in study participants who received budesonide.80

The cholesterol drug Fenofibrate, is also being studied as a COVID-19 treatment. This medication is reportedly capable of diminishing illness symptoms to that of the common cold.81 82

Blood plasma donated from individuals who have recovered from COVID-19 is also under investigation as a potential treatment option. In early August 2020, Mayo Clinic researchers reported that this therapy was helpful despite a lack a formal data to support its use.83 A study on the use of convalescent plasma to treat moderate COVID-19 illness in adults in India published in the British Medical Journal in October 2020 reported that this treatment was not effective in reducing the progression to severe disease or preventing COVID-19 related deaths.84

On February 4, 2021, the FDA revised the convalescent plasma EUA to limit it to the use of only high-titer convalescent plasma for early treatment of hospitalized patients or in persons with impaired humoral immunity who are unable to produce an adequate antibody response. Low-titer convalescent plasma was declared ineffective and its use was no longer authorized.85

IMPORTANT NOTE: NVIC encourages you to become fully informed about covid-19 and the covid-19 vaccine by reading all sections in the Table of Contents, which contain many links and resources such as the manufacturer product information inserts, and to speak with one or more trusted health care professionals before making a vaccination decision for yourself or your child. This information is for educational purposes only and is not intended as medical advice.

« Return to Vaccines & Diseases Table of Contents

Updated October 20, 2021

References

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13 Bundgaard H, Bundgaard JS, Raaschou-Pedersen DET et al. Effectiveness of Adding a Mask Recommendation to Other Public Health Measures to Prevent SARS-CoV-2 Infection in Danish Mask Wearers : A Randomized Controlled Trial. Ann Intern Med. Mar. 2021;174(3):335-343.

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17 Van Beusekum M. Double masking amid COVID-19 not backed by research, experts say. CIDRAP News Apr. 22, 2021.

18 Van Beusekum M. Double masking amid COVID-19 not backed by research, experts say. CIDRAP News Apr. 22, 2021.

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25 U.S. Centers for Disease Control and Prevention. When You’ve Been Fully Vaccinated. In: COVID-19. Oct. 15, 2021.

26 Lee M. University of Florida Lab Finds Dangerous Pathogens on Children’s Masks. The Epoch Times June 22, 2021.

27 Walach H, Weikl R, Prentice J et al. Experimental Assessment of Carbon Dioxide Content in Inhaled Air With or Without Face Masks in Healthy Children: A Randomized Clinical Trial. JAMA Pediatr. June 30, 2021. doi: 10.1001/jamapediatrics.2021.2659. Epub ahead of print. PMID: 34190984.

28 Ozimek T. Author of Retracted Study on Harm of Mask-Wearing by Children Says Removal Was ‘Political’. The Epoch Times July 21, 2021.

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32 Merzon E, Tworowski D, Gorohovski A. et al. Low plasma 25(OH) vitamin D level is associated with increased risk of COVID-19 infection: an Israeli population-based study. FEBS J. Sep 2020;287(17):3693-3702.

33 Radujkovic A, Hippchen T, Tiwari-Heckler S. et al.  Vitamin D Deficiency and Outcome of COVID-19 Patients. Nutrients Sep. 2020;12(9):2757.

34 Raines K. Vitamin D Deficiency Studies and COVID-19. The Vaccine Reaction July 19, 2020.

35 Cáceres B. Vitamin D Benefits Confirmed by New COVID-19 Research. The Vaccine Reaction May 18, 2020.

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