Last week Tom was interviewed by Michael Smerconish, once on a radio programme and two days later on the morning TV programme of CNN.

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The background to this frenetic activity was an increase in Covid cases (whatever that may mean) in the US and a consequent interview that Smerconish did with Dr. Anthony Fauci, who once described himself as ”the science”. Narcissism apart, Dr. Fauci made some enigmatic claims about masks. Asked to comment on his views after the publication and circulation of Cochrane review A122, Dr Fauci stated that there is no doubt that masks work against SARS CoV-2 at a personal level, but the data at the community level is “less strong” (listen to a clip of his interview during the Smerconish podcast).

This apparent second flip-flop (Dr Fauci initially held the view that mask use did not interfere with the spread of the agents and then changed his mind during the crucial late March 2020) drove certain sectors of the US media to a frenzy, with the run-up to party primary elections looming large. Dr Fauci was excoriated and was called names in respected broadsheets, which shocked us. We do not agree with calling people out in the most vulgar way, whatever their views.

Anyway, to calm people down or perhaps to inflame the debate, Tom was wheeled in as the “senior author” of the iconic A122. His role was at first to interpret the Fauci statements, which he refused to do and then to explain the message of A122 on masks, never mind distancing other barriers (goggles, gloves, bin liners, - sorry - aprons, antiseptics and hygiene). Tom refused to play the soothsayer to the Fauci oracle and was plunged into a series of questions on whether he thought masks “worked or not”.

By that stage, as you will hear from Smerconish, political battle lines had been drawn, and whatever was said would be interpreted by one side as a stick with which to beat the other side.

The political interventions of the Cochrane Editor were called into play, and the possible interactions with a New York Times influencer with a negligible scientific background were wheeled in to heat up the debate.

What has become clear, though, is that nowadays, no area of science is free from interference by funders, editors, influencers and the latest Johnny-come-lately.

The degree of censorship, nonsense statements, undermining, interference, and personal attacks will only get worse and worse until a reform of the academic production system is carried out, the plague of “publish or perish” is dealt with, and editors are given support and in turn, support their authors.

All of this noise sadly has obscured some of the evidence on the other interventions assessed in Cochrane Review A122. For example, let’s take hand washing, a politically marginally acceptable intervention. It is marginally acceptable because, unlike masks, it is not visible compliance with the wishes of our owners. Folks do not go round with an electronic sign saying, “I washed my hands 38, 37, 36…. etc. minutes ago” around their necks.

When we pooled the results of 19 trials and did a few statistical gizmos, we found that hand hygiene may lead to a reduction from 200 events per 1000 people to 178 per 1000 people (95% Confidence Interval 166 to 188). The trials were heterogeneous in design and setting, but this is the modest bit of good news that should be confirmed by further trials, which no one seems to want to carry out or fund. Would a mix of interventions based on hygiene work? The effects are likely to be minor, so larger trials are needed.

Tom’s favourite trial, however, is the Danish nursery study by Ibfelt and colleagues. This little gem of a study was conducted in twelve nurseries in Copenhagen, caring for 587 children aged 6 months to 3 years from January to March 2013. The authors asked whether it is possible to reduce the transmission of pathogens via shared toys in a daycare environment through disinfection treatment every two weeks. Six nurseries were randomised to commercial cleaning of linen and toys suitable for washing machines. This was carried out at 46 °C and subsequently disinfected. The objects unsuitable for going around in a machine were manually washed and disinfected with a panoply of sanitisers.

The remaining six nurseries were “controls”, i.e., they had the usual cleaning routine. Surveillance for child absence (with the recording of the reasons) was carried out in all nurseries. All nurseries were also sampled for faecal and nasopharyngeal bacteria and a set of 16 respiratory viruses in December 2012 and April 2013, so either end of the experiment. Playrooms and toilet areas were sampled following the same pattern or frame. Throughout the investigation, hygiene standards were the same in all nurseries. 

Real science then, and the F word was nowhere to be seen.

Results show no effect of the cleaning regime on the overall sparse bacterial growth.

For viruses, we have a different story. Coronaviridae were everywhere (in 97% positive samples), then bocavirus (96%), adenovirus (73%) and rhinovirus (46%). The special cleaning regime reduced the presence of adenovirus, rhinovirus and RSV approximately two- to five-fold compared to the control nurseries. But appeared to have no effect on metapneumovirus or the detection of other viruses. Fomites with the highest respiratory virus density were pillows, sofas, toys, and playroom tables. 

That’s fine for the micro stuff, but how did all this affect sickness absence?

Apparently none. This is how the authors report it:

Many interesting points arise, which we will leave to our readers to consider, but bear in mind that PCR identified the viruses.

PCR cannot distinguish between a whole virus capable of replication and one tiny piece or antigen the test has been told to look for. In other words, if the toys were covered in boca or coronaviridae “positives”, it does not necessarily mean that they would get infected. The authors make that clear in the text. 

But how can we explain the control group's lower sickness absence?

Such evidence and real puzzles that need answers are drowned by the noise around masks, to the detriment of progression in our understanding of the ecology of respiratory viruses and effective ways to limit their impact.

Reference

Ibfelt, T., et al., Effect of cleaning and disinfection of toys on infectious diseases and micro-organisms in daycare nurseries. Journal of Hospital Infection, 2015. 89(2): p. 109-115. 10.1016/j.jhin.2014.10.007.