Should You Double Mask? Experts Also Address Variants, Vaccine Challenges

Media briefing features three Duke experts on vaccines, infectious diseases and emergency preparedness

Part of the The Briefing: The Impact of COVID-19 Series
Should You Double Mask? Experts Also Address Variants, Vaccine Challenges
David Montefiori, Dr. Becky Smith and Jason Zivica

While the emergence of two approved COVID-19 vaccines – and more on the way – is clearly great news, there are many hurdles to distributing them quickly. At the same time, there continue to be problems with new virus variants, the ongoing objections to mask-wearing, and other challenges.

Three Duke experts on vaccines, infectious diseases and emergency preparedness spoke Wednesday to reporters in a virtual media briefing about myriad issues surrounding vaccine distribution.

Watch the briefing on YouTube.

Here are excerpts:

DR. BECKY SMITH, INFECTIOUS DISEASE SPECIALIST

On wearing two masks

“There is no downside to double-masking on your own in public at this point. We know that it’s a little bit more cumbersome, but if you have access, particularly to a medical mask, the proper sequence that has been posed based on one small study … was a medical mask underneath the cotton, outer mask to have that medical mask closest to the source, your nose and mouth.”

“The only downside to you is that you’re actually helping everyone else and it’s not the reverse. Everyone has to kind of do it to get the same benefit.”

“Should we just mandate two masks? I feel like some areas are just getting around to one mask. I’ve always said the mask someone wears that’s well-fitting is a great mask. So focusing on getting the one mask to be correct is a great first step.”

On vaccine side effects

“As with any vaccine, you can have a range of experiences. Often times the most common symptom people feel is a sore arm. Additionally, people have experienced fevers, body aches, feeling fatigued, having headaches. I like to spin those symptoms as a happy response, knowing that your immune system is responding to the vaccine and helping build that antibody protection for you.”

On not getting both doses of vaccine if you’ve had COVID-19

“For now, sticking with the original plan of two doses of the vaccines available for maximum efficacy is a good strategy. We should continue to work with that in mind.”

On airplane travel

“If you must travel or you’re going to travel, my recommendation would be to wear a higher-filtration efficacy mask. If you have access to the more widely available KN95 or N95 mask, that’s what I’d be wearing.”

“Depending on what people are doing on the plane – some people are not wearing their masks, they’re eating and drinking on the plane – if I were traveling on a plane, I’d be wearing my K95, my eye protection, and I would not eat or drink on that flight until I could physically distance from people.”

“I would really question – do I really need to be going?”

“There’s really no safe travel at this time that’s 100 percent risk free. Just stay safe out there.”

On getting vaccine shots too close together, or too far apart

“It’s probably better to get them too far apart than too close together.”

“You want to give your body time to do all the fancy things it needs to do in terms of making (memory cells) … the second dose of the vaccine is really what helps your immune system refine its approach for when it sees this virus again.”

On advice to someone reluctant to get vaccinated

“All of the data is very compelling that they’re safe. We’ve already vaccinated over 26 million Americans; we would be seeing a signal if there were any safety issues that weren’t caught by the clinical trials. … I feel very, very comfortable with these vaccines.”

“Whatever one is being offered to you, go get it. It’s been studied well.”

DAVID MONTEFIORI, VACCINE EXPERT

On new COVID-19 variants from UK, South Africa

“It’s no surprise this virus is mutating. All viruses mutate. That’s something to be expected. What’s surprising to scientists is how rapidly we’re seeing this virus mutate. Viruses need to replicate in order to mutate. The more opportunities they have to replicate, the more opportunity there is for variants to arise.”

“The appearance of these new variants is, in hindsight, something that should be expected. That’s why there’s been a very diligent effort to monitor through genetic surveillance.”

“Neither one of these variants seem to be very prevalent in the United States. They’re all found here … but so far their prevalence has been relatively low. That could change over time as genetic surveillance increases. But given the low prevalence, I don’t really consider them to be too much of a concern in most of the United States. There are a couple of hot spots right now -- Southern California, South Florida … but for the rest of the country, so far the indications are the prevalence of these new variants are low.”

On not getting both vaccine doses if you’ve already had COVID-19

“We don’t know yet whether or not one dose of the vaccine in people previously infected is all that you might need. We do know that 20 to 30 percent of people who have been infected and recovered have low levels of antibodies.”

“Almost everyone who gets this vaccine has high (levels) of antibodies. For now, the best policy is to receive these vaccines and to receive both doses of them.”

On whether COVID-19 will eventually be an annual occurrence like the flu

“We don’t have the answers, but it’s certainly possible. The biggest concern right now is the virus will mutate again into something that’s a bigger concern than the current variants are now. The only way to prevent that is to double down on all the methods we have now, wearing masks, social distancing … and getting vaccinated. We need to stop the virus from replicating. The more it replicates the more opportunities there are for it to mutate.”

On getting two vaccine doses too close together, or too far apart

“It’s much better in having a delay in getting the second dose than getting the second dose earlier. The way the immune system works, you’re exposed to a foreign pathogen, your immune system kicks into gear, and then it calms down. That calming down period is actually very important for it to prepare itself to come back and attack even stronger.”

“That’s what we want, a little bit of a calming down before you see the vaccine again. You have all of these immune cells built up and they’re ready to take off and generate an even stronger response. The interval for vaccination in the case of this coronavirus is actually very contracted; three to four weeks is actually a short period of time. Most vaccines when there’s more than one administration, it’s often several months in between.”

On whether you can carry virus after being vaccinated

“What we know about the vaccines right now is they’re preventing symptomatic infection. We do not yet know whether they’re preventing infection altogether. Those data will come later on, hopefully pretty soon. There’s still the risk that … you still might be infected and capable of spreading that infection for some period of time.”

On whether vaccines will prompt people to let their guards down

“We have to remain vigilant until we really turn the tide on this pandemic. It’s not an issue of whether or not an individual has been vaccinated and protected. It comes down to what’s happening at a society level. Only when the number of infections and the risk of acquiring infections gets low enough at a society level will we be able to take our masks off.”

On what you say to someone reluctant to get the vaccine

“These vaccines have been shown to be very safe and very effective. Someone once said the most dangerous vaccine is the one you don’t take, because you leave yourself susceptible. It’s much better to have some discomfort from getting this vaccine than getting infected.”

“People also have a social responsibility, a civic responsibility, I believe, to get the vaccine in order to bring an end to this pandemic.”

JASON ZIVICA, DUKE EMERGENCY PREPAREDNESS DIRECTOR

On the biggest vaccine rollout challenge

“One of our biggest challenges right now is the supply chain. We’re trying to provide the best service we possibly can. We recognize the supply chain nationally is still being fleshed out.”

“We’re trying to kind of balance our scheduling process … along with the type of supply that we’re getting, while also recognizing that’s fluctuating.”

“When you’re in the operations it’s great to see the reactions from some of our patients that get to be signed up for the vaccinations. Their day is here and they’re excited. But when you have to call and cancel their appointment, that’s when you’re going to have a pretty big letdown.”  

“We are doing our very best to make sure we’re not canceling any appointments, if we can. (But) we are going to have a fluctuation in the supply that we get over the next several months.”

“We’re also going to have a run on vaccination supplies. Needles, alcohol prep pads, all of these items, there’s a run on all these supplies. So making sure you’re proactively working with your vendors and suppliers to make sure you have an ample supply.”

“Our staff are tired. We’ve been at this for about a year now.”

“We’ve been testing, we’ve been doing the swabbing. Recognizing that our staff have gotten sick and have had to go out. The stress of the pandemic is not immune to them. They’re going to feel what happens at home, with their children, what’s going on with school.”

“So I think our staffing becomes an issue. We are tired. We know the vaccination campaign is not going to be short-lived. We’re not going to be out of this in a couple of months. So it’s making sure you’re supporting your staff, checking in to see how they’re doing.”

On hurdles associated with scheduling vaccinations

“As we expand our age groups we know there will be different needs coming from these community members and residents. There will be an uptick in the sheer numbers of people coming through. We know there’s going to be more 45-year-olds lining up than we do have 75-year-olds coming through. We’ll be looking at more … mass vaccinations.”

“There’s a lot of opportunity. We can partner with local businesses and organizations to try and bring the vaccine to them. We know we’re going to have to look at off hours; there’s going to be parents coming to get vaccinated after a child gets out of school. … We do recognize we’ll have to be changing our strategies to address the different populations as they come on board.”

“This goes back to us just having a multi-faceted approach and recognizing that one solution isn’t going to suit everyone. The easiest, quickest way is to have sign-up online. … But we have actually dedicated percentages of our slots to our historically marginalized population. We are basically working with the community leaders, allowing them to schedule those appointments to come through. We can say, ‘We’ll give you 20 slots on a Friday; you can go ahead and fill them.’ That can eliminate some of the barriers.”

“We can’t be locked in on one approach or method for scheduling and access into the system. We have to be multifaceted and be able to adapt.”

On getting vaccines to under-served populations

“One of the first components is recognition of who these groups are. The marginalized populations and disproportionate infection rates that we’ve noticed in these communities, that’s a piece of just where they live. Is there shared housing? Are they in close proximity? Some of our mobility-constrained individuals living in long-term care communities, we really need to wrap our arms around these communities and recognize what are the individual challenges they face and how can we address these needs?”

“How do we actually engage the local leaders who are trusted and that can advise us on the best ways to move forward in vaccinating these groups? It’s reaching out to the faith-based communities, any community-based organizations, community health care workers.”

On using influencers as vaccine ambassadors

“I can see where it is controversial. I think we have seen the use of ambassadors work – even with our flu shots that we do annually. It is beneficial. We have to recognize there is fear or distrust out in the community – and I think those ambassadors can help.”

“What we have tried to do at Duke is ensure the ambassadors we have at Duke meet the criteria the state has provided us.”

On what you say to someone reluctant to get the vaccine

“Don’t be afraid to talk about it. The fears that people have are real; if you do have fear or concern, reach out to your doctor; talk to someone who’s already got it. We’re all going through this together. It’s just smart to open that conversation up.”

Meet the Experts:

David Montefiori
David Montefiori is a professor and director of the Laboratory for AIDS Vaccine Research and Development in the Department of Surgery, part of the Division of Surgical Sciences at Duke University Medical Center.

Dr. Becky Smith
Dr. Becky Smith is the medical director of infection prevention and control and an infectious diseases specialist at Duke University Hospital, and associate professor of medicine at the Duke School of Medicine.

Jason Zivica
Jason Zivica is director of emergency preparedness and business continuity for Duke University Health System, where he is managing the logistics of the health system’s vaccination effort.

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Duke experts on a variety of other topics related the coronavirus pandemic can be found here.

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