The Debate Continues...

Do masks work?

There is not an easy answer to that question. Having endured the Covid pandemic, all of us have worn masks either willingly or unwillingly. After three years, the efficacy of mask wearing is still in question and is oftentimes hotly debated. In this article, we will present studies on both sides of the controversy, so our readers can make up their own minds as to how beneficial face masks are in preventing the spread of respiratory disease.

PROS

A randomized controlled trial with 6,000 participants from Denmark was published in Annals of Internal Medicine in November 2020. Infection with SARS-CoV-2 occurred in 42 participants with recommended masks (1.8%) and 53 control participants (2.1%). The authors stated, “Although the difference observed was not statistically significant, the 95% CIs (confidence interval) are compatible with a 46% reduction to a 23% increase in infection. This shows a modest reduction in risk of coronavirus infection among individuals who received free surgical masks and were told to wear them outside the home, but this result was not statistically significant.(3)

A cluster randomized controlled trial of 342,183 participants published in the journal Science in December 2021 found that handing out free masks and promoting their use in communities in rural Bangladesh led to a 29 percentage point increase in mask wearing and reduced the risk of COVID-19-like illness by about 9%. They found very little difference in results with surgical versus cloth masks.(4)

CONS

The non-profit prestigious Cochrane group from the UK, performed a meta-analysis of 78 studies from around the world; six of them were performed during the pandemic.(1) The researchers concluded “Wearing masks in the community probably makes little or no difference to the outcome of laboratory-confirmed influenza/SARS-CoV-2 compared to not wearing masks.” Regarding the types of masks used, they concluded, “There were no clear differences between the use of medical/surgical masks compared with N95/P2 respirators in healthcare workers when used in routine care to reduce respiratory viral infection.” However, the authors cautioned, “The high risk of bias in the trials, variation in outcome measurement, and relatively low adherence with the interventions during the studies hampers drawing firm conclusions.”(1)

Another study from Norway carried out a randomized study from 3,209 participants.(2) The researchers concluded, “We found that the incidence of self-reported COVID-19 was 33% higher in those wearing face masks often or sometimes, and 40% higher in those wearing face masks almost always or always, compared to participants who reported wearing face masks never or almost never.” Due to these surprising results, the authors said, “We believe the observed increase in the incidence of infection associated with wearing a face mask is likely due to unobservable and hence nonadjustable differences between those wearing and not wearing a mask.(2)

MORE CONFUSION

To add to the confusion, Dr. Anthony Fauci said on February 5, 2020, "Masks are really for infected people to prevent them from spreading infection to people who are not infected rather than protecting uninfected people from acquiring infection. The typical mask you buy in the drug store is not really effective in keeping out virus, which is small enough to pass through material." Then on March 8 he said "There's no reason to be walking around with a mask." He later reversed his stance on mask wearing saying that the earlier statements were made because he was worried about health care workers not having enough protective equipment.(5)

So what do our MicroBytes readers think? Are masks effective? We would appreciate hearing your comments and opinions about this controversial topic. In our February edition, we will post some of your comments (without names). Send your thoughts HERE.

References: 1, 2, 3, 4, 5

Hepatitis C is the primary cause of liver caer and the need for liver transplants among patients infected with the virus.

Infection is often the result of coming into contact with contaminated blood, usually through injected drug use, but also from sexual intercourse, babies born to infected mothers, sharing of contaminated instruments (toothbrushes, razors, nail clippers, glucose monitors, etc), and unregulated tattoos and body piercings.(8) There is no vaccine for hepatitis C, as there is for A and B.

Cases of hepatitis C begin as an acute infection within the first six months of exposure, and for many people, this stage has no symptoms. As the disease progresses, possible symptoms that could occur within weeks or months after exposure include fever, fatigue, nausea, vomiting, dark urine, clay colored bowel movements, joint pain, and yellow skin or eyes. Most cases (approximately 75%) develop into a chronic infection, which in turn, result in large amounts of cirrhosis if left untreated. Without treatment, liver failure and death may occur.(4,5) The CDC estimates that over 2.4 million persons are living with hepatitis C in the US.

Interferon injection treatments, in use from the 1980s until 2015, have not been effective in reducing the viral burden from the body. Patients with this therapy were often subject to long-term treatments with significant side effects.(7) Although there have been incremental improvements over the years, treatments have largely become more effective for patients since 2015. Since then, therapies have changed to the use of protease inhibitors that interfere with viral replication with the liver cells.(7) Protease inhibitor treatments are available in oral pill formats that can be taken over eight to twelve weeks.(2,4,7)

Different treatments target specific hepatitis C genotypes, and may not be utilized if the patient has cirrhosis or other medical conditions. Consequently, it is important to know which genotype of hepatitis C a patient has and the health and condition of their liver.(5) Genotype 1 is the most common type of hepatitis C and, thankfully, most of the new treatments cover this type.(2)

Zepatier, Mavyret, Harvoni, Viekira Pak, and Epclusa are some of the brand names of treatments available in pill format.(2,3,4) Each treatment regimen varies from taking one to three pills per day. The drug Mavyret, FDA approved in 2017, targets all genotypes of hepatitis C. This is a welcome option for patients who may have a less common genotype. However, for Mavyret to be effective there needs to be mild to no evidence of cirrhosis present.(4) Another benefit to the Mavyret treatment is the eight week treatment duration.

In 2016, Epclusa was the first FDA-approved treatment for all types of hepatitis C in pill format, with a low number of side effects and a high cure rate. In 2020, FDA approved Epclusa to treat hepatitis C in children ages six years and older; another breakthrough in earlier treatment options for younger patients diagnosed with hepatitis C.(4,7) This medicine offers a twelve week regimen with a low number of side effects and a high cure rate.

The availability and effectiveness of today’s treatments offers significant hope to those diagnosed with hepatitis C. However, “the cure” does not mean living completely virus free. Efficacy is defined as blood concentrations below detectable levels three months post-treatment.(3) A 2015 study showed patients who achieve this milestone have a lower risk of liver-related deaths.(4) While patients may never be 100% free of hepatitis C, the reduced viral burden allows patients to live longer and healthier lives.

References: 1, 2, 3, 4, 5, 6, 7, 8

By Anna Klavins

HARDY DIAGNOSTICS

New Therapies for Difficult-to-Treat Pathogens:

Sulbactam-Durlobactam

and Rezafungin

Healthcare professionals face a constant challenge with ever-evolving bacterial and fungal infections. Multidrug-resistant pathogens threaten the efficacy of existing treatments and highlight the need for new antimicrobial therapies. These microorganisms are typically resistant to the majority of antimicrobial agents, including carbapenems, making them difficult to treat. The Centers for Disease Control and Prevention (CDC) has identified carbapenem-resistant Acinetobacter baumannii (CRAB) as an urgent public health threat.

Sulbactam-Durlobactam (Xacduro) was FDA approved in May to treat hospital-acquired bacterial pneumonia (HABP) and ventilator-associated bacterial pneumonia (VABP) caused by Acinetobacter baumannii-calcoaceticus complex. HardyDisk™ AST Sulbactam-Durlobactam was subsequently FDA cleared 44 days later. The intravenous drug developed by Entasis Therapeutics Inc., provides a promising solution to treatment of CRAB.

Rezafungin (Rezzayo) is a new antifungal agent that gained FDA approval in March. HardyDisk™ AST Rezafungin was subsequently FDA cleared 71 days later. Cidara Therapeutics developed this echinocandin antifungal agent to combat invasive fungal infections. This marks the first new treatment option approved for individuals with candidemia and invasive candidiasis in over 10 years.

Drug-resistant fungal infections are becoming more common, especially in patients with weakened immune systems. Serious fungal infections are often life-threatening with a mortality rate of up to 60%. Candida is part of the normal human microflora and invasive infections can occur if the organism is introduced into the bloodstream via catheter insertions, injections, endocarditis, or peritonitis. Candidemia and invasive candidiasis are often treated with antifungal agents such as fluconazole, caspofungin, and amphotericin B. However, the emergence of antimicrobial resistance in Candida species has complicated treatment strategies.

The introduction of Sulbactam-Durlobactam and Rezafungin expands the armamentarium of healthcare professionals. These new therapies provide hope for improved patient outcomes when drug-resistant microorganisms are encountered.

HardyDisk™ AST Sulbactam-durlobactam and HardyDisk™ AST Rezafungin will allow clinicians to make informed treatment decisions, ultimately improving patient care, and contributing to the global fight against antimicrobial resistance. Click here to see Hardy's complete selection of products for Antimicrobial Susceptibility Testing.

By Anna Klavins and Lauren Hamilton

Sulbactam-Durlobactam (Xanduro)

   Catalog# Z9461 - Single Pack

   Catalog# Z9465 - 5 Pack

Rezafungin (Rezzayo)

   Catalog# Z9471 - Single Pack

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