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Why we really should wear masks

By Andrew Polmear, our intrepid wine and cheese man – it’s OK kids, he’s a retired doctor

Most of us are pretty good at wearing a mask in a public place, possibly because we’d get thrown out if we don’t. But have a look round on a bus or train and you’ll often see someone whose mask is useless – either below the nose or even round the chin. There are people, of course, who are exempt, but they wouldn’t be wearing one at all. Does it matter? How good is the evidence that wearing a mask saves lives?

Comparing different countries. The first sort of evidence is from countries where almost everybody wears a mask when they leave home. One careful study showed that transmission of SARS-CoV-2 (the virus that causes Covid-19) is 7.5 times higher in countries where mask wearing is not universal compared to those where it is. That’s not proof, of course – the difference may have been due to something else; they may also have been hand-washing, or distancing, or just not shaking hands, for example. But the masks probably help. A study of US states found that states in which mask-wearing was compulsory had slower disease growth rates than states where it wasn’t.

Studies that asked contacts of coronavirus cases whether they wore a mask or not, then checking whether or not they caught the disease. It’s not a reliable technique – it all depends on people’s memory and honesty. Roughly, wearing a mask seemed to result in half the risk of catching coronoavirus disease. But almost all of these cases were SARS or MERS, not Covid-19.

Lab studies. The final sort of study is done in a laboratory where they measure particles the size of the water particles that carry coronavirus. Researchers have looked at the different situations that arise. I’ll focus on where the contagious person is coughing:

  • The person coughing is masked: a mask roughly halves the number of particles getting out. (Warning – different studies come up with different figures, according to what size particles were measured and how far away from the person being tested.) A 3-layer homemade cloth mask does as well as a surgical mask. An N95 mask may do a bit better but it’s quite a bit more expensive. Whether it fits properly may be more important than what it’s made of.
  • The person with the mask is in the same room as the person coughing (who is not masked): there is benefit but it’s much less.
  • If both are masked the benefit is much greater at about 80%. But what really makes a difference is if both wear double masks – that is, a surgical mask with a fabric mask over the top. That reduces particle transmission by 95%. It may be that the double masking works more by ensuring a close fit, than by the ability of the extra mask to filter more particles. Try it, it’s quite comfortable!

Where should we wear those masks? Obviously in public enclosed spaces. Keeping 2 metres apart isn’t enough. Those masking studies I mention above were done 6 feet apart. I think masks should also be worn out of doors. If there are no crowds and a good breeze you would probably be all right, but you can never protect yourself against the panting jogger who pushes past you, or against bumping into someone as you round a blind corner. If you can smell the cigarette smoke of a smoker you are inhaling their breath.

Finally, what about in the home if a family member becomes ill or is a contact. There’s just one study on this, from Beijing. Transmission of Covid-19 was reduced by 79% if everyone in the household was masked. But there’s a catch. Masking has to be all the time, including before the person who becomes ill develops symptoms. That’s partly why Covid-19 is such a problem. The time when a person is most contagious is from 2 days before symptoms begin until 1 day after they start. If the person you live with is a contact you have time – mask up straight away, don’t wait for them to become ill. If they develop symptoms out of the blue you’ve probably missed the boat, but mask up anyway.

PS. You may be wondering whether higher quality masks would do better than the fabric and surgical masks described above. After all, an FFP2 mask is, by EU definition, one that filters out 94% or more particles (roughly the same as an N95 mask (the US equivalent) and a KN95 (the Chinese equivalent)). An FFP3 mask filters out 98% or more particles. The answer is no, not necessarily. They were designed for industrial use, not specifically for viral protection. Also, those EU tests do not attempt to mimic the human situation, with one person coughing, or talking, or even just breathing out, and another person breathing in. They may still be better than fabric or ordinary surgical masks, especially if properly fitted, but don’t expect 94% or 98% reduction in transmission. And, of course, don’t wear a mask with a valve in it – that would allow out any virus you are exhaling.

PPS. Those who wear glasses find masks a problem. Their moist breath fogs up the inside of the lenses. From all the people who have commented on this it is clear there’s only one solution: wear the mask high up on your nose and perch the glasses on top of it. One eye surgeon, who needs to wear glasses while operating, tapes the top of his mask to his nose, so it can’t slip down below his glasses.

This is an area of science where new information is coming out every day. By the time this article is published it may already be out of date. And please bear in mind that it is the opinion of one retired GP, not a leading scientist. Andrew regrets that he cannot enter into correspondence with individual readers.

What’s Going On?

In the second of Andrew Polmear’s Covid reports, he looks at the Oxford AstraZeneca vaccine and the over 65s.

A friend has just emailed to say that she’s delighted that she’s had her first Covid vaccination – but disappointed that it was the Oxford/AstraZeneca version. She’s in her 70s and I guess she’s heard that a number of European countries will not be using the Oxford/AZ vaccine in people over 65. Indeed, President Macron of France has been the most outspoken, saying that “it’s quasi-ineffective in the over 65s” Yet our own Medicines and Healthcare Products Regulatory Agency, and the EU equivalent, have approved its use in all adults. So what’s going on?

The problem is that the Oxford study began with patients under 55 years old. They wanted to prove that it was safe in younger patients before giving it to the elderly. Once it was clear that it was safe they included adults of all ages. But when they reported their first results only 2 patients over 65 had the disease. Neither had been given the vaccine but the numbers were too small to say that that proved that the vaccine worked in the older patient. They could, however, say that President Macron was wrong to say it didn’t work. All that can be said is that they hadn’t proved it did work.

So why has the Oxford/AZ vaccine been approved for all ages? There are two reasons:

  1. The researchers measured the antibodies in the blood following administration of the vaccine. Subjects over 65 had a strong immune response, as measured in the lab. It was not quite as strong as in younger subjects but it was plenty strong enough.
  2. All other studies so far reported have shown that older people are protected by the other vaccines. Especially reassuring is the vaccine made by J&J which uses the same technology as the Oxford/AZ vaccine. It would be very odd if the Oxford/AZ vaccine didn’t behave in the same way.

My belief is that, like President Macron, politicians in those countries have confused ‘no evidence of benefit’ with ‘evidence of no benefit’. If the Oxford/AZ vaccine isn’t shown to be effective at all ages in the next few weeks, I’ll eat my hat.

This is an area of science where new information is coming out every day. By the time this article is published it may already be out of date. And please bear in mind that it is the opinion of one retired GP, not a leading scientist. Andrew regrets that he cannot enter into correspondence with individual readers.

Covid-19 and vaccines – a (retired) doctor writes…

Not only is Andrew Polmear our intrepid wine and cheese man, he’s also a retired doctor and asks… Does delaying the second dose till 12 weeks after the first put us at risk?

One of the joys of being a retired doctor is having the satisfaction of responding to people’s concerns about medical matters without the worry of being responsible for them. So I enjoy queries from friends; and of all the questions I’ve been asked about Covid-19, the commonest is about the 12 week delay between jabs. Is it safe?

The short answer is yes, but, of course, it’s a bit more complicated than that.

The first bit of the answer is the straightforward one that Matt Hancock, Health Secretary, gave when he announced the change. If you have a vaccine that’s in short supply it’s better to give everyone at risk a first dose rather than give some a second dose and others nothing at this stage. The first dose gives a better “bang for your buck”. That means Matt Hancock made the right choice for the country; but it doesn’t stop us, as individuals, wanting that second dose.

But does delaying that second dose reduce our protection?

Things are easiest to understand with the Oxford/AstraZeneca vaccine, because there’s published information about this. The Oxford researchers had intended to test a single dose. But after they’d started the trials they found that, when they gave a second jab to a small group, they got a better antibody response. They went back to the regulator and got permission to change the trial, so they could give a second jab 28 days after the first. However, by the time they gave their subjects the second dose, some were at least 90 days after the first. So they could compare the effect of early and late second jabs:

  • second dose given early (between 22 and 90 days after the first) – 76% of cases of Covid were prevented, with no sign that protection was tailing off towards the end (and none of those who did get Covid were bad enough to go to hospital).
  • second dose given late (more than 90 days) – 82% protection. What’s more, subjects had higher antibody levels than those who had an earlier second dose.

So, with the Oxford/AZ vaccine, we can say that a 90 day gap is fine, possibly even better than a 28 day gap.

With the Pfizer vaccine it’s more difficult because all of those taking part in the trial got the second dose at between 19 and 42 days after the first. So Pfizer are correct to say that there’s no evidence that delaying the second dose until 90 days is safe. The World Health Organisation hedges its bets by recommending that the gap go up to 6 weeks. So why does our own, highly regarded, Joint Committee on Vaccination and Immunisation recommend 3 months? There are two reasons:

  • The first is that most, possibly all, vaccines give better long-term immunity if the second dose is delayed. The HPV vaccine, for instance, given to girls and boys to protect against certain types of cancer, works best if the second dose is given between 6 months and two years after the first. Immunity from vaccination doesn’t fall off rapidly. It takes 2 – 3 weeks after a jab to develop. It doesn’t then suddenly disappear, at least not for months or years.
  • The second reason is a detailed look at the Pfizer trial. Patients in the week before the second jab were 89% protected against Covid-19. After the second jab they were 95% protected. Such a small improvement in protection from an early second dose isn’t statistically significant.

 So, the chances are that a delay in receiving a second dose of the Pfizer vaccine will do no harm. And it’ll certainly mean that more people will get their first jab sooner; which is good for everybody.

This is an area of science where new information is coming out every day. By the time this article is published it may already be out of date. And please bear in mind that it is the opinion of one retired GP, not a leading scientist. Andrew regrets that he cannot enter into correspondence with individual readers.

A passion for appassimento

We’re still in lockdown. It’s cold. There’s snow on the ground. Let’s go to southern Italy and talk about wine.

About two years ago, I was introduced by a friend to a wine, currently available at Waitrose for under £10 (sometimes well under £10), that has become one of our favourite weekday wines. It’s made by a firm called Terre di Faiano which is based in Chianti but they have vineyards in Southern Italy and Sicily.

The grape is Primitivo, the same grape as Zinfadel in the USA, and it’s from Puglia. It’s extraordinarily full-bodied, creamy smooth, and unlike almost any other Italian wine I’ve tasted.

For two years I’ve puzzled over how this wine comes to be so good and only discovered the answer when Waitrose put another wine on the shelf alongside it. This is also by Terre di Faiano but the grape is Nero d’Avola and it’s from Sicily. And the giveaway is that on the label it mentions appassimento. The penny dropped. Perhaps the Primitivo is made the same way, I wondered, and a look at Waitrose’ website shows that it is.

What is appassimento? It means ‘dried up’ or ‘tired out’. The basic principles of winemaking are pretty standard: once ripe, the grapes are pressed, the juice is put into some sort of container and left to ferment, then bottled, sometimes after spending some months or years in oak casks. But if the wine is made by the appassimento method the grapes are left to dry before starting the whole process. They used to be left out in the sun on a bed of straw, which is why it’s called in English ‘straw wine’. The purpose is to increase the sugar content of the grapes and reduce the water content. The resulting wines are more alcoholic or sweet or both, a deeper red and packed with flavour.

They’ve been making wine like this since the Ancient World. Hesiod (he’s the one who was roughly contemporary with Homer but less grand, more personal) described it in around 700 BCE and it’s been used in Sicily and Puglia for centuries. But the most famous wine to use it is in northern Italy, just north of Verona, where the local wines tend to be thin and bitter. Amarone della Valpolicella is made this way. It gives a red wine of extraordinary power, nearer to a port than to an ordinary Valpolicella, which can be thin and bitter. Just to complete the northern Italian story, they even keep the lees left after draining off the fermented Amarone and pour ordinary Valpolicella wine on top. There follows a second fermentation and you get another beefy wine that’s called Ripasso (‘re-passed’ in English) though less full-bodied, and much cheaper, than Amarone. Finally, the winemakers may deliberately leave enough sugar unfermented to make it sweet. It’s called Recioto and the Italians drink it at the end of the meal.

I’ve had other wines from Puglia made by the appassimento method and I’ve found them too much. The heaviness is overdone, the flavours too ‘jammy’. The Terre di Faiano from Sicily is a bit that way, to my taste, although it gets great customer reviews. It’s made with the Nero d’Avola grape which has no trouble making dark, robust wine without the need to dry the grapes. But somehow, with the Primitivo from Puglia the winemakers seem to have hit the spot. I plan to get a good supply in before this article goes to press!

Just close your eyes…

…and you could be there. Andrew Polmear takes us to windswept, rugged Corbières for a fine glass of cool Castelmaure 

I don’t usually recommend specific bottles of wine, being more interested in writing about the principles behind why we enjoy drinking. And I’m especially interested in relating how a wine tastes to where it comes from, who makes it and what they do to it that makes it special. But there’s a bottle available as I write that illustrates those principles so well that I’m breaking my rule. It’s Les Hauts de Castelmaure 2018, from the Corbières in France and Majestic has it for £11.99. If they’ve sold out, the Scottish wine merchant Exel will post you a case for not much more.

I found out about it because Decanter magazine recently published the results of a tasting of 55 Corbières reds and the Castelmaure came equal top with 95 points out of 100. That’s the sort of score Bordeaux wines selling for over £30 a bottle would be pleased to have. The tasters found it rich and powerful with an aroma of black fruits, fine leather and soft spice. 

The Corbières is that windswept, rugged part of France between Narbonne and the Pyrenees bordering the Mediterranean coast. It’s dotted with ruined castles where the last of the Cathars held out against persecution in the 13th century and they’ve been making wine there since the Romans. The village of Embrès-et-Castelmaure is perched on a hilly plateau just 22 miles in from the sea. That’s the first clue as to why their wine is special. It’s so hot in the Corbières that it’s easy to make bland, blousy wine with grapes that have ripened too quickly. Castelmaure’s altitude in the foothills of the Serre mountain keeps them that bit cooler. 

The second clue is that the vineyards are steep and the soil arid – hopeless conditions for making lots of cheap wine, prefect for
wine of quality. The grapes have to be picked by hand and the
yield is inevitably low. And, to ensure that none of the wine growers aims for quantity rather than quality, the Co-op pays by the size of the vineyard, not by the weight of grapes grown. A low yield means that the flavours are concentrated.

Which brings us to the third clue: all wine made under the Castelmaure label (and there are cheaper Castelmaure wines than this one) comes from the village Co-operative: it’s what the village does. It helps that the actual winemaker, Bernard Pueyo, who has been there since 1983, is passionate about what he does. As he says on the label, the Co-op prefers to make wine with the flavours of the local “garrigue” rather than bother with the flim-flam (the word he uses in French is “falbalas”) of professional experts.

Then there’s the detail of how the wine is made. At least half of the grapes are fermented by carbonic maceration. This means the grapes are not crushed but allowed to break open as they ferment. It gives more flavour to the wine, especially with Carignan; and 20% of the grapes of this wine are Carignan, the rest being Syrah and Grenache. Then the wine is aged for 11 months in small oak barrels (“barriques”) as in Bordeaux. I don’t find that the wine tastes of oak (that’s an unmistakable vanilla flavour) but it’s the oak that permits the development of those flavours of leather and spice. 

Why have I gone into such detail? Because I find that understanding all those points adds hugely to my enjoyment of this gorgeous, rich and complex wine.