Masks May Do More than We Think: ZDoggMD talks with Dr Monica Gandhi

This is recent episode from ZDoggMD' podcast.    

I'd read cited the NEJM article last month and was intrigued with the idea of variolation, so I was happy to hear one of the authors talk about it in this discussion with Dr. Zubin Damania (aka ZDoggMD).   Dr. Gandhi also goes over the current state of the evidence re: face masks.  I was pleased to hear that I was familiar with all the studies she talks about concerning the efficacy of masks to prevent transmission of respiratory infections.  Dr. Gandhi comes from a background of treating patients with HIV, and has a different approach to convincing people to take care of themselves and others, whether it be wearing condoms or face masks.  No shaming here. ;-)

I hope you enjoy it as much as I did!  

Here is the PubMed citation for her article: 

Facial Masking for Covid-19 - Potential for "Variolation" as We Await a Vaccine.
Gandhi M, Rutherford GW.N Engl J Med. 2020 Sep 8. doi: 10.1056/NEJMp2026913. Online ahead of print.  PMID: 32897661

Masks May Do More Than We Think (w/Dr. Monica Gandhi)

From ZDogg's introduction to this episode:

What if masks acted to reduce severity of COVID-19 infection for the WEARER, fostering immunity like a vaccine and allowing a full societal reopening?

Dr. Monica Gandhi is a UCSF professor of Medicine in the division of HIV, infectious diseases, and global medicine. She and her colleagues recently proposed just such a theory in the New England Journal of Medicine. In this fantastic interview she outlines the emerging data in support of the idea that masks may do more than we think.

Here’s a NY Times piece about her proposal, and here’s a paper she co-authored in the Journal of General Internal Medicine.

And here’s ZDogg's piece on masks that summarizes some of Dr. Gandhi’s work.

Full Transcript is available at ZDoggMD.

References (directly from Dr. Gandhi) :

Viral inoculum theory: Higher viral inocula or “dose” linked to severity of disease

Well described in animal studies and some human studies for respiratory and GI illnesses -higher infective dose thought to lead to faster/greater pathogen replication, leading to a more aggressive and damaging innate inflammatory response, or overwhelming adaptive immune response- all leading to more severe disease.   This is a hypothesis for diseases in which immunopathology plays a role in viral pathogenesis, such as COVID-19 (Rouse BT, Sehrawat S. Immunity and immunopathology to viruses: what decides the outcome? Nat Rev Immunol. 2010;10(7):514-526)

Some evidence for the “viral inocula” theory for SARS/MERS. Evidence in SARS-CoV-2 fom degree of illness in household contacts/ health care workers at beginning of pandemic.  Papers supporting viral inoculum theory. [43 more citations available at ZDogg's site.]