'To be or not to be, that is the question: Whether 'tis nobler in the mind to suffer the slings and arrows of outrageous fortune, or to take arms against a sea of troubles.” (Hamlet, William Shakespeare). These immortal words seem very apropos to the COVID-19 scourge. As the world enters the fifth month of the global SARS-Cov-2 outbreak, many countries are at different phases of this pandemic. In some, such as China, South Korea, Israel and New Zealand, the bell curve of new infections went down to relatively low numbers within six to eight weeks. Indeed, New Zealand, which never had a large number of cases (~1,510 to date) is now reported to be virus-free. In others, such as Italy, Spain, and Germany the bell curve was much broader, requiring 10-12 weeks to reach pre-rise values. In still others, like the US and Russia, the bell curve shows no indication of asymptoting to baseline values even after 12 weeks. Obviously, both Russia and the US are geographically large and diverse countries with urban, suburban and rural centers that are spread out and which increase the time required for infections to wax and wane. Nevertheless, one can learn a great deal by analyzing the available data on COVID-19 infections and trying to glean information that can be used to protect our citizens' health and economic well-being. How should we “take arms” against COVID-19? The reaction of many governments, with some notable exceptions, to the SARS-CoV-2 infection has been, for the most part, impressive. Even more so has been the unprecedented response of the medical/scientific/pharmaceutical arms of our society. Basic science quickly determined the genetic make-up of the infectious agent causing the new disease spreading through Wuhan, China. This information was made available to scientists and physicians throughout the world, and led to the development of various vaccine candidates in approximately two months; a heretofore unparalleled achievement. Several vaccines have preceded through phase 1 and phase 2 testing and are scheduled for large-scale human trials in the coming weeks. If successful, vaccines might be available by this coming winter. Great efforts are also being made to test existing antiviral drugs. Despite some early encouraging results with remdesivir, its effects are modest and it is not yet known whether it saves lives. Convalescent plasma (CP) donated by those recovered from COVID-19 contains antibodies that, in principle, should help recipients fight infection. Anecdotal successes and historical data with this approach create hope that it will be a very effective strategy, especially if given early in the course of the infection, or prophylactically, to high-risk individuals such as nursing-home residents. THIS APPROACH is under scrutiny through clinical trials run out of the Mayo Clinic. The New York Orthodox Jewish community has been at the forefront of donating plasma and characterizing it through the COVID Plasma Initiative. The use of CP and hyper-immune serum (an enriched serum that is high in antibodies against a specific pathogen) or CP spiked with monoclonal antibodies (a single antibody known to target a feature of the virus) are both very exciting derivatives of this strategy. Now that the first wave of SARS-Cov-2 seems to be past peak in many locales, people are attempting to return to “normalcy.” In the absence of a vaccine or an efficacious therapy, the virus remains extremely dangerous. The Johns Hopkins' data base reveals that many countries have experienced “second waves” of infections that were correlated to the lifting of restrictions. So far, the second wave in many locales has not stressed the medical infrastructure to the same extent as the first outbreak. However, increased infections ultimately lead to more deaths. The question that arises is: How should countries and individuals behave upon returning to the workplace, office or school? It would appear that the answer to the “To Mask or Not to Mask” question is clear. Early on, there was skepticism – even among medical experts – as to the efficacy of face masks. Now, however, it seems clear that wearing a mask is not only effective, it is a must. Wearing a mask may not be totally protective but it stops spread of the virus. The situation in Japan and in many Asian countries supports this conclusion. Japan did not respond to the COVID-19 outbreak with draconian restrictions or large-scale random testing. It also didn't close down the society completely. Rather it called for voluntary adherence to responsible actions; most notably wearing a mask at all times in public. The disciplined and socially conscious Japanese adhered almost totally to this request. The result is that despite returning to work and using public, crowded mass transportation, the rate of infection has remained extremely low. At the time of writing, Japan has reported a total of 17,347 infections with a relatively narrow bell-shaped curve and no second spike in infection. The low number of infections is striking; Japan with 14-times the population has fewer infections than Israel, and compared with the US has 50 times fewer infections per capita. Israel, where adherence to face masks is spotty, is now experiencing a spike in infections. Common sense dictates that until we know more about factors that can result in immunity against SARS-CoV-2, three almost painless ways to arm ourselves against the virus are to maintain social distancing, wash our hands frequently, and make sure to always to wear a face mask when in public. Not to mask is to risk your life and the lives of those you love. The writer is a distinguished professor of chemistry and biochemistry at the College of Staten Island, CUNY; a former provost of CSI; a member of the Medical Advisory Board of the COVID Plasma Initiative; and a visiting scientist at the Weizmann Institute of Science, Rehovot.
