Misinformation about COVID-19 is rampant, particularly on social media. Patients get mixed (and sometimes blatantly false) messages from news sources, family and friends. As our knowledge of the virus continues to grow and evolve, guidance from health experts changes, which leads to more confusion and suspicion. Here are some information and resources you can share with patients to help them sort through the misinformation.

Face Coverings

It is becoming very clear that wearing cloth face coverings combined with appropriate social distancing (6 feet) works to stop the spread of COVID-19.

• Two recent modeling studies reinforce the benefits of mask wearing and social distancing. (Nature; Oct 23) (Ann Intern Med; Oct 27)
• This October 6 article from Nature magazine summarizes the evidence to date on the effectiveness of face coverings in reducing the spread of COVID-19.
• In this issue of the Morbidity and Mortality Weekly Report (MMWR), the authors report on a case of two hairstylists who worked for 8 and 5 days respectively with about 139 different clients while symptomatic with COVID-19. Both of the hair stylists and clients wore face coverings per salon policy, resulting in no new infections.
• There is no evidence that wearing a cloth face covering compromises an individual’s oxygen levels or causes carbon dioxide buildup that could potentially be harmful. Claims that wearing a mask will make you sick due to increased toxin load are similarly unfounded.
• Use and share the AAAAI handout on wearing a face covering or mask to slow the spread of COVID-19 (also available in Spanish). We also have a mask handout that is written at a lower reading level (also available in Spanish).
• Here is a great link illustrating the effectiveness of masks in reducing spread of the virus.
• The American Medical Association has started the #MaskUp campaign with a toolkit that contains a variety of social media posts and videos that emphasize the importance of mask use.
• Fake face mask exemption cards and flyers claiming that the person carrying them have a physical or mental condition covered by the American With Disabilities Act that makes them unable to wear a mask are showing up in some areas. The U.S. Department of Justice issued a statement on these.

Hydroxychloroquine and Other False Medical Claims

There is no evidence to support the use of hydroxychloroquine for prophylaxis or treatment of COVID-19 as illustrated in two recent publications:

• A study published in the New England Journal of Medicine on June 3 looked at the efficacy of hydroxychloroquine in over 800 patients as post-exposure prophylaxis after a high-risk or medium-risk exposure to a confirmed case of COVID-19 and noted no difference in rate of infection between treated and untreated groups.
• A study published in the BMJ on May 14 on 150 hospitalized COVID-19 patients with mild-moderate disease who were enrolled in a multi-center, open-label randomized control trial of hydroxychloroquine plus standard care versus standard care alone showed no difference in negative conversion of SARS-CoV-2 by day 28.

People with allergic disease are not at higher risk for severe outcomes from COVID-19 due to a cytokine storm. Reports that patients with severe COVID-19 infection experience a cytokine storm are being extrapolated by some to infer that anyone with underlying ‘inflammation’, including allergic conditions, is at increased risk. There is no evidence to suggest that a patient’s allergic rhinitis, atopic dermatitis, chronic urticaria, food allergies, history of anaphylaxis, etc., places them at risk for severe outcomes should they become sick with COVID-19.

Supplements or other holistic remedies cannot prevent or cure COVID-19. Claims of supplements, vitamins, or foods that ‘boost immunity’ are rampant, including from medical professionals and large healthcare organizations. Specific unproven COVID-19 treatments being promoted include essential oils, supplements, colloidal silver, Vitamin C, elderberry, homeopathy, and chiropractic adjustments.

Allergists can help patients by guiding them towards these simple fact-checking questions for any claim:

• What are the qualifications of the person making the claim?
• What does the body of evidence demonstrate for both benefits and risks?
• Is the person making the claim directly profiting from services or products?
• How can this apply to my specific situation, including factors pertaining to my medical history and possible interaction with medications or underlying conditions?

Asthma and COVID-19

The majority of evidence does not support asthma as a risk factor for becoming infected with SARS-CoV-2, and there are no data to suggest that, if infected, asthma patients have a more severe course of COVID-19 disease or will experience an exacerbation of their asthma.

Asthma patients should be counseled that their inhaled corticosteroids are safe and necessary to continue use to prevent an exacerbation, and that systemic corticosteroids can and should be used to treat an asthma exacerbation even if it is caused by COVID-19. The studies showing a potentially worse outcome with systemic steroids were in hospitalized COVID-19 patients who received the steroids as a treatment for the viral illness and not for another disease.

There is no evidence that the biologics we use in asthma have any adverse effect on COVID-19 cases, and it would be important to continue them based on the need for asthma control.

You cannot catch COVID-19 from using a nebulizer, and patients that require treatment with nebulized medications should start treatment early and repeat until better. However, if a person with asthma who is receiving nebulized treatment has COVID-19, they could spread the virus to others in close proximity due to the respiratory droplets created through the nebulizer.

Some current research:

• Among the 11,405 patients within the Mount Sinai Health System in New York City who had a COVID-19 related hospital encounter, “asthma was not associated with a higher risk of mortality.” (CHEST; June 6)
• A retrospective study of 1,526 patients with confirmed COIVD-19 infection in the Northwestern University health system noted a higher prevalence of asthma (14%) in this population, but asthma was not associated with an increased risk of hospitalization (RR of 0.96) after adjusting for age, sex, gender and co-morbidities, regardless of the use of inhaled steroids. (JACI; June 14)
• Chronic respiratory disease was not a risk factor associated with hospitalization in a study that analyzed data from 220 hospitalized and 311 non-hospitalized COVID-19 adult patients from six metropolitan Atlanta hospitals and associated clinics. (MMWR; June 26)
• A study of 212 children with allergic asthma in Spain showed similar rates of mild COVID-19 illness compared to children without allergic asthma (JACI: In Practice; July 27)

Children and COVID-19

Although children are less likely to get seriously ill from COVID-19, they can get sick and they are likely to spread the infection while asymptomatic. Here is some of the latest data:

• Asymptomatic children with SARS-CoV-2 had Ct values (cycle threshold for RT/PCR) 10.3 cycles higher than children with symptoms (so less of a viral load). (J Clin Microbiol; Oct 22)
• While children are less likely to be hospitalized for COVID-19 than adults, one in three hospitalized children are admitted to the ICU. Hispanics and Blacks accounted for the majority of hospital admissions and 42.3% had an underlying medical condition. (MMWR; Aug 14)
• A large study including more than 5,700 COVID-19 patients in South Korea indicates that while children under 10 appear to transmit the virus less often than adults, adolescents and older children (age 10-19) transmit the virus at higher rates. (Emerg Infect Dis; July 16)
• A team from Massachusetts General Hospital demonstrated that children infected with COVID-19, even those who are asymptomatic or with mild disease, have a significantly higher viral load than adults hospitalized with severe COVID-19. (J Pediatr; Aug 19)

The American Academy of Pediatrics has updated their guidance for school re-entry, emphasizing that decisions on how and when to resume in-person learning should be based on local public health data and include a multi-pronged, layered approach to protect students, teachers and staff.

Vaccines

Concepts surrounding the need for clinical trials to demonstrate safety, efficacy, and dosing are challenging for many. Allergists are in a position to explain the necessary steps involved in drug and vaccine discovery to patients in an effort to help them understand timeline, expectations, and why some early claims will not pan out.

• A nice discussion on Clinical Endpoints for Evaluating Efficacy in COVID-19 Vaccine Trials was recently published. (Ann Intern Med; Oct 22)
• Several vaccine candidates (NEJM; July 14) (Lancet; July 20) (JAMA; July 6) are in various stages of study, but it is unclear when a final vaccine will be made available and who will be first in line to receive it.
• There is no data to suggest that the seasonal influenza vaccine will interfere with the body’s ability to fight off COVID-19. The viruses will be circulating simultaneously this fall and winter, making it more important than ever for individuals (particularly those at high risk for complications) to get a flu shot.

The National Academies of Sciences, Engineering and Medicine recently issued a set of recommendations designed to aid in the equitable allocation of COVID 19 vaccine when it is available.

Additional Resources

Misinformation about COVID-19 is also addressed in the following resources:

• The Centers for Disease Control and Prevention now has a webpage called "Stop the Spread of Rumors" that lists known facts about COVID-19 and a social media toolkit with sample messages and graphics related to various COVID-19 topics for Twitter, Facebook and Instagram.
• The World Health Organization has a mythbusters webpage that addresses many common false claims about COVID-19.