Addressing Common COVID‑19 Misconceptions

Disease Misconceptions

Misconception #1: "It's just another flu."

The Facts: Influenza ("the flu") and COVID‑19 are both caused by RNA viruses that can lead to respiratory symptoms, but that is where the similarities end. COVID‑19 is many times more contagious than influenza, has a wider range of symptoms, and has more severe long-lasting complications including heart, lung, and brain damage (Mayo Clinic, 2020b).

Discussion: Let's start things off with an entertaining way to look at this: Viruses and other organisms are classified by realm/domain, kingdom, phylum, class, order, family, genus, and species; the realm (Riboviria) is the only classifier in common between the viruses that cause these two diseases with no further subclassifications in common. Given this information, saying that COVID‑19 is "a flu" is arguably even less accurate than saying that humans are a type of jellyfish since humans and jellyfish share both the same domain (Eukaryota) and kingdom (Animalia).

Misconception #2: "There shouldn't be nearly as much concern as there is, especially among healthy people, since the survival rate is so high."

The Facts: Survival is only one point to consider, as COVID‑19 can also cause crippling, life-long complications.

Discussion: It could be another 50 years before we learn just how many life-long injuries this disease ends up causing, but COVID‑19 has been known to cause blood clots leading to strokes (even in young people), heart attacks, liver and kidney damage, along with many other serious complications (Mayo Clinic, 2020a).

Furthermore, just because someone doesn't die, it doesn't mean that they won't become seriously ill and require hospitalization. Hospitals have become so full that many children's hospitals are now needing to accept adult patients because their affiliated adult hospitals are at or near 100% capacity and are unable to accept any new patients (Merrilees, 2020).

Misconception #3: "Deaths have been grossly misreported to make money and provoke fear."

The Facts: Very few medical professionals would ever consider lying on a death certificate, both on ethical grounds and based on the fact that they would be putting their license(s) in jeopardy. If providers or hospitals were to act in such a way, they would also be putting their contracts with insurance companies in jeopardy.

Discussion: Death certificates and insurance claims allow for the provider to list multiple conditions as applicable. Even if someone is ultimately hospitalized for, or dies as a result of, a condition such as pulmonary edema or secondary pneumonia, that was directly linked to COVID‑19 if they had it. It is absolutely acceptable to claim reimbursement for both diagnoses - this is nothing new. While it is true that insurance/Medicare/Medicaid pays a set amount of money per diagnosis and adding a diagnosis to the bill would get higher reimbursements, these agencies routinely investigate claims to prevent fraud. If fraud is found, contracts could be terminated, and those providers and facilities would lose massive amounts of money - a risk they are rarely willing to take.

Mask/PPE Misconceptions

Misconception #1: "Masks are ineffective because virus particles are smaller than the gaps between the threads of a mask and the gaps around it."

The Facts: Virus particles require a medium in which to be transmitted - primarily respiratory droplets in this case. Droplets are larger than those gaps between threads, and are thereby stopped by masks (Konda et al., 2020). Well-made cloth masks are even capable of stopping smaller, aerosolized particles (Lustig et al., 2020).

Discussion: "Viruses don't have wings." This is the somewhat silly response that I like to use to simplify the explanation as to why the size of the virus doesn't matter nearly as much as the size of respiratory droplets matters. There have been multiple demonstrations where somebody talks, sings, coughs, or sneezes at separate petri dishes with and without a mask and allowing sufficient time to show how effective a mask really is at stopping droplets. While these demonstrations classically show bacterial growth rather than viral replication, the respiratory droplets are the same size whether they are carrying bacterial cells or viral particles.

Misconception #2: "Somebody I know got COVID‑19, and they wore a mask everywhere they went. This proves that masks don't work."

The Facts: Incorrect. What this suggests is that they were likely around someone else who was wearing a mask incorrectly or not at all. Widespread mask wearing is intended to protect others around the wearers.

Discussion: Unfortunately, if a mask is not well-fitted and does not use special filtration (such as an N95 mask), it only provides limited protection to the wearer. However, even cloth masks can offer fantastic protection to others around the wearer. This is why it is so important for every person to wear a mask when around others - if everyone is wearing a mask, everyone is protected from each other.

While it is true that there is limited research available specific to the virus that causes COVID‑19 (SARS‑CoV‑2), we have over 100 years of evidence proving that mask wearing protects others from infectious agents, including viruses similar to this virus. Surgeons have worn masks since the 19th century to protect their vulnerable patients. Other medical providers wear masks for the same reason. The standard of care, even before the start of this pandemic, was that I would wear a mask while caring for vulnerable patients such as a kid with cystic fibrosis or someone undergoing chemotherapy for cancer.

Because there is a period of time between when we become infected with a contagion and when we start to have symptoms (Mayo Clinic, 2020b), it is every person's responsibility to take precautions to protect those around them even if we do not believe that we are ill.

Misconception #3: "I saw a '[this product] will not provide any protection against COVID‑19' warning label on a box of masks. This proves that masks don't work."

The Facts: Incorrect. When used properly, surgical and cloth masks provide significant protection to people around the wearer and limited protection to the wearer (Konda et al., 2020).

Discussion: These disclaimers have been largely misinterpreted because of a lack of understanding of the purpose of mask wearing. Going back to the facts and discussions from mask misconceptions #1 and #2, widespread mask use is intended to prevent the spread of COVID‑19, not to prevent contracting COVID‑19. When all people in an area are properly wearing masks, everybody there is well protected.

Misconception #4: "Masks cause a person to rebreathe carbon dioxide, leading to dangerously low oxygen levels."

The Facts: This assertion has been disproved in multiple research studies that analyzed oxygenation, even during vigorous exercise (Chan et al., 2020; Samaritan Health Services, 2020). Interestingly enough, oxygen levels actually increased for trial participants wearing masks in some of the studies conducted (Chan et al., 2020).

Discussion: In many cases where wearing a mask for an extended period of time causes someone to get a headache, the headache is caused by tension from the loops pulling on their ears (Ong et al., 2020) - not from a change in oxygen or carbon dioxide levels. A simple remedy for this is to use a mask that ties behind the head rather than one with ear loops, or to use a device to connect the ear loops behind the head to take the strain off of the ears (there are straps available commercially, or you could even simply use a piece of string to bring the loops together; a headband with buttons sewn onto it for the ear loops to connect to is another option). Please note that this should not be considered medical advice; consult your personal healthcare provider if you are experiencing headaches or have any concerns about your breathing!

COVID‑19 Vaccine Misconceptions

Misconception #1: "The vaccine was rushed and needs more trials before we can trust it."

The Facts: The COVID‑19 vaccines were able to be developed quickly because of technological advances made over the past decade, epidemiologic advantages that we have not typically had, and increased funding (Pardi et al., 2018; Xu et al., 2020).

Discussion: We were very fortunate that researchers and biotech companies had already been developing a new vaccine technology for many years, as it was able to be applied quickly when the need for a COVID‑19 vaccine came along. Trials for new vaccines usually take much longer for two main reasons: lower likelihood of contracting the target disease and the cost of running trials.

Since it would be unethical to intentionally expose trial participants to the target disease in order to test a vaccine's efficacy, statistics must be gathered over a long period of time in order to gain sufficient information as to whether or not the participants contract the disease in their day-to-day lives less often than the general public. In the case of a pandemic, however, this information can be gathered much more quickly because the likelihood of contracting the disease in day-to-day life is higher. This allows for the study to be concluded sooner.

In terms of cost, research and trials are extremely expensive. Researchers and pharmaceutical companies usually need to provide their own funding, as well as constantly apply for grants and search for investors. This challenge requires them to proceed slowly, only doing as much work as they can afford. In the case of COVID‑19 research, however, governments worldwide and private investors rapidly contributed billions of dollars in order to help speed up the process, even allowing several studies to be conducted simultaneously. As a matter of fact, there were more than 200 COVID‑19 vaccine candidates developed over the course of 2020 (London School of Hygiene & Tropical Medicine, n.d.).

Misconception #2: "The vaccine rewrites your DNA."

The Facts: The type of vaccine in question, such as the COVID‑19 vaccines produced by Pfizer-BioNTech and Moderna (the Johnson & Johnson/Janssen and Oxford-AstraZeneca vaccines are addressed in vaccine misconception #4), is called an mRNA vaccine. mRNA vaccines do use your body's ability to interpret genetic code, but they do not enter cell nuclei (where your DNA is located) and they cause no changes to your DNA (Nirenberg, 2020; Pardi et al., 2020).

Discussion: "Traditional" vaccines take a long time to manufacture because the target pathogen (the viruses that cause influenza or the bacterial toxin that causes tetanus, for example) must be grown in large quantities in a lab to then be processed in order to make the pathogen unable to harm someone before it can be administered. An mRNA vaccine, on the other hand, is basically an "instructions manual" that briefly shows the body how to produce a component of the target pathogen. This component is harmless on its own, yet it resembles the target pathogen closely enough that the immune system is able to learn how to fight the real pathogen if it is ever encountered. After the immune system has learned what it needs to know, it naturally destroys the remainder of the vaccine and the components that were created, while retaining a memory of how to fight the real pathogen in the future. This method of vaccine manufacturing is safer than "traditional" methods and allows the vaccine to be produced much more efficiently (Pardi et al., 2020).

In the case of the COVID‑19 vaccine, the vaccine instructs the body to briefly make something called a "spike protein" that looks like a portion of the outside of the virus that causes COVID‑19 (SARS‑CoV‑2) - this spike protein is not the virus itself and cannot cause COVID‑19 (Hubert, 2020; Pardi et al., 2020).

The fact that mRNA vaccines contain a strand of genetic material (mRNA) to serve as an "instructions manual" is where this misconception began. However, this genetic material never contacts where your DNA is stored, is incapable of modifying DNA, and is naturally destroyed shortly after being administered.

Misconception #3: "mRNA vaccines have never been used before and we lack safety data."

The Facts: There is an incredible amount of data proving the safety of mRNA vaccines. mRNA vaccines have been researched in animal studies dating back to 1990, with human clinical trials published as early as 2008 (Weide, Carralot, et al., 2008; Weide, Pascolo, et al., 2009; Wolff et al., 1990; Xu et al., 2020).

Discussion: One of the biggest reasons that mRNA vaccines have not been adopted for use before now is that they must be stored at extremely low temperatures and they expire quickly after being thawed (Hubert, 2020), making them impractical for the on-demand model seen in most physician offices and pharmacies. In the setting of COVID‑19 vaccination, however, this is more acceptable because a large number of vaccines are needed at a single time and administration is largely pre-scheduled. mRNA vaccines had many difficulties in their early years, such as causing too strong of an immune response leading to them being destroyed before they had adequate time to work; but these were overcome several years ago (Hubert, 2020; Pardi et al., 2020; Xu et al., 2020).

mRNA vaccines are unique in that not only can they be used to prevent contracting disease, but they have also shown to be effective in teaching the immune system how to treat ailments such a cancer that someone already has. Because mRNA vaccines are relatively fast and easy to produce with the right equipment, they have even been used in personalized medicine to treat a specific type of cancer that someone has, optimized for people on an individual basis (Weide, Carralot, et al., 2008; Weide, Pascolo, et al., 2009; Pardi et al., 2020; Xu et al., 2020).

Misconception #4: "The upcoming Johnson & Johnson/Janssen and Oxford-AstraZeneca vaccines do enter cell nuclei, though. This means that they can rewrite DNA."

The Facts: The type of vaccine in question here, such as the COVID‑19 vaccines produced by Johnson & Johnson/Janssen and Oxford-AstraZeneca, is called an adenoviral vector vaccine. While these vaccines do contain DNA and enter cell nuclei, they lack the ability to alter DNA (Lee et al., 2017).

Discussion: The DNA contained in adenoviral vector vaccines is considered episomal, which basically means that it minds its own business. In order for foreign genetic material to become integrated with your DNA, a process called reverse transcription must occur. This process is unique to a very small subset of viruses including the viruses that cause hepatitis B and HIV/AIDS; the particles in the adenoviral vector vaccines lack the mechanisms necessary to perform such tasks.

The way these vaccines function is similar to how the mRNA vaccines work, but with a couple extra steps. Adenoviral vector vaccines are hardier than mRNA vaccines because they contain DNA, which is more durable than mRNA; this is why these vaccines do not require the extreme levels of cold for storage that mRNA vaccines do. Once adenoviral vector vaccines are injected, their DNA briefly enters cell nuclei so that it can be broken down into mRNA; this mRNA then exits the cell nuclei and proceeds to follow the same steps that mRNA vaccines do (which were described in vaccine misconceptions #2 and #3).

Misconception #5: "The vaccine contains HIV, the virus that causes AIDS."

The Facts: This claim is 100% false. No FDA authorized/approved COVID‑19 vaccine contains any HIV viral particles.

Discussion: This misconception came from two places. The first time this topic came along it was related to a single research paper being written at an academic institution in New Delhi, India that mentioned similarities between the virus that causes COVID‑19 (SARS‑CoV‑2) and the virus that causes AIDS (HIV). This paper was uploaded to a service called a preprint server, a location online where scientists can share projects that they are working on before being peer reviewed and published in medical journals. The paper was later withdrawn by its authors, never underwent a formal peer review process, and has never been published in any reputable medical journal (Oransky & Marcus, 2020).

The second time this came up was related to a vaccine trial in Australia where some trial participants developed false‑positive HIV screening test results. That specific vaccine candidate (named UQ‑CSL v451 or simply "v451") was using a promising new technology called a "molecular clamp" that helped stabilize the vaccine components. The particular molecular clamp used in v451 was derived from a protein found on the surface of HIV particles. While v451 did contain a small component derived from HIV, it did not contain the whole virus. Additionally, all participants were made aware of this fact and that it carried the risk of causing a false‑positive result on HIV screening tests; there was never any risk of v451 causing an actual HIV infection since it did not expose participants to the actual virus. Once it was confirmed that v451 did cause a false‑positive on HIV screening tests, development of that vaccine was stopped (Sami, 2021; Vermes, 2020).