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Thread: Disease and pandemics thread (because it's science)

  1. #1441
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    Quote Originally Posted by Ken G View Post
    The question there is, again, what do they do in South Korea? Do they constantly reuse masks, or discard them, or clean them? It shouldn't be that hard to just figure out what they're doing, and do it. That is very sobering indeed. In the US, there is great stress on getting more ventilators, but if even a ventilator is not going to save most cases, it sounds like the stress is on the wrong things. I get that hospitals don't want to have to decide who gets a ventilator and who just dies, but that shouldn't be the main focus of how our society is coping. Everything we do must be to reduce R0 with minimal cost to everything else. I hear maybe 5% of the reports focused on just being smart about how to do that, and 95% on short-term issues like who needs a ventilator tomorrow and who should stay in their homes for a month. It's time to think more strategically, we know a lot about this disease, or should by now. Time for real solutions. The stopgaps are needed at the moment, like more ventilators and stay-at-home orders, but those stopgaps are not long-term solutions and I think we can start asking what those solutions are going to be. If facial covering is going to be part of the solution, and are not actually part of the problem, then our focus needs to be on how to make lots and lots of masks-- of good kinds that help prevent people from spreading the disease, including asymptomatic people who think they are trying to keep from getting it but are actually needing to not spread it. Do we even know what fraction of new cases are coming from asymptomatic spread, like someone has COVID-19 and also a seasonal allergy? Do we know what fraction is airborne or surface borne? These questions are not even being asked in any of the media I'm seeing.
    I have just listened to a ministerial explanation that we did not enter this period with a scaled up lab service but it is about now coming on stream. Testing by swab for patients, triage, then antibody testing to find those asymptomatic people. Tests that have high false negatives are worse than no test, so I find the argument is fair. Testing will, I think, arrive before a vaccine and will scale up faster. A reliable antibody finger prick test will make a huge policy difference. They are going to start sample testing the only approved antibody test at small scale now.
    Unless it is all lies, the reliability of these tests has not reached an acceptable level, some already proved inaccurate.

    Personally I prefer distancing over mask wearing and self isolation for those with a cough and fever, which seems to be policy here.
    Masks are for trained front line people. I would want one if treating a coughing patient.
    sicut vis videre esto
    When we realize that patterns don't exist in the universe, they are a template that we hold to the universe to make sense of it, it all makes a lot more sense.
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  2. #1442
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    Quote Originally Posted by George View Post
    I'm convinced this is right and it's why I have ordered a couple gross of bandannas.
    I suggest infected people should stay at home, where they do not need a mask.
    sicut vis videre esto
    When we realize that patterns don't exist in the universe, they are a template that we hold to the universe to make sense of it, it all makes a lot more sense.
    Originally Posted by Ken G

  3. #1443
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    We went to the grocery store this morning during the senior citizen’s hour. This week, there were quite a few people wearing masks, from surgical to simple bandannas. Last week, there were none.

    Of course, this means nothing more than people are becoming increasingly worried.


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    The First Minister of Scotland (a lawyer by training) has just, on our regional TV news, demonstrated a sound grasp of how the Positive Predictive Value of a diagnostic test varies with prevalence of disease, and has explained the concept clearly to a journalist.
    I'm astonished and gratified--it's a concept I've often had difficulty getting across to medical trainees, and it would appear that the political mantra of "we're following the science" is actually more than just an empty buzz-phrase on this occasion.

    Also, the UK government's public COVID-19 briefing tonight contained a surprising nugget, the significance of which seems to have been missed by journalists in the discussion that followed. We were told that early data and modelling suggests that the current control measures have pushed R0<1 in the UK. Obviously early days, need for caution and more data, and I'm very much not holding my breath, but it's interesting that this has even been ventured into the public domain.

    Grant Hutchison
    Last edited by grant hutchison; 2020-Apr-02 at 06:27 PM.

  5. #1445
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    Quote Originally Posted by Swift View Post
    Call this prejudice if you wish, but I automatically ignore anything that Dr. Oz says; I think he is basically a snake oil salesman.
    But are his objective claims erroneous or untestable or what? In my experience, sometimes great ideas come from strange people. He at least is both lucid and articulate in his short interviews, and he warns that using HCQ may prove to be not that beneficial, something you don't hear from most any salesman. Perhaps I'll have time later to chase down the Wuhan story from those doctors as I found his account interesting from a scientific point of view, perhaps just because I like the history involved.

    I have also heard from multiple news sources that all these reports about HCQ and related drugs have created shortages for patients with diseases, like lupus, that are being treated with them.

    LINK
    Yes, and to keep my prior post less long, I omitted the part where Oz mentioned Israel was shipping 100 million units, but he didn't happen to mention when they would arrive. Dr. Oz also addressed this shortage concern and stated that NY has recently banned HCQ likely to protect the normal users of the drug.

    This apparent shortage, hopefully short-term, however, isn't due to toilet-paper hoarders but by doctors, which is an indication that there may be something to HCQ in treating Covid-19. Your link noted, "Organizations representing doctors and pharmacists criticized physicians who, they say, have prophylactically prescribed chloroquine, hydroxychloroquine and the antibiotic azithromycin “for themselves, their families, or their colleagues.” It's a good sign when the cook eats its own cooking.

    [Added: Why can't prescriptions for HCQ and perhaps z-pack be limited to those Covid-19 patients who are severely ill, thus allowing enough to assist NY patients, no doubt.?]
    Last edited by George; 2020-Apr-02 at 09:04 PM.
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    Quote Originally Posted by profloater View Post
    I suggest infected people should stay at home, where they do not need a mask.
    Agreed but who are they if they are untested? We don't even know how many are aymptomatic, some say 25% as a guess. Serological tests, however, are coming soon, I think. [Now that I know what that means.]

    I may have even had the virus because I've been fighting what I have assumed to be allergies and, most years, I struggle with it this time of year as spring arrives with lots of pollen. But this year I had a fever, yet for only one day, and my upper lungs were congested more than I can remember, and not long after attending a 75,000 person expo in Vegas (cough). I called the doctor and did get my normal prescription including a z-pack (uh oh) but it didn't do the trick so he gave me another prescription that finally, with the last pill, cleared it up by perhaps >90%, and I'm improving each day with just an off-the-shelf allergy pill. Until I'm tested to see if I'm contagious I would think that a bandanna vs. no bandanna -- along with distancing, washing, etc. -- will be the better course.
    Last edited by George; 2020-Apr-02 at 07:13 PM.
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    Quote Originally Posted by grant hutchison View Post
    The First Minister of Scotland (a lawyer by training) has just, on our regional TV news, demonstrated a sound grasp of how the Positive Predictive Value of a diagnostic test varies with prevalence of disease, and has explained the concept clearly to a journalist.
    I'm astonished and gratified--it's a concept I've often had difficulty getting across to medical trainees, and it would appear that the political mantra of "we're following the science" is actually more than just an empty buzz-phrase on this occasion.
    The director of our National Institute for Public Health and the Environment (RIVM) is doing a great job in presenting to our parliament on live TV. Taking the time to calmly explain why FAQs aren't always so easily answered.

    As to how the disease develops, the usually careful news site shows that the number of people admitted into hospitals in our country is slowly dropping. Of course that might be driven by dropping demand or decreasing capacity. Or both. Still, the explanation we got on the lag between being exposed to the virus, admitted in hospital typically 2 weeks later, and ICU stay of 2 to 3 weeks is sobering. A few days ago, only 40 patients had left the ICU, I presume they meant alive. The company I work for is still expanding the emergency capacity to care for COVID infected elderly and special needs that don't require hospital care (yet), and we're carefully being warned the big hit still has to come. Even those trying to keep the IT and other infrastructure working for the care givers and the work-at-home folks are slowly starting to get very, very tired.
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    In 1918 there was no internet, so people could not telecommute. This time around many people can and yet many companies are still reluctant to let their employees do so even though studies indicate productivity goes up. "Working" 9 to 5 is such an idiotic concept. Time spent in the office is not a measure of the work done.[̲̅$̲̅(̲̅ ͡° ͜ʖ ͡°̲̅)̲̅$̲̅] earned by the companies is. I hope more executives will eventually figure this out and we can save some lives. As-is, there does not seem to be a clear path out of this Covid-19 affair.

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    Quote Originally Posted by George View Post
    But are his objective claims erroneous or untestable or what? In my experience, sometimes great ideas come from strange people. He at least is both lucid and articulate in his short interviews, and he warns that using HCQ may prove to be not that beneficial, something you don't hear from most any salesman.
    I watched one interview with Oz some days ago about this. My impression was that he was cheerleading for the drug, but after talking it up he put in some qualifiers. I don’t care for that behavior. Like I mentioned in my last post, other doctors consider existing “studies” to be junk (or worse), but he didn’t say anything like that.

    Of course it can be tested, and should be, but in my opinion at this point the position should be that this is one of a number of drugs that is to be tested in proper studies, and until that’s done we can’t say much about it. Also the problems with current “studies” should be pointed out. And that’s it. It shouldn’t be promoted or put ahead of other investigational drugs.

    Again, here is an article I linked to in my earlier post on this, discussing hydroxychloroquine and azithromycin and some of the bad science surrounding it:

    https://sciencebasedmedicine.org/are...-for-covid-19/

    There is a follow-up:

    https://sciencebasedmedicine.org/hyd...rsus-covid-19/

    It discusses another “study” that Raoult has put forward, how poor it is, yet Oz is apparently promoting it. Quoting from the article:

    One version of the treatment uses chloroquine (which is sold under the trade name Aralen and others), an anti-malaria drug that’s also used to treat autoimmune diseases. Another version, the one that at the time was getting the most press, claimed that the combination of hydroxychloroquine (trade name Plaquenil, and it’s a drug which is very similar to chloroquine) and the antibiotic azithromycin (often prescribed in the famous “Z-Pak”) could completely render SARS-CoV-2, the virus that causes COVID-19, undetectable in patients. As I described, it was a horrible, horrible study about which I later found out things that make me suspect that its awfulness could have been due to more than mere incompetence and instead might have been scientific fraud. Meanwhile, the only existing randomized trial of chloroquine in COVID-19 was negative. As I said at the time, that doesn’t mean that the drug doesn’t work, but it does strongly suggest that its effects are probably not dramatic, although it is also possible that the dose used was too low.
    This was written by David Gorski. I trust him a lot more than Oz. He often covers questionable medical claims with a skeptical focus.


    Quote Originally Posted by George View Post
    This apparent shortage, hopefully short-term, however, isn't due to toilet-paper hoarders but by doctors, which is an indication that there may be something to HCQ in treating Covid-19. Your link noted, "Organizations representing doctors and pharmacists criticized physicians who, they say, have prophylactically prescribed chloroquine, hydroxychloroquine and the antibiotic azithromycin “for themselves, their families, or their colleagues.” It's a good sign when the cook eats its own cooking.
    Not everyone that can write prescriptions has the expertise to properly evaluate this and has done so. Hopefully the majority are skeptical and considering risks, but there are credulous doctors too that can be taken in by hype. There are doctors that are just plain bad. As I mentioned before, there are dentists that have tried to write prescriptions for this. It doesn’t take a huge number of doctors to cause shortages for a drug like this that is being produced for established uses with an expected level of demand.

    Quote Originally Posted by George View Post
    [Added: Why can't prescriptions for HCQ and perhaps z-pack be limited to those Covid-19 patients who are severely ill, thus allowing enough to assist NY patients, no doubt.?]
    It has other legitimate uses, so it is hard to police. Apparently there is some attempt, though.

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  10. #1450
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    Quote Originally Posted by George View Post
    That's surprising to learn especially for women who wear them, who I assume even in Asia like to wear makeup and look nice. If it's now in their culture to wear them, then why are they, apparently, all white and not more colorful? I associated a lot of their use of masks with their terrible air pollution.
    I'm not sure where the idea came up that it has something to do with fashion. At least in Japan and South Korea, it is definitely not about fashion in the sense that makeup is. It really doesn't have much to do with pollution (though it does in China). In Japan it has to do with two things. One is hay fever. Because there was a bad policy after the war to plant massive numbers of cedar trees throughout Japan (for rebuilding), there is a huge problem with hay fever, and people wear masks to (whether it works or not is a different question) help with that. And then secondly, it is considered impolite to cough on other people, so when people are coughing they tend to wear masks. I got reprimanded once by a colleague because I was coughing at work (a long time ago) and wasn't wearing a mask. So as Grant says, an expression of respect for others. I think that is what he meant by "fashion."
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    Quote Originally Posted by Jens View Post
    ...Because there was a bad policy after the war to plant massive numbers of cedar trees throughout Japan (for rebuilding), there is a huge problem with hay fever, and people wear masks to (whether it works or not is a different question) help with that....
    Having recently purchased a house on 15 acres of forest, many of the trees being cedar, I had to look that up! I was relieved to find:


    Hay fever in Japan (花粉症, kafunshō, "pollen illness") is most commonly caused by pollen from Cryptomeria japonica (known as sugi in Japanese and often translated as "cedar" though it is not a member of the Cedrus genus [i.e., cedar]). - wiki
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    Quote Originally Posted by profloater View Post
    I suggest infected people should stay at home, where they do not need a mask.
    Are you aware that roughly half the people who test positive for the virus never know they have it? I don't know if those people are as much of a threat to be contagious, but that's all just part of what we don't know at this point. Given the absence of knowledge, I suggest we imitate what has shown to work.

    Also, I think there is probably good reason to ask sick people at home to wear masks, as they will share the air with their caregivers. In hospitals, it is the caregivers that wear masks, not the patients, but at home the infected people are not as sick as those in the hospital, and the caregivers are not going from patient to patient. But I would expect that either the caregivers, or the sick persons, should wear masks at home-- I certainly would, because I'm very concerned with inhaling high viral loads, that seems like a great way to cause death.
    Last edited by Ken G; 2020-Apr-03 at 04:26 AM.

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    Quote Originally Posted by grant hutchison View Post
    The First Minister of Scotland (a lawyer by training) has just, on our regional TV news, demonstrated a sound grasp of how the Positive Predictive Value of a diagnostic test varies with prevalence of disease, and has explained the concept clearly to a journalist.
    I'm astonished and gratified--it's a concept I've often had difficulty getting across to medical trainees, and it would appear that the political mantra of "we're following the science" is actually more than just an empty buzz-phrase on this occasion.
    It's a potential positive in all this, that respect for science is returning. In the US, even the President has shown a willingness to listen to scientists. That could be very important going forward, outside the realm of this virus.
    Also, the UK government's public COVID-19 briefing tonight contained a surprising nugget, the significance of which seems to have been missed by journalists in the discussion that followed. We were told that early data and modelling suggests that the current control measures have pushed R0<1 in the UK. Obviously early days, need for caution and more data, and I'm very much not holding my breath, but it's interesting that this has even been ventured into the public domain.
    I think the evidence is quite clear from every country that has invoked what are essentially lockdown measures that R0 goes below 1 pretty quickly, roughly two weeks or so. The strategy then seems to be to drive the case number way down, and switch back to more focused containment measures. What remains to be seen is whether that will prevent a new flareup, without taking the kind of high tech measures that South Korea is using. In Italy, the lockdown so far has only achieved a leveling off of cases, so maybe it's too soon to tell or maybe they are not doing some aspect of it well enough to see the cases drop. In my state in the US, we are on a partial lockdown, and have only achieved a leveling of the cases as well. We are waiting for the other shoe to drop as to what is required to get the cases to really drop, it might just need another week or it might need a stay-at-home order. I worry about what measures will actually be sustainable, though-- I suspect one has to get the case numbers down to what they were a month ago, and do a kind of "do over" as to what is the right way to handle that, whatever was not done then. I suspect that what was not done basically boils down to people not taking it seriously, especially since they were widely instructed to not take it seriously.
    Last edited by Ken G; 2020-Apr-03 at 04:34 AM.

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    Regarding the incidence of Covid-19 in South Korea.
    I can't help but think that there is an elephant in the room regarding the use of masks.

    If their culture leads many people to wear a mask habitually, why was there such a rapid rise in cases in the beginning?

    After reading about the measures taken by the S. Korean government, I don't see any mention of masks as a contributing factor in their success in flattening the curve. It is more about social distancing and control, widespread testing and tracing of contacts.

    Maybe things might have been worse without the cultural mask wearing, but there is no evidence to support that conjecture.

    Interesting timeline here.
    https://www.ijidonline.com/article/S...150-8/fulltext

    It's worth noting that their cases continue to rise steadily despite everything they have done so far.

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    Quote Originally Posted by headrush View Post
    Regarding the incidence of Covid-19 in South Korea.
    I can't help but think that there is an elephant in the room regarding the use of masks.

    If their culture leads many people to wear a mask habitually, why was there such a rapid rise in cases in the beginning?

    After reading about the measures taken by the S. Korean government, I don't see any mention of masks as a contributing factor in their success in flattening the curve. It is more about social distancing and control, widespread testing and tracing of contacts.

    Maybe things might have been worse without the cultural mask wearing, but there is no evidence to support that conjecture.

    Interesting timeline here.
    https://www.ijidonline.com/article/S...150-8/fulltext

    It's worth noting that their cases continue to rise steadily despite everything they have done so far.
    They and other countries learned from SARS before, and had stocks of PPE ready plus a protocol for rapid response. Everyone agrees rapid response in the first week is what makes the difference when an outbreak occurs. When you leave it three to four weeks, then lockdown is required. Otherwise you accept many more deaths until immunity ramps up.
    sicut vis videre esto
    When we realize that patterns don't exist in the universe, they are a template that we hold to the universe to make sense of it, it all makes a lot more sense.
    Originally Posted by Ken G

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    Quote Originally Posted by Ken G View Post
    Are you aware that roughly half the people who test positive for the virus never know they have it? I don't know if those people are as much of a threat to be contagious, but that's all just part of what we don't know at this point. Given the absence of knowledge, I suggest we imitate what has shown to work.

    Also, I think there is probably good reason to ask sick people at home to wear masks, as they will share the air with their caregivers. In hospitals, it is the caregivers that wear masks, not the patients, but at home the infected people are not as sick as those in the hospital, and the caregivers are not going from patient to patient. But I would expect that either the caregivers, or the sick persons, should wear masks at home-- I certainly would, because I'm very concerned with inhaling high viral loads, that seems like a great way to cause death.
    Yes it is clear that at a stage where tracing becomes impractical, stay at home policy is the way to reduce numbers with, as you say, two to three weeks lag time. Then society can gear up, if it was not already prepared, to test and isolate more specifically. It seems UK is entering that phase with sample testing at first.

    My comment was and is aimed at the idea that mask wearing is an alternative to self isolation. It is if you accept rapid spread and overwhelming resources. Because, in my assessment, masks do not reduce R0 much in an untrained population.
    sicut vis videre esto
    When we realize that patterns don't exist in the universe, they are a template that we hold to the universe to make sense of it, it all makes a lot more sense.
    Originally Posted by Ken G

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    Quote Originally Posted by Jens View Post
    I'm not sure where the idea came up that it has something to do with fashion.
    Well, I got the idea from the large number of patterned "Japanese fashion face masks" available--flowers and manga faces and roaring mouths, even just bold plain colours. There's a discussion here, with what passes for survey data in the fashion industry, and some illustrative pictures. You're not seeing this on the ground, I take it?

    (My aim was to list the various non-medical reasons I'm aware of for the use of face-masks in East Asia. People who wear masks for non-medical reasons have no reason to think about how they handle or reuse their masks. One could even make the case that these people now have ingrained bad habits of mask usage, which would serve them poorly in an epidemic--I doubt if we have data.)

    Grant Hutchison
    Last edited by grant hutchison; 2020-Apr-03 at 11:32 AM. Reason: bracketed

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    Quote Originally Posted by profloater View Post
    They and other countries learned from SARS before, and had stocks of PPE ready plus a protocol for rapid response. Everyone agrees rapid response in the first week is what makes the difference when an outbreak occurs. When you leave it three to four weeks, then lockdown is required. Otherwise you accept many more deaths until immunity ramps up.
    Sure, I can accept that. None of that speaks to the usage of masks by the general population though, or any efficacy in the prevention of infections in the general population.

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    Quote Originally Posted by headrush View Post
    Sure, I can accept that. None of that speaks to the usage of masks by the general population though, or any efficacy in the prevention of infections in the general population.
    I am sure you are right. Masks which fit and are changed for new regularly must reduce breathed in doses. But note all the comments about touching, poor fit, prolonged use, plus any complacency effect. A reduced dose may still cause infection. Separation may require major changes in retail practice but surely it’s worth it. What is the dose reduction of separation compared with mask use?
    sicut vis videre esto
    When we realize that patterns don't exist in the universe, they are a template that we hold to the universe to make sense of it, it all makes a lot more sense.
    Originally Posted by Ken G

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    Quote Originally Posted by profloater View Post
    I am sure you are right. Masks which fit and are changed for new regularly must reduce breathed in doses. But note all the comments about touching, poor fit, prolonged use, plus any complacency effect. A reduced dose may still cause infection. Separation may require major changes in retail practice but surely it’s worth it. What is the dose reduction of separation compared with mask use?
    I think that question is unanswerable at the moment. It should also be noted that health professionals working in close proximity to sick people are still catching the virus, despite their ppe.

    I'm slightly irritated by ongoing calls for public mask usage despite the lack of evidence. The hashtag #masks4all is trending and it seems that because a few vocal supporters shout loud enough, everyone jumps on the bandwagon without a serious reason why. Distortion of WHO and CDC guidelines are becoming rampant which is a danger in itself. Scientific evidence is the correct approach not mob rule.
    A feel good factor may be useful, but not when the masks are in short supply.

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    Quote Originally Posted by headrush View Post
    I think that question is unanswerable at the moment. It should also be noted that health professionals working in close proximity to sick people are still catching the virus, despite their ppe.
    I'm sure there a multiple reasons for that, but in my experience the most common reason for people getting contaminated with blood or secretions is "the unexpected"--sudden life threatening airway emergencies, patients who present with one disease but turn out to have another disease, patients who become confused and thrash their way out of an isolation cubicle, and so on. Hospitals work with graded zones of infection risk, and graded zones of PPE, and patients and circumstances will always find one-off ways to breach that careful structure.
    A colleague of mine once came in off the street to start work and called the elevator to ascend to his department. When the lift doors opened there was a person inside, thrashing around on the floor spraying arterial blood from a dialysis shunt. The colleague arrived at work fifteen minutes late, his skin and his outdoor clothing covered in blood from head to foot. Another colleague on his way out of the hospital ended up resuscitating a collapsed patient in the hospital entrance, got them transferred to an appropriate care setting, carried on home ... and the next morning discovered that he had the patient's dentures in the pocket of his jacket, although he had no recollection of how they got there.
    Usually these protocol breaching events are less spectacular, but they happen.

    Grant Hutchison

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    Quote Originally Posted by headrush View Post
    It's worth noting that their cases continue to rise steadily despite everything they have done so far.
    it’s definitely worth noting that the countries of East Asia have not escaped. The rate of increase may have been shallowed, but it’s definitely rising. It’s just following a less explosive path, which might be good for the health care system, but it doesn’t necessarily mean the final result will be different.
    As above, so below

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    Quote Originally Posted by grant hutchison View Post
    Well, I got the idea from the large number of patterned "Japanese fashion face masks" available--flowers and manga faces and roaring mouths, even just bold plain colours. There's a discussion here, with what passes for survey data in the fashion industry, and some illustrative pictures. You're not seeing this on the ground, I take it?
    No, definitely not. I see lots of people with white masks, a minority with black masks, and not much beyond hat.
    As above, so below

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    So, "mask wars" is now an international thing, with countries, states and other entities fighting for supplies. One would like to imagine that all these hard-won masks are going where the evidence overwhelmingly says they need to go.

    Grant Hutchison

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    Quote Originally Posted by Jens View Post
    No, definitely not. I see lots of people with white masks, a minority with black masks, and not much beyond hat.
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    Quote Originally Posted by profloater View Post
    My comment was and is aimed at the idea that mask wearing is an alternative to self isolation.
    It's not an either/or, it's do everything that is easy all the time, and whatever is necessary as it becomes necessary. Remember, self isolation of sick people is insufficient because people don't self identify as sick until after they are contagious, if at all. So self isolation must include everyone, it requires a lockdown order and that is not sustainable as a continuous strategy.
    Because, in my assessment, masks do not reduce R0 much in an untrained population.
    And in the absence of good data that could tell us this, I can't see how they wouldn't reduce R0 enough to be well worth the minimal societal cost. I am building a suspicion that way too much stress is going into avoiding surface exposure, and too little into airborne exposure. Especially in regard to the more serious cases. There is so much stress on keeping surfaces clean, and all we ever hear about airborne contagions is to keep the magic 6 feet away. But if you have people sneezing and coughing who are not themselves wearing masks, I don't think being 6 feet away is going to be much of a guarantee of anything. All I can say is that if I'm in a public place, and someone ten feet from me coughs or sneezes, I'm a lot more comfortable if they have a mask and try to cover that cough with their elbow, than if the just try to cover it with their elbow. I don't know if other people have noticed this, but elbows are not ideally designed to prevent airborne particles, and even if masks aren't either, why do we hear all about how bad masks are while everyone thinks elbows are just fine?

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    Quote Originally Posted by Jens View Post
    No, definitely not. I see lots of people with white masks, a minority with black masks, and not much beyond hat.
    Interesting. There are a couple of East Asian girls I see regularly in the shops down the road from us, who wear masks all the time (as in, every time I've seen them for several years), always black as part of some sort of general vaguely goth look, but always ornamented in white--sometimes what looks like kanji characters at the side, little cat noses and whiskers in the middle, various other things. It's what made me look up "fashion masks" in the first place, and I think I identified these as being specifically K-Pop styling. (Which was another thing I had to look up.) There do seem to be masks designed for a variety of fashionable looks (I'm not going to get "Lolita" out of my head in a hurry, sadly).
    Various websites also suggest that a facemask is something you might wear if you get up not liking the look of your face that morning, or don't have time for make-up--like a westerner cramming on a hat on a bad hair day.
    And then of course there's the imminent arrival of printable facemasks, so you can have an image of your face on your mask to let you unlock your phone without pulling down the mask. (This would do me no good, since my phone has always insisted I don't have a face.) If ever there was a recipe for dangerous mask reuse, that'll be it.

    Grant Hutchison

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    Quote Originally Posted by Ken G View Post
    All I can say is that if I'm in a public place, and someone ten feet from me coughs or sneezes, I'm a lot more comfortable if they have a mask and try to cover that cough with their elbow, than if the just try to cover it with their elbow. I don't know if other people have noticed this, but elbows are not ideally designed to prevent airborne particles, and even if masks aren't either, why do we hear all about how bad masks are while everyone thinks elbows are just fine?
    Have you ever coughed or sneezed while wearing a surgical mask? Seen anyone do that? Compliance will approach zero very quickly. It's why no-one asks a patient with a respiratory infection to wear a barrier mask.

    Grant Hutchison

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    Quote Originally Posted by Jens View Post
    it’s definitely worth noting that the countries of East Asia have not escaped. The rate of increase may have been shallowed, but it’s definitely rising. It’s just following a less explosive path, which might be good for the health care system, but it doesn’t necessarily mean the final result will be different.
    It certainly does mean the final result will be different. The thing to understand about exponential growth is that it is a fundamentally different type of behavior than a steady rate of cases, it is very much the difference between catastrophic failure and overwhelming success. The phrase "continues to rise steadily" is a rather vague statement that means they have a wonderfully constant (and low!) case rate, which is fantastic, and fails to recognize this staggeringly important, life vs. death, distinction. What is happening in South Korea right now is life, what is happening in the western world is death. I just can't make it any clearer.

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    Quote Originally Posted by grant hutchison View Post
    Have you ever coughed or sneezed while wearing a surgical mask? Seen anyone do that? Compliance will approach zero very quickly.
    I don't think people should be walking around with surgical masks anyway, the doctors need them. (Though I guess what doctors really need are the N95.) I can certainly imagine that a mask will pull away from the face in a sneeze, but it's better than an elbow-- especially if someone also uses their elbow. What is the compliance of an elbow?
    It's why no-one asks a patient with a respiratory infection to wear a barrier mask.
    So you ask them to use their elbow? I would have thought you simply don't attempt to prevent contagions at that end of the process in a hospital environment. But maybe in the waiting room?
    Last edited by Ken G; 2020-Apr-03 at 04:37 PM.

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