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

  1. #1411
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    Quote Originally Posted by George View Post
    Sure. The y-axis is the daily rate (% increase over the prior day) for each of the three categories. For instance, the US no. of cases yesterday totaled 161,807, up 20,921 in new cases from the prior day's total of 140,886. This is an increase rate for yesterday of 14.8% (20,921/140,886). So as bad as those numbers look, the actual daily rate is coming down, which should be worth noting. The semi-vertical graphs at many sites like Johns Hopkins are don't graphically tell the full story, and I suspect this approach does help. Does
    The CFR values are about double if you use a 4-day time lag, of course higher for each increase in lag days. From earlier graphs where I used 2,4,6,8 and 10 day delay periods, there was no noticeable bump in the profile between those higher CFR values, respectively. IOW, it seemed to me at least that there must be a somewhat even distribution in the no. of days until death, though I suspect I might be wrong in that simple assumption.
    Thanks, i messed up rwo replies but thanks anyway.,
    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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    Quote Originally Posted by kzb View Post
    I don't see what the functional difference is between a clinical setting and a store.
    The clinical setting involves prolonged, close-quarters exposure to people producing large amounts of droplet spray directly into your face. Like, hours on end, your face recurrently within a metre of copious spraying secretions. It also involves aerosol-generating procedures, such as instrumenting the patient's airway, which are high risk because of the number of small persistent droplets produced.
    Trust me, the clinical setting is like nothing you will ever encounter in a store. (And promise me you will never make that comparison in the vicinity of someone who has just come off a long ICU shift.)

    Grant Hutchison

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    Grant, I would be pleased to see your view about the use of simple cloth covers to minimize droplet propagation for those who may or may not be symptomatic. Even if they only stop the large droplets, wouldn't this be helpful? [I'm referring to general use, not clinical of course.]
    We know time flies, we just can't see its wings.

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    In a review by “MD” in Private Eye magazine, a sobering statistic that of the most severe patients, two thirds of those intubated in hospital, die. More in the very elderly. This raises the question of whether 21stcentury medicine offers much over 19th century precautions. Of course we don’t want to overwhelm hospitals, but this does raise the stakes in the damage caused by isolation, with its own separate risks of death. Most countries failed to respond early enough with testing and tracing. It was better done is the 2003 SARS world response. Let’s hope we do learn this early response lesson for next time! Delay causes pandemic.
    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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    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 George View Post
    Grant, I would be pleased to see your view about the use of simple cloth covers to minimize droplet propagation for those who may or may not be symptomatic. Even if they only stop the large droplets, wouldn't this be helpful? [I'm referring to general use, not clinical of course.]
    As ever, I suggest people read the research. There's actually a very sensible review on a commercial site here.
    But the danger with home-made cloth masks is that they'll be worn for long periods and reused, and so effectively turn into little virus reservoirs you occasionally apply to your nose and mouth.

    Grant Hutchison

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    Quote Originally Posted by profloater View Post
    Amen to that, any filter also accumulates filtrate, so the whole protocol of maskwearing has to be thought through. Yes it will limit the trillions of particles from an infected cough, but it also stores and accumulates ambient particles which remain infectious for hours or days. Plus the tendency to breathe harder through a mask and to touch it regularly, especially if unaccustomed. Spacing discipline makes sense and may make the mask redundant. Finally, masks tend to collect water too, from breathing, does that allow longer time for the virus before desiccation finishes it off?
    Very good points from both you and Grant.

    Where I work we normally use N95 masks and other respirators, because of dust hazards from the raw materials we use. Users have to go through annual training in their use (and our training is aimed at dust hazards, which are not the same as virus hazards) and have to have annual lung capacity testing, as there are dangers for users with respiratory problems to use a mask.
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    Quote Originally Posted by grant hutchison View Post
    But the danger with home-made cloth masks is that they'll be worn for long periods and reused, and so effectively turn into little virus reservoirs you occasionally apply to your nose and mouth. Grant Hutchison
    I am borrowing that line to use when I encounter people here doing that.
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    Quote Originally Posted by grant hutchison View Post
    As ever, I suggest people read the research. There's actually a very sensible review on a commercial site here.
    But the danger with home-made cloth masks is that they'll be worn for long periods and reused, and so effectively turn into little virus reservoirs you occasionally apply to your nose and mouth.
    Perfect! The efficacy report (2nd link) is especially helpful.
    We know time flies, we just can't see its wings.

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    Here are the daily rates for both cases and deaths. These numbers don't help find the time lag so more explicit data is needed and it may be out there for various categories of patients. The spikes are likely just a delay in reporting the full data, so if you combine those two dates, the peak is more about 50%, which was an ugly day to behold.

    New Case rates US March 31.jpg
    We know time flies, we just can't see its wings.

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    Quote Originally Posted by kzb View Post
    You know those machines blowing out the white clouds, what are they spraying? What is the white smoke?
    Who know? East Asia is fairly relaxed about public chemical exposure compared to the West--that sort of activity would be illegal in Europe, I think, or at least very heavily regulated.
    Science says a lot of it may be sodium hypochlorite, household bleach.
    But it’s unclear whether bleach destroys coronaviruses outside, and if it does kill them on surfaces it's unclear whether it would kill viruses in the air. Bleach itself breaks down under ultraviolet (UV) light. Then again, Leon says, UV light seems to destroy coronaviruses as well. And coronavirus exposure from outdoor surfaces may be limited already: “Nobody goes around licking sidewalks or trees,” Leon says.
    There may even be downsides to widespread overzealous disinfection with bleach, notes Julia Silva Sobolik, a graduate student in Leon’s lab. “Bleach is highly irritating to mucous membranes,” Sobolik says. That means people exposed to sprayed disinfectants—especially the workers who spray them—are at risk of respiratory troubles, among other ailments.
    This whole COVID-19 epidemic is turning into a vast uncontrolled experiment--which country can induce the worst unintended consequence for the most negligible gain?

    Grant Hutchison

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    Quote Originally Posted by George View Post
    Perfect! The efficacy report (2nd link) is especially helpful.
    But, they did not test what happens to the mask viral load as you breathe in and then out.
    So, carry a mask, then if someone is about to cough, pu it on, then dispose of it
    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

  13. #1423
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    Quote Originally Posted by George View Post
    Here are the daily rates for both cases and deaths. These numbers don't help find the time lag so more explicit data is needed and it may be out there for various categories of patients. The spikes are likely just a delay in reporting the full data, so if you combine those two dates, the peak is more about 50%, which was an ugly day to behold.

    New Case rates US March 31.jpg
    So, if we take 30% that’s doubling in three days. Probably four days average?
    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
    But, they did not test what happens to the mask viral load as you breathe in and then out.
    So, carry a mask, then if someone is about to cough, pu it on, then dispose of it
    The covering use is based on the idea that a lot of people are contagious and don't know it, especially given how hard it still is to get tested. The use of the covering cloth (e.g bandanna) will greatly reduce the droplet propagation that could infect others. I assume, but am curious to have clarity, that those who are contagious won't be too adversely affected in re-breathing those droplets on the cloth. Of course, washing them more often than normally and perhaps drying them in sunshine would be advised. Perhaps even using a microwave. Does the cloth idea not seem practical, at least until real masks can be used?

    Which reminds me, my wife microwaves all food that comes from the take-out places to minimize the risk of getting Covid-19. But how many seconds are needed to take it out?
    We know time flies, we just can't see its wings.

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    Quote Originally Posted by profloater View Post
    So, if we take 30% that’s doubling in three days. Probably four days average?
    Yes and at 50% (perhaps the corrected high point for that graph) it was doubling every 40 hours. If we are now, hopefully, around 15%, the doubling is every 5 days, but the goal is to get to 0% or very close to it.
    We know time flies, we just can't see its wings.

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    Quote Originally Posted by grant hutchison View Post
    Who know? East Asia is fairly relaxed about public chemical exposure compared to the West--that sort of activity would be illegal in Europe, I think, or at least very heavily regulated.
    Science says a lot of it may be sodium hypochlorite, household bleach.
    This whole COVID-19 epidemic is turning into a vast uncontrolled experiment--which country can induce the worst unintended consequence for the most negligible gain?

    Grant Hutchison
    It doesn't look like an aqueous solution being sprayed. It looks like dense white smoke.

    Actually whilst writing, thought of this: could it be bleaching powder? Solid, finely-ground calcium hypochlorite? I have some of this and it does indeed have a very fine particle size fraction in it. Terrible stuff in the atmosphere, would be life threatening to the unprotected in the area.

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    More on the white smoke:

    https://blogs.sciencemag.org/pipelin...iral-theatrics

    So it could be antiviral theatrics. Or:

    One of the more constructive comments suggests that Virosil foggers have been used in the military, and Virosol is 10% H2O2 plus 0.01% silver nitrate. That sounds both expensive and messy to me.

    Another suggestion is vapourised paraformaldehyde.

  18. #1428
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    Quote Originally Posted by grant hutchison View Post
    People just don't use masks properly without training--they touch their faces, they touch the insides of the mask, they reuse masks that are damp and have been allowed to rest on random surfaces. By doing so they undoubtedly increase their risk above the baseline achieved by social distancing.
    OK, then I should not say there is no cost, but I think the evidence is pretty clear that mask wearing (or use of facial covering, to distinguish from real N95 masks which are being reserved for healthcare needs) is of net benefit. We must not overlook the results being achieved in South Korea, it would seem to be wise to do every single thing they are doing there, whenever possible. Of course I don't know what fraction of their success comes from widespread usage of facial covering, but it's hard to believe their amazing success is coming in spite of the harms of that usage. I suspect the real benefit is not so much that it prevents you personally from getting the disease (it might help against getting a deadly viral load, that kind of data is slow in coming), but rather that it helps already infected people from spreading it. The goal is to find low-cost ways to reduce R0, that's literally the only way we will defeat COVID-19 until there is a vaccine. Hand washing clearly isn't nearly enough, and continuous lockdown is not economically sustainable. Roving lockdowns might work, but if everyone is wearing facial coverings all the time in public, that might reduce R0 with essentially zero cost to economic sustainability. I don't see why we shouldn't do every single thing South Korea does, it's that simple.
    In an ideal world, with an infinitely renewable supply of useful masks and a trained public, then by all means we should distribute many masks to everyone because any tiny reduction in R0 is good. In the less-than-ideal world the WHO is dealing with, their pragmatic advice makes sense.
    Then the question is, how close to that ideal world is South Korea, and why it is regarded as so unattainable that places like the UK and US could simply do what they're already doing?

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    Quote Originally Posted by Roger E. Moore View Post
    I am borrowing that line to use when I encounter people here doing that.
    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.
    Quote Originally Posted by profloater
    In a review by “MD” in Private Eye magazine, a sobering statistic that of the most severe patients, two thirds of those intubated in hospital, die. More in the very elderly.
    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.
    Last edited by Ken G; 2020-Apr-02 at 03:56 PM.

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    There are further reports about HCQ (hydroxychloroquine) that are encouraging in fighting Covid-19. I'm not in the medical field and the use of this drug is unproven on an appropriate level to be given as a normal prescription from doctors. Its use may even prove to be not worth the risk, and, as Dr. Oz notes that we need bigger clinical trials to determine “whether it’s the right way to go or the wrong way to go.” Dr. R. Smith -- a pre-infectious disease expert (apparently) – claimed, due to the HCQ regimen, this is the “beginning of the end of pandemic.” Perhaps he’s right, but only time and great medical efforts will reveal the answer. I'm pitchin' the ball not knowing if this will lead to a homerun or just fouls that just look like home runs.

    I’ll start with the juicier news, IMO, from Dr. Oz. The French Dr. in Marseille, France, who seems to be the first in the western world to apply HCQ, directed Oz to the Wuhan doctors who used it. The Wuhan doctors shared that none of 80 hospital patients admitted with Lupus were infected with Covid-19 and none of 190 patients admitted with Covid-19 had Lupus. Those with Lupus were using HCQ, those with Covid-19 were not. So they suspected it might be more than just a coincidence. It is now, apparently, part of China’s medical protocol to use HCQ. [I’m unclear if z-pack, as is used by the French doctor and now others, was used in Wuhan.]

    Dr. Oz took this comparison idea to the head of Medicare/Medicaid to draw on their huge database of patients to see if their Lupus patients show a significant reduction in also having Covid-19 than would be expected. [I assume we will hear more about this very soon.]

    From Dr. Oz….
    One unpublished study of 62 random Covid-19 patients, all with pneumonia, ½ treated normally, the other ½ taking HCQ (unsure if this included z-pack):

    Days with Fever:
    w/o HCQ… 3.2 days
    w/ HCQ….. 2.2 days

    Days with Cough:
    w/o HCQ… 3.1 days
    w/ HCQ….. 2.0 days

    Percent lung improvement:
    w/o HCQ… 54.8%
    w/ HCQ….. 80.6%

    4 patients not using HCQ got significantly worse, none using HCQ got worse. [extremely small sample, admittedly.]

    I think all the above were receiving antibiotics as well.

    A CEO (Dr. R. Oskoui) for a cardiologist firm suggested that any use of this drug should include an EKG to establish a baseline before the drug is used followed by EKGs taken daily or every few days to avoid cardiac deaths.
    These EKGs were done in another study by a Dr. Smith on 72 patients with 75% being either pre-diabetic or diabetic and with an average BMI (Body Mass Index) of 30.7. [The BMI score has the overweight level of 25 and over, 30 is the obese min.]
    With 4 or 5 days of the HCQ regimen, none required incubators.

    2 patients of, by then, 80 had negative changes noted from their EKGs.
    Last edited by George; 2020-Apr-02 at 03:41 PM.
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  21. #1431
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    Quote Originally Posted by Ken G View Post
    Then the question is, how close to that ideal world is South Korea, and why it is regarded as so unattainable that places like the UK and US could simply do what they're already doing?
    Setting aside the problem of sifting through the heterogeneous pile of poorly designed and not particularly applicable studies that form the evidence base for the mask debate, the obvious difficulty is that, in countries that do not have an established and widespread culture of public mask wearing, there are far fewer masks in the system, and those were strip-mined early by panic buyers. So in most Western nations we're only just addressing the problem of getting masks to health-care providers--so the capacity to provide masks to citizens in useful quantities must still be some way off. And of course the human, technical and monetary resources tied up in ramping mask production would be removed from other potentially beneficial activities.
    For South Korea, there are huge public health differences--they were lucky enough to have an outbreak primarily in young people, they launched an early massive testing and contact-tracing programme, and they tracked the movements of their citizens using mobile phone data, issuing alerts if a person was approaching an area with known infections. So these are interventions that we can predict would impact the spread of an epidemic hugely. By contrast, any positive (or negative!) effect of the pubic mask thing seems like it's got to be down in the noise.
    So I guess I'd rather see resources applied first to the lessons from South Korea that are likely to have the largest impact.

    Grant Hutchison

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    Quote Originally Posted by grant hutchison View Post
    Setting aside the problem of sifting through the heterogeneous pile of poorly designed and not particularly applicable studies that form the evidence base for the mask debate, the obvious difficulty is that, in countries that do not have an established and widespread culture of public mask wearing, there are far fewer masks in the system, and those were strip-mined early by panic buyers. So in most Western nations we're only just addressing the problem of getting masks to health-care providers--so the capacity to provide masks to citizens in useful quantities must still be some way off. And of course the human, technical and monetary resources tied up in ramping mask production would be removed from other potentially beneficial activities.
    For South Korea, there are huge public health differences--they were lucky enough to have an outbreak primarily in young people, they launched an early massive testing and contact-tracing programme, and they tracked the movements of their citizens using mobile phone data, issuing alerts if a person was approaching an area with known infections. So these are interventions that we can predict would impact the spread of an epidemic hugely. By contrast, any positive (or negative!) effect of the pubic mask thing seems like it's got to be down in the noise.
    So I guess I'd rather see resources applied first to the lessons from South Korea that are likely to have the largest impact.
    The phone application was likely very wise to put into service. I agree with your assessment of their use of masks, which is common in other Asian countries, like Japan. It does make sense that their cultural experience also gives them inventory. I also heard S. Korea was quick to engage a lock-down, so this too does little to advance the mask use as a major benefit.
    We know time flies, we just can't see its wings.

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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.
    I imagine it varies from person to person, according to why they wear the mask. Bear in mind that mask wearing in the Far East had little to do with actual disease prevention, prior to the Current Unpleasantness, but was of largely cultural significance. Mask wearing communicated respect for others, it concealed the face, it was a fashion statement. There was actually no reason not to wear the same mask day after day.
    So if we want to wear masks, we should look at best practice for wearing masks in order to prevent the spread of disease, rather than try to tease a signal out of a culture that wears masks for other reasons.

    Grant Hutchison

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    Quote Originally Posted by Ken G View Post
    ...I suspect the real benefit [of masks] is not so much that it prevents you personally from getting the disease (it might help against getting a deadly viral load, that kind of data is slow in coming), but rather that it helps already infected people from spreading it.
    I'm convinced this is right and it's why I have ordered a couple gross of bandannas.
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    Quote Originally Posted by grant hutchison View Post
    I imagine it varies from person to person, according to why they wear the mask. Bear in mind that mask wearing in the Far East had little to do with actual disease prevention, prior to the Current Unpleasantness, but was of largely cultural significance. Mask wearing communicated respect for others, it concealed the face, it was a fashion statement.
    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.
    We know time flies, we just can't see its wings.

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    I’m seeing more articles on mask wearing. I have the impression lots of people will be wearing masks or mask substitutes soon whether it matters or not. If nothing else, it might make them feel better.

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    Quote Originally Posted by George View Post
    <snip>
    There are further reports about HCQ (hydroxychloroquine) that are encouraging in fighting Covid-19. I'm not in the medical field and the use of this drug is unproven on an appropriate level to be given as a normal prescription from doctors. Its use may even prove to be not worth the risk, and, as Dr. Oz notes that we need bigger clinical trials to determine “whether it’s the right way to go or the wrong way to go.”
    Call this prejudice if you wish, but I automatically ignore anything that Dr. Oz says; I think he is basically a snake oil salesman.

    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

    The millions of doses of chloroquine donated to the federal stockpile can now be used to treat COVID-19 patients. At the same time, pharmacists are concerned that prescribing the drug for the novel coronavirus has created shortages of the medication for patients with lupus and rheumatoid arthritis and raises questions about safety.
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    Quote Originally Posted by grant hutchison View Post
    I imagine it varies from person to person, according to why they wear the mask. Bear in mind that mask wearing in the Far East had little to do with actual disease prevention, prior to the Current Unpleasantness, but was of largely cultural significance. Mask wearing communicated respect for others, it concealed the face, it was a fashion statement. There was actually no reason not to wear the same mask day after day.
    So if we want to wear masks, we should look at best practice for wearing masks in order to prevent the spread of disease, rather than try to tease a signal out of a culture that wears masks for other reasons.

    Grant Hutchison
    Everyone wearing a mask has their own story, but some in Asia would wear them simply because of air pollution, which in parts of Asia can be really, really bad.
    A: "Things that are equal to the same are equal to each other"
    B: "The two sides of this triangle are things that are equal to the same"
    C: "If A and B are true, Z must be true"
    D: "If A and B and C are true, Z must be true"
    E: "If A and B and C and D are true, Z must be true"

    Therefore, Z: "The two sides of this triangle are equal to each other"

  29. #1439
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    Quote Originally Posted by grant hutchison View Post
    There are risks associated with mask wearing ... People just don't use masks properly without training--they touch their faces, they touch the insides of the mask, they reuse masks that are damp and have been allowed to rest on random surfaces. By doing so they undoubtedly increase their risk above the baseline achieved by social distancing.
    The evidence for risk reduction in social settings with social distance is slight and equivocal (see my link above), and on theoretical grounds it would seem that good mask use would make a very slight reduction in R0 compared to simple social distancing and good hand hygiene. The worry is that that might be offset by the risks of bad mask use, and mask reuse. ...
    You missed a risk.

    Quote Originally Posted by Van Rijn View Post
    I’m seeing more articles on mask wearing. I have the impression lots of people will be wearing masks or mask substitutes soon whether it matters or not. If nothing else, it might make them feel better.
    (emphasis addd)

    To me that is a significant downside to wearing a mask, a feeling of complacency. "I'm wearing a mask so I'm protected. I don't have to wash my hands, sanitize things, or keep my distance. I'm safe 'cause I'm wearing a mask."
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    Quote Originally Posted by grant hutchison View Post
    Setting aside the problem of sifting through the heterogeneous pile of poorly designed and not particularly applicable studies that form the evidence base for the mask debate, the obvious difficulty is that, in countries that do not have an established and widespread culture of public mask wearing, there are far fewer masks in the system, and those were strip-mined early by panic buyers.
    I completely agree, but the issue is, how can this problem be addressed? So far on the media I'm seeing, it has been more or less equally split between "here are ways to make your own masks", to "stop wearing masks" in all caps (that from the Surgeon General some time ago). So with zero strategic stress on addressing the problem of number of masks, not much is going to be done for quite awhile. It seems to me that instead, we need a huge stress on making more healthcare-rated masks, and also more out-on-the-street level of masks, which need not be of the same quality and need not take away from workers who desperately need high quality masks.
    And of course the human, technical and monetary resources tied up in ramping mask production would be removed from other potentially beneficial activities.
    Precisely the issue. Right now I'm hearing about enormous resources being used to make hundreds of thousands of ventilators, which makes sense because each ventilator, if needed, could save about 10 lives a year (based on the various statistics we're hearing). So a hundred thousand more ventilators could save a million lives, if they are needed. But that also implies millions will die, because for every life a ventilator saves, we are accepting that we have two deaths on our hands. That's the part no one is saying-- they seem to be ignoring the glaring fact that if we really ever need 200,000 more ventilators, it will mean we have completely failed to stop the epidemic and our efforts have been an abject failure even while South Korea has had complete success. So much for lots more ventilators!

    So even though that cannot be viewed as a successful strategy, we are setting out to make the ventilators all the same, because the hospitals need them to avoid wartime triage in the short run, and that's fine-- in the short run. But in the long run that's a disaster scenario. I'm saying let's look at the resources needed to make decent masks that could help in the long run by changing the culture now. We have lots of people sitting at home, with plenty of thread and cloth and time on their hands, so let's get the elastic bands out to those people and get them making their own masks to wear in public. That would not be much problem for resource allocation, and with proper information, the masks could be helpful to prevent the spread. They are used widely in South Korea, how bad could they be?
    For South Korea, there are huge public health differences--they were lucky enough to have an outbreak primarily in young people, they launched an early massive testing and contact-tracing programme, and they tracked the movements of their citizens using mobile phone data, issuing alerts if a person was approaching an area with known infections. So these are interventions that we can predict would impact the spread of an epidemic hugely. By contrast, any positive (or negative!) effect of the pubic mask thing seems like it's got to be down in the noise.
    That's just what isn't clear. I agree with you that we don't know how much of their amazing results comes from what intervention effort, but I would imagine a good general policy would be to do everything they are doing, minus whatever we are simply not capable of or find culturally unacceptable (in the US, for example, people hate government intervention of all kinds, but their attitudes about masks are being formed right now-- we literally don't have an attitude yet, other than what we are told about them either being useful or detrimental).
    So I guess I'd rather see resources applied first to the lessons from South Korea that are likely to have the largest impact.
    I'd rather see us do everything they are doing, it obviously works in total. And if your goal is to do everything, you always start with what's easiest.
    Last edited by Ken G; 2020-Apr-02 at 05:15 PM.

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