4 ms·

Yep, we ought to be evidence-based about everything we have done: travel bans, masks, respirators, distancing, plexiglass, closing businesses, forcing healthy k

by timr 5y ago

Yep, we ought to be evidence-based about everything we have done: travel bans, masks, respirators, distancing, plexiglass, closing businesses, forcing healthy kids to wear masks in schools, forcing everyone to get vaccinated, rubber gloves in the grocery store. All of it. So far, our track record isn't that great. The two RCTs for masks and Covid showed minimal (if not zero) effect [1], and you can barely say the results out loud lest you get silenced by the angry mob (as you can see from the color of this comment). I'm not hopeful. But please let me know when someone actually does an unbiased study of travel restrictions. I have yet to see one. The biggest tragedy of this pandemic is the number of people who are willing to substitute their (popular) opinions for evidence and call it "science". I guarantee that every response to this comment will be from someone asserting that "masks work", and linking to a paper that they haven't actually read, or worse: an editorial about papers they haven't read. Most people have literally no idea what the data is on any of this. [1] https://vinayprasadmdmph.substack.com/p/do-masks-reduce-risk-of-covid19-by https://vinayprasadmdmph.substack.com/p/do-masks-reduce-risk...

actually_a_dog 5y ago
That's incorrect. Here is a review of 19 RCTs showing that masks work: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7191274/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7191274/
- timr 5y ago
  This review says that none of the community mask trials showed a significant effect. It says that 3/6 studies on respirators in medical settings had no significant effect. It said that 3/5 studies for masks as source control showed no significant effect. Here's a review of every mask study ever performed: https://www.cato.org/working-paper/evidence-community-cloth-face-masking-limit-spread-sars-cov-2-critical-review https://www.cato.org/working-paper/evidence-community-cloth-... Here's a summary written by the same author, in case you're too busy to read 30,000 words: https://vinayprasadmdmph.substack.com/p/do-masks-reduce-risk-of-covid19-by https://vinayprasadmdmph.substack.com/p/do-masks-reduce-risk...
  - flunhat 5y ago
    Why is everyone you're referencing -- and for that matter, you too -- so damn hysterical? Vinay Prasad, case in point: > When democratically elected systems transform into totalitarian regimes, the transition is subtle, stepwise, and involves a combination of pre-planned as well as serendipitous events. Indeed, this was the case with Germany in the years 1929-1939, where Hitler was given a chance at governing, the president subsequently died, a key general resigned after a scandal and the pathway to the Fuhrer was inevitable. It's a mask & a vaccine, not the beginning of the Third Reich. The fact that your sources can't see the two as different things (and not as part of some slippery slope), tells me they've already arrived at a conclusion and will ignore all contrary evidence. I know masks & vaccines feel oppressive -- but facts simply do not concern themselves with your feelings. There is a world of difference between the Third Reich and public health measures to slow the tide of preventable deaths. To be honest, I can't believe I'm having this debate here.
    - spookthesunset 5y ago
      Humans are meant to see faces. Requiring people, including kids, to wear them for 8+ hours a day with absolutely no metric to get rid of them is insanity. Especially when said people are fully vaccinated. Vaccinated individuals have no business wearing a mask, period.
      - flunhat 5y ago
        I will repeat myself one more time: Facts simply do not concern themselves with your feelings. I know it feels like oppression (a new Third Reich!!111!) & like there is no metric to get rid of masks, but your feelings alone do not make these true statements. The fact -- and we should concern ourselves with facts, not vague feelings or bouts of hysteria -- is that all of these measures will go away once the pandemic has abated to such an extent that it no longer poses a substantial threat to human lives. It's as simple as that: given that masks do an excellent job of slowing the spread, ceteris paribus, wearing a mask is better than not wearing one. This kind of "feelings logic" is why Trump lost, more or less -- most people are willing to undergo mild inconvenience to save lives & slow the spread of a deadly virus. Despite the feelings of frustration, which we all have.
soperj 5y ago
https://med.stanford.edu/news/all-news/2021/09/surgical-masks-covid-19.html https://med.stanford.edu/news/all-news/2021/09/surgical-mask... There's one from Stanford & Yale that says they do.
- timr 5y ago
  Read the study, not a press release. It said quite explicitly that cloth masks had no effect, and surgical masks had an extremely minor overall effect (11.3% reduction in symptomatic seroprevalence), with an absolute effect size of 0.09%: https://www.poverty-action.org/sites/default/files/publications/Mask_RCT____Symptomatic_Seropositivity_083121.pdf https://www.poverty-action.org/sites/default/files/publicati...
  - actually_a_dog 5y ago
    11.3% reduction in the base of an exponential process is huge.
    - timr 5y ago
      Sure, but that is not what the study said, and not at all what the observed difference means. They found a tiny effect in symptomatic seroprevalence at a single point in time.
      - actually_a_dog 5y ago
        If 11.3% fewer people were infected overall up to that point in time, how many people are likely to be infected at T+1? 11.3%. It's not even a trick question.
        timr 5y ago
        But again, that's not what the study measured. You're extrapolating incorrectly. First, the study conflates distancing and mask-wearing. They admit this in the paper (there is a significant increase in distancing amongst the mask wearers). There is also a large change in the size of the populations that could easily swamp the effect size (i.e. the size of the mask population was something like 9% bigger than the control). Second, just because you observe effect size X at time T does not mean that you will see an equivalent effect at T+1. It also doesn't mean that you will see a compounding effect. In human terms: maybe you get a surge of behavior at the start of the intervention that doesn't continue, due to burnout or non-compliance. Or maybe you got lucky at time T, and randomly saw a population that yielded a result. You can't make the assumption.
Kkoala 5y ago
It's pretty clear at this point that restrictions and masks help reduce the spread. Of course it's another question how does that balance out in the longer term, e.g. how did the lockdowns affect the economy, or the mental and physical healtht of people.
- timr 5y ago
  Is it? Cite the evidence. Editorials and commentaries don't count. All of the good evidence (RCTs) on masks is extremely marginal, at best, and there hasn't been a single RCT I'm aware of that showed any effect of the other interventions. https://vinayprasadmdmph.substack.com/p/do-masks-reduce-risk-of-covid19-by https://vinayprasadmdmph.substack.com/p/do-masks-reduce-risk...
  - kevin_thibedeau 5y ago
    Surprisingly, masks with poor filtration underperform at filtering. Show a study that demonstrates the ineffectiveness of an N95.
    - cassonmars 5y ago
      Most people aren’t wearing N95s, and to my understanding, no jurisdiction has a mask policy that requires them.
      - freeflight 5y ago
        Right now FP2/N95 are the only masks allowed for adults in public transport/supermarkets in Bavaria Germany. Cloth or surgical mask are treated like wearing no mask at all, unless it's a child up to a certain age. Compliance in public transport and supermarkets is extremely high, pretty much never see any adult with just a mask, everybody wearing actual respirators.
      - eulenteufel 5y ago
        In a lot of places in Germany public transport was only restricted to using N95 masks. This summer in Berlin all the stores required N95 masks, as did universities. They have relaxed the rules since then and you can see in the recent infection statistics how that worked out for them.
flunhat 5y ago
> you can barely say the results out loud lest you get silenced by the angry mob Would you chill out? People are disagreeing with you & presenting evidence, not burning you at stake. When did everyone get so damn fragile??
- tenuousemphasis 5y ago
  I find that the sort of people who call others snowflakes end up being the biggest snowflakes of all.
  - flunhat 5y ago
    Yup -- projection, plain & simple
  - coolso 5y ago
    I find that the worst counter to being called a snowflake, is calling others a snowflake in return because they simply called you out on trying to silence opinions that aren't your own. Here we see the GP disappointed that every time he and others bring up salient points, they are silenced by an angry mob. It's a real stretch to call him the snowflake in this situation. Nobody calls people a snowflake for disagreeing, it's the way that traditional snowflakes disagree that people have a problem with.
js2 5y ago
> A large, randomized trial led by researchers at Stanford Medicine and Yale University has found that wearing a surgical face mask over the mouth and nose is an effective way to reduce the occurrence of COVID-19 in community settings. > The researchers enrolled nearly 350,000 people from 600 villages in rural Bangladesh. Those living in villages randomly assigned to a series of interventions promoting the use of surgical masks were about 11% less likely than those living in control villages to develop COVID-19, which is caused by infection with the SARS-CoV-2 virus, during the eight-week study period. The protective effect increased to nearly 35% for people over 60 years old. https://med.stanford.edu/news/all-news/2021/09/surgical-masks-covid-19.html https://med.stanford.edu/news/all-news/2021/09/surgical-mask... Earlier studies said there wasn’t sufficient evidence, not that masks aren’t effective: > Results: Fourteen studies were included in this study. One preclinical and 1 observational cohort clinical study found significant benefit of masks in limiting SARS-CoV-2 transmission. Eleven RCTs in a meta-analysis studying other respiratory illnesses found no significant benefit of masks (±hand hygiene) for influenza-like-illness symptoms nor laboratory confirmed viruses. One RCT found a significant benefit of surgical masks compared with cloth masks. > Conclusion: There is limited available preclinical and clinical evidence for face mask benefit in SARS-CoV-2. RCT evidence for other respiratory viral illnesses shows no significant benefit of masks in limiting transmission but is of poor quality and not SARS-CoV-2 specific. There is an urgent need for evidence from randomized controlled trials to investigate the efficacy of surgical and cloth masks on transmission of SARS-CoV-2 and user reported outcomes such as comfort and compliance. https://pubmed.ncbi.nlm.nih.gov/33565274/ https://pubmed.ncbi.nlm.nih.gov/33565274/ The cost of wearing a mask is basically zero when there is sufficient supply. While waiting to gather evidence, it seems like an easy low cost precaution while gathering evidence. Slate Star Code (March 2020): > Please don’t buy up masks while there is a shortage and healthcare workers don’t have enough. > If the shortage ends, and wearing a mask is cost-free, I agree with the guidelines from China, Hong Kong, and Japan – consider wearing a mask in high-risk situations like subways or crowded buildings. Wearing masks will not make you invincible, and if you risk compensate even a little it might do more harm than good. Realistically you should be avoiding high-risk situations like subways and crowded buildings as much as you possibly can. But if you have to go in them, yes, most likely a mask will help. https://slatestarcodex.com/2020/03/23/face-masks-much-more-than-you-wanted-to-know/ https://slatestarcodex.com/2020/03/23/face-masks-much-more-t...
freeflight 5y ago
The whole mask discourse has been heavily riddled with communication and terminology errors since the very beginning. A mask is not a respirator, yet the two of these are regularly confused not just in the public discourse, but were even confused in official messaging during the beginning of the pandemic. The WHO and health agencies the world over were suddenly asking people to "prioritize masks for at risk groups", which in some places was parsed as "no need to wear masks", as everybody was struggling to get medical masks, and particularly respirators, for the HCW treating infected patients.

by timr 5y ago

actually_a_dog 5y ago

That's incorrect. Here is a review of 19 RCTs showing that masks work: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7191274/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7191274/

timr 5y ago
This review says that none of the community mask trials showed a significant effect. It says that 3/6 studies on respirators in medical settings had no significant effect. It said that 3/5 studies for masks as source control showed no significant effect. Here's a review of every mask study ever performed: https://www.cato.org/working-paper/evidence-community-cloth-face-masking-limit-spread-sars-cov-2-critical-review https://www.cato.org/working-paper/evidence-community-cloth-... Here's a summary written by the same author, in case you're too busy to read 30,000 words: https://vinayprasadmdmph.substack.com/p/do-masks-reduce-risk-of-covid19-by https://vinayprasadmdmph.substack.com/p/do-masks-reduce-risk...
- flunhat 5y ago
  Why is everyone you're referencing -- and for that matter, you too -- so damn hysterical? Vinay Prasad, case in point: > When democratically elected systems transform into totalitarian regimes, the transition is subtle, stepwise, and involves a combination of pre-planned as well as serendipitous events. Indeed, this was the case with Germany in the years 1929-1939, where Hitler was given a chance at governing, the president subsequently died, a key general resigned after a scandal and the pathway to the Fuhrer was inevitable. It's a mask & a vaccine, not the beginning of the Third Reich. The fact that your sources can't see the two as different things (and not as part of some slippery slope), tells me they've already arrived at a conclusion and will ignore all contrary evidence. I know masks & vaccines feel oppressive -- but facts simply do not concern themselves with your feelings. There is a world of difference between the Third Reich and public health measures to slow the tide of preventable deaths. To be honest, I can't believe I'm having this debate here.
  - spookthesunset 5y ago
    Humans are meant to see faces. Requiring people, including kids, to wear them for 8+ hours a day with absolutely no metric to get rid of them is insanity. Especially when said people are fully vaccinated. Vaccinated individuals have no business wearing a mask, period.
    - flunhat 5y ago
      I will repeat myself one more time: Facts simply do not concern themselves with your feelings. I know it feels like oppression (a new Third Reich!!111!) & like there is no metric to get rid of masks, but your feelings alone do not make these true statements. The fact -- and we should concern ourselves with facts, not vague feelings or bouts of hysteria -- is that all of these measures will go away once the pandemic has abated to such an extent that it no longer poses a substantial threat to human lives. It's as simple as that: given that masks do an excellent job of slowing the spread, ceteris paribus, wearing a mask is better than not wearing one. This kind of "feelings logic" is why Trump lost, more or less -- most people are willing to undergo mild inconvenience to save lives & slow the spread of a deadly virus. Despite the feelings of frustration, which we all have.

soperj 5y ago

https://med.stanford.edu/news/all-news/2021/09/surgical-masks-covid-19.html https://med.stanford.edu/news/all-news/2021/09/surgical-mask... There's one from Stanford & Yale that says they do.

timr 5y ago
Read the study, not a press release. It said quite explicitly that cloth masks had no effect, and surgical masks had an extremely minor overall effect (11.3% reduction in symptomatic seroprevalence), with an absolute effect size of 0.09%: https://www.poverty-action.org/sites/default/files/publications/Mask_RCT____Symptomatic_Seropositivity_083121.pdf https://www.poverty-action.org/sites/default/files/publicati...
- actually_a_dog 5y ago
  11.3% reduction in the base of an exponential process is huge.
  - timr 5y ago
    Sure, but that is not what the study said, and not at all what the observed difference means. They found a tiny effect in symptomatic seroprevalence at a single point in time.
    - actually_a_dog 5y ago
      If 11.3% fewer people were infected overall up to that point in time, how many people are likely to be infected at T+1? 11.3%. It's not even a trick question.
      - timr 5y ago
        But again, that's not what the study measured. You're extrapolating incorrectly. First, the study conflates distancing and mask-wearing. They admit this in the paper (there is a significant increase in distancing amongst the mask wearers). There is also a large change in the size of the populations that could easily swamp the effect size (i.e. the size of the mask population was something like 9% bigger than the control). Second, just because you observe effect size X at time T does not mean that you will see an equivalent effect at T+1. It also doesn't mean that you will see a compounding effect. In human terms: maybe you get a surge of behavior at the start of the intervention that doesn't continue, due to burnout or non-compliance. Or maybe you got lucky at time T, and randomly saw a population that yielded a result. You can't make the assumption.

Kkoala 5y ago

It's pretty clear at this point that restrictions and masks help reduce the spread. Of course it's another question how does that balance out in the longer term, e.g. how did the lockdowns affect the economy, or the mental and physical healtht of people.

timr 5y ago
Is it? Cite the evidence. Editorials and commentaries don't count. All of the good evidence (RCTs) on masks is extremely marginal, at best, and there hasn't been a single RCT I'm aware of that showed any effect of the other interventions. https://vinayprasadmdmph.substack.com/p/do-masks-reduce-risk-of-covid19-by https://vinayprasadmdmph.substack.com/p/do-masks-reduce-risk...
- kevin_thibedeau 5y ago
  Surprisingly, masks with poor filtration underperform at filtering. Show a study that demonstrates the ineffectiveness of an N95.
  - cassonmars 5y ago
    Most people aren’t wearing N95s, and to my understanding, no jurisdiction has a mask policy that requires them.
    - freeflight 5y ago
      Right now FP2/N95 are the only masks allowed for adults in public transport/supermarkets in Bavaria Germany. Cloth or surgical mask are treated like wearing no mask at all, unless it's a child up to a certain age. Compliance in public transport and supermarkets is extremely high, pretty much never see any adult with just a mask, everybody wearing actual respirators.
    - eulenteufel 5y ago
      In a lot of places in Germany public transport was only restricted to using N95 masks. This summer in Berlin all the stores required N95 masks, as did universities. They have relaxed the rules since then and you can see in the recent infection statistics how that worked out for them.

flunhat 5y ago

> you can barely say the results out loud lest you get silenced by the angry mob Would you chill out? People are disagreeing with you & presenting evidence, not burning you at stake. When did everyone get so damn fragile??

tenuousemphasis 5y ago
I find that the sort of people who call others snowflakes end up being the biggest snowflakes of all.
- flunhat 5y ago
  Yup -- projection, plain & simple
- coolso 5y ago
  I find that the worst counter to being called a snowflake, is calling others a snowflake in return because they simply called you out on trying to silence opinions that aren't your own. Here we see the GP disappointed that every time he and others bring up salient points, they are silenced by an angry mob. It's a real stretch to call him the snowflake in this situation. Nobody calls people a snowflake for disagreeing, it's the way that traditional snowflakes disagree that people have a problem with.

js2 5y ago

> A large, randomized trial led by researchers at Stanford Medicine and Yale University has found that wearing a surgical face mask over the mouth and nose is an effective way to reduce the occurrence of COVID-19 in community settings. > The researchers enrolled nearly 350,000 people from 600 villages in rural Bangladesh. Those living in villages randomly assigned to a series of interventions promoting the use of surgical masks were about 11% less likely than those living in control villages to develop COVID-19, which is caused by infection with the SARS-CoV-2 virus, during the eight-week study period. The protective effect increased to nearly 35% for people over 60 years old. https://med.stanford.edu/news/all-news/2021/09/surgical-masks-covid-19.html https://med.stanford.edu/news/all-news/2021/09/surgical-mask... Earlier studies said there wasn’t sufficient evidence, not that masks aren’t effective: > Results: Fourteen studies were included in this study. One preclinical and 1 observational cohort clinical study found significant benefit of masks in limiting SARS-CoV-2 transmission. Eleven RCTs in a meta-analysis studying other respiratory illnesses found no significant benefit of masks (±hand hygiene) for influenza-like-illness symptoms nor laboratory confirmed viruses. One RCT found a significant benefit of surgical masks compared with cloth masks. > Conclusion: There is limited available preclinical and clinical evidence for face mask benefit in SARS-CoV-2. RCT evidence for other respiratory viral illnesses shows no significant benefit of masks in limiting transmission but is of poor quality and not SARS-CoV-2 specific. There is an urgent need for evidence from randomized controlled trials to investigate the efficacy of surgical and cloth masks on transmission of SARS-CoV-2 and user reported outcomes such as comfort and compliance. https://pubmed.ncbi.nlm.nih.gov/33565274/ https://pubmed.ncbi.nlm.nih.gov/33565274/ The cost of wearing a mask is basically zero when there is sufficient supply. While waiting to gather evidence, it seems like an easy low cost precaution while gathering evidence. Slate Star Code (March 2020): > Please don’t buy up masks while there is a shortage and healthcare workers don’t have enough. > If the shortage ends, and wearing a mask is cost-free, I agree with the guidelines from China, Hong Kong, and Japan – consider wearing a mask in high-risk situations like subways or crowded buildings. Wearing masks will not make you invincible, and if you risk compensate even a little it might do more harm than good. Realistically you should be avoiding high-risk situations like subways and crowded buildings as much as you possibly can. But if you have to go in them, yes, most likely a mask will help. https://slatestarcodex.com/2020/03/23/face-masks-much-more-than-you-wanted-to-know/ https://slatestarcodex.com/2020/03/23/face-masks-much-more-t...

freeflight 5y ago

The whole mask discourse has been heavily riddled with communication and terminology errors since the very beginning. A mask is not a respirator, yet the two of these are regularly confused not just in the public discourse, but were even confused in official messaging during the beginning of the pandemic. The WHO and health agencies the world over were suddenly asking people to "prioritize masks for at risk groups", which in some places was parsed as "no need to wear masks", as everybody was struggling to get medical masks, and particularly respirators, for the HCW treating infected patients.