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I have seen two vaccinated patients who got sick enough to come to the hospital out of a BUNCH of unvaccinated people who got sick enough to show up. At first, I intended to keep a tally in order to put some vague numbers together, but it has been so lop-sided that I didn't bother. I have no idea what the vaccine does for risk of transmitting the virus, and I admit that I have no understanding of the transmission dynamics of COVID-19. A buddy (another hospitalist) and I commuted to work every day in his wife's compact car, I was already sick with something that wasn't COVID, and he got sick. His wife made him get tested and sure enough he had COVID. I got tested again and was STILL negative (my 4th negative test during that illness).

I sat in a tiny enclosed space, sick with a NASTY upper respiratory infection, coughing on a guy with COVID for 8 15 minute drives and still never got it.

ScottDLS wrote: ↑Wed Aug 05, 2020 2:47 pm The explanation that we always hear seems to be: It helps block the expulsion of respiratory droplets (i.e. spit and snot/sputum & mucous) from a cough or sneeze of an asymptomatic infected person (if they're asymptomatic, how come they're coughing and sneezing...anyway).

That's the explanation. The data is deeply divided on how infectious asymptomatic carriers are, and the latest guidance from the CDC says that people who haven't had symptoms in 10 days are probably not contagious. Every single part of this is governed by statistics: you aren't producing an absolute result with some combination actions or failures to act, but moving yourself to a different part of a statistical curve. Come to think of it, that's just life.

OK, how about not coughing or sneezing on other people in public, or alternatively, doing so into a handkerchief or towel, rather than wearing one on yourface attached with rubber bands? How about during normal respiration? Are there really that many droplets expelled? How far do they travel and how long to they remain in the air? Why does the mask only work when the "other guy" wears one? So your walking down the chips aisle at Wal-Mart and along comes this non-mask wearing guy going the wrong way against the painters' tape arrows on the floor. But! You have a cheap Chinese made faux surgical dust mask on that you just bought at the same store. So for the 1/3 sec that it takes to run away from the people seeking viral missiles of respiratory pathogens that he is expelling with every breath, you breathe IN through your mask. The drops must be a lot more diffuse than they were coming out of his mouth. So why would it only work if "the other guy" wears a mask? If you are concerned about the unmasked, why wouldn't YOU wear one? Better yet, a good one like an N95?.

If you look at the last link that I posted, it has a phenomenal diagram explaining this exact phenomenon and why the difference matters. First, in the setting of a true airborne pathogen (let's take measles as an example), you could care less about the guy coughing on you because you've been vaccinated. But let's say it's 1925: no mask that you can get is going to save you, even if you and your WalMart aisle-buddy both double up. However, because COVID is a spread via respiratory droplets, i.e. much larger droplets of water which sink to the earth far more quickly, the requirements for sealing your airways off are greatly relaxed. Surgeons don't wear N95s during surgery UNLESS they are doing something which is known to produce airborne particles that they don't want to breathe (I'm not going to mention the common example because it's not pretty, but it involves lasers). The don't wear regular masks during most surgeries because they are afraid of spending money (an N95 is like $2) or because they don't care about their patients: they wear regular masks because they get the job done. If a new LTC started talking about how he would only carry a 10mm or a .500 S&W, unless he happened to live in Alaska, he would probably be advised that matching the tool to the task at hand is universally wise. Same principle.

If you are in close proximity to people who are actively coughing without masks, then yes, an N95 is a good idea. As I mentioned, my solution is to wear an N95 when I cannot control my surroundings and to wear a cloth mask and socially distance when I can. That has worked so far, hopefully it continues to do so. YMWV.

No no, better to make everyone ELSE wear an ineffective virtue signalling placebo like a dirty bandanna or coffee filter strapped to their face with rubber bands. It's about control and making people obey

I think that there is almost certainly an element of control, and I think that you are completely missing it. The lockdowns have a very thin (if any) basis in the law, but every level of government is pushing ahead with them anyway. As grayling pointed out, those measures are costing lives and livelihoods that aren't being counted with any great accuracy. Wearing a mask, keeping a fathom between you and the folks near you and washing your hands is a way to completely undermine that power grab. It eliminates the immediate threat that is causing fearful people to surrender to overreaches and it can (and should) be completely voluntary.

When the common people rise up to fix a problem, the government can't claim that it has to. When they refuse to do so, they get scared and beg <Insert Favorite Dictator Here> to come save them.

One area I am a bit stumped on is the N95 and equivalents, especially with healthcare providers and to a lesser degree the general public. There seems to be a much larger consensus on the efficacy of the N95. Despite this, Dr. Fauci is wearing what seems to be a bit more expensive cloth face mask (albeit on the mound and not particularly in the stands around others). Is the National Institute of Allergy and Infectious Diseases so cash strapped that they could not get him a N95.
I realize there are optics and politics involved. When I talk to many healthcare workers they wear a N95 while working but cloth face mask at all other times. Why not wear the most effective tool in the arsenal at all times?
Just a question that has me stumped.

I only wear an N95 when I am at work and cannot control how close I need to be while examining coughing people with COVID 19. Any other time, I wear regular cloth face masks.

In truth, I am not sure we should be trying to slow it but that is another debate.

There isn't a way to answer this question, essentially "Is Sweden correct?" until we have data on the safety and efficacy of the vaccine(s), which will come out piecemeal of the course of YEARS. If the vaccines prove to be universally poor, then Sweden's strategy is the only correct one. If any of the vaccines proves to be safe and effective, then Sweden killed people for no reason We have no idea right now.

This is based on the masks the media and government are asking for and how they want them worn. First rule is that a mask must be airtight if it is to protect a wearer from any airborne virus particles.

You're correct, but the key error in your thought process is in assuming that COVID-19 is an airborne infection. It is not. It is spread via respiratory droplets, which are far easier to stop than aerosols (AKA airborne). https://thescrubnurse.com/airborne-vs-d ... fferences/ basic, from an OR nurse perspective. Our head ID guy explained it during a conference a:s "one coughing person with measles or TB would infect half of the (200 person conference) room. One person with COVID 19 would infect the 10-20 people around them." If COVID were airborne, everyone would have it by now and there would be no point in any kind of mask. We are fortunate that it is transmitted via droplets against with commonly available cloth and surgical masks are effective. When I am seeing patients, I wear an N95. When I am out and about, I stay back from folks and wear a cloth mask.

I'm going to chime in and add that every "scientific study" has some sort of bias and assumption made to link cause and effect together in simple terms to persuade people to go in a certain direction. In reality, things have gotten far more complicated than it was decades ago.

You raise a valid point. Scientific studies are absolutely biased to some extent, even when the authors try their very best to avoid it. I am a physician: a big part of my job is sifting through scientific papers funded by drug companies which have a very clear motive (telling me that the new, expensive drug is amazing). That does not mean that the studies have no utility, just that there is implicit bias. The only solution is to look at the data, not at the conclusions (which are, necessarily opinion), and certainly not at a journalist's interpretation of the conclusions. In the case of masks and handwashing, the theoretical observational, and epidemiological data is very clear in favor of masks and handwashing.

I posted a long discussion of a JAMA article maybe 2 years ago on a decline in gun injuries during the NRA convention, in which the authors' clear intent was to paint all gun owners, even seemingly experienced ones, as unsafe. Instead, they accidentally published the single most pro-gun study in decades in a premier US medical journal. Their data solidly proved the fact that guns cause 20-40x fewer injuries among insured people vs such things as balconies, chairs and non-powered garden implements (extrapolated data was something like 4500 firearm injuries per year vs 120,000-200,000 for common household items). That study was quite possibly more important to our cause as supporters of the 2A than the data showing how law-abiding LTC holders are, and that was the EXACT OPPOSITE of the authors' intent.

In reality, things have gotten far more complicated than it was decades ago. I'm going to use hand washing as an example. It is a scientific fact that washing your hands is better than not washing your hands, right? Maybe. I never said what you are washing your hands with. It could be plain water. It could be soap and water. It could be washing them in a bucket of radioactive filth. OK, let's assume it's one of the first two. Are you drying your hands with a towel or an air dryer? The air dryer is supposedly more sanitary, but not if you didn't use soap. In which chase, you are better off using a towel and not spreading your germs all over the place. Now what happens afterwards? Let's say you were in a public restroom. Did you just touch the door handle to exit? That is the most viral surface in any part of a public bathroom. You may as well have skipped hand washing just like half the people do.

Ultimately, it gets complicated. Masks too. People are more likely to touch their faces to put on, adjust, and take off their masks. Masks are probably dirty and filthy too. But under the right circumstances, it can also help in case you have spit talkers nearby. It will also keep people from touching their lips or noses (like the Band-Aid effect). Also, maybe the people who are willing to wear masks are more likely to have good hygiene in general, leading to lower infection rates than those who don't wear masks. That would be an example of correlation without causation.

Technique is important, but we aren't there yet. We haven't made it to muzzle control and trigger discipline because we haven't cleared the "don't randomly run downrange" hurdle yet. There are people who have their noses hanging out of their masks and folks who believe that exam gloves confer some kind of magical protection from germs. Epidemiology studies have to take into account the mask-saggers and the magic glove believers, but they still find a benefit. It is VERY difficult to prove causation in that kind of study (though Florida Man is doing his best to show us what a no-mask control group looks like), so we combine that with basic science studies showing how many viral particles a simple mask actually blocks (it reduced the risk/amount of particles by 95% in two of the studies on that list).

With that in mind, it is insanely easy to come up with studies to show that masks are terrible or that masks are life savers. So what's the truth?

https://www.acpjournals.org/doi/10.7326/M20-1342

They published this and then retracted it because the PCR quantities that they used to say "the virus is there or not there" were below what their lab technique could accurately characterize. If you trickle a few flakes powder into a digital scale accurate to +/- 0.5 grain (buy a better scale, they aren't expensive) and the scale reads 64.2 before and 64.5 after, you cannot say from the readout whether you have actually added any powder. The authors in this study said "well the number is different, so I bet something happened. But let's ignore that fatal error and just take their findings as valid (though they aren't). The issue is that they measured petri dishes 8" from the faces of people with COVID who coughed 5 times and then found the virus on the outer surface of the mask and on the petri dish (sometimes). By itself, this is an interesting finding, and it reinforces my behavior of wearing a fitted N95 with a surgical mask over it while seeing COVID patients and particularly if they're coughing, but it doesn't have much to do with the discussion here. Specifically, the study shows that if you refuse to wear a mask AND place your face 8" from the face of an actively coughing, mask-wearing, infectious COVID carrier, you are likely to contract the virus. This reinforces the "don't hold your face 8" from someone else's unless you're on VERY good terms rule, which applies even when there isn't a pandemic (call that "social distancing" or just "manners"). It also points out that even if other folks wear masks, you should as well.

Grayling813 wrote: ↑Tue Aug 04, 2020 11:06 am

MaduroBU wrote: ↑Tue Aug 04, 2020 10:36 am Masks help. How much masks help or when they help is matter of debate, and the differences between a circumstance where "my mask kept me from getting/passing along COVID" and "my mask was a nuisance that did nothing" are hard to spot. Unless you have perfect, real-time data not only of COVID carriers but also of the state of surrounding viral particles integrated into a real-time map of the fluid dynamics of the air surrounding all of those people (in which case you should immediately volunteer your services to the CDC), you CANNOT know when wearing a mask is saving a life and when it's a hassle. Anyone who carries a gun for safety (I assume most of us) but fails to wear a mask is displaying a startling failure to appreciate risks akin to living in a fallout shelter while failing to properly ventilate it.

You can ignore gun safety rules and probably not shoot anyone. You can leave your finger on the trigger, sweep people, shoot at marginal backstops and assume that guns are empty and the vast majority of the time, those behaviors won't result in a fatality or injury. However, the extreme harm associated with having a piece of lead/copper forcibly inserted into a human body is such that adopting safety measures which only rarely prevent prevent harm (i.e. vs behaving unsafely) means that safe behavior is still worthwhile. The cost of safe firearm handling is minimal, but the benefit is both enormous and unpredictable. Likewise, the cost of wearing a mask is minimal but the benefit is enormous.

Masks are more effective if the potential spreader wears it, and we are all potential carriers. You don't know if you have COVID, and neither do I. If you know today, you don't know tomorrow or next week. Much like gun safety, you are more likely to save another life than your own, and we all depend upon one another to gain that benefit. If the guy in the lane next to you is a moron and accidentally shoots you, wearing a vest to the range might save your life, but it would be far better if he were simply trained, careful and safe (i.e. not shooting you at all).

Please don't make me call your family to tell them that I can't do anything more and to pray. Please don't make me call someone else's family to tell them that I can't do anything more and to pray. It's miserable for me and it's far worse for the people who don't get to see someone they love ever again.

bull....total bull. Equating wearing masks when experts can't agree that it even helps to gun safety which everyone agrees prevents injuries/deaths.

To be clear, I'm not equating them; I am saying that wearing a mask until we have herd immunity is orders of magnitude more important. The odds that you ever draw your carry weapon in self defense pales in comparison to the odds that wearing a mask protects you or someone else. The agreement of experts is WHOLLY IRRELEVANT. The opinions of scientists are merely opinions; only reproducible data and well-reasoned interpretation thereof are science. The science universally shows that wearing a mask and washing your hands drastically reduces (50-94% reduction) the two principal means of spreading COVID or any other respiratory virus. Feel free to work your way down the list, as most of the articles are free: https://pubmed.ncbi.nlm.nih.gov/?term=m ... d+efficacy. Don't listen to what the news networks say that the expert say (the news networks are completely useless for this because they 1) never understand the science and 2) always have at least one axe to grind), but instead look at their data directly. Listening to FOX and CNN to learn what "experts" say about ANY kind of science say is akin to learning firearm handling from Die Hard.

Do you have any scientific evidence showing that following Cooper's Rules saves lives? I don't, but I'm still willing to follow them on the (unfounded) belief that they almost certainly keep people safe. So if we are willing to do something for the sake of safety for which we have no evidence, how could we refuse to do something for the sake of safety which has been repeatedly shown to stop the spread of a virus that has killed more than 150,000 Americans?

Masks help. How much masks help or when they help is matter of debate, and the differences between a circumstance where "my mask kept me from getting/passing along COVID" and "my mask was a nuisance that did nothing" are hard to spot. Unless you have perfect, real-time data not only of COVID carriers but also of the state of surrounding viral particles integrated into a real-time map of the fluid dynamics of the air surrounding all of those people (in which case you should immediately volunteer your services to the CDC), you CANNOT know when wearing a mask is saving a life and when it's a hassle. Anyone who carries a gun for safety (I assume most of us) but fails to wear a mask is displaying a startling failure to appreciate risks akin to living in a fallout shelter while failing to properly ventilate it.

You can ignore gun safety rules and probably not shoot anyone. You can leave your finger on the trigger, sweep people, shoot at marginal backstops and assume that guns are empty and the vast majority of the time, those behaviors won't result in a fatality or injury. However, the extreme harm associated with having a piece of lead/copper forcibly inserted into a human body is such that adopting safety measures which only rarely prevent prevent harm (i.e. vs behaving unsafely) means that safe behavior is still worthwhile. The cost of safe firearm handling is minimal, but the benefit is both enormous and unpredictable. Likewise, the cost of wearing a mask is minimal but the benefit is enormous.

Masks are more effective if the potential spreader wears it, and we are all potential carriers. You don't know if you have COVID, and neither do I. If you know today, you don't know tomorrow or next week. Much like gun safety, you are more likely to save another life than your own, and we all depend upon one another to gain that benefit. If the guy in the lane next to you is a moron and accidentally shoots you, wearing a vest to the range might save your life, but it would be far better if he were simply trained, careful and safe (i.e. not shooting you at all).

Please don't make me call your family to tell them that I can't do anything more and to pray. Please don't make me call someone else's family to tell them that I can't do anything more and to pray. It's miserable for me and it's far worse for the people who don't get to see someone they love ever again.