Another really good and credible thread on how to prevent covid transmission

[grabachair]

Thank you, this is really forcing me to dig in and do some harder research. I was a bit lazy with Google prior, but now we're going to do it right.

1. I am wiling to concede that masks may not be pyshologically harmful, but you skipped over the psychological harm. I'd love to get your take there.
2. The benefits are still probably not what you think they are - I would contend they are not there at all. Here are some solid studies and meta-analyses going back more than a decade. Check it out:

Jacobs, J. L. et al. (2009) “Use of surgical face masks to reduce the incidence of the common cold among health care workers in Japan: A randomized controlled trial,” American Journal of Infection Control, Volume 37, Issue 5, 417 – 419. https://www.ncbi.nlm.nih.gov/pubmed/19216002

N95-masked health-care workers (HCW) were significantly more likely to experience headaches. Face mask use in HCW was not demonstrated to provide benefit in terms of cold symptoms or getting colds.

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Cowling, B. et al. (2010) “Face masks to prevent transmission of influenza virus: A systematic review,” Epidemiology and Infection, 138(4), 449-456. https://www.cambridge.org/core/journals ... ystematic- review/64D368496EBDE0AFCC6639CCC9D8BC05

None of the studies reviewed showed a benefit from wearing a mask, in either HCW or community members in households (H). See summary Tables 1 and 2 therein.
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bin-Reza et al. (2012) “The use of masks and respirators to prevent transmission of influenza: a systematic review of the scientific evidence,” Influenza and Other Respiratory Viruses 6(4), 257–267. https://onlinelibrary.wiley.com/doi/epd ... 11.00307.x

“There were 17 eligible studies. … None of the studies established a conclusive relationship between mask/respirator use and protection against influenza infection.”
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Smith, J.D. et al. (2016) “Effectiveness of N95 respirators versus surgical masks in protecting health care workers from acute respiratory infection: a systematic review and meta-analysis,” CMAJ Mar 2016 https://www.cmaj.ca/content/188/8/567

“We identified six clinical studies … . In the meta-analysis of the clinical studies, we found no significant difference between N95 respirators and surgical masks in associated risk of (a) laboratory-confirmed respiratory infection, (b) influenza-like illness, or (c) reported work-place absenteeism.”
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Radonovich, L.J. et al. (2019) “N95 Respirators vs Medical Masks for Preventing Influenza Among Health Care Personnel: A Randomized Clinical Trial,” JAMA. 2019; 322(9): 824–833. https://jamanetwork.com/journals/jama/f ... le/2749214

“Among 2862 randomized participants, 2371 completed the study and accounted for 5180 HCW-seasons. ... Among outpatient health care personnel, N95 respirators vs medical masks as worn by participants in this trial resulted in no significant difference in the incidence of laboratory-confirmed influenza.”
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Long, Y. et al. (2020) “Effectiveness of N95 respirators versus surgical masks against influenza: A systematic review and meta-analysis,” J Evid Based Med. 2020; 1- 9. https://onlinelibrary.wiley.com/doi/epd ... jebm.12381

“A total of six RCTs involving 9,171 participants were included. There were no statistically significant differences in preventing laboratory-confirmed influenza, laboratory-confirmed respiratory viral infections, laboratory-confirmed respiratory infection, and influenza-like illness using N95 respirators and surgical masks. Meta-analysis indicated a protective effect of N95 respirators against laboratory-confirmed bacterial colonization (RR = 0.58, 95% CI 0.43-0.78). The use of N95 respirators compared with surgical masks is not associated with a lower risk of laboratory-confirmed influenza.”



Start with these and let me know what you think. Setting aside the question of psychological effects for the moment, if there aren't any medical benefits or drawbacks to masking, then we're really just talking about theatre and virtue signaling, aren't we?

[RikkiTikkiTavi]

Okay.... (takes off gloves)....

Glad to look at some science, but the ground rules have to remain consistent. Previously you have discounted meta-analysis (studies that looked at multiple studies) in my sources, so I am going to have to discount them in yours. Fair is fair and we don't want to be moving the goal posts.

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Jacobs, J. L. et al. (2009) “Use of surgical face masks to reduce the incidence of the common cold among health care workers in Japan: A randomized controlled trial,” American Journal of Infection Control, Volume 37, Issue 5, 417 – 419. https://www.ncbi.nlm.nih.gov/pubmed/19216002
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1. "Thirty-two health care workers completed the study..." This is an incredibly small study and as such does not hold much weight.

2. "Presence of a cold was determined based on a previously validated measure of self-reported symptoms..." Self reporting is not considered as credible as actual testing.

3. "Of the 8 symptoms recorded daily, subjects in the mask group were significantly more likely to experience headache during the study period..." Interesting, but again, self reported and also what were the other factors influencing headaches? The study was not looking for this and what this should do is cause another study to find out if mask wearing causes headaches. We cannot say this was a conclusion of the study because it was not set up to search for this - in other words, not enough controls for any conclusions to be drawn. We see correlation, but need another study to identify causation.

4. "Subjects living with children were more likely to have high cold severity scores over the course of the study...." Colds have a different transmission route than Covid in that they are not as airborne and very much a 'touch' based kind of virus. Living with children - ! at home where you would not be wearing a mask! is going to give you a cold.

This is a meta-study
Cowling, B. et al. (2010) “Face masks to prevent transmission of influenza virus: A systematic review,” Epidemiology and Infection, 138(4), 449-456. https://www.cambridge.org/core/journals ... ystematic- review/64D368496EBDE0AFCC6639CCC9D8BC05

The link did not work for me.

This is a meta-study
bin-Reza et al. (2012) “The use of masks and respirators to prevent transmission of influenza: a systematic review of the scientific evidence,” Influenza and Other Respiratory Viruses 6(4), 257–267. https://onlinelibrary.wiley.com/doi/epd ... 11.00307.x

Meta-studies allow us to cherry pick finding. You chose your finding, so here is mine:
"Eight of nine retrospective observational studies found that mask and ⁄ or respirator use was independently associated with a reduced risk of severe acute respiratory syndrome (SARS)." This (SARS) is the Covid class of virus.

This is a meta-study
Smith, J.D. et al. (2016) “Effectiveness of N95 respirators versus surgical masks in protecting health care workers from acute respiratory infection: a systematic review and meta-analysis,” CMAJ Mar 2016 https://www.cmaj.ca/content/188/8/567

This is actually comparing one mask against another and finding they were comparable - it was not studying the effectiveness of masks - just whether one type of mask was better than another.

At last - an actual randomized study!
Radonovich, L.J. et al. (2019) “N95 Respirators vs Medical Masks for Preventing Influenza Among Health Care Personnel: A Randomized Clinical Trial,” JAMA. 2019; 322(9): 824–833. https://jamanetwork.com/journals/jama/f ... le/2749214

I don't think you understand the findings : “Among outpatient health care personnel, N95 respirators vs medical masks as worn by participants in this trial resulted in no significant difference in the incidence of laboratory-confirmed influenza.”

This is not studying whether the masks are effective in preventing the infection - this is merely showing whether there is a difference between the two masks.

This is a meta-study
Long, Y. et al. (2020) “Effectiveness of N95 respirators versus surgical masks against influenza: A systematic review and meta-analysis,” J Evid Based Med. 2020; 1- 9. https://onlinelibrary.wiley.com/doi/epd ... jebm.12381

Here again, the purpose of the study: "We aimed to assess the effectiveness of N95 respirators versus surgical masks for prevention of influenza by collecting randomized controlled trials (RCTs)"

Did not evaluate the effectiveness of the masks as a preventative - merely whether one type of mask was better than another.

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Okay, so you have just two studies that are not meta-studies. Of those one was very small and relied on self reporting of symptoms. The controls were poorly set up with some subjects having children at home who were apparently high risk vectors for disease (the cold). Cold viruses transmit differently than Covid - so this study is not conclusive. Also the headaches reported were not in the study design, so cherry picking this result - when the study has no controls for this result - is not good science.

The other study just showed that both masks seemed equal in effectiveness - not that they were ineffective.

you skipped over the psychological harm. I'd love to get your take there.

Okay, the 'proof' you mentioned in another post turned out to be just the subjective comments of the article writer - so there is not study for us to draw from.

However, here is my take on psychological issues with mask wearing.

It is all about initial perception and resistance.

Initially we may see things as stressful. Someone who wears a mask looks different. This may at first cause alarm and confusion. So yes, at first a person may have more stress in this type of situation.

But humans are quite capable of accommodation to new stimuli - in other words, we quickly adapt and the stimulus no longer produces the same response. Within a very short time there is no stress produced when seeing someone wearing a mask. This happens in a matter of days.

But also - we live in a contentious society - we can manipulate responses by crafting a 'bogeyman' out of things. So in a situation where a person is hearing that a mask is 'dangerous' - we can influence the person to develop a 'fear' and raise the stress level. There was one horrible study done where a child was influenced to be afraid of a white lab rat. The study was set up such that the child's initial slight nervousness was exacerbated until it was frank fear. They then went on to agitate the child further until he was fearful of anything white. The study was supposed to show that phobias could be acquired - and it did that - but mostly it showed the complete inhumanity of the person running the study.

So, we know we can make masks a problem just by focusing people's fears on the mask. Thus there are people out there who are now afraid that masks - (the ones that surgeons wear for hours in surgeries without any negative effect) - those masks cause hypoxia, headaches, and stress. You put a mask on a person who has developed that phobia and they will experience shortness of breath - get a headache - and feel stress. It is not the mask causing this - it is the conditioning.

Do masks help people avoid SARS infections - yes they do - you can debate if 11-22% effectiveness is enough - but the well run study that proves this shows that masks do help.

You have yet to show a single study that has proven that masks cause harm.

Now as far as virtue signaling - it goes both ways. Yes, we have seen a lot of mask wearing 'virtue signalling' especially by politicians who wear a mask for photo ops but then are seen not wearing a mask in real situations. Hypocrisy never looks good.

But there is another type of 'virtue' signalling - the 'I am not wearing a mask and you are WRONG and a COWARD and STUPID if you wear one'. Oh, I see that one all the time in areas where the 'mood' is such that either the majority think that Covid is a hoax... Covid is just a 'cold'... Covid is being used to rob me of my liberties...

Neither type of virtue signalling is appropriate. Strong arming people is not the answer.

We are in a very precarious place in regards to Covid. Many people have died. Science is far behind the curve in giving us much useful information. The prevention methods are not perfect. You can do all the 'right things' and still get Covid and die. But mostly it is people doing all the wrong things who get Covid and die.

Vaccines are only effective for a short time. The virus itself is morphing all the time which will eventually render all previous vaccination invalid. Herd immunity only works if the virus stays the same.

But also, to be fair, the virus can change to become less deadly. Hopefully that is what is happening right now with the Omicron variant.

What I am personally doing is creating habits that will protect me against this type of virus. My wearing a mask and washing my hands and avoiding crowded indoor spaces and using social distancing - this is for me going to be the way. It hurts no one. It has scientifically proven positive benefits for me - and also for others since I am reducing my 'vector for disease' contribution to humanity.

You live your life the way you think best. Wear a mask or not. Wash your hands or not. Share spit particles with close contact with others or not. I am not going to shame you for your choices. I may shake my head in private, but I do that a lot already.

But also - learn a little more what constitutes a good scientific study. Keep reading and researching. Learning how to read actual studies is not that hard and you can learn a lot of things that the 'news' will never tell you.

[grabachair]

Thank you for the detailed response! I think we have reached “agree to disagree” territory on masks, but share a lot of the same ideas around lowering risks being a good thing; my risk calculation and yours are just calibrated differently.

Good discussion. Let’s do it again sometime!

[Tanagra]

I live in Japan. It continues to do well, and an article was recently posted in The New York Times, so of course behind a paywall. So of course well...

What Japan Got Right About Covid-19
Jan. 24, 2022
Credit...Issei Kato/Reuters

By Hitoshi Oshitani

Dr. Oshitani is a professor of virology at Tohoku University Graduate School of Medicine in Japan. He has helped advise the Japanese government on its Covid-19 response.

It all began with the coronavirus outbreak on a Diamond Princess cruise ship back in February 2020.

Nine health care workers and quarantine officers who were responding to the outbreak on the ship in Japan became infected. An official report suggested that they had most likely been infected through contact with infectious droplets and contaminated surfaces. But as an expert investigating respiratory infections, I had my doubts. These were people experienced in infection control and prevention procedures, and it was difficult to believe that not one, not two, but nine of them failed to wash their hands properly. While this was still in the very earliest days of the pandemic, it seemed possible that the coronavirus was spreading in some other way than through large droplets.

Then a report revealed that a traveler from China who visited Germany spread the coronavirus to other people despite not having symptoms at the time. This report confirmed what I and colleagues helping Japan’s Ministry of Health respond to Covid-19 had speculated: That the coronavirus was being spread by people who were asymptomatic or hadn’t developed symptoms yet.

At that point, we had to consider whether aerosols — tiny infectious particles or droplets suspended in the air — were playing a role in how the coronavirus was spreading. This wouldn’t be a surprise. In 2017, a World Health Organization report discussed the critical role that aerosol transmission played in the spread of the flu. Why couldn’t it be the same for Covid-19, a similar respiratory illness?

Japan’s unique way of contact tracing also gave us more clues into how the virus spread. While other countries focused on prospective contact tracing, in which contact tracers identify and notify infected people’s contacts after they are infected, we used retrospective contact tracing. This is an approach where tracers identify an infected person and look back to figure out when and where that person was infected and who else might have been infected simultaneously with them.

This approach turned out to be critical as we learned that the coronavirus was being spread predominantly by small numbers of infected individuals who then go on to seed super-spreading events. My research colleague Hiroshi Nishiura calculated that a majority of cases were most likely coming from infected people in closed, indoor environments. More data from public health centers in Japan confirmed that most Covid-19 clusters occurred in close-contact indoor settings, such as dinners, night clubs, karaoke bars, live music venues and gyms.

This has become common knowledge now, but we knew all of this before the end of February 2020 and before the World Health Organization considered Covid-19 a pandemic. This became the basis of Japan’s strategy going forward and is ultimately what allowed Japan to have one of the lowest death rates among its peer countries.

If SARS-CoV-2, the coronavirus, was being spread by aerosols and people could spread the virus before they developed any symptoms, it meant that Covid-19 was largely invisible and would be extremely challenging to eliminate. Prior diseases like SARS (caused by SARS-CoV, a related virus), which causes pneumonia in most cases, made it easy to identify patients.

Because this wasn’t the case with SARS-CoV-2, a strategy of containment would be too difficult, and Japan needed to figure out an approach to living with Covid-19.

I suggested a basic concept: People should avoid the three C’s, which are closed spaces, crowded places and close-contact settings. The Japanese government shared this advice with the public in early March, and it became omnipresent. The message to avoid the three C’s was on the news, variety shows, social media and posters. “Three C’s” was even declared the buzzword of the year in Japan in 2020.

Although Japan declared certain periods of the pandemic states of emergency, that equated to not much more than strongly worded warnings and some travel restrictions for residents. (Japan has prohibited foreign tourists from entering the country.) Drastic measures, such as lockdowns, were never taken because the goal was always to find ways to live with Covid-19. (Japanese law also does not allow for lockdowns, so the country could not have declared them even if we had thought them necessary.)

The three C’s taught people what to avoid. How they do that may be different, depending on individual circumstances and risk tolerance. Some people may be able to stay home. Others may remain silent on crowded trains as they commute to work to avoid spread. Some people may dine out but avoid sitting immediately across from one another. Most people are likely to continue to mask.

These types of behavioral cues may work better in certain social environments, and Japan has a tendency toward adherence and responding to powerful peer pressure. Not everyone may agree with preventive measures, but many are reluctant to face the disapproval of their friends and neighbors.

When it comes to the numbers of cases and deaths, Japan has fared well compared to other countries. It has had about 146 deaths per million people in the pandemic so far. The United States has had about 2,590 deaths per million.

Japan’s approach to Covid-19 has often been misunderstood. Some have assumed the country was either doing poorly and hiding it or doing well because of Confucian traditions of people putting community over themselves. What really happened was that science was used to create an effective strategy and a digestible message. That message — to avoid the three C’s — was actionable without being alarmist and prescribed a solution that could outlast changing circumstances. It worked because of an underlying trust between the public and pandemic responders.

Our approach hasn’t been without consequences. Our economy was affected and people like service industry workers lost jobs as bars and restaurants were avoided. Some have suffered mental health challenges brought on by isolation. Going forward, the Japanese government needs to acknowledge the challenges, improve on them and work to protect the most vulnerable and underserved populations.

But broadly speaking, Japan has weathered Covid-19 well. After a period of low transmission rates, the country is facing an uptick in cases because of Omicron, as are other countries. Even though over 70 percent of Japanese citizens are fully vaccinated, vaccination alone won’t be sufficient for the world to live with Covid-19. The Japanese people will need to embrace the three C’s whenever there’s a surge. This is most likely how we will continue to adapt to life with the virus.

It would require a much deeper analysis to understand how anthropological, cultural and historical contexts have played into the various response measures around the world and their effectiveness. But for now, we know that an effective, science-based message has helped Japan keep deaths lower compared to the numbers in peer countries and could be an example of how to move forward in a world where Covid-19 will always be with us.

Hitoshi Oshitani is a professor of virology at Tohoku University Graduate School of Medicine in Japan and has helped advise the Japanese government on its Covid-19 response. He researches the epidemiology and control of viral infections, particularly respiratory viruses.