IOM Covid removing restrictions

[monasqueen]

That's only because people who are still wearing masks wear them below the nose or round the neck.

[Gladys]

21 minutes ago, monasqueen said:

That's only because people who are still wearing masks wear them below the nose or round the neck.

Even some nurses at Noble's.  Completely pointless. 

Edited February 2, 2023 by Gladys

[Roger Mexico]

4 hours ago, TheTeapot said:

Oh.

 

As ever it's worth reading the actual document to get the full story:

https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD006207.pub6/full

The high risk of bias in the trials, variation in outcome measurement, and relatively low adherence with the interventions during the studies hampers drawing firm conclusions. There were additional RCTs during the pandemic related to physical interventions but a relative paucity given the importance of the question of masking and its relative effectiveness and the concomitant measures of mask adherence which would be highly relevant to the measurement of effectiveness, especially in the elderly and in young children.

There is uncertainty about the effects of face masks. The low to moderate certainty of evidence means our confidence in the effect estimate is limited, and that the true effect may be different from the observed estimate of the effect. The pooled results of RCTs did not show a clear reduction in respiratory viral infection with the use of medical/surgical masks. There were no clear differences between the use of medical/surgical masks compared with N95/P2 respirators in healthcare workers when used in routine care to reduce respiratory viral infection. Hand hygiene is likely to modestly reduce the burden of respiratory illness, and although this effect was also present when ILI and laboratory‐confirmed influenza were analysed separately, it was not found to be a significant difference for the latter two outcomes. Harms associated with physical interventions were under‐investigated.

There is a need for large, well‐designed RCTs addressing the effectiveness of many of these interventions in multiple settings and populations, as well as the impact of adherence on effectiveness, especially in those most at risk of ARIs. 

This confirms something that has struck me since I started looking at it the beginning of the pandemic, which is just how little evidence (pro or con) most public health interventions are based on regarding infection control and other things.  There were only six RCTs on mask in Covid for example, none of great quality.  And: We found no RCTs on gowns and gloves, face shields, or screening at entry ports.

It's not just that many of the ways we try to mitigate infection don't seem to have changed since the time of Florence Nightingale, hardly anyone seems to be as interested as she was in finding out what works.

[thommo2010]

Started watching the Last of us last night, now that's a pandemic.

[CallMeCurious]

7 minutes ago, thommo2010 said:

Started watching the Last of us last night, now that's a pandemic.

 

21 minutes ago, Roger Mexico said:

As ever it's worth reading the actual document to get the full story:

https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD006207.pub6/full

The high risk of bias in the trials, variation in outcome measurement, and relatively low adherence with the interventions during the studies hampers drawing firm conclusions. There were additional RCTs during the pandemic related to physical interventions but a relative paucity given the importance of the question of masking and its relative effectiveness and the concomitant measures of mask adherence which would be highly relevant to the measurement of effectiveness, especially in the elderly and in young children.

There is uncertainty about the effects of face masks. The low to moderate certainty of evidence means our confidence in the effect estimate is limited, and that the true effect may be different from the observed estimate of the effect. The pooled results of RCTs did not show a clear reduction in respiratory viral infection with the use of medical/surgical masks. There were no clear differences between the use of medical/surgical masks compared with N95/P2 respirators in healthcare workers when used in routine care to reduce respiratory viral infection. Hand hygiene is likely to modestly reduce the burden of respiratory illness, and although this effect was also present when ILI and laboratory‐confirmed influenza were analysed separately, it was not found to be a significant difference for the latter two outcomes. Harms associated with physical interventions were under‐investigated.

There is a need for large, well‐designed RCTs addressing the effectiveness of many of these interventions in multiple settings and populations, as well as the impact of adherence on effectiveness, especially in those most at risk of ARIs. 

This confirms something that has struck me since I started looking at it the beginning of the pandemic, which is just how little evidence (pro or con) most public health interventions are based on regarding infection control and other things.  There were only six RCTs on mask in Covid for example, none of great quality.  And: We found no RCTs on gowns and gloves, face shields, or screening at entry ports.

It's not just that many of the ways we try to mitigate infection don't seem to have changed since the time of Florence Nightingale, hardly anyone seems to be as interested as she was in finding out what works.

Which is strange given that some cultures have been wearing masks for decades https://www.voanews.com/a/science-health_coronavirus-outbreak_not-just-coronavirus-asians-have-worn-face-masks-decades/6185597.html

You think there'd be data one way or the other. Even on things like air pollution.

 

 

[TheTeapot]

There's no real evidence to say that universal masking works in a pandemic because they don't. Anyone who had worn a mask for what they are designed for prior to the pandemic would have been able to tell you that.

If you demand people make changes to their lives through the threat of fines, denial of access to places or propaganda that makes people like Amadeus think its perfectly ok to photograph peoples noses and put it on social media, then you need to make sure that there is some fucking proof that what you are demanding will actually work.

But there wasn't any then, and there isn't any now.

The often repeated line 'my mask protects you' is complete bullshit and people fell for it big time.

Makes you wonder what else they fall for, and how easy it must be.

[TheTeapot]

Of course, the World Health Organisation already knew all this 

 

[wrighty]

There's a concept in study design known as 'power'.  Briefly, this is the ability of a study to detect an effect of an intervention (such as giving a drug, washing your hands, wearing a mask etc).  When designing a study you include a power analysis which tells you the probability that the study will detect the effect you're looking for.  The bigger the study, generally speaking, the higher the power to detect the effect in question.

Doing all this needs some idea of the size of the effect you expect to find - often via a pilot study.  One way of doing this is to use Cohen ratios (the change in a variable divided by the standard deviation of the normal distribution of that variable).  Small, Medium, Large effects are commonly chosen as ratios of 0.2, 0.5 and 0.8.

If something has a 0.8 (large) treatment effect, it should be obvious, and you probably won't need a large study to prove it.  If something has a 0.2 treatment effect, the main question is 'is it worth it' as the effect is small, and will require a massive study to demonstrate it rigorously. I suspect mask wearing is in this latter category - a small effect, if any, and probably impossible to prove.  Hence it gets politicised as there will never be a categorical right or wrong answer.

[Roger Mexico]

12 minutes ago, wrighty said:

If something has a 0.8 (large) treatment effect, it should be obvious, and you probably won't need a large study to prove it.  If something has a 0.2 treatment effect, the main question is 'is it worth it' as the effect is small, and will require a massive study to demonstrate it rigorously. I suspect mask wearing is in this latter category - a small effect, if any, and probably impossible to prove.  Hence it gets politicised as there will never be a categorical right or wrong answer.

But the thing is even a small effect may make a big difference in a pandemic.  An improvement of 10% may mean a lot of lives saved where millions are affected.  And (as the Cochrane review points out) it may be particularly important when considering the vulnerable.  The astonishing thing is how little effort goes into finding out what works - and this applies to 'ordinary' procedures as well - not just in times of crisis.

As it is the only this we seem to have discovered on the last few years is that PPE is very effective at transferring money into offshore banking accounts.

[wrighty]

19 minutes ago, Roger Mexico said:

But the thing is even a small effect may make a big difference in a pandemic. 

Just as a small adverse effect could result in a big (in terms of numbers) downside.  You just don't know, and for reasons I illustrated probably can't.

[It's possible that mask mandates could have a negative effect - people may interact more with the false sense of invincibility afforded to them by the mask, masks are often fiddled with which may transfer pathogens to the hands more compared with if they're not worn at all, masks are often worn incorrectly which could lead to more effective upwards distribution of aerosols...]

[Roger Mexico]

19 minutes ago, wrighty said:

Just as a small adverse effect could result in a big (in terms of numbers) downside.  You just don't know, and for reasons I illustrated probably can't.

[It's possible that mask mandates could have a negative effect - people may interact more with the false sense of invincibility afforded to them by the mask, masks are often fiddled with which may transfer pathogens to the hands more compared with if they're not worn at all, masks are often worn incorrectly which could lead to more effective upwards distribution of aerosols...]

Oh quite, you have to look at how measures operate in the real world and over time and you need to look at the way they operate in different settings as well.  You could argue that the Cochrane concentration on RCTs should be widened in these circumstance.  But that just demonstrates the importance of assessing and monitoring the actual effect of such measures, rather than relying on 'common sense'.

[woolley]

There is always the urge to be doing, or to be seen to be doing, something, anything. This is especially acute in the modern Western world,

[Thereisnt]

[Thereisnt]

[Thereisnt]

3 hours ago, TheTeapot said:

There's no real evidence to say that universal masking works in a pandemic because they don't. Anyone who had worn a mask for what they are designed for prior to the pandemic would have been able to tell you that.

If you demand people make changes to their lives through the threat of fines, denial of access to places or propaganda that makes people like Amadeus think its perfectly ok to photograph peoples noses and put it on social media, then you need to make sure that there is some fucking proof that what you are demanding will actually work.

But there wasn't any then, and there isn't any now.

The often repeated line 'my mask protects you' is complete bullshit and people fell for it big time.

Makes you wonder what else they fall for, and how easy it must be.

It does indeed.

I wonder if it could be possible to rebrand ‘flu and call it a deadly new disease? A pandemic even..