Guidance against wearing masks for the coronavirus is wrong – cover your face
bostonglobe.com
bostonglobe.com
According to physics and common sense, anything you put between you and the cough-er is going to reduce the number of cough particles to reach you.
Anything will work with different effectiveness.
N95 > Surgical > Handkerchief > Covering your mouth with your hand.
CDC, US, and WHO are just so incompetent around this matter. If they didn't want N95 shortage, they could've told people to wear cotton washable masks. It was such a simple and effective solution that they couldn't think of.
Source: https://twitter.com/CMichaelGibson/status/123971835157384397... Scarf is ~50% effective relative to surgical masks. Though this is tested against influenza, it's still applicable to COVID
It boggles the mind how some people prefer to suggest to just not use anything at all.
No problem you would say, except for the fact that they constantly had to keep their hand in front of their mouth to keep the scarf up.
I don't know about you, but in a shop where everybody touches everything, I keep my hands as far away from my face as possible, especially when some people like to breath in their hand and then touch everything.
So no, scarfs are really bad and counter productive.
Are you saying nobody can do that?
If you can't do that with scarf, then get a washable cotton mask.
Also, we should all stop touching our face, mask or not. It shouldn't be too hard to learn that.
There's also products such as the buff scarf. Which are ideally suited to use as an impromptu mask[2].
It's not the scarf that is bad and counter productive, it's the haphazard application of it ;)
Given the choice, I pretty much prefer that over the scenario where they carry the virus and freely spread it into the environment by having zero filters between their airways and the world.
Scarves over the mouth and nose are not a panacea. They are a way to mitigate the problem.
Counterpoint: I've seen policemen wearing masks on their chin instead of their mouth and nose.
It’s also worth noting that there isn’t a straightforward way to map particle blocking ratio of a mask to probability of becoming infected.
There is also reason to believe that enforcing wearing of masks in public spaces INCREASES social distancing, because people are less likely to slip into an illusion of normality in certain places.
WHO says masks are not effective. Also, do you have source that says masks work?
I actually don't know how to reply to that.
Fortunately, Cambridge published a research about DIY mask against influenza.
Then, that person will say that's not covid. They aren't the same thing.
Science wins, I guess.
We cant say masks work without scientific research backing it up.
That logic is deeply flawed in my opinion. Sure, any sort of protective gear might give a false sense of security. However, people still need to get out, and odds are some of them already carry the virus. Getting a filter between them and the world is an effective way to contain the spread. After all, some efficiency is far better than completely unobstructed access, right?
https://slatestarcodex.com/2020/03/23/face-masks-much-more-t...
I have to go out to buy stuff periodically. What do I do?
Should I wear any kind of mask or not?
According to WHO guideline, I should not wear masks....
Still, we don't see adoption of DIY masks in most countries so far, and I start to wonder what is holding back officials from promoting it. Maybe the variability in quality of DIY masks made by individuals might be too large, and officials just have too strong of a resilience against such DIY solutions as to ever promote them? Perhaps a standardized design for cotton masks, not made by individuals but local businesses would be more acceptable for officials?
[1] https://link.medium.com/LY7RRNr2X4 "Promoting simple do-it-yourself masks: an urgent intervention for COVID-19 mitigation", Svara et al. 2020
The behavior of the CDC, WHO, and FDA during this crisis has long since passed incompetence and entered the territory of active malevolence. They're institutions at their most corrupted, driven more by the bureaucratic impulse towards self-sustenance than any connection to their ostensible mission. I hope we burn them to ground after this is over (I mean that metaphorically: more literally, we should dramatically reform them).
What is the evidence supporting that claim?
Let's say I cough at you. 33% go to your eyes, 33% go to your nose, and 33% go to your mouth.
Are you saying that getting 33% is the same as getting 100%?
I'm fairly certain that your immune system works better if you are exposed to less amount of virus. This is true for bacteria and toxin as well.
Every measure reduces risk/amount. Nothing can guarantee 100% that you won't get covid.
But you do want to keep reducing risk.
Consider the case where you're on a flight with someone who's got COVID-19 and is coughing. The scarf blocks 50% of the particles a surgical mask would block. You then spend the rest of the flight breathing in and out through the scarf that blocked those particles. Does wearing the scarf lower your risk, leave it unchanged, or actually raise it?
The amount of misinformation coming out of the WHO has been staggering and hard to account for, but I will stop short of suggesting any conspiracy.
* They held that there was no evidence of person-to-person transmission for far too long in the face of evidence out of China.
* They claimed for far to long that if you weren't showing symptoms you weren't contagious. This advice has been very widely used to not quarantine people who were exposed to a person who got sick shortly after interactions... to devastating effect around the world.
* They claimed it does not spread through atomized particles, only droplets. This has been demonstrated to be false by experiment.
* They said masks are not effective.
* They said you didn't need to cover your eyes. Medical staff now wear full face shields.
* They said travel bans don't work. This defies basic logic.
* They delayed declaraing the pandemic to be a pandemic.
* They've been completely silent about ACE inhibitors and ARBs upregulating the expression of ACE2 receptors, and that available evidence strongly suggests that people on these medicines have much more severe reactions to the disease. WARNING: I cannot say whether these drugs are the cause -- it may well not be the case -- but shoudn't this have been seriously investigated by now?
She pointed out the W was for World and suggested they have a different focus. I thought it was a brilliant swerve. Accurate, but I suspect not the whole picture.
Do you have a link on this for further reading?
1. In one experiment in a hospital room detected virus on surfaces but not in the air, but it did so many (I vaguely recall it was 4) hours after the patient was in the room. I think I heard this in answer to a press question during a New Zealand official 1pm broadcast on COVID-19. They didn't categorically claim it can't be atomized, but suggested strongly that this wasn't expected to be a significant vector for transmission.
2. The other source was a paper someone linked to on Twitter. And I neglected to download it. But someone physically atomized material with the virus and then after some time period was able to detect the virus still atomized in the air. This proved it was possible to remain atomized, but not that sick people actually atomize the virus well. Again, perhaps not a significant mode of transmission.
I'll keep looking. I'll temporarily retract that bullet point.
The WHO has been an epic disaster this entire time, wrong several critical times and behind on everything. They should not be regarded as to have much credibility after their failures on this pandemic.
This tweet by the WHO on Jan 14 will go down in history for the 21st century as one of the dumbest things said by anyone prominent in the medical sphere (it's astounding they left it up):
https://www.npr.org/2020/03/28/823292062/who-reviews-availab...
> They delayed declaraing the pandemic to be a pandemic.
I have come to think that a major problem with the WHO might be that it is not independent enough from the political interests of major countries.
Banning non-essential travel from/to highly affected countries early would probably have helped to slow down global spread, but political opposition made that impossible.
Yeah unfortunately the WHO showed it lacked any credibility and is sounding like a major tool.
> Banning non-essential travel from/to highly affected countries early would probably have helped to slow down global spread
I think the point was that people tend to get round those travel bans - people instead of going from A to B (now banned) go A to C to B. But again, I don't know and would like to understand why they though that way.
But that's what you're doing.
> They held that there was no evidence of person-to-person transmission for far too long in the face of evidence out of China
Possibly true. Any pointers to that?
> They claimed for far to long that if you weren't showing symptoms you weren't contagious
If you make these claims, provide refrences please. This is new to me.
> They've been completely silent about ACE inhibitors and ARBs upregulating the expression of ACE2 receptors, and that available evidence strongly suggests that people on these medicines have much more severe reactions to the disease
Provide a link. If you're going to post stuff that sounds relevant and important, post references to it.
I don't think the WHO is trying to get people sick, or that China is doing this to the USA, or anything like that. I do think that something doesn't smell right, but I'm unwilling to make any kind of conclusion on what it might be.
As for the person-to-person thing, I lived through the storm of data and information and distinctly remember them claiming there was no evidence of person-to-person transmission after I had seen multiple bits of evidence out of China. To prove that, I'd have to do a lot of wayback machine work.
People have been contagious before symptoms and also without showing any symptoms. I thought this knowledge was widespread at this point. The 3rd case and 5th case in NZ were a couple where the 5th case (wife) travelled to Iran. The man got sick after she returned. She was not sick. They tested her and she was positive and became the 5th case. https://www.nzherald.co.nz/nz/news/article.cfm?c_id=1&object... https://www.nzherald.co.nz/nz/news/article.cfm?c_id=1&object... Probably sexual transmission, so not too suprising. But there are many other reports which the CDC acknowledges on this page: https://www.cdc.gov/coronavirus/2019-ncov/prevent-getting-si...
The question on ACE/ACE2 has references itself: https://www.thelancet.com/journals/lanres/article/PIIS2213-2...
I'll accept your point about no P2P transmission claim as I remember it too, and I suspect that was just parroted back from China early on - but they've not said that for a while.
The ACE stuff from your links just says 'we suspect'.
The WHO has indeed spoken on this recently (https://mobile.twitter.com/WHO/status/1240409217997189128):
"WHO is aware of concerns on the use of #ibuprofen for the treatment of fever for people with #COVID19. We are consulting with physicians treating the patients & are not aware of reports of any negative effects, beyond the usual ones that limit its use in certain populations"
You're being unfair here, they have spoken and it's clear they don't feel enough to recommend for or against at this point. Getting clean yes/no info out of a filthy cloud of murk like this covid situation - I'm glad I'm not them.
Nonetheless, thank you for a civil and informative reply
Other links I have on this topic that might be relevant:
https://www.healio.com/cardiology/vascular-medicine/news/onl...
https://www.nature.com/articles/s41421-020-0147-1
https://www.bmj.com/content/368/bmj.m810/rr-2
https://www.eshonline.org/spotlights/esh-statement-on-covid-...
And you originally said
> upregulating the expression of ACE2 receptors
So ibuprofen is relevant.
And your first link says
“This speculation about the safety of ACE inhibitor or angiotensin receptor blockers treatment in relation to COVID-19 does not have a sound scientific basis or evidence to support it,” de Simone wrote in the ESC statement. “Indeed, there is evidence from studies in animals suggesting that these medications might be rather protective against serious lung complications in patients with COVID-19 infection, but to date there are no data in humans. The Council on Hypertension strongly recommends that physicians and patients should continue treatment with their usual antihypertensive therapy because there is no clinical or scientific evidence to suggest that treatment with ACE inhibitors or angiotensin receptor blockers should be discontinued because of the COVID-19 infection.”
THEY DON'T HAVE THE INFO TO MAKE A DECISION ONE WAY OR ANOTHER.
STOP SPREADING YOUR NON-EXPERT OPINION AS IF IT WERE FACT.
WHO repeating CCP bullshit is one thing, but you are not being honest here. Stop this.
Now I'm going to stop because I have some work to do that is laterally related to covid and I need to get on with it.
The bullet point about this topic was the final bullet point, and I put a clear warning in place on the bullet point (originally too, not as an edit). I did not pass off my opinion as if it were fact, nor did I claim to be an expert. I questioned why we still don't have better data on this, given how strong the coorelation is in people who have conditions that are treated with these medicines.
But I will concede one point: The list about the WHO was not the right place for me to bring up this topic, and putting it there was misleading.
I can't speak for ACEs and ARBs.
Let's agree to disagree on why we don't have better data on these. I trust doctors and the WHO on this. You maybe feel they can do more. I can't take the time to look into it, nor if I did, to interpret what I found.
I repeat I appreciate your constructive attitude and have upvoted several of your posts and this one, because it's done in the right spirit. Good luck.
https://www.nejm.org/doi/full/10.1056/NEJMc2001468 A woman from Shanghai traveled to Germany for a business trip between January 19 and January 22. She had no symptoms of coronavirus during this time and only became sick on her flight back to China. She was diagnosed with COVID-19 on January 26. But on January 24, a businessman who met with the woman on January 20 and 21 developed symptoms of coronavirus. He went back to work on January 27 and later tested positive for COVID-19. “We discovered that shedding of potentially infectious virus may occur in persons who have no fever and no signs or only minor signs of infection,” the report’s authors concluded.
https://www.nejm.org/doi/full/10.1056/NEJMc2001899 two individuals who had recently returned to Germany from Wuhan, China, appeared to be asymptomatic, but tested positive for COVID-19 when they were given a throat swab. "We discovered that shedding of potentially infectious virus may occur in persons who have no fever and no signs or only minor signs of infection,"
https://science.sciencemag.org/content/early/2020/03/13/scie... A majority of cases in China were transmitted by “undocumented infections” in the period before the country placed travel restrictions on Hubei province on January 23. “This high proportion of undocumented infections, many of whom were likely not severely symptomatic, appears to have facilitated the rapid spread of the virus throughout China"
https://www.medrxiv.org/content/10.1101/2020.03.05.20031815v... a significant number of infections can be attributed to people who had not yet developed symptoms
https://www.nejm.org/doi/full/10.1056/NEJMp2003762 Bill Gates "COVID-19 is transmitted quite efficiently," he wrote. "There is also strong evidence that it can be transmitted by people who are just mildly ill or even pre-symptomatic. That means COVID-19 will be much harder to contain than the Middle East respiratory syndrome or severe acute respiratory syndrome (SARS), which were spread much less efficiently and only by symptomatic people."
However, quick dig in wikipedia: (https://en.wikipedia.org/wiki/2019%E2%80%9320_outbreak_of_no...)
<<< On 12 January, based on additional information from the Chinese National Health Commission, WHO stated that "at this stage, there is no infection among healthcare workers, and no clear evidence of human to human transmission." >>>
So, fuck.
(you provided references in good faith, which I really appreciate).
Source?
That puts the whole "China is doing brilliantly" WHO comedy show into perspective.
As a public health intervention, social distancing is vastly more effective and deserving of emphasis than mask wearing. There aren't enough masks. Public health orgs were worried about running out of masks, which is exactly what has happened, and this is a huge problem for doctors and nurses who whinge about it a lot less than your random person on twitter decrying the apparent conspiracy to stop mask wearing.
The surgeon general's tweet (February 29) at the time was reasonable. On Feb 29 there were 66 cases in a country with 327 million people.
But of course, truth is more important than lives. Which will earn lots of anger from people who contributed to the mask shortage, but I don't care. I'm not saying I'm right about the previous paragraph, just that it's a simpler explanation based on basic human nature than some conspiracy theory.
What does Taiwan say? We should follow leaders like Taiwan: they were at huge risk, yet economy is running and schools open, their VP is an epidemiologist and he was minister of health during their SARS outbreak. Taiwan’s CDC says: “Prevention is the same as for other respiratory infections including washing hands frequently, wearing masks and cleaning up secretion from the mouth and nose appropriately. Other measures include avoiding crowded places such as markets or local hospitals, avoiding contact with animals and dead animals and avoiding eating raw meat or eggs. Additionally, you should wear masks and attend medical attention immediately when flu-like symptoms occur (such as body temperature ≧38℃, and coughing, etc)” - https://www.cdc.gov.tw/En/Category/QAPage/LnqBFJsulw6fW3nswc... and “Our guidelines and policy for wearing masks have not changed, but people should consider wearing a mask in enclosed crowded spaces with poor air ventilation,” Minister of Health and Welfare Chen Shih-chung (陳時中), who heads the center, told a news conference in Taipei. People who must attend events in small crowded venues, where they would have frequent and close contact with other people, are advised to wear a mask, he said.”. Of course Taiwan also has many other layers of effective control against Covid: https://www.dw.com/en/taiwan-coronavirus/a-52724523 and a wired article too: https://www.wired.com/story/taiwan-is-beating-the-coronaviru...
Also i think it is significant that citizens commonly wear masks in the countries that are most successful at controlling the virus (and haven’t shut down their economies, Taiwan, Vietnam, SK, Singapore, Japan). It is a social stigma to not wear a mask in some places. However, although Japan looks like they have slowed the outbreak maybe they are just at the corner of the hockey stick. And in HK: “Dr. Pak-Leung Ho, head of Centre for infection at @hkumed ... highlighted universal mask-wearing as one of the reasons widespread outbreak didn't occur.” https://twitter.com/lwcalex/status/1235091542219448321
There is a huge back-pressure against wearing masks in western countries, which leads to an environment of glib advice against them. I know this isn’t a very scientific issue, but I think it matters. https://www.nytimes.com/2020/03/17/opinion/coronavirus-face-... and “Why some countries wear face masks and others don't” https://www.bbc.com/news/world-52015486
Finally, here is a sciency article “Would everyone wearing face masks help us slow the pandemic?”: https://www.sciencemag.org/news/2020/03/would-everyone-weari...
> Even experts who favor masking the masses say their impact on the spread of disease is likely to be modest. Many are also afraid to promote mask buying amid dire shortages at hospitals. But as the pandemic wears on, some public health experts think government messages discouraging mask wearing should shift.
> “It’s really a perfectly good public health intervention that’s not used,” argues KK Cheng, a public health expert at the University of Birmingham. “It’s not to protect yourself. It’s to protect people against the droplets coming out of your respiratory tract.”
So even this pro-mask article makes it sound to me like wearing a mask will not protect you from getting the virus. At best, they're effective at presenting people who don't know they're sick from infecting others. And that only works if you can mask a significant portion of the population without a shortage of masks for people who we know need them. That doesn't seem to be the case in the United States at present.
I don't have numbers, but I'm pretty sure the number of people infected by people that didn't know they were sick is significant. Imagine if all those sick people wore masks (or some substitute, like a scarf over their mouth/nose).
If we can agree that wearing a mask (or substitite) if you might be sick is a good idea, but you don't know if you might be sick, that seems to translate to wearing a mask (or substitute) is a good idea.
> that only works if you can mask a significant portion of the population without a shortage of masks for people who we know need them.
I agree it's important to reserve masks for those who need them most, but that doesn't mean we have to teach people they are not effective. We could instead teach them how "non-masks" can make very reasonable substitutes. And let's not forget that reducing the spread has a real impact on the need for healthcase workers to have them.
Look at the number of asymptomatic or pre-symptomatic cases (approx 50%) there are in the two full population studies on the Princess Cruise ship, and Vò (in Italy).
But take care to differentiate between surgical masks (only help protect others), and N95 protects both ways (protects the wearer from others, protects others from the wearer).
Go to 43:20 on https://www.youtube.com/watch?v=E3URhJx0NSw and Michael Osterholm (a very clued up epidemiologist) says:
1. Surgical masks help prevent transmission
2. N95 masks help prevent catching it
Note also in that same section he says washing hands is probably a waste of time - because transmission vector is respiratory (duhhh). I think too much of our media and fear is concentrating hard on washing hands, with little science behind it for respitory viruses.
A flat out lie from the leading spokesperson on matters of public health.
All of the hand-wringing about foreign misinformation. But what if the misinformation is coming from within the house?
Seriously though, do you have any evidence that the consensus of the medical profession is that getting the general, non-sick population to wear masks is useful in combating the crisis? I'm open to the possibility that it is, but remain rather skeptical.
It is not the consensus in countries that currently still see an explosion in cases.
This is something I definitely said.
> I don't see any particular reason to trust the opinion section of the Boston Globe over the US Surgeon General or the WHO
You: you think that whatever the official government official says must be true
Do you see the issue here?
Yes:
https://www.thelancet.com/journals/lancet/article/PIIS0140-6...
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3810906/
https://www.ijidonline.com/article/S1201-9712%2808%2901008-4...
"Wearing a face mask was a protective factor against influenza infection."
"The staff who wore surgical masks and N95 masks were significantly associated with non-infection."
"In compliant users, masks were highly efficacious."
Also common sense. If you wear a mask you reduce the probability that you transmit the virus. And, to a lesser extent, you reduce the probability that you are infected by the virus.
Claiming that "they are not effective" is simply false. Perhaps "lie" is too strong, but it was untrue and irresponsible considering the position he holds.
"Wearing a face mask was a protective factor against influenza infection."
Besides, the other links concern a SARS virus.
It is amazing how people naively believe in politician’s bullshit. The same is with “don’t hoard the food” with appearing articles about shortage of cheap workers in agricultural sector.
Next week a dude is coming to each flat in a complex with hundreds of flats to inspect pipes. There is pandemic outside, but it’s best time to inspect pieces. Politicians scream every day about pandemic and how one should stay at home. Maybe this pipe inspection might wait couple months!?
If those privileged enough to be able to afford to hoard have cleaned out the supermarkets to an extent that the supermarkets' supply chain isn't designed for, the person shopping weekly is screwed.
Seems pretty straightforward to me.
On the other hand I saw the hoarders in action: throwing 2 shopping carts with cans to the car’s trunk. Really disgusting. Especially knowing, that this canned food does not taste well and will end in a landfill afterwards.
Hoarding food increases demand, thus exacerbates potential food shortages.
The best way to boost your immune function is to be exposed to a pathogen. Then you will develop antibodies. Those antibodies boost your ability to avoid that pathogen. Vaccines work in a similar way. Of course this advice is currently useless in the context of COVID-19.
Specific foods and supplements might help here and there, but most of the evidence is that they are antimicrobial (antibiotic/antiviral/antifungal) in vitro. There's much less research in vivo. That's not to say that some foods won't help, but just not to rely on them having a significant effect in your body. The effect, if any, is probably very slight.
There is stronger evidence for a healthy lifestyle: regular exercise, maintaining a healthy weight, getting adequate sleep, avoiding infection, not smoking, minimizing stress. Some good evidence for sun exposure too.
Back on the foods though, you didn't mention black elderberry syrup (sambucus nigra). A 2004 study (randomized, double blinded, placebo controlled) showed efficacy against influenza.https://www.ncbi.nlm.nih.gov/pubmed/15080016 and a 2016 study (randomized, double blinded, placebo controlled) showing it reduced the duration of the common cold (often a coronavirus): https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4848651/ And it's quite safe -- Europeans traditionally use it for pancake syrup.