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Thread: What's messing with your Groove?

  1. #5251
    Everyone, please tell your friends: masks don't do shit when they only cover your chin.

  2. #5252
    Don't worry, they don't do all that much when they cover your mouth and nose, either.
    "When I meet God, I am going to ask him two questions: Why relativity? And why turbulence? I really believe he will have an answer for the first." - Werner Heisenberg (maybe)

  3. #5253
    They're effective at preventing the wearer from spreading the virus, they're just useless at protecting the wearer. Sure, it's not 100% effective, but it significantly and meaningfully reduces the risk. It's a useful risk reduction since nobody can maintain social distancing while moving, and it's hard to tell when a surface was last breathed on and nobody's going to memorize the virus survival times on all the different surface types they come into contact with. My mask does almost nothing for me, but it protects you - I need your mask to protect me.

    If people are going to wear it, it should be because they're going to actually wear​ it, not just virtue signal with it.

  4. #5254
    Quote Originally Posted by Wraith View Post
    They're effective at preventing the wearer from spreading the virus, they're just useless at protecting the wearer. Sure, it's not 100% effective, but it significantly and meaningfully reduces the risk. It's a useful risk reduction since nobody can maintain social distancing while moving, and it's hard to tell when a surface was last breathed on and nobody's going to memorize the virus survival times on all the different surface types they come into contact with. My mask does almost nothing for me, but it protects you - I need your mask to protect me.

    If people are going to wear it, it should be because they're going to actually wear​ it, not just virtue signal with it.
    None of this is actually known to be true, it's just the current best guess line of supposition. There are extremely few studies that have been done to look at the effect of community use of masks to cut down transmission of respiratory diseases. To my knowledge, none of them were particularly well powered or high quality, none were set in the United States, and definitely none actually looked at SARS-CoV-2 (or COVID-19).

    Public health interventions are tricky things, where a given intervention might work in a controlled setting (e.g. lab tests to see if particles of a given size are partially stopped by a poor quality cloth mask) but are ineffective or even counterproductive in a real life situation. The broader population simply doesn't have the training or discipline to (a) make the right kind of mask, (b) fit and wear the mask correctly, (c) behave appropriately when wearing a mask, and (d) remove and sanitize the mask correctly. Don't even get me started on what I've seen people doing with gloves. We have little understanding of typical use of these face masks in the context of the United States, little understanding how it interacts with other interventions like social distancing and hand hygiene, and zero understanding of how that typical use translates into SARS-CoV-2 infections. The data just isn't there.

    If there is a real, statistically significant improvement, I suspect the magnitude of the effect is relatively small compared to other interventions. I am somewhat concerned with the emphasis on face coverings in both official guidance as well as the popular virtue signaling/public shaming associated with people who aren't wearing masks or are using them incorrectly. It's not clear that this intervention is helpful, especially if it shifts prevention efforts from other behaviors (e.g. people use a mask in place of social distancing or adequate hygiene, or governments open up sooner because they believe masks significantly decrease transmission in crowded environments). The holier than thou people policing mask use of others (to be clear I am *not* grouping you into this category, I mean people starting confrontations about it) may believe that they are crusaders for public health and all that is right in the world, but it's based on extremely flimsy evidence.

    All of the above notwithstanding, of course I wear a face covering when I am outside of my home, and I endeavor to do so in a manner that maximizes the potential benefit of such a behavior. But I don't do it out of a misguided conviction that I am saving others from my coronavirus breath, I do it because I am a follower of rules and our society has determined that this is a rule we should all be following. It's solidarity, perhaps, but not out of a belief that it will be effective.
    "When I meet God, I am going to ask him two questions: Why relativity? And why turbulence? I really believe he will have an answer for the first." - Werner Heisenberg (maybe)

  5. #5255
    Quote Originally Posted by wiggin View Post
    None of this is actually known to be true, it's just the current best guess line of supposition. There are extremely few studies that have been done to look at the effect of community use of masks to cut down transmission of respiratory diseases. To my knowledge, none of them were particularly well powered or high quality, none were set in the United States, and definitely none actually looked at SARS-CoV-2 (or COVID-19).
    That's a cop-out. It would be extremely unethical to run trials, so you can only get results through statistical analysis after the fact which isn't ever going to produce high quality results, regardless of how they're popularly represented afterwards. We know the mechanics of the virus, and its mode of transportation is not uncommon and fairly well studied independently. It's also been lab verified that masks vastly reduces the amount of viral load in the air; the numbers I've seen have all been in the 95% or higher range.

    It doesn't really matter if you have doubts about how useful this turns out to be at large scales, when you have to factor in the public's willingness and ability to do it all correctly and all that goes into that. Or if you just doubt it's real world effectiveness is going to be anywhere near the lab reported numbers. It's supported enough and by a wide enough group that it's a knowable risk. However you weigh the probabilities, at any reasonable levels of skepticism the ultimate conclusion is going to be the same: the consequence of being wrong is so high and the cost of protecting against it is so very, very low in comparison that the only rational move is to just put on a mask. I mean, you're doing it, right?

    I am somewhat concerned with the emphasis on face coverings in both official guidance as well as the popular virtue signaling/public shaming associated with people who aren't wearing masks or are using them incorrectly. It's not clear that this intervention is helpful, especially if it shifts prevention efforts from other behaviors (e.g. people use a mask in place of social distancing or adequate hygiene, or governments open up sooner because they believe masks significantly decrease transmission in crowded environments). The holier than thou people policing mask use of others (to be clear I am *not* grouping you into this category, I mean people starting confrontations about it) may believe that they are crusaders for public health and all that is right in the world, but it's based on extremely flimsy evidence.
    I think this is a totally fair point. There's some pretty good reasons to believe that it's been over-emphasized: it did go far enough to slip into politicization which then turned into a feedback loop. It's gotten to the point that wearing a mask has become a part of some people's identities instead of just being rational choice that they made. What I was venting about a few posts ago was basically just a symptom of what you said - people are using masks to virtue signal because it's been over-emphasized to the point that groupthink is starting to take over and people are wearing it to virtue signal instead of for a rational reason, and that's compromising the effectiveness of the whole effort. The practical reasons for wearing the mask aren't at the forefront of their thinking, so they wind up misusing them because they're not thinking enough about the real reasons they should.

    That's really the root of my one-liner vent. I didn't complain about the people not wearing masks, just the people who want to be seen wearing a mask but don't actually care enough to wear it. The numbers I saw locally had taken me by surprise.
    Last edited by Wraith; 05-28-2020 at 04:47 AM.

  6. #5256
    Quote Originally Posted by Wraith View Post
    That's a cop-out. It would be extremely unethical to run trials, so you can only get results through statistical analysis after the fact which isn't ever going to produce high quality results, regardless of how they're popularly portrayed. We know the mechanics of the virus, and its mode of transportation is not uncommon and fairly well studied independently. It's also been lab verified that masks vastly reduces the amount of viral load in the air; the numbers I've seen have all been in the 95% or higher range.
    This is not a cop out at all. The only way we actually know if an intervention works is by testing it. You know all of the furor over hydroxychloroquine? The proposed mechanism of action frankly seemed plausible, that's why people were thinking of it at all - and the reason why it was being tested in multiple clinical trials. The reason we didn't deploy it ahead of time is threefold:

    1. There's limited supplies of the drug and it has other known uses that would have been sidelined.
    2. There are substantial risks to using the drug, especially for some populations.
    3. Most importantly, a hypothesis does not equate to actual clinical data.

    The only reason why it's vaguely acceptable for public health authorities to push for mask wearing is because #1 isn't true, and the risks from #2 are smaller but not nonexistent. We do not know if it is efficacious or even potentially harmful. We can't be evidence based only when it suits us.

    There are ways to run these studies in an as-ethical manner as possible, but you're right, in general it's going to be challenging to design a prospective RCT for this kind of public health intervention. However, there are much better ways to get decent quality data than the available data to date. I've seen a handful of studies, generally studying things like influenza, generally in places very different to the US, and generally with at most a couple hundred participants. There's a huge gap between this level of quality and a reasonably achievable and ethically sound study that would actually give meaningful results.

    A lab study looking at one specific question (how many particles of a given size does a given type of material stop) is so far removed from reality that it's at the very best vaguely directional in nature. We should in no way make an assumption that wearing cloth masks substantially protects anyone from transmission of this virus.

    It doesn't really matter if you have doubts about how useful this turns out to be at large scales, when you have to factor in the public's willingness and ability to do it all correctly and all that goes into that. Or if you just doubt it's real world effectiveness is going to be anywhere near the lab reported numbers. It's supported enough and by a wide enough group that it's a knowable risk. However you weigh the probabilities, at any reasonable levels of skepticism the ultimate conclusion is going to be the same: the consequence of being wrong is so high and the cost of protecting against it is so very, very low in comparison that the only rational move is to just put on a mask. I mean, you're doing it, right?
    I'm not doing it because I believe it is a particularly effective public health measure. I'm doing it because it's a mandate of my local public health authorities. I also am willing to countenance the possibility that my skepticism is wrong, and that said public health experts have their hands on more sophisticated information than I have been privy to.

    You're assuming that the risk/benefit analysis is always going to be skewed in the favor of the benefit, because no matter how small the potential benefit in the real world, the risk is negligible. I disagree. We have a limited amount of 'public health capital', if you will, to work with. If we focus our efforts on one large scale intervention like masks, it is very easy to lose our messaging and divert the public's focus from other, potentially more protective, behaviors. People are so convinced that masks are protective - whether of themselves (definitely incorrectly) or of others (possible) - that they can and do relax other behaviors that are known to affect the spread of any disease, most notably social distancing. Until we have data that weighs these different interventions against each other, we will have problems.

    One of the only good things about this pandemic is that so many different countries and local jurisdictions have employed very different public health strategies to address the crisis. One can hope that the heterogeneity of the response will yield a treasure trove of data to help us better prepare for a future pandemic. I can only hope that the poor quality studies noted above are supplanted by much more sophisticated analyses in the future.

    I think this is a totally fair point. There's some pretty good reasons to believe that it's been over-emphasized: it did go far enough to slip into politicization which then turned into a feedback loop. It's gotten to the point that wearing a mask has become a part of some people's identities instead of just being rational choice that they made. What I was venting about a few posts ago was basically just a symptom of what you said - people are using masks to virtue signal because it's been over-emphasized to the point that groupthink is starting to take over and people are wearing it to virtue signal instead of for a rational reason, and that's compromising the effectiveness of the whole effort. The practical reasons for wearing the mask aren't at the forefront of their thinking, so they wind up misusing them because they're not thinking enough about the real reasons they should.

    That's really the root of my one-liner vent. I didn't complain about the people not wearing masks, just the people who want to be seen wearing a mask but don't actually care enough to wear it. The numbers I saw locally had taken me by surprise.
    Yes, I had assumed that was your take - my response was intended to be more flippant than leading to a substantive discussion of my concerns (though I'm always happy to chat with you!). I see widespread misuse of masks, not just from people who aren't wearing them appropriately, but who also aren't thinking about what their hands are touching while wearing a mask. It's natural to do so; most people don't have training in sterile technique, and I frankly wouldn't expect anyone to be very good at this without training. But I tend to view that not as 'this person is an idiot, they're not doing it right and just posturing' and more as 'these people can't possibly be expected to implement this public health intervention effectively, I question whether it's a good idea at all'.

    If everyone had well-fitted N95 masks and had been trained how to wear PPE, I would have a very different take on the efficacy of face coverings in combating this pandemic.
    "When I meet God, I am going to ask him two questions: Why relativity? And why turbulence? I really believe he will have an answer for the first." - Werner Heisenberg (maybe)

  7. #5257
    Quote Originally Posted by wiggin View Post
    I'm not doing it because I believe it is a particularly effective public health measure. I'm doing it because it's a mandate of my local public health authorities. I also am willing to countenance the possibility that my skepticism is wrong, and that said public health experts have their hands on more sophisticated information than I have been privy to.
    Arriving at it through a social contract line of reasoning is fine, and I'm not going to complain about that. I'm hoping I'm giving a good explanation of a different rationale that leads to the same conclusion.

    For your doubts about real world effectiveness, it still doesn't really matter. What probability would you assign to there being a measurable impact on virus spread in the real world? What value do you place on not wearing a mask in public? I know you're a rational person, so I'm pretty sure however you weight these things, it's going to come to the same conclusion.

    You could characterize the whole politicization problem in that frame - we accidentally oversold mask wearing and people started placing too high a value on going maskless because it got tied to their identity via the culture war.

    You're assuming that the risk/benefit analysis is always going to be skewed in the favor of the benefit, because no matter how small the potential benefit in the real world, the risk is negligible. I disagree. We have a limited amount of 'public health capital', if you will, to work with. If we focus our efforts on one large scale intervention like masks, it is very easy to lose our messaging and divert the public's focus from other, potentially more protective, behaviors. People are so convinced that masks are protective - whether of themselves (definitely incorrectly) or of others (possible) - that they can and do relax other behaviors that are known to affect the spread of any disease, most notably social distancing. Until we have data that weighs these different interventions against each other, we will have problems.
    I agree on public health capital being misspent here, and you're right that I haven't been factoring that in. I don't have a firm grasp on what the right way to communicate and coordinate the effort would have been, but it seems pretty clear that there's room for improvement.

  8. #5258
    Quote Originally Posted by Wraith View Post
    For your doubts about real world effectiveness, it still doesn't really matter. What probability would you assign to there being a measurable impact on virus spread in the real world? What value do you place on not wearing a mask in public? I know you're a rational person, so I'm pretty sure however you weight these things, it's going to come to the same conclusion.
    Ah, but my concern has nothing to do with my personal choice to wear a mask. I'm trained in sterile technique and could use a mask in the least awful way possible; it's likely that there's a marginal benefit (though likely quite small and of questionable clinical significance) compared to the counterfactual in my specific case. Is wearing a cloth mask better at reducing transmission from a careful user compared to, say, coughing/sneezing into a sleeve? Probably. Is it much better, even when done well? Questionable, but I'd agree the risk to public health for an appropriately informed, trained, and conscientious person is relatively low.

    My concern is that typical use of the mask may not result in a net improvement in community spread of SARS-CoV-2; it's entirely reasonable to believe that typical use could actually worsen transmission. I am disputing that there exists evidence of its efficacy as a public health tool, not disputing that I might personally be able to do my part by putting on a mask.
    Last edited by wiggin; 05-28-2020 at 08:09 AM.
    "When I meet God, I am going to ask him two questions: Why relativity? And why turbulence? I really believe he will have an answer for the first." - Werner Heisenberg (maybe)

  9. #5259
    Wig, what about evidence from the response to the Spanish flu?
    Hope is the denial of reality

  10. #5260
    There's evidence about social distancing, albeit poor quality. Afaik there isn't any on cloth face masks. We should also be cautious extrapolating from influenza, the public health considerations are quite different.
    "When I meet God, I am going to ask him two questions: Why relativity? And why turbulence? I really believe he will have an answer for the first." - Werner Heisenberg (maybe)

  11. #5261
    I don't really understand your argument. We have evidence that masks have an effect on the mechanism through which this virus is spread. There's pretty significant evidence that places that have widespread usage of masks slowed down the spread of the viruses (I will admit there are confounding variables in that scenario). There is no chance of doing a controlled trial. You conclude that we should therefore do nothing.

    I also don't buy the "staging this intervention is going to make people less willing to be involved in more effective interventions" logic. I could see this being the case if the intervention was particularly burdensome, but it really isn't. The people who wear masks, especially in places where they're not legally mandated, have shown a willingness to listen to public health authorities. The people who won't wear masks are the ones who aren't taking this seriously and they wouldn't take other interventions seriously either.
    Hope is the denial of reality

  12. #5262
    I have a substantive response but I'm afraid my schedule is full until Sat pm. I'll try to get back to this then.
    "When I meet God, I am going to ask him two questions: Why relativity? And why turbulence? I really believe he will have an answer for the first." - Werner Heisenberg (maybe)

  13. #5263
    Quote Originally Posted by Loki View Post
    I don't really understand your argument. We have evidence that masks have an effect on the mechanism through which this virus is spread. There's pretty significant evidence that places that have widespread usage of masks slowed down the spread of the viruses (I will admit there are confounding variables in that scenario). There is no chance of doing a controlled trial. You conclude that we should therefore do nothing.

    I also don't buy the "staging this intervention is going to make people less willing to be involved in more effective interventions" logic. I could see this being the case if the intervention was particularly burdensome, but it really isn't. The people who wear masks, especially in places where they're not legally mandated, have shown a willingness to listen to public health authorities. The people who won't wear masks are the ones who aren't taking this seriously and they wouldn't take other interventions seriously either.
    Loki, there's two different concerns that I have:

    First, we do not have evidence that cloth masks substantially affect the transmission of SARS-CoV-2. Just because it sometimes has modest effects in the case of entirely unrelated viruses doesn't mean it will work here. The mechanistic information on the spread of SARS-CoV-2 is extremely limited to date; we simply don't know what droplet size is most likely to transmit the virus, what other conditions need to be met, and things like the typical viral load needed to initiate an infection. We just don't know. In this context (a purely mechanism based argument) we would not be able to conclude that a cloth face covering is helpful, but it's probably fair to say that the downside is negligible. I would say that further mechanistic studies will help strengthen the case but aren't a super high priority. We barely understand much more important things about this virus.

    Secondly, I am quite concerned about the practical application of this mechanistic hypothesis that, in a vacuum, a face mask will reduce transmission of the virus. That's where a semi-controlled trial would be valuable. We have lots of uncontrolled de facto trials going on, mostly driven by geography and politics, but I think it's far from unclear that a controlled trial to look at this would be infeasible or unethical. Regardless, it's easy to imagine scenarios where a public health emphasis on mask wearing results in higher and not lower transmission of the virus. This isn't because the individual person is less willing to engage in other interventions, but because people are more likely to view mask wearing as providing protection that it may not actually provide, and thus become laxer on other, likely more important, interventions. The biggest one I can see happening in my own state is social distancing, where I've seen people use mask wearing as a substitute for keeping one's distance and minimizing contact with others. But there are others - things like frequent handwashing and touching mucous membranes - that are also likely being done more sloppily given the extraordinary focus on mask wearing (at least in Massachusetts).

    This second concern isn't about people who are intentionally ignoring public health advice; it's for people who are well intentioned and doing their best to follow the rules, but without adequate context of which behaviors are known to be most effective and which are frankly guesses. The practical result might be more transmission even if you have relatively good adherence to the intervention (in this case, mask wearing).
    "When I meet God, I am going to ask him two questions: Why relativity? And why turbulence? I really believe he will have an answer for the first." - Werner Heisenberg (maybe)

  14. #5264
    Quote Originally Posted by wiggin View Post
    Loki, there's two different concerns that I have:

    First, we do not have evidence that cloth masks substantially affect the transmission of SARS-CoV-2. Just because it sometimes has modest effects in the case of entirely unrelated viruses doesn't mean it will work here. The mechanistic information on the spread of SARS-CoV-2 is extremely limited to date; we simply don't know what droplet size is most likely to transmit the virus, what other conditions need to be met, and things like the typical viral load needed to initiate an infection. We just don't know. In this context (a purely mechanism based argument) we would not be able to conclude that a cloth face covering is helpful, but it's probably fair to say that the downside is negligible. I would say that further mechanistic studies will help strengthen the case but aren't a super high priority. We barely understand much more important things about this virus.

    Secondly, I am quite concerned about the practical application of this mechanistic hypothesis that, in a vacuum, a face mask will reduce transmission of the virus. That's where a semi-controlled trial would be valuable. We have lots of uncontrolled de facto trials going on, mostly driven by geography and politics, but I think it's far from unclear that a controlled trial to look at this would be infeasible or unethical. Regardless, it's easy to imagine scenarios where a public health emphasis on mask wearing results in higher and not lower transmission of the virus. This isn't because the individual person is less willing to engage in other interventions, but because people are more likely to view mask wearing as providing protection that it may not actually provide, and thus become laxer on other, likely more important, interventions. The biggest one I can see happening in my own state is social distancing, where I've seen people use mask wearing as a substitute for keeping one's distance and minimizing contact with others. But there are others - things like frequent handwashing and touching mucous membranes - that are also likely being done more sloppily given the extraordinary focus on mask wearing (at least in Massachusetts).

    This second concern isn't about people who are intentionally ignoring public health advice; it's for people who are well intentioned and doing their best to follow the rules, but without adequate context of which behaviors are known to be most effective and which are frankly guesses. The practical result might be more transmission even if you have relatively good adherence to the intervention (in this case, mask wearing).
    We don't need to have perfect knowledge about this particular knowledge to know what should work against the family of viruses. Similar viruses are transmitted mostly through coughing and sneezing and masks clearly cut down on that form of transmission. Are you arguing that this is not the case?

    Except we have numerous case studies of countries requiring the wearing of masks and the rate of transmission definitely didn't increase there (if anything, it fell sharply). Are we to assume that the virus somehow works differently in those countries?
    Hope is the denial of reality

  15. #5265
    Senior Member Flixy's Avatar
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    Did any of those countries just implement masks or simultaneously other measures as well?
    Keep on keepin' the beat alive!

  16. #5266
    Wearing masks is a strong visual reminder that the virus hasn't magically disappeared. And that until we have a vaccine and/or therapeutic meds, the only protection we have comes by altering human behaviors.

    It's been hard to watch high-risk populations congregate in large numbers to protest institutional inequities/injustices, which also increases their risks of covid-19 infection, and possible death. But I can see how they feel screwed no matter what they do, or that insult is worse than injury, since they've been hurting for generations.

    White guilt is real, and for good reasons we should feel ashamed.

  17. #5267
    Also, I wish this era was ushering in great new music, like the 60's did, but it's not.

  18. #5268
    Quote Originally Posted by Loki View Post
    We don't need to have perfect knowledge about this particular knowledge to know what should work against the family of viruses. Similar viruses are transmitted mostly through coughing and sneezing and masks clearly cut down on that form of transmission. Are you arguing that this is not the case?
    Perfect knowledge, no. Some actual data, hell yes. Not all coronaviruses are the same, and definitely not all respiratory viruses are the same. The way in which most transmission occurs varies widely even within related types of virus. Sure, I imagine that an infected person who sneezes/coughs over everyone else is likely an important vector. But what proportion of new infections is that mode of transmission causing? It could be 80%, it could be 10% - remember a lot of 'super spreader' events in pandemics often occur from people with mild or no symptoms. If it's 80% - and, crucially, we show that cloth masks reduce enough of the airborne particles from such sneezes/coughs that are most likely to cause transmission (itself dubious), then sure, face coverings are probably an extremely good idea when coupled with other measures. But if it's 10%, we need to start asking ourselves if the mechanistic value of focusing on this intervention justifies the potential cost in other behaviors.

    Loki, we cannot reason by analogy here. Viruses are tricky things and you can rarely make assumptions about how they will spread or affect the body just because they're genetically related to other viruses. There's so many things we simply don't know until we do the studies. Those highly cited studies a few weeks ago about SARS-CoV-2 on different surfaces? Lots of holes that need to be filled to understand the actual risk of touching such surfaces within a given period of time. Potential models for seasonal spread of the virus that would give us a breather? Pretty much a WAG since we barely understand how seasonal transmission works in other respiratory viruses.

    As I mentioned above, there were perfectly good reasons to believe that various chloroquine derivatives might be effective in treating SARS-CoV-2. There was a reasonable mechanism of action, in vitro data that looked promising, and data going back to SARS as being potentially valuable in treating these kinds of coronaviruses. But most medical and public health experts were appropriately cautious and insisted on controlled trials before implementing it willy-nilly. Why shouldn't we use a similar approach for other interventions?

    Patients with COVID-19 are presenting with a spectrum of symptoms that are, frankly, well outside the envelope of other coronaviruses. You have people coming into the hospital with obscenely low O2 saturation but apparently without debilitating symptoms. We're seeing very odd clotting behavior and multisystem damage. It's complicated and trying to suggest that we can promote an unproven method of reducing transmission as our primary public health messaging just because it might work in vaguely related viruses seems farcical.

    Except we have numerous case studies of countries requiring the wearing of masks and the rate of transmission definitely didn't increase there (if anything, it fell sharply). Are we to assume that the virus somehow works differently in those countries?
    There are so many confounding variables about how different countries work that this is a meaningless question. The virus does work differently in different countries because the demographics are different as are the population density, mobility, healthcare systems, adherence to public health directives, implementation of other measures to enforce social distancing, etc. That's why a controlled trial is important. It's possible that masks help, on the margins. It's also possible they hurt, on the margins, but are masked by other secular trends associated with different public health interventions and stages of the pandemic. It's possible they don't do anything at all! We don't know, the data are worse than sparse.
    "When I meet God, I am going to ask him two questions: Why relativity? And why turbulence? I really believe he will have an answer for the first." - Werner Heisenberg (maybe)

  19. #5269
    A followup for Loki. I'd invite you to read this opinion piece published a couple of days ago in Science:

    https://science.sciencemag.org/conte...c6197.full.pdf

    They are advocating quite strongly for universal adoption of 'well fitted medical masks' (as if that's what people are using) to reduce the spread of SARS-CoV-2. But if you look closely at their argumentation and their citations, you'll see just how thin the data is. There's a massive number of assumptions they're making. I'll give them credit for doing a reasonable job of highlighting those pieces of information that they're lacking (though there is a bit of exaggerating the conclusions one could draw from cited work, a common failing), but the things they don't know far outweigh the things they do.
    "When I meet God, I am going to ask him two questions: Why relativity? And why turbulence? I really believe he will have an answer for the first." - Werner Heisenberg (maybe)

  20. #5270
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    Quote Originally Posted by wiggin View Post
    A followup for Loki. I'd invite you to read this opinion piece published a couple of days ago in Science:

    https://science.sciencemag.org/conte...c6197.full.pdf

    They are advocating quite strongly for universal adoption of 'well fitted medical masks' (as if that's what people are using) to reduce the spread of SARS-CoV-2. But if you look closely at their argumentation and their citations, you'll see just how thin the data is. There's a massive number of assumptions they're making. I'll give them credit for doing a reasonable job of highlighting those pieces of information that they're lacking (though there is a bit of exaggerating the conclusions one could draw from cited work, a common failing), but the things they don't know far outweigh the things they do.
    You expend a lot of energy to convince us that masks have next to no influence on the spreading of covid-19. This is based a good deal on the lack of data about the effectiveness of masks. Usually that would be convincing.

    The reason why it's not really convincing is that first of all you are kind of sloppy in the definition of which masks it is you are talking about. Second, you totally ignore the fact there probably are super spreading events where people do things that can be described as 'breathing intensely in a closed space'. Noth coughing, not sneezing, breathing. Doing it in your elbow is not an almost as effective, and feasible, strategy as with either coughing or sneezing.

    Rather than fight the idea on your reflexes, you should consider that something could be learned from it (mass use of surgical masks) in a situation where even the experts are frequently caught with their pants on their ankles
    Trump: Lock him up.

  21. #5271
    Quote Originally Posted by wiggin View Post
    Perfect knowledge, no. Some actual data, hell yes. Not all coronaviruses are the same, and definitely not all respiratory viruses are the same. The way in which most transmission occurs varies widely even within related types of virus. Sure, I imagine that an infected person who sneezes/coughs over everyone else is likely an important vector. But what proportion of new infections is that mode of transmission causing? It could be 80%, it could be 10% - remember a lot of 'super spreader' events in pandemics often occur from people with mild or no symptoms. If it's 80% - and, crucially, we show that cloth masks reduce enough of the airborne particles from such sneezes/coughs that are most likely to cause transmission (itself dubious), then sure, face coverings are probably an extremely good idea when coupled with other measures. But if it's 10%, we need to start asking ourselves if the mechanistic value of focusing on this intervention justifies the potential cost in other behaviors.

    Loki, we cannot reason by analogy here. Viruses are tricky things and you can rarely make assumptions about how they will spread or affect the body just because they're genetically related to other viruses. There's so many things we simply don't know until we do the studies. Those highly cited studies a few weeks ago about SARS-CoV-2 on different surfaces? Lots of holes that need to be filled to understand the actual risk of touching such surfaces within a given period of time. Potential models for seasonal spread of the virus that would give us a breather? Pretty much a WAG since we barely understand how seasonal transmission works in other respiratory viruses.

    As I mentioned above, there were perfectly good reasons to believe that various chloroquine derivatives might be effective in treating SARS-CoV-2. There was a reasonable mechanism of action, in vitro data that looked promising, and data going back to SARS as being potentially valuable in treating these kinds of coronaviruses. But most medical and public health experts were appropriately cautious and insisted on controlled trials before implementing it willy-nilly. Why shouldn't we use a similar approach for other interventions?

    Patients with COVID-19 are presenting with a spectrum of symptoms that are, frankly, well outside the envelope of other coronaviruses. You have people coming into the hospital with obscenely low O2 saturation but apparently without debilitating symptoms. We're seeing very odd clotting behavior and multisystem damage. It's complicated and trying to suggest that we can promote an unproven method of reducing transmission as our primary public health messaging just because it might work in vaguely related viruses seems farcical.
    "N95 masks offered 96 percent protection, the analysis found, while the figure for surgical masks was 77 percent."

    From a quoted study: "Face mask use by the primary case and family contacts before the primary case developed symptoms was 79% effective in reducing transmission (OR=0.21, 95% CI: 0.06 to 0.79)"

    Another quoted article: "Infectious aerosol particles can be released during breathing and speaking by asymptomatic infected individuals. No masking maximizes exposure, whereas universal masking results in the least exposure."

    "Standing more than three feet away cuts the risk of transmission to 3 percent from 13 percent, the analysis found. Use of masks reduces the odds of infection to 3 percent from 17 percent, and eye protection to 6 percent from 16 percent."

    https://www.nytimes.com/2020/06/01/h...ronavirus.html
    Hope is the denial of reality

  22. #5272
    Let's see. First, this is from a meta-analysis published yesterday, while public health advice has been around for a few months with poor support. Second, if you read the Lancet piece you'll see the data quality was uniformly poor: out of 172 studies included, no a single one was a prospective controlled trial. The vast majority of the studies included weren't actually looking at SARS-CoV-2 but rather vaguely related diseases like the original SARS or MERS (and themselves very poor quality data). In fact, their study indicated a pretty good risk reduction from eye protection - on par with that from surgical masks - but you simply don't see anyone suggesting this as a public health intervention. Furthermore, the data in non-healthcare settings was largely limited to members of the same household rather than community spread. The conclusions of the study itself say that they need prospective RCTs to really make conclusions. They also highlight that the type of PPE is crucial in determining the relative risk; homemade face coverings are hardly going to be as effective as much of the studies performed to date.

    Another quoted article: "Infectious aerosol particles can be released during breathing and speaking by asymptomatic infected individuals. No masking maximizes exposure, whereas universal masking results in the least exposure."
    This is from the opinion piece in Science that I linked to. It's not data.

    I want to be absolutely clear here. I think it is possible that there is a modest positive effect on transmission from universal wearing of cloth masks, even with real world usage and all of the unintended knock-on effects. I just am not willing to endorse this kind of massive intervention (which also has a real chance of having a modest negative effect) without data that doesn't suck. A prospective trial is really not that hard to do here, and making the kinds of sweeping statements I've heard people make - both politicians and online mask vigilantes - is simply unsupported by the available evidence.

    Quote Originally Posted by Hazir
    You expend a lot of energy to convince us that masks have next to no influence on the spreading of covid-19. This is based a good deal on the lack of data about the effectiveness of masks. Usually that would be convincing.

    The reason why it's not really convincing is that first of all you are kind of sloppy in the definition of which masks it is you are talking about. Second, you totally ignore the fact there probably are super spreading events where people do things that can be described as 'breathing intensely in a closed space'. Noth coughing, not sneezing, breathing. Doing it in your elbow is not an almost as effective, and feasible, strategy as with either coughing or sneezing.

    Rather than fight the idea on your reflexes, you should consider that something could be learned from it (mass use of surgical masks) in a situation where even the experts are frequently caught with their pants on their ankles
    Hazir, a few points. First, I'm using face masks as a catch-all for non-respirator masks, like disposable cloth surgical masks or homemade masks. Obviously the former are likely to be somewhat better than the latter, but I don't expect either to be great. Second, you're absolutely right, there are likely superspreaders who are asymptomatic who are shedding all sorts of viruses without sneezing or coughing. I think a mask is even less likely to be effective than in the case of large droplets (e.g. coughing/sneezing); aerosols are very hard to keep in with fabric, and are the main thing you'd get in asymptomatic speakers/breathers (e.g. see the Science piece I posted). An elbow won't help you, true, but a mask probably won't do much either. You're much better off with a real focus on social distancing.

    I'm not really sure what your last paragraph was about here. I'm open to getting good data from the patchwork public health response to date; hopefully it can inform us for the next pandemic. But the reality is that if we don't get good quality data instead of a smattering of retrospective observations, we're not going to be able to draw very strong conclusions - for the current or the next pandemic.
    "When I meet God, I am going to ask him two questions: Why relativity? And why turbulence? I really believe he will have an answer for the first." - Werner Heisenberg (maybe)

  23. #5273
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    I'm not going to put up a big fight over this, but your approach is not very different from people who advice abstention to stop spreading HIV. The advice is sound but at the same time is not enough for the simple reason that people don't tick that way.

    You are right about inconclusive data being inconclusive. But given the choices between hoping everyone is going to be consistently keeping social distancing and slapping something on their faces so that they remember not to breathe in my face, I know which way I go.
    Trump: Lock him up.

  24. #5274
    Let sleeping tigers lie Khendraja'aro's Avatar
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    Quote Originally Posted by wiggin View Post
    which also has a real chance of having a modest negative effect
    I'd like to point out that if you get to dispute the positive side then we also get to dispute the supposedly negative side. Works both way, y'know?

    So, do you have data "which doesn't suck" which supports your narrative?
    When the stars threw down their spears
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  25. #5275
    Quote Originally Posted by wiggin View Post
    Let's see. First, this is from a meta-analysis published yesterday, while public health advice has been around for a few months with poor support. Second, if you read the Lancet piece you'll see the data quality was uniformly poor: out of 172 studies included, no a single one was a prospective controlled trial. The vast majority of the studies included weren't actually looking at SARS-CoV-2 but rather vaguely related diseases like the original SARS or MERS (and themselves very poor quality data). In fact, their study indicated a pretty good risk reduction from eye protection - on par with that from surgical masks - but you simply don't see anyone suggesting this as a public health intervention. Furthermore, the data in non-healthcare settings was largely limited to members of the same household rather than community spread. The conclusions of the study itself say that they need prospective RCTs to really make conclusions. They also highlight that the type of PPE is crucial in determining the relative risk; homemade face coverings are hardly going to be as effective as much of the studies performed to date.


    This is from the opinion piece in Science that I linked to. It's not data.

    I want to be absolutely clear here. I think it is possible that there is a modest positive effect on transmission from universal wearing of cloth masks, even with real world usage and all of the unintended knock-on effects. I just am not willing to endorse this kind of massive intervention (which also has a real chance of having a modest negative effect) without data that doesn't suck. A prospective trial is really not that hard to do here, and making the kinds of sweeping statements I've heard people make - both politicians and online mask vigilantes - is simply unsupported by the available evidence.
    On the one hand, we have numerous studies showing masks work and have a significant impact on both covid19 and similar viruses. Yes, they are observational studies. That's life. On the other hand, we have your hunch. Which should we believe?

    I work in an area where experimental designs are impractical. A good study will test the hypothesized causal mechanism (rather than simply run a bunch of regressions). Once you have multiple studies end up with the same outcome despite relying on different data and making different methodological choices, you have a pretty strong reason to accept the results. Yes, it's quite possible the results will be overturned in the future. But perfect is the enemy of the good enough. Pretending that consistent though imperfect evidence should be dismissed is silly and counterproductive. Especially when there is no evidence, even imperfect evidence, in the other direction.
    Hope is the denial of reality

  26. #5276
    Quote Originally Posted by Hazir View Post
    I'm not going to put up a big fight over this, but your approach is not very different from people who advice abstention to stop spreading HIV. The advice is sound but at the same time is not enough for the simple reason that people don't tick that way.

    You are right about inconclusive data being inconclusive. But given the choices between hoping everyone is going to be consistently keeping social distancing and slapping something on their faces so that they remember not to breathe in my face, I know which way I go.
    I am not an expert on HIV transmission, but I would assume that there is high quality data about the relative efficacy of different methods to prevent transmission of HIV, especially for PrEP. But I do have an acquaintance who just got a PhD in public health who specifically studied different public health interventions to reduce transmission of HIV in sub-Saharan Africa (including performing a number of controlled prospective studies, I believe), and what do you know? Some interventions work better in certain populations and regions than others, and they actually needed data to figure it out.

    As I've said before, you're assuming there's no cost in laxity wrt other known methods to reduce transmission when you harp on face coverings. I'm less convinced.

    I have no idea if cloth masks are helpful or harmful. No one else really does either. I'd prefer that we were honest about that and worked to rectify our ignorance. It's entirely reasonable for public health authorities to say something along the lines of 'we're not sure this is going to help, we think it might based on X sketchy data, but we're going to run a clinical trial to figure it out. In the meantime we recommend them but not as a replacement for social distancing.' But instead most people (including my governor, who in general I have given high marks on his response to this pandemic) have been saying 'if you can't social distance, use a face covering.' In people's minds that's just a small step away from 'you can wear a face mask instead of social distancing', and that's the behavior I've been people doing.

    Quote Originally Posted by Khendraja'aro View Post
    I'd like to point out that if you get to dispute the positive side then we also get to dispute the supposedly negative side. Works both way, y'know?

    So, do you have data "which doesn't suck" which supports your narrative?
    No, I don't. In the clinical world, you have to prove safety and efficacy of an intervention, not the status quo. I'm not proposing inaction, though, I'm proposing we find out one way or the other. I don't have a 'narrative' that masks are good or bad, I just haven't found compelling data.

    Quote Originally Posted by Loki View Post
    On the one hand, we have numerous studies showing masks work and have a significant impact on both covid19 and similar viruses. Yes, they are observational studies. That's life. On the other hand, we have your hunch. Which should we believe?
    NO. You don't have studies that show anything like that. You have a small number of studies that demonstrate that in a certain sample of a certain population, the people who wore surgical masks had lower transmission rates of SARS-CoV-2 to their family members than those who didn't. You have a larger number of studies that show similar correlations with other coronaviruses. That is not the same thing as showing that 'masks' in general 'work' or have a significant impact on communal spread. Even for observational studies, these were pretty poor quality and the sheer amount of potential bias in them makes them barely worth the paper they are printed on.

    I don't have a 'hunch', I just have skepticism. I want to make data driven decisions when we're dealing with something as important as the lives of a few million people. The same people who are now all holier than thou about the maskless or poorly worn masks were parroting the conventional wisdom the CDC had back in February that masks were unnecessary and potentially unhelpful. I don't believe that we should make decisions based on literally meaningless data and pile on a bandwagon. I think we should pause, evaluate the data we have, figure out how to get better data, and then make a nuanced recommendation. Frankly, that is not what has happened.

    I work in an area where experimental designs are impractical. A good study will test the hypothesized causal mechanism (rather than simply run a bunch of regressions). Once you have multiple studies end up with the same outcome despite relying on different data and making different methodological choices, you have a pretty strong reason to accept the results. Yes, it's quite possible the results will be overturned in the future. But perfect is the enemy of the good enough. Pretending that consistent though imperfect evidence should be dismissed is silly and counterproductive. Especially when there is no evidence, even imperfect evidence, in the other direction.
    Loki, with respect, the burden of proof to justify a clinical intervention is and should be higher than the burden of proof to support a political science theory. We have all sorts of putative causal mechanisms that would help treat or reduce transmission of SARS-CoV-2. We just don't know which one will work in the context of the incredibly complex world of biology and human behavior. We can't just wave our hands at some shitty data and make one of the most consequential public health directives that forms the core of our plan to return to some form of 'normal'. People can and do die when we are that sloppy.

    There was just a furor about some of the recent studies released based on observational data that suggested that certain treatments for COVID-19 were either effective or were dangerous (it looks like a small data analytics firm that supplied data to the authors was either unbelievably incompetent or fraudulent). Those studies have resulted in huge - absolutely massive - changes in how COVID-19 is treated. A number of prospective RCTs were put on hold or stopped because the increased risk appeared to be so strong that they felt it was unethical to continue. A different therapy that was reported to have positive results has been deployed en masse in parts of Latin America, without other data to support its safe use. Precious time has been lost because people took some poor quality observational studies (published in Lancet and NEJM!) as truth instead of getting real data the hard way. We cannot afford that kind of delay.

    It is not impossible to get this data. In fact, a forward thinking person could have started a trial as early as March in the US and we'd already have much more compelling data. But we haven't done so, and we are going down a path that might be just fine - but we have no way of finding out.

    edit:
    Two opposing perspectives on this issue from April may help to explain my argumentation better:
    https://osf.io/preprints/socarxiv/uyzxe/
    https://www.bmj.com/content/bmj/369/bmj.m1435.full.pdf
    Last edited by wiggin; 06-04-2020 at 02:36 AM.
    "When I meet God, I am going to ask him two questions: Why relativity? And why turbulence? I really believe he will have an answer for the first." - Werner Heisenberg (maybe)

  27. #5277
    Let sleeping tigers lie Khendraja'aro's Avatar
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    Quote Originally Posted by wiggin View Post
    No, I don't.
    Riiight. Cut the bullcrap. Seriously. What is this shit? First you moan about there being "probable risks" and then you can't be fucking arsed to back up this bullshit when prompted to? YOU MADE THE CLAIM, you support it.

    Otherwise I'm labelling you a fucking stupid wanker who thinks that this is a game.

    And don't give me the "oh, but we need to first prove its safe!" It's a fucking mask. Not botox. But please, tell me how we subjected our medicinal personell to a potentially dangerous intervention for decades now. You realize that those people had to wear masks for quite a while now. We've probably had a lot of them keeling over dead... oh, wait. We didn't. Big surprise.

    But sure, keep on riding your high horse. Jesus Christ. Next up: You're telling us that the mandate to dress decently is also a potential health hazard.
    When the stars threw down their spears
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    Did he who made the lamb make thee?

  28. #5278
    Quote Originally Posted by Khendraja'aro View Post
    Riiight. Cut the bullcrap. Seriously. What is this shit? First you moan about there being "probable risks" and then you can't be fucking arsed to back up this bullshit when prompted to? YOU MADE THE CLAIM, you support it.

    Otherwise I'm labelling you a fucking stupid wanker who thinks that this is a game.

    And don't give me the "oh, but we need to first prove its safe!" It's a fucking mask. Not botox. But please, tell me how we subjected our medicinal personell to a potentially dangerous intervention for decades now. You realize that those people had to wear masks for quite a while now. We've probably had a lot of them keeling over dead... oh, wait. We didn't. Big surprise.

    But sure, keep on riding your high horse. Jesus Christ. Next up: You're telling us that the mandate to dress decently is also a potential health hazard.
    You don't seem to be getting what Wiggin is driving at. He isn't saying the mask is itself harmful, he is saying that it can give people a false sense of security which might mean they alter their behavior in ways that puts them at risk. Masks are not only very easy to use ineffectually, they also can cause people to do things that may in fact aid in spreading the virus, (not cleaning or disposing of masks regularly, constantly touching the face, etc...).

    He has been very clear about his position, and it doesn't seem to be that unreasonable. More data isn't bad. Being able to improve advice to the general public isn't bad. Understanding how the layman uses a mask versus a trained professional isn't bad. It isn't difficult to see that interventions that might be good in theory can become problematic in practice.

  29. #5279
    The people I see wearing masks are the ones being cautious.
    Hope is the denial of reality

  30. #5280
    People who refuse to wear masks in public are selfish.
    .

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