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Jun 10, 2023Liked by Vinay Prasad

Breaking Now. Experts say Dr. Fauci wanted to come out of retirement to guide us through this. And there are reports that Ashish Jha is tweeting about the dangers of smoke inhalation so he can become the smoke czar. Little does he know that he actually is qualified for the job given that he was blowing smoke up our collective asses for so long.

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I think we made a mistake discounting the extent of neurosis early on. I remember one of my main arguments at the time was “if masking works so well against colds, why haven’t you been masking yourself and your kids your whole life to protect from the flu, RSV, etc?”

Well, apparently they took my word for it… Now they have a newfound regret over decades of recklessly breathing free, and are making up for it overtime over any excuse!

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Dr. Prasad is a fine scientist. He shares an even finer attribute - "common F'in sense" - with the great philosopher and wise man Yogi Berra who said: "In theory there is no difference between theory and practice. In practice there is."

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I would grab a handful for my next couple of drywall projects.

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It's not just in medicine...we have so many who want to create regulation, policy, legislation, etc... based on the "...But it just makes sense that it would be effective because I'm just sure it would..." methodology.

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I'm a bit confused. Either the masks make the air less smoky or they don't. It's really up to the individual to figure out if it's having a benefit. I don't see at all why we'd bother with an RCT. Either the air smells better or it doesn't. And how you breathe isn't affecting anyone else, so who cares? Is that the point - don't recommend, just offer masks for those who find them helpful? That's fine, but I hope we're not arguing that we need an RCT to see a benefit.

Woodworkers wear masks all the time to reduce particulate. It works. How do you know? By the color of your snot after a day in the woodshop. Sometimes, I wear a mask when I'm doing gardening as well. I don't need an RCT to tell me if it works or not - either my snot is black or it's not.

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Obviously we all should be masking to prevent climate change. All that CO2 is a hazard 😱

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As VP says, “Masking is a mental illness.” Masking for the smoke from fires, or when demand masking by unvaccinated athletes visiting the White House in June 2023.

What the hell is going on with people? Are they really this ill? Or are they cult victims? Or just stupid? It’s all so mind boggling.

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Given how often I see people outside and seemingly alone in their cars w masks on, VP is spot on imo. BTW, I live in a southern purple state.

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If one wants to be quantitative, smoking a single cigarette corresponds to inhaling 8 mg of PM2.5, which is equivalent to 8 hours (that's right 8 hours) of very heavy exercise (e.g. cycling at close to one's FTP) at NYC's peak level of 500 ug/m^3 if the PM2.5 from a cigarette smoke and the NYC smog/haze due to the Quebec fires have comparable toxicity. Bottom line: if one has ever been to a smoke-filled bar, then cycling under these conditions for an hour or two is really no big deal.

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I fear that public health wants to normalize masking so they can trot out mask mandates at will. I agree that masking is a symptom of a mental health issue, presumably untreated anxiety disorder. Forcing (or even recommending) face coverings is wrong.

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Vinay, you are a bit harsh today. Yes, masking studies are very difficult but not impossible to do. One part of NYC during the height of Canadian forest fire might be quite a bit different in terms of respiratory hazard than another. In addition, adherence to the protocol will always be problematic. On the other hand, I think that it is not helpful to call public heath people as the "dumbest people". I would characterize them as arrogant and blind to the intelligence of those who have disagreed with them and will disagree with them. It is also not helpful to call masking a "mental illness". I think that the Asians and African Americans who continue to mask more than the rest of us are poorly informed and have an exaggerated sense of vulnerability. Yes, the fears are exaggerated and the knowledge base is inferior but this is hardly a mental illness.

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RCTs are not the only evidence that one can use to decide to wear a mask outdoors with heavy smoke above 200 ppm .5um from fires. I have hiked, breathing hard, in such bad air both with and without N95 masks. Without a mask, the smoke irritates the lungs, and wearing a mask is a small price to pay to avoid the discomfort. I believe that a recommendation to CONSIDER wearing an N95 mask outdoors when there is very heavy, irritating smoke, is sensible. As is the recommendation to avoid strenuous exercise in such conditions.

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Mandating masks without evidence is one thing. But optional masks without evidence is entirely different. The first relates to government forcing it on a population, which should not be done without evidence. The second relates to an individual assessing the asymmetric risks that apply to him specifically. The precise probability of smoke harm to him is unknowable but probably very small. But the consequences may not be: they may be catastrophic. Whereas, the consequences of him masking for the short term in NYC is negligible. With this kind of asymmetry in outcomes, it makes sense to wear a mask in NYC, and I would myself if I were there.

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The first step—even before you launch that RCT—is to figure out what you’re trying to protect against. An N95 will NOT protect you from gases. It WILL protect you from particulate matter down to about the 2 micron level. Wildfire smoke does contain particles like that. So an N95 may be a good idea.

Terri H had a good suggestion: the snot test. If you blow your nose and get dirty stuff, try a mask. If your snot is cleaner then the mask is helping. Also, a mask that is working should wear out! It should get dingy and/or become gradually harder to breathe through. That means it is getting clogged with tiny particles, the ones you did NOT breathe in.

An RCT could be very useful. But Vinay might have to broaden his Lit Search to include occ-health-and-safety stuff, or even engineering rather than medical journals.

Or he can go home to LaPorte and ask the Mill Rats (g).

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This is another instance when our doughty public health leaders get to puff up their chests and make grave pronouncements on the existential threat posed by the "forest fire crisis". Never waste a minor problem which can be framed as the end of times with the eager complicity of the legacy main stream media.

Of course this is little more than kabuki theater; you can be certain the N95 mask recommendations would never have come out but for their three-year covid mask rehearsal.

In normal times, Vinay's criticism may be a little heavy handed: Our public health officials could be seen as merely offering an innocuous bit of useless "help". --perhaps better seen as vaudeville retirees, rather than escapees from an institute for behavioral disorders. However, I continue to harbor the reservation that our public health officials are practicing unscientific dictates that violate norms of democracy, when they become mandated on penalty of law.

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