Vinay, you are too nice. Topol (with whom we both have personal interaction) is an idiot -- through and through. His knowledge level on many topics (including epidemiology) is way BELOW sophomoric. A kindergartener would be ashamed of most of the things he says. It is perhaps one of the saddest commentaries on medicine that he holds the position he does. Scripps stopped getting all referrals from me when he took that spot. He has done them no favors.
This article is on my list for worst top 10 articles over the past five years (and there have been so many bad ones, that is a hard place to be). The premises are wrong; the reasoning is wrong; the conclusions are actually dangerous.
You are usually frank, but this deserves much harsher treatment than you gave it. Articles like this do us all a world of damage.
Erik, I think that we make an error in attributing nefarious motives to our opponents. Topol, like Fauci, is likely totally sincere and has an above average IQ. He is convinced that he is right and may subconsciously believe that the ends justifies the means. Good honest and open debate might be of help. However, Topol and Fauci are NOT participating in such debates. Read Scott Atlas's book. A Plague Upon Our House, to get some accurate background information about how Birx and Fauci refused to consider dissenting views during 2020. To embrace science publicly and operate as they did is quite sobering about the depth of bias that was and is operative.
The clear purpose of the STAT article is to make the case for not doing studies that might not support already-in-place public policy. That’s it; there is no science in the article at all. As the article admits, “Such research sows confusion that erodes trust in science, misleads policymakers, depletes social capital, and squanders critical resources. We believe that many of these studies should never have been done at all, reserving resources for studies that could improve health outcomes… Such studies can confuse people who want to know how effective face masks are, while emboldening people who are already completely convinced that face masks are ineffective — and are looking for grounds to sow doubt about them.“ So that’s the point… any nuance in the results of a study, that don’t fully support a policy in place, should not be published, because nuance “sows confusion” and “erodes trust in science.” Just have “experts” tell people what to do, and suppress anything that doesn’t provide absolute evidence for existing policy.
By the logic of this STAT article, newspapers in the 1920s and early 1930s should have never published investigative pieces on organized crime, and how it was fueled by the illegal alcohol trade, because it would “sow confusion” about and “erode trust” in Prohibition.
My masking is still at the mercy of the covid numbers reported in the county. Despite most testing at home (if at all), at a certain arbitrary number of positives reported to the DOH I wear a mask for the week. If it falls below that level the next week they mask police give me a reprieve. Very scientific!
When oh when will these BS papers to justify their erroneous narrative cease. The fact, people like Topol say the things he does with impunity is insane. The only silver lining I see is that in talking with my patients, they are VERY skeptical of anything the talking heads of the administration say and what the MSM parrots.
Unfortunately, they extend that to most of the medical profession as well. As individuals, those of us who have always been honest with our patients still have a modicum of trust between us. But many are perfectly willing to throw the entire medical baby out with the bathwater -- and I cannot blame them. Really a sad state of affairs that will take generations to repair, if it can be repaired at all.
A few suggestions here. Please define your terms when you reference “mask”, as “masking” is a huge umbrella term.
SARS CoV2 is airborne, and much more contagious than the original wild type. Surgical and cloth masks are therefore rendered obsolete we can agree. This is what most RCTs study, and which you are invoking to undermine “masks”, right? Or am I misunderstanding because your terms are not defined here in this post?
KN95, N95, and other properly fit respirators absolutely do work, even for SARS CoV2. They work for individuals in the community, on planes, and in tight poorly ventilated quarters. This is how I have personally not become sick, despite being in 100 square-foot rooms for the past three years with multiple patients with Covid, some of them not wearing masks for up to 40 minutes while we’re together and they are presymptomatic by a day or less.
“N95 masks are designed to remove more than 95% of all particles that are at least 0.3 microns (µm) in diameter. In fact, measurements of the particle filtration efficiency of N95 masks show that they are capable of filtering ≈99.8% of particles with a diameter of ≈0.1 μm (Rengasamy et al., 2017). SARS-CoV-2 is an enveloped virus ≈0.1 μm in diameter, so N95 masks are capable of filtering most free virions, but they do more than that.”
A well fitting mask/respirator of N95 quality absolutely works. These can also be called masks. Hospital fit tests and prior experience with respiratory precautions for all sorts of contagious diseases in hospitals give us ample decades of experience, too. Call for more studies of this if you will.
Ideology-driven use and denigration of the word “mask”, without pointing out to your readers that N95/99s are at one spectrum and cloth masks are at the other does a disservice to your elderly, immunocompromised, and other readers who might otherwise spare themselves a case of Covid. Or spare others. Because of reductionist arguments like the one presented here I am frequently having to educate patients who tell me “masks don’t work.” It’s not that reductionist, agreed?
And ad hominem attacks on Topol, Fauci, and others do a great job of inciting anger, intolerance, and perhaps violence against these figures who are also trying to communicate and help others. Ok to disagree with them and point out their shortcomings. But your conclusions are not perfect here either, and they invite people to openly challenge healthcare workers and others who mask with hostility and disdain as they chose to wear a mask, preferably a real mask.
At this point “masking” is a choice, that’s fine, but masking exists along a continuum.
If you can cite any RCTs or other quality evidence that I’ve missed about N95 masks not working, please let me and your readers know so that I can review (and educate myself as well.)
Dr. Prasad is correct to lump masks together in the same basket, since that is what governmental mandates did in almost every region (parts of Germany being an exception, later in the pandemic). And all the RCT evidence about non-N95 masking for covid is negative or shows miniscule effectiveness, you agree?
But the evidence of RCTs of N95 vs surgical masks also fails to show significant benefits of the N95s. The first link below is of a large RCT of healtcare workers in several countries. Notably, the participants in the N95 arm wore *fit-tested* N95s according to the trial protocol -- which ordinary citizens do not and cannot do. This RCT found statistically significant benefit of N95 over surgical only when they did an unplanned subgroup analysis, and even in the subgroup the N95s were hardly miraculous in their effectiveness.
That’s the only covid-specific RCT of N95s that I know of. Pre-covid there were some RCTs of N95s against influenza, and they showed only modest benefit of N95 over surgical (often not statistically significant). Hence the recent Cochrane review’s conclusions that so agitated pro-masking folk. See the Cochrane review linked here:
Thanks I will read. I just can’t believe that conclusion though. I can’t imagine myself going in to see my next patient with Covid, and not wearing an n95. This has prevented infection for everyone I work with, even before vaccines. Primary care docs were actually dying at the highest rate of all specialties early on, as we were told surgical masks are sufficient. Rates were much lower in ICU docs who had all the proper PPE as they took care of the sickest of the sick. I’ll read later though thanks.
You can’t believe it? You can’t believe real science? Can you believe there are MANY people who lived in the same household as others who got Covid while they didn’t? Your anecdotal experiences are not evidence of anything.
The fact is, the “science” on this subject was pretty well settled and understood prior to Covid-19.
I had a confirmed case of covid in late 2021, no one in my house got sick. Nobody bothered to wear masks or isolate. Same for a friend of mine; her son had covid, no one bothered isolating, no one else got sick. It's a bit of a crapshoot I guess.
Dr. McCormick - Your comment seems to one of the few here that employs common sense. Of course, KN95 and N95 masks/respirators help protect people exposed to COVID. I can't imagine a doctor advising their patient with comorbidities or who is immunocompromised NOT to wear one of those. Besides, why are we not seeking opinions from industrial hygienists who have far greater expertise regarding the protective value of masks/ respirators than do physicians -- even brilliant ones like Dr. Prisad?
I recently watched a YouTube video where an amateur cleans a thick layer of rust from the engine bay of his steel narrowboat. He wore an expensive N95 mask as he generated a thick dust cloud. After a days work he spoke to camera. His whole face (including his nose and mouth) was covered in a thick layer of dust. He asked for advice about preventing a recurrence.
There's been non-inferiority trials that compare surgical to N95 for masks in healthcare settings. Surgical masks are non-inferior. Cochrane review references this. Vinay knows way more about this than you, hell I do.
Edit: Let me add that virus particles are smaller than what N95s are made to filter. They filter bacteria well though. Even in lab tests fit tested n95s let some virus contamination in.
Also, almost no one is actually fit testing those things I suspect. I can believe they would reduce your exposure if properly fitted, but not stop it for very long.
In three years, taking care of actual patients with Covid, my N 95 has never failed. I don’t think people wear them properly, I am hard-core. It’s hard to pick that up in pooled meta-analysis with sloppy mask wearing among individuals. Also, these individuals go home and then circulate in the community, usually with children going to schools with no masks, etc. Are you aware of any subset analysis of healthcare workers without children who also mask at supermarkets, airports, etc?
Please reply without any snarkiness, if people are able to do that on this website!
I also tend to think that a properly fitted N95 will protect the wearer for a while in the presence of virus-bearing aerosols. (The virus itself is small enough to go through the mask, but that's irrelevant since the virus doesn't float around bare, it's contained in droplets or aerosol particles mostly > .1micron).
Almost nobody I saw wearing N95s during the pandemic was wearing them with proper fit, and that includes healthcare workers. Probably you do wear yours well. But anyone with a beard, or who doesn't pinch the nose bridge, or whose mask is too big for their face (many petite women) ... it's just a decoration.
And given the RCT results and real-world experiences we've gained, it's clear that mandating mask-wearing does very little, if anything, to stop spread. THAT's the important point, not the technical issue of whether perfectly worn N95s block 95% of aerosol particles. But the pro-mask crowd seems to want to push mandates forever.
Sorry, I am a bit grouchy because I am trying to quit caffeine entirely.
I think that is part of the problem with masks, that the vast majority of people are not wearing them correctly. Plus, if you would have to keep it on your face even in your interactions with family members to truly be protected, assuming they're working at all.
It's certainly possible that a fit tested N95 is reducing your exposure enough that if you change them out frequently it could give you some edge in avoiding it, but I personally have hard time believing they're protecting you for long. Even a fit tested N95 allows for viral contamination in lab tests, just significantly less than one not fit tested
Keep in mind I have never caught COVID either and I don't really take any particular precautions. Some people don't seem to get infected by it also.
Maybe it is your mask though, but it's going to be very hard to prove that.
I work at an adult school, and it's rare to see a mask, even among the elderly. This is in Los Angeles County (not City). What saddens me is seeing young or young-ish people still wearing masks, or people who wear masks everyday but do so improperly: taking it off and putting it back on frequently, wearing it under the nose or on the chin, wearing a useless cloth one, etc.
What covid policies and the state of science they are based on should remind us all, is that it is very easy to fool ourselves into believing what we want: we aren't as rational as we would like to believe. Witchcraft, voodoo, elixirs and spells are alive and well in modern medicine.
We must teach the current crop of young physicians and in training the proper critical approach to data analysis and manuscript critiques. Vinay has the tools but so many others do as well. Students need to be exposed to improper studies and conclusions WITHOUT the sometimes value-laden interpretations of possible explanations (idiocy, political bias, Big Pharma, etc.). The key is to refine our current clinical databases and our health beliefs. As I have suggested in the past, the absence of valid, large studies proving the efficacy of masks in preventing the spread of respiratory viruses does NOT prove that masks are always ineffective. Perhaps, the right studies have not yet been done. I believe that, at best, such studies are likely to show minimal to zero efficacy. The NIH needs to get its act together and fund key studies.
I guess no one here is going to address the questions raised by my comment: (1) Do we need an RCT to establish that if you keep SOME DISTANCE (TBD) from an infected person(s), your chances of catching COVID will be reduced? and (2) Do we need an RCT to establish that wearing SOME QUALITY MASK/RESPIRATOR (TBD) for SOME % OF THE TIME (TBD) will protect you? If not, scientists/doctors need to be more precise in their communications. Obviously, under some circumstances, distancing and masking can protect individuals; we just need to define the parameters.
Dr. Prasad's critique of the STAT paper could be improved if he addressed the following question in a footnote or an addendum: Do we need an RCT to establish that some form of distancing and/or correctly wearing a certain quality mask will mitigate the effects of -- if not prevent -- COVID for an individual patient who is compliant 100% of the time? Please see also Gandhi et al.: Masks Reduce Viral Inoculum of SARS-CoV-2 (July 2020).
There are a wealth of RCTs on masks -- not just with covid. Some were done in ORs where half the staff wore them and half did not -- never made one whit of difference for practitioners or patients. The influenza and covid virions are about the same size so it is almost certain that the studies apply. And virtually all RWE studies done with covid (other than, literally, lies published by the CDC) also show no effects.
The German covid data also shows NO difference (with high compliance rates in both cases) between N95s and surgical masks. So "high quality" is just noise as well.
If you really want to amuse yourself, get a well fitted N95 mask on a smoker, then have them inhale and breathe out through the mask. (I have wonderful videos of this). Then keep in mind that the smoke particles are far larger than the virions.
So any RCT would be good to have. But the amount of dead horse beating that masking has gotten with covid is mind-numbing...and to me inexplicable except as a psyop.
We can mitigate the effects of COVID via vaccines, infection-acquired immunity, long-term monoclonal antibodies, and other means, so why would anyone (who is not seriously immunocompromised) be interested in wearing a high-quality mask “100% of the time”? That boat has left the dock.
Ah, yes, the “parachute” argument. Well, long before parachutes were used, they were extensively tested with dead weights, and on ropes to slow descent using jump towers to test landing speeds and other factors. Yes, scientists and engineers actually ran extensive tests of them before they were used by people, and have continued to do so for the past century to improve them! And yes, if a parachute design doesn’t work, I’m not using it.
Thank you. You've helped make my point: There are other forms of evidence in science that may have equal or greater probative value than RCTs. To the extent that anyone thinks otherwise, they are simply wrong.
Vinay, you are too nice. Topol (with whom we both have personal interaction) is an idiot -- through and through. His knowledge level on many topics (including epidemiology) is way BELOW sophomoric. A kindergartener would be ashamed of most of the things he says. It is perhaps one of the saddest commentaries on medicine that he holds the position he does. Scripps stopped getting all referrals from me when he took that spot. He has done them no favors.
This article is on my list for worst top 10 articles over the past five years (and there have been so many bad ones, that is a hard place to be). The premises are wrong; the reasoning is wrong; the conclusions are actually dangerous.
You are usually frank, but this deserves much harsher treatment than you gave it. Articles like this do us all a world of damage.
Is Topol in fact a totalitarian statist? Or ‘merely’ an idiot?
Erik, I think that we make an error in attributing nefarious motives to our opponents. Topol, like Fauci, is likely totally sincere and has an above average IQ. He is convinced that he is right and may subconsciously believe that the ends justifies the means. Good honest and open debate might be of help. However, Topol and Fauci are NOT participating in such debates. Read Scott Atlas's book. A Plague Upon Our House, to get some accurate background information about how Birx and Fauci refused to consider dissenting views during 2020. To embrace science publicly and operate as they did is quite sobering about the depth of bias that was and is operative.
The clear purpose of the STAT article is to make the case for not doing studies that might not support already-in-place public policy. That’s it; there is no science in the article at all. As the article admits, “Such research sows confusion that erodes trust in science, misleads policymakers, depletes social capital, and squanders critical resources. We believe that many of these studies should never have been done at all, reserving resources for studies that could improve health outcomes… Such studies can confuse people who want to know how effective face masks are, while emboldening people who are already completely convinced that face masks are ineffective — and are looking for grounds to sow doubt about them.“ So that’s the point… any nuance in the results of a study, that don’t fully support a policy in place, should not be published, because nuance “sows confusion” and “erodes trust in science.” Just have “experts” tell people what to do, and suppress anything that doesn’t provide absolute evidence for existing policy.
By the logic of this STAT article, newspapers in the 1920s and early 1930s should have never published investigative pieces on organized crime, and how it was fueled by the illegal alcohol trade, because it would “sow confusion” about and “erode trust” in Prohibition.
My masking is still at the mercy of the covid numbers reported in the county. Despite most testing at home (if at all), at a certain arbitrary number of positives reported to the DOH I wear a mask for the week. If it falls below that level the next week they mask police give me a reprieve. Very scientific!
Where are you? Let's shrine the light of reason on places that continue this.
When oh when will these BS papers to justify their erroneous narrative cease. The fact, people like Topol say the things he does with impunity is insane. The only silver lining I see is that in talking with my patients, they are VERY skeptical of anything the talking heads of the administration say and what the MSM parrots.
Unfortunately, they extend that to most of the medical profession as well. As individuals, those of us who have always been honest with our patients still have a modicum of trust between us. But many are perfectly willing to throw the entire medical baby out with the bathwater -- and I cannot blame them. Really a sad state of affairs that will take generations to repair, if it can be repaired at all.
Yes, have seen that too.
Topol=Still a tool
Outstanding.
A few suggestions here. Please define your terms when you reference “mask”, as “masking” is a huge umbrella term.
SARS CoV2 is airborne, and much more contagious than the original wild type. Surgical and cloth masks are therefore rendered obsolete we can agree. This is what most RCTs study, and which you are invoking to undermine “masks”, right? Or am I misunderstanding because your terms are not defined here in this post?
KN95, N95, and other properly fit respirators absolutely do work, even for SARS CoV2. They work for individuals in the community, on planes, and in tight poorly ventilated quarters. This is how I have personally not become sick, despite being in 100 square-foot rooms for the past three years with multiple patients with Covid, some of them not wearing masks for up to 40 minutes while we’re together and they are presymptomatic by a day or less.
“N95 masks are designed to remove more than 95% of all particles that are at least 0.3 microns (µm) in diameter. In fact, measurements of the particle filtration efficiency of N95 masks show that they are capable of filtering ≈99.8% of particles with a diameter of ≈0.1 μm (Rengasamy et al., 2017). SARS-CoV-2 is an enveloped virus ≈0.1 μm in diameter, so N95 masks are capable of filtering most free virions, but they do more than that.”
A well fitting mask/respirator of N95 quality absolutely works. These can also be called masks. Hospital fit tests and prior experience with respiratory precautions for all sorts of contagious diseases in hospitals give us ample decades of experience, too. Call for more studies of this if you will.
Ideology-driven use and denigration of the word “mask”, without pointing out to your readers that N95/99s are at one spectrum and cloth masks are at the other does a disservice to your elderly, immunocompromised, and other readers who might otherwise spare themselves a case of Covid. Or spare others. Because of reductionist arguments like the one presented here I am frequently having to educate patients who tell me “masks don’t work.” It’s not that reductionist, agreed?
And ad hominem attacks on Topol, Fauci, and others do a great job of inciting anger, intolerance, and perhaps violence against these figures who are also trying to communicate and help others. Ok to disagree with them and point out their shortcomings. But your conclusions are not perfect here either, and they invite people to openly challenge healthcare workers and others who mask with hostility and disdain as they chose to wear a mask, preferably a real mask.
At this point “masking” is a choice, that’s fine, but masking exists along a continuum.
If you can cite any RCTs or other quality evidence that I’ve missed about N95 masks not working, please let me and your readers know so that I can review (and educate myself as well.)
Dr. Prasad is correct to lump masks together in the same basket, since that is what governmental mandates did in almost every region (parts of Germany being an exception, later in the pandemic). And all the RCT evidence about non-N95 masking for covid is negative or shows miniscule effectiveness, you agree?
But the evidence of RCTs of N95 vs surgical masks also fails to show significant benefits of the N95s. The first link below is of a large RCT of healtcare workers in several countries. Notably, the participants in the N95 arm wore *fit-tested* N95s according to the trial protocol -- which ordinary citizens do not and cannot do. This RCT found statistically significant benefit of N95 over surgical only when they did an unplanned subgroup analysis, and even in the subgroup the N95s were hardly miraculous in their effectiveness.
Https://www.acpjournals.org/doi/10.7326/M22-1966
That’s the only covid-specific RCT of N95s that I know of. Pre-covid there were some RCTs of N95s against influenza, and they showed only modest benefit of N95 over surgical (often not statistically significant). Hence the recent Cochrane review’s conclusions that so agitated pro-masking folk. See the Cochrane review linked here:
https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD006207.pub6/full
Thanks I will read. I just can’t believe that conclusion though. I can’t imagine myself going in to see my next patient with Covid, and not wearing an n95. This has prevented infection for everyone I work with, even before vaccines. Primary care docs were actually dying at the highest rate of all specialties early on, as we were told surgical masks are sufficient. Rates were much lower in ICU docs who had all the proper PPE as they took care of the sickest of the sick. I’ll read later though thanks.
You can’t believe it? You can’t believe real science? Can you believe there are MANY people who lived in the same household as others who got Covid while they didn’t? Your anecdotal experiences are not evidence of anything.
The fact is, the “science” on this subject was pretty well settled and understood prior to Covid-19.
https://web.archive.org/web/20200412005611/https://www.oralhealthgroup.com/features/face-masks-dont-work-revealing-review/
Guess why I had to use the internet archive for that link. Because the pressures of politics displaced science in 2020.
I had a confirmed case of covid in late 2021, no one in my house got sick. Nobody bothered to wear masks or isolate. Same for a friend of mine; her son had covid, no one bothered isolating, no one else got sick. It's a bit of a crapshoot I guess.
Dr. McCormick - Your comment seems to one of the few here that employs common sense. Of course, KN95 and N95 masks/respirators help protect people exposed to COVID. I can't imagine a doctor advising their patient with comorbidities or who is immunocompromised NOT to wear one of those. Besides, why are we not seeking opinions from industrial hygienists who have far greater expertise regarding the protective value of masks/ respirators than do physicians -- even brilliant ones like Dr. Prisad?
I recently watched a YouTube video where an amateur cleans a thick layer of rust from the engine bay of his steel narrowboat. He wore an expensive N95 mask as he generated a thick dust cloud. After a days work he spoke to camera. His whole face (including his nose and mouth) was covered in a thick layer of dust. He asked for advice about preventing a recurrence.
Can anyone help him?
There's been non-inferiority trials that compare surgical to N95 for masks in healthcare settings. Surgical masks are non-inferior. Cochrane review references this. Vinay knows way more about this than you, hell I do.
Edit: Let me add that virus particles are smaller than what N95s are made to filter. They filter bacteria well though. Even in lab tests fit tested n95s let some virus contamination in.
Also, almost no one is actually fit testing those things I suspect. I can believe they would reduce your exposure if properly fitted, but not stop it for very long.
In three years, taking care of actual patients with Covid, my N 95 has never failed. I don’t think people wear them properly, I am hard-core. It’s hard to pick that up in pooled meta-analysis with sloppy mask wearing among individuals. Also, these individuals go home and then circulate in the community, usually with children going to schools with no masks, etc. Are you aware of any subset analysis of healthcare workers without children who also mask at supermarkets, airports, etc?
Please reply without any snarkiness, if people are able to do that on this website!
I also tend to think that a properly fitted N95 will protect the wearer for a while in the presence of virus-bearing aerosols. (The virus itself is small enough to go through the mask, but that's irrelevant since the virus doesn't float around bare, it's contained in droplets or aerosol particles mostly > .1micron).
Almost nobody I saw wearing N95s during the pandemic was wearing them with proper fit, and that includes healthcare workers. Probably you do wear yours well. But anyone with a beard, or who doesn't pinch the nose bridge, or whose mask is too big for their face (many petite women) ... it's just a decoration.
And given the RCT results and real-world experiences we've gained, it's clear that mandating mask-wearing does very little, if anything, to stop spread. THAT's the important point, not the technical issue of whether perfectly worn N95s block 95% of aerosol particles. But the pro-mask crowd seems to want to push mandates forever.
Sorry, I am a bit grouchy because I am trying to quit caffeine entirely.
I think that is part of the problem with masks, that the vast majority of people are not wearing them correctly. Plus, if you would have to keep it on your face even in your interactions with family members to truly be protected, assuming they're working at all.
It's certainly possible that a fit tested N95 is reducing your exposure enough that if you change them out frequently it could give you some edge in avoiding it, but I personally have hard time believing they're protecting you for long. Even a fit tested N95 allows for viral contamination in lab tests, just significantly less than one not fit tested
Keep in mind I have never caught COVID either and I don't really take any particular precautions. Some people don't seem to get infected by it also.
Maybe it is your mask though, but it's going to be very hard to prove that.
And yet, UC Davis continues to demand masks.
Really? That's nuts.
I work at an adult school, and it's rare to see a mask, even among the elderly. This is in Los Angeles County (not City). What saddens me is seeing young or young-ish people still wearing masks, or people who wear masks everyday but do so improperly: taking it off and putting it back on frequently, wearing it under the nose or on the chin, wearing a useless cloth one, etc.
What covid policies and the state of science they are based on should remind us all, is that it is very easy to fool ourselves into believing what we want: we aren't as rational as we would like to believe. Witchcraft, voodoo, elixirs and spells are alive and well in modern medicine.
We must teach the current crop of young physicians and in training the proper critical approach to data analysis and manuscript critiques. Vinay has the tools but so many others do as well. Students need to be exposed to improper studies and conclusions WITHOUT the sometimes value-laden interpretations of possible explanations (idiocy, political bias, Big Pharma, etc.). The key is to refine our current clinical databases and our health beliefs. As I have suggested in the past, the absence of valid, large studies proving the efficacy of masks in preventing the spread of respiratory viruses does NOT prove that masks are always ineffective. Perhaps, the right studies have not yet been done. I believe that, at best, such studies are likely to show minimal to zero efficacy. The NIH needs to get its act together and fund key studies.
I guess no one here is going to address the questions raised by my comment: (1) Do we need an RCT to establish that if you keep SOME DISTANCE (TBD) from an infected person(s), your chances of catching COVID will be reduced? and (2) Do we need an RCT to establish that wearing SOME QUALITY MASK/RESPIRATOR (TBD) for SOME % OF THE TIME (TBD) will protect you? If not, scientists/doctors need to be more precise in their communications. Obviously, under some circumstances, distancing and masking can protect individuals; we just need to define the parameters.
Preach it Vinay.
Dr. Prasad's critique of the STAT paper could be improved if he addressed the following question in a footnote or an addendum: Do we need an RCT to establish that some form of distancing and/or correctly wearing a certain quality mask will mitigate the effects of -- if not prevent -- COVID for an individual patient who is compliant 100% of the time? Please see also Gandhi et al.: Masks Reduce Viral Inoculum of SARS-CoV-2 (July 2020).
There are a wealth of RCTs on masks -- not just with covid. Some were done in ORs where half the staff wore them and half did not -- never made one whit of difference for practitioners or patients. The influenza and covid virions are about the same size so it is almost certain that the studies apply. And virtually all RWE studies done with covid (other than, literally, lies published by the CDC) also show no effects.
The German covid data also shows NO difference (with high compliance rates in both cases) between N95s and surgical masks. So "high quality" is just noise as well.
If you really want to amuse yourself, get a well fitted N95 mask on a smoker, then have them inhale and breathe out through the mask. (I have wonderful videos of this). Then keep in mind that the smoke particles are far larger than the virions.
So any RCT would be good to have. But the amount of dead horse beating that masking has gotten with covid is mind-numbing...and to me inexplicable except as a psyop.
ignoratio elenchi
We can mitigate the effects of COVID via vaccines, infection-acquired immunity, long-term monoclonal antibodies, and other means, so why would anyone (who is not seriously immunocompromised) be interested in wearing a high-quality mask “100% of the time”? That boat has left the dock.
ignoratio elenchi ...
Nice non-sequitur reply. Mask up! Evidence that it might work should be along now any day… any day…
Soon they may have an RCT on whether parachutes work. No need for you to use them until then.
Ah, yes, the “parachute” argument. Well, long before parachutes were used, they were extensively tested with dead weights, and on ropes to slow descent using jump towers to test landing speeds and other factors. Yes, scientists and engineers actually ran extensive tests of them before they were used by people, and have continued to do so for the past century to improve them! And yes, if a parachute design doesn’t work, I’m not using it.
Thank you. You've helped make my point: There are other forms of evidence in science that may have equal or greater probative value than RCTs. To the extent that anyone thinks otherwise, they are simply wrong.