Author Topic: Coronavirus  (Read 800792 times)

Spekulatius

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Re: Coronavirus
« Reply #8200 on: November 18, 2020, 05:33:12 PM »
Interesting comparison of the two mRNA vaccine front runners (Moderna, Pfizer-BioNtech):
https://twitter.com/biohazard3737/status/1329131035540516865?s=21

FWIW, that @biohazard3737 fellow is worth a follow.
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patience_and_focus

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Re: Coronavirus
« Reply #8201 on: November 18, 2020, 10:50:19 PM »
For those who think wearing a mask is ineffective, next time you go in for a surgery tell the doctors & nurses not to bother wearing masks as they slice you open.

Covid is like any other serious risk. You take common sense steps to avoid becoming a victim. But if your number comes up, your number comes up.

I think my comment is being taken out of context and this issue is becoming unnecessarily emotional as opposed to invoking rational thought. So let me clarify. My comment of masks not being shown to be effective so far was in the context of multiple previous posts specifically on covid studies that are being cited to argue in favor of or against effectiveness of masks to prevent infection for the wearer (not source control). I am not making any general claims about masks, especially for source control.

Also I was clear that so far there is absence of evidence that is coming from gold standard randomized controlled trials that unequivocally show effectiveness in that context. I am fully aware that absence of evidence is not evidence of absence. However, given what we know so far, wearing masks just by themselves is unlikely to show very high effectiveness to prevent getting infected in such studies. This may be partly due to difficulty in getting a large enough study going for something that is behavioral or masks may be more effective when combined with other non pharmaceutical interventions. But such trials have not been conducted.

By the way, I do wear mask in public. It has more to do with lack of harm doing it and potential for source control (in the unlikely situation of source being myself) than proof of preventative intervention.

mattee2264

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Re: Coronavirus
« Reply #8202 on: November 19, 2020, 12:27:20 AM »

 Re mask wearing and social distancing I think there is an analogy with the effectiveness of condoms with perfect use as opposed to typical use. I'd imagine in Asian countries you get a lot closer to perfect use than you would in the West. So while part of the solution the best way to achieve reduce transmission is by ruining peoples' social lives through lockdowns.

 Moderna had much worse side effects in the Phase 2 trials. So it could be dose dependent. I think most people if given a choice would prefer the Pfizer vaccine and especially if they aren't a high risk demographic would probably wait for it. So that could slow the roll-out.

 I think now it is clear all the vaccines work there will be a much greater focus on safety and speed of roll-out and that uncertainty is going to result in a lot of volatility especially while you have the virus raging in the background. Could end up being a replay of the summer where recovery plays got ahead of themselves before pulling back.

Investor20

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Re: Coronavirus
« Reply #8203 on: November 19, 2020, 02:38:01 AM »
For those who think wearing a mask is ineffective, next time you go in for a surgery tell the doctors & nurses not to bother wearing masks as they slice you open.

Covid is like any other serious risk. You take common sense steps to avoid becoming a victim. But if your number comes up, your number comes up.

I checked and did not find confirmation that masks in surgery help.  But may be I missed something.  Could you let me know any study you know that masks in surgery helps reduce infections?

cwericb

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Re: Coronavirus
« Reply #8204 on: November 19, 2020, 10:40:16 AM »

I checked and did not find confirmation that masks in surgery help.  But may be I missed something.  Could you let me know any study you know that masks in surgery helps reduce infections?

Hopefully that was sarcasm.

I will add to this original post.

On second thought, I have to agree that while there seems to be a lack of study into the effectiveness of masks in surgeries, there is a certain amount of common sense involved.

When breathing we often exhale bodily droplets. If that person were carrying a disease those droplets could spread that disease to others because we know that is one way disease is spread. Wearing a mask might not completely stop the spread, but it would certainly reduce the amount of those droplets going into the air.

If masks serve no purpose, we must have a lot of dumb doctors.

To go back to my original post, would you prefer that doctors and nurses involved in operating on you wear masks or not?
« Last Edit: November 19, 2020, 11:01:29 AM by cwericb »
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Castanza

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Re: Coronavirus
« Reply #8205 on: November 19, 2020, 11:00:07 AM »
I would assume masks are certainly beneficial during surgeries. But I cannot speak to that.

My wife has worked in a few different hospitals now, all top of their field level 4 NICUs. Some hospitals required gloves and masks for specific procedures and others did nor require anything except washed hands for the same procedures. It seems there is not a lot of uniformity in some healthcare best practices (which is shocking). She looked into this as it worried her at first, but both hospitals took stances with peer reviewed research to back their "best practice" choices.
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rb

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Re: Coronavirus
« Reply #8206 on: November 19, 2020, 12:01:22 PM »
For those who think wearing a mask is ineffective, next time you go in for a surgery tell the doctors & nurses not to bother wearing masks as they slice you open.

Covid is like any other serious risk. You take common sense steps to avoid becoming a victim. But if your number comes up, your number comes up.

I think my comment is being taken out of context and this issue is becoming unnecessarily emotional as opposed to invoking rational thought. So let me clarify. My comment of masks not being shown to be effective so far was in the context of multiple previous posts specifically on covid studies that are being cited to argue in favor of or against effectiveness of masks to prevent infection for the wearer (not source control). I am not making any general claims about masks, especially for source control.

Also I was clear that so far there is absence of evidence that is coming from gold standard randomized controlled trials that unequivocally show effectiveness in that context. I am fully aware that absence of evidence is not evidence of absence. However, given what we know so far, wearing masks just by themselves is unlikely to show very high effectiveness to prevent getting infected in such studies. This may be partly due to difficulty in getting a large enough study going for something that is behavioral or masks may be more effective when combined with other non pharmaceutical interventions. But such trials have not been conducted.

By the way, I do wear mask in public. It has more to do with lack of harm doing it and potential for source control (in the unlikely situation of source being myself) than proof of preventative intervention.
I think that there's pretty well understood that mask work much better as source control than infection control. That's why it's important that you have a mask mandate. That's also why it works really well in disciplined populations. Even if masks are not very good at infection control, they become very good at controlling the infection if they're good at source control and have a high % of mask wearing.

As for a randomized trial for mask infection control I'm not sure how you do that. You get people to cough in other people's faces with covid, some with masks some without? I don't think there's any setup that goes past an ethics panel.

Cigarbutt

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Re: Coronavirus
« Reply #8207 on: November 19, 2020, 03:34:04 PM »
Added for analytical purposes and sterilized of political content, to the extent possible.

In terms of evidence for surgical masks, Investor20 is mostly right and to be mostly right means potential dramatic and detrimental outcomes, especially at the margin. So what to do?
Much of what is done in the medical field is related to ‘common sense’, tradition and even dogma. At least, there is a certain amount of internal will to re-evaluate various aspects. This discussion about surgical masks and their efficacy is relevant to the whole coronavirus episode. There are built-in expectations now and in most places that people going about operating rooms should always wear a mask but little evidence supports that. Outside of people closely involved with the ‘case’, there is actually reasonable evidence that wearing a mask does not reduce the rate of surgical site infections. Even for people closely involved, in minimally invasive and short procedures like cataracts or vasectomy, it very likely does not make a material difference for all relevant outcomes (the patient and the healthcare people). However, at least because of common sense and some evidence and because of the precautionary principle, masks of various sorts are used for more extensive procedures, especially when critical body cavities are opened (brain, chest, abdomen etc) and especially if implants are left inside. In these cases, the burden of proof is lowered as wearing a mask is a relatively simple measure, cost is reasonable, masks also protect healthcare personnel (infections can go both ways) and complications from a deep-seated infection in those cases can have catastrophic consequences. Investor20 will be happy to learn that it’s standard procedure to have sophisticated ventilation systems even with laminar air flow, filters and differential pressures in operating rooms but the evidence remains uncertain as to whether these specifications make a difference for infections.

About 20 years ago, I was asked to participate in a group whose responsibility was to produce an updated guideline for the use of antibiotics at the onset of various procedures in order to reduce infections. The use of antibiotics has clearly been shown to reduce infection risks in key categories. There were (and still are) many contentious and controversial issues. Although this was only a guide and individual decisions had to be tailored to specific conditions, this was a clear case where recommendations from ‘experts’ was potentially constructive as inappropriate use of antibiotics could contribute to unwanted side effects, allergic reactions, selection of resistant bugs and systemic build-up of resistance globally (and unnecessary costs). When deciding where to draw the line, the idea is to constructively argue based on facts and to adjust to cover grey areas because of the precautionary principle in selected cases. When such systematic approach is consistently applied, outcomes tend to improve in a cost effective way and people wearing masks don't typically feel that their personal freedom is threatened.

Tonight, the household is going to skate (indoor rink). The reservation procedure is an extra step, the procedure to get on and leave the ice is slightly more complicated and it’s prescribed to wear masks during the activity. I guess that some of that is excessive but I can easily live with that.

Investor20

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Re: Coronavirus
« Reply #8208 on: November 19, 2020, 06:06:58 PM »
https://www.c-span.org/video/?478159-1/senate-hearing-covid-19-outpatient-treatment&live
Senate Hearing on COVID-19 Outpatient Treatment

The problem described Dr. Peter Mcculough I think is real.  There is no early treatment protocol in US.

Unfortunately virus is not waiting and unless the person has good immune response, the virus is replicating.  To try to treat after the virus has replicated is not done for any infection says Dr. Peter Mcculough. And even if the doctors are succesfful in treating them in hospital, there is damage done by virus and we end up with long term symptoms.

Medicines like Remdesivir even if they work, they can be given only in hospital and there are only so many hospital beds.

And so much is about masks, with no clear study showing they work, while completely disregarding medicines for early treatment.

I think this is something to listen to.

cwericb

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Re: Coronavirus
« Reply #8209 on: November 19, 2020, 06:21:38 PM »
" And even if the doctors are sucessful in treating them in hospital, there is damage done by virus and we end up with long term symptoms."

And that certainly is a major concern many people seem to ignore. Too many seem to be under the impression that Covid really only effects seniors and people with pre-existing problems. There is another concern with the creation of future ongoing health problems and that is the health and social costs should millions of people have recurring issues. 
Politicians and diapers must be changed often, and for the same reason. - Mark Twain