Thank you. Your posts are always so informative. I especially love your posts on risks of COVID versus risks of other illnesses/accident rates as it helps me make informed decisions for my family.
My 5 year old son was in an accident at school this past week. His finger was shut in one of those heavy, reinforced, quick to close doors that have been installed for safety measures to protect against gun violence in schools. His finger tip was torn halfway off and it broke his finger. The ER Dr said this was happening more often with these doors. He called it before we even told him what happened- he knew it was the heavy, defense doors by how bad the trauma was to his finger. This got me thinking. Our school has spent thousands updating features of the school to make it as safe as it can against gun violence, but has done little this year to stop the spread of viruses in the school. This has even created days when less than half the class was in attendance because of the illness spread (RSV wave). I’d love to have a discussion with the school about a framework of safety inclusive of health safety. Are there any ways to look at risks of say gun violence in schools vs risk of spread that could lead to poor outcomes from COVID and other viruses in school? I’d like to try to make a case for why we should, at the very least, be focused on both areas. Is there a way to compare the risks of both? You were the first person I thought of given your amazing lessons about both COVID and guns- but I also understand if this is too sensitive of a subject.
I am so sorry that this happened to your son. I think we (and policy makers) often make poor decisions because we focus on the rare and "newsworthy" occurrences vs more common but mundane ones. Not that what happened to your son is mundane for him! In my community I still see lots of people worry about school shootings when in reality my city has never had a shooting in or near a school, but almost every year at high school graduation and sometimes even at middle school moving up ceremonies, there is a memorial for a student who was lost to gun violence. But I don't hear much at all on how to prevent those deaths. We are not good at weighing the odds of things.
If my own history is any benefit to long Covid sufferors. March 2020 caught it. Probably either the A or B strain from China. The C strain wss reaching the east coast at roughly the same time. Received 2 Moderna vaccinations in 2021 and later, one Moderna and one Pfizer booster and finally one Moderna bivalent in 2022. Back to 2020, was told in April I could consider myself recovered. My initial illness wasn't that severe, lots of symptoms but none severe enough to warrant hospitalization. However the initial fever, etc. went away but many of the other symptoms continued or even got worse as spring passed into summer and autumn 2020. By that time I was concerned to put it mildly. I lost 70% 0f hearing in one short hour or so period. Probably a blood clot. Never regained. I had my first heart arrhythmias in early 2021 or late 2020. Now am on heart medication. Had my first neurological issues, like ocular migraine type attacks same time period. Most recent one was three days ago. And on and on. These are not hypochondriac complaints; most are verified by the testing I've been having since 2021. The point of this screed is to once again reiterate that Long Covid is nothing to dismiss lightly. No matter what ones politics are or attitudes toward masking or vaccinations, take all possible measures to avoid getting it! The pandemic is not over. In fact the worse may not have come yet.
Any news on when elders like me and my husband should get our 2nd bivalent vaccination? We're in our mid-to-late 70s. Our primary care doc says she doesn't know. We had our bivalent vaccinations September 8, 2022, just over four months ago. Our protection's waning!
I have the same question. I’m over 50 and am coming up on 4 months since my first bivalent booster. Recommendations for when to get your next booster appear to be a thing of the past. Does that mean we should wait or just go ahead and get another? If the latter, how often?
And if there’s nothing in 6 months (2 months after what is assumed to be waning immunity), just go in for another? There’s unfortunately no guidance on offer as to what to do regularly from here on out.
There's some recently published evidence that the current booster is responding to even the new variants... and there remains benefit from the original composition of the ancestral vaccine, an element in the bivalent vaccine itself. There's ongoing work on new vaccines, too. I'm still looking forward to pan-coronavirus vaccine success at some point in the future.
Katelyn, Lengthy post, please give it some thought. Note that outside of the mask hypothesis we have nearly identical politics, so don't reject my critique as some MAGA nonsense.
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"A recent study showed that people (n = 2) taking a daily regimen of Ivermectin had 5 fewer cases per 100 than the control group (n = 17). Perhaps of note, the group taking Ivermectin was tested much less than the control arm, but the authors of the study didn't mention this difference."
Should we conclude "Ivermectin works"?
Of course not. The difference in testing alone invalidates the entire study, not to mention the extremely small sample sizes, nor the fact a retrospective study is bottom tier of science.
Yet here you conclude "Mask mandates in schools work" based on a nearly identical study, with the same flawed design, and the same glaring flaws.
Katelyn, please consider that the mask hypothesis may be incorrect. It could be that the 100 years of science showing masks didn't stop viruses was correct all along, and the recent deluge of weak studies showing benefit may be merely that - a deluge of weak studies. I know you are 2+ years deep into the hypothesis, and the sunk cost fallacy can be powerful, but that is still 6 years less than William Farr took to realize his error on Cholera. If you bother reading this I am sure you will want to drop the hundreds of studies you have on hand showing efficacy. I will address that at the end and show the quality of a study is inversely proportional to the efficacy of masks, indicating that we let bias dictate our outcome.
If you go back to first principles, the very premise that a mask could stop virions seems unlikely. They may make intuitive sense because you think breathing through something must perform some filtering effect, but that is because we are very poor at understanding incredibly small (or large) things.
The moment you scale a virion to something human size, say a beachball, then the burden of the mask hypothesis becomes clear. When scaled to a beachball, the micropore in an n95 is scaled to the size of the Epcot Center Buckyball, the micropore in the surgical mask is scaled to the size of the entire Magic Kingdom, and the micropore in a cloth mask is scaled to the size of downtown Orlando.
Framed another way, you could place roughly 3,000 covid virions side by side in a single micropore of an n95.
Here you may be tempted to interject "but they travel on larger droplets" or "what about the electrostatic effects"?
These are the claims the hypothesis has to prove. For a trapped virion in a mask, how many breaths does it take to dislodge/nebulize the virion so it breaks free? How long does the electrostatic charge last in a cloth mask (certainly what the children in the Boston study were wearing)? In a Surgical mask? Short of wearing a form fitted n95, with surgical tape around the sides, most of your breathing will be pulling in air from the path of least resistance - the gaps against your nose, the sides of the mask, where your chin meets - when scaled to the beachball, these gaps scale between the size of the Grand Canyon to the state of Texas. How can masks prevent virions entering your lungs when a significant amount of your breath is pulling air through the sides and gaps?
The claim is extraordinary, so where is the extraordinary evidence?
Is the study you cited from Boston "extraordinary"?
Try to be disinterested and consider the following timeline, and recheck your hypothesis:
1) We discovered viruses in the 1890s only because some unseen pathogen far smaller than bacteria was passing through ceramic Chamberland filters. (the pore sizes of these filters are 40 times smaller than n95 micropores, smaller than bacteria)
2) We attempted to use masks in the 1918 flu, they didn't work, and it became conventional wisdom they couldn't stop the flu, hence we never used them again for this purpose.
3) The use of masks in medicine has been confined to the operating theater, where they were seen as a tool in achieving an aseptic environment, though RCTs have found they made no difference preventing infection (from bacteria, which again are magnitudes larger than viruses). It seems you were not aware of this based on your comments last month in your interview with Dr. Wachter
4) While some Asian cultures adopted masks after SARS, in western medicine they were regarded as useless and even among Asians they were largely for reasons having little to do with stopping viruses and more about fashion, anxiety, allergies, and a cultural desire to be fade to the background and not be noticed. As recent as 2016 it was even considered rude in South Korea to wear a mask. Japan itself had a terrible flu year in 2018, and even had mask psychologist to help people addicted to their masks.
5) Without evidence (yet), a large part of the scientific community and MSM made a complete 180 on mask efficacy in March of 2020. There are a number of reasons this happened: part political, part hypothesis, but I suspect mostly because the dynamics of power require that leaders propose something - anything - in face of a crisis. Even if the solution proposed is of no real value (like telling people to build bomb shelters in the Cold War, avoid mosquitos in early days of AIDS, "go shopping" like GWB proposed following 9/11), leaders know that the public needs something to indicate they have a plan and can be trusted (and re-elected).
6) In support of this hypothesis, those making the extraordinary claim pointed to countries like Japan, South Korea, and China - arguing that the correlation of masks must be casual, as they were not seeing large Covid cases. No one seemed to point out their low testing rates may be why they weren't seeing large number of cases, though it was mentioned in a passing story on Japan early in the pandemic.
7) I can't stress enough how important it is to remember that the argument of masks hinged on the fact that they worked in Japan, South Korea, and China. This is important for two reasons: #1 there was near zero coverage of the obvious counterfactual - all the Nordic countries had the lowest masking rates in the world and had either identical or better outcomes, and #2, the collective silence on why China, South Korea, and Japan exploded in covid cases later on - did the masks stop working? Or could it be, we jumped the gun on assuming casual inference?
Now let's address the mountain of evidence that came in showing mask efficacy starting in April of 2020 through today. I took the original list of 85 articles you used to support this hypothesis on November 5th 2020, and have added to it since (I'm at around 350 or so).
I understand how tempting it can be to have hundreds of studies supporting a hypothesis and assume the hypothesis is correct. I argue this is why physicians employed bloodletting, mercury, electroshock and even "daily aspirin for all" - they had a mountain of studies supporting their treatments, but none of them truly RCT.
So let us review at 100 feet what we have with the hundreds of pro-mask studies, and why they can't be trusted.
1) Starting in 2020 we had clear bias towards outcome.
You can verify this by plotting the studies, with the X axis being the quality of the study - beginning with X = 0 as opinion pieces, moving along axis you get Computer Models, experiments like Bill Nye blowing on candles, mannequin studies, case control studies, and eventually to RCT. Y Axis is then efficacy.
Quick example:
In an early opinion piece (X = 0 ) Robert Redfield says "If All Americans Wore Masks 'We Could Drive This Epidemic to the Ground" (Y=10, high impact)
Missouri hairdressers who wore cloth masks and didn't pass Covid to the clients who responded to a survey (X = .5) had 100% success rate (Y = 10) blocking Covid.
Kansas Mask Study, which picked arbitrary dates to compare counties with and without mask mandates, didn't bother to analyze adoption of masks, didn't account for testing differences, or any other confounder, found 100% difference, though when it was published a simple replication of the claim finds identical outcomes. X = 1, Y = 10
"Identifying airborne transmission as the dominant route for the spread of COVID-19" by Zhang et al became the go-to study to cite by the press in June 2020, showed large benefit (Y = 8) but quality was so poor (X = -3) that it was immediately requested for retraction by scientists who still thought masks worked, but this study was so poor it couldn't be trusted (note that you included this as number #4 in your original list, but failed to include the retraction request)
Yet when we finally move along the X axis and get RCTs, notably Bangladesh and Danmask, we find negligible benefit in the former and none in the latter.
I argue: When we find our evidence becomes weaker the stronger the study, it is evidence of bias. In truly disinterested science the slope should be near zero as we move from each tier of the evidence pyramid.
As further evidence of bias, note that the Danmask study, which was preregistered (rarely done for any other study) struggled to get their paper published in a journal. While I find many flaws in the Danmask study and don't pretend it is a perfect paper, it is lightyears better than Missouri Salon, Kansas Study, Tennessee schools, and roughly 72 of the 85 articles you listed 2+ years ago and almost everything since.
If the authors of Danmask were rejected so many times, despite being highly credentialed and submitting a preregistered and peer reviewed study, how many lesser known authors had to "file-drawer" any paper not showing mask efficacy?
Or worse, how many of those authors (intentionally or not) data drudged their study until it found a positive signal for mask. Most school studies used this method - they manipulated the dates studied - just like Kansas Mask study - to get the effect they expected to see. If you doubt this, rerun these studies yourself - they always far apart once you move the dates. This is likely why when journalist David Zweig asked to review the data in these studies he was refused.
Additionally I argue, if one is so confident of their claims, they should have no problem responding to reporters, replicating their work, openly sharing their data sets, seeking feedback to cut away errors.
Instead we see the exact opposite. These authors are defensive, and skeptical scrutiny is opposed. This is precisely what Carl Sagan outlined as qualities of people pushing pseudoscience.
2) The Gish Gallop
A Gish Gallop is when an extraordinary claim is not backed by extraordinary evidence, rather an extraordinary volume of weak evidence.
This was the strategy the infamous creationist Duane Gish used to employ when debating, he would drop hundreds of studies, which individually were poor in quality, but as sum-of-the-parts were nearly impossible to refute without succumbing to Brandolinis Law - the effort to disprove bullshit is magnitudes higher than the effort to create bullshit.
I present for consideration Katelyn, that you may have been Gish Galloped early in the pandemic, and are now trapped by a combination of sunk cost fallacy and whatever it is that caused William Farr to not see the obviousness of germ theory for 9 years.
You are barely at year 3, there is still time to step back, embrace the art of scientific skepticism, and see if 250 weak studies are extraordinary evidence, or an extraordinary example of the failure of how we organize scientific discovery. If the latter, there is a huge career to be made improving scientific discovery and addressing the perverse incentives which allowed us to create hundreds of (probably) nonsense studies arguing little kids wearing masks makes any difference in the trajectory of a viral pandemic.
(Happy to give footnotes/citations on any claim I made above)
Cutting to the chase, studies that focus on aerosols and droplets as vehicles for the virus simply make the most sense. SARS-Cov2 virus and variants have no means of propelling from one warm host to another. The vehicle that permits that is moisture. The aerosols and the bulk of the viruses that are confined to the carrier do not disburse beyond the appropriate type and properly fitted mask. As to whether a mask is better for the carrier or the prospective hosts in the same airspace, intuitively its unmasked people that are the delivery systems as well as the raison d’etre we all suffer from these variant viruses in my opinion and others. Mr D’Ambrosio If you don’t accept the aerosol/droplet science and find the masking rituals “inconvenient” or “annoying” then its possible you contribute to a high risk environment for everyone around you. It also may explain why we might anticipate another 2-3 years of excess deaths from COVID19 as long as there are plenty of unvaccinated and/or unmasked folks. The 3 W’s remain the next best defense. Vaccines and boosters remain valuable until the science tells us otherwise. Changing recommendations from our Health Agencies isn’t due to lies or deceit, its simply a broader knowledge base and better understanding of the mechanisms involved. Communicating those changes more concisely is Dr Jetelina’s task with the CDC going forward and I join the many subscribers who applaud every bit of the expanding knowledge she has painstakingly provided for her faithful readers.
One other thing to consider is that the material used in an N95 or legitimate KN95 is not a pure filtration material but carries an innate electrostatic charge which attracts and binds particles... and aerosols,,, to the fibers. Note that this is part of the basis for changing these masks frequently. This was something we had to ignore early in the pandemic when supplies were low and a used N95, properly worn by someone used to fit-testing and wearing them properly, beat no decent electrostatic options.
Good point Mr Creager. I personally use the Armbrust surgical masks: 3-ply, ASTM Level 3, electrostatic barrier made in U.S. even if they don't appear on "official" lists. Good fit and comfort. Reasonably priced. Their KN95 have similar specs. Disclaimer: I'm only a fan, not affiliated in any way. Interested in good protection in closed environments in light of a highly infectious virus. Check them out. You'll be please. End of unabashed product promo. ;>)
I use BNX, US manufactured, and easy for me to fit and fit-test. I spent years in surgical masks and learned about appropriate fitting requirements along time ago. BNX also has a KN95 with the only difference being ear loops. My affiliation: purchased/user.
Excellent point Gerry, and that raises several questions we should be investigating. Including but not limited to:
"What % of virions get trapped by the charge, what % pass through?"
"How long does the charge last? [1]"
"Can repeated breaths dislodge the virion from the charge?"
In addition to simple questions:
"What % of the air we breathe is passing through the gaps?"
"How many virions do we typically inhale, what % are captured by various mask types, and what is the number of virions which can trigger an infection?" (if the answers are, for example, 10,000, 9,000, and 100, respectively, then we have an explanation why real world results don't match mannequin studies)
The point I am trying to make is that as long as we continue to stick our head in the sand on how poorly these are working in the real world, we deny ourselves practical answers and better understanding of viral transmission.
For example, it may be that not wearing goggles matters more than we thought. I recall one of the studies on the original list Katelyn shared [2] in November of 2020 showed that eye protection had similar efficacy to masks. Perhaps that is true and may be part of the reason masks didn't work outside of laboratory and observational studies?
I really don't think I am making a controversial argument. I am merely proposing that the pre-March 2020 hypothesis may have been correct all along. Consider attached hastily made graph, where on the Y axis is efficacy, and X axis lists 10 tiers of masks, ranging from "Fake Masks" (mesh products sold as gags) to eventually the industrial Positive Pressure Personnel Suits worn in BSL4 labs.
I think we all agree on the efficacy of the outliers - nearly 0 efficacy all the way to the left for Fake Masks and Gaitors, nearly 100% efficacy all the way to the right on X axis for PPPS.
We are debating the plot points for everything in-between those tails. The blue curve approximates the consensus prior to March 2020 while the red curve indicates the sudden shift which happened in March 2020.
Perhaps the blue curve was correct all along.
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[1] "N95 Masks' Efficiency Can Be Restored With Electricity: Smart Masks May Follow"
Excerpt: "N95 and other medical-grade masks rely on two filtration methods: mechanical filtering by mask fibers, and electrostatic filtering, in which stationary electric charges attract and ensnare tiny 0.3-micron particles such fluid droplets containing viruses. The masks are specified for single-use only because even after a day, the electrostatic charges in the mask leak out into the air and the mask becomes less effective at filtering out particles. That gradual loss of efficiency is even worse in countries like India where high humidity speeds the loss of static charge to the air."
[2] "Physical distancing, face masks, and eye protection to prevent person-to-person transmission of SARS-CoV-2 and COVID-19: a systematic review and meta-analysis"
Excerpt: "Face mask use could result in a large reduction in risk of infection (n=2647; aOR 0·15, 95% CI 0·07 to 0·34, RD −14·3%, −15·9 to −10·7; low certainty), with stronger associations with N95 or similar respirators compared with disposable surgical masks or similar (eg, reusable 12–16-layer cotton masks; pinteraction=0·090; posterior probability >95%, low certainty). Eye protection also was associated with less infection (n=3713; aOR 0·22, 95% CI 0·12 to 0·39, RD −10·6%, 95% CI −12·5 to −7·7; low certainty)"
Based on observational evidence, the vast majority of masks I've seen worn in the last 6 months are incorrectly fitted and unlikely to provide any protection. I attribute this to the misinformation that "masks are theater" when there's evidence that masks do, in fact, work as an element of a layered defensive system. And, despite your note earlier, those cities with mask mandates that did not end them prematurely, favored better in the 1918-1922 influenza pandemic than those who either never mounted a mandate, or ended it early due to complaints similar to what we are still hearing today. I'm assuming you were interested in https://www.healthaffairs.org/do/10.1377/forefront.20200508.769108/full/#:~:text=Masks%20failed%20in%201918%20to,in%20response%20to%20COVID%2D19, or a similar article. Note that the limitations cited for mask wearing, using them for too long, poor fit and improper wear, remain issues today. Use of eye protection evolved pretty rapidly to use for aerosol-generating procedures. We also learned early-on that there was little or no benefit to use of full face shields, especially in place of some form of masking. Yet, the myth persists today that face shields somehow prevent fine-droplet aerosols from reaching the wearer. This is best described as unfortunate.
Another point made in the Health Affairs article on masks in 1918 was that their wear was "uncomfortable". Having spent close to 20 years in masks at least 5 days a week, and often for in excess of 12 hours per day, I can assure you, you can get used to it. A long time ago, I learned about infection-control precautions, and whether we later determine all our efforts were indeed futile, or not, that's how we attempted to control disease transmission in clinical facilities. This included simple barrier protection over clothing, masks, and gloves, and sometimes PPPS, although I never had to actually use that gear save in training in the facilities I worked in . Mask wearing, even properly, isn't impossible, nor must it be uncomfortable. This past week, while attending a meteorological conference, I reverted from simple KN95 (fitted and fit-tested daily) to N95s because they were for me, more comfortable.
The physicist Peter Woit, in a critique of string theory, asked "what point does theory depart the realm of testable hypothesis and come to resemble something like aesthetic speculation, or even theology? ... A theory which can't predict anything is of no value."
Similarly the mask hypothesis is unable to predict anything with any measure of accuracy, it can only be validated through retrospective analysis like the Boston study. Worse than String Theory though, it does lend itself to falsification.
Here are 7 example I gave last night to another commenter:
1) It was predicted that if 80% of the country (US) wore masks, Covid would be crushed. 90% wore them, cases skyrocketed anyway.
2) Germany was a "Master Class in Science" for communicating, among other things, the value of masking, which their population adopted. Cases exploded anyway.
3) It was predicted that the high mask use in Asia was responsible for their avoidance of Covid outbreaks. Covid overwhelmed them regardless.
4) Nursing homes had extremely high mask rates among staff and patients, yet Covid swept through.
5) Conversely, it was predicted that countries that didn't mask up would have a horrible outcome, yet these countries with the lowest mask use (Sweden, Norway, Finland, Denmark) all have the lowest excess deaths in the world. (In your response you made the claim "...we might anticipate another 2-3 years of excess deaths from COVID19 as long as there are plenty of unvaccinated and/or unmasked folks" which this falsifies)
6) It was predicted that removing the mask mandate in Texas March of 2021 was "throwing gas on fire", instead the Covid rates dropped identically to neighboring states.
7) When schools across the US dropped mask mandates in early 2022, it was "too soon". Yet again, cases continued to plummet, and parents soon found what many Europeans discovered in 2021 or Scandinavians in 2020 - it didn't seem to make much difference.
If the science on this was serious, proponents of the theory would be doing their best to understand why these predictions failed.
When a hypothesis is made and then falsified, we revisit the hypothesis to find out what went wrong and either adjust or discard the hypothesis.
This theory has been repeatedly falsified in the real world, while proponents of the theory ignore the counterfactuals and instead promote these poor studies. This is why you have seen, even in "blue" areas, mask rates plummet - the public has heard incredible claims for 2 years that didn't match what they saw with their own eyes. A bit of "cried wolf" or "chicken little" syndrome perhaps?
To your point "it has no means of propelling from one host to another", extremely small objects don't need to self propel to travel great distances. Applying Stokes Law to particles of this size - even when traveling with molecules of water - estimates can vary between .5 to 5 miles even in ambient conditions.
You can stress test this point by watching the movement of the tiniest dust particles visible to the naked eye (the kinds you only see when light is shining through) and watch it float around the room - then consider that the particle you are looking at could fit between 500 million and 16 billion virions inside it. Extrapolate from there.
At no point did I say I find these "inconvenient" or "annoying", I couldn't care less. The practice has ended in Cleveland much like the rest of the Western world.
I do find it interesting that you call masking a "ritual", as I agree that actions based on faith rather than hard evidence are akin to religious belief systems.
I am proposing we need to return to the Mertonian norms of science - specifically disinterestedness and organized skepticism. From there we can better understand the behavior of invisible pathogens you need an electron microscope to see, and find out what strategies actually work, and which slices of the "Swiss Cheese Model" are useless.
It may be they travel on their own. It may be that they travel on something larger but are easily separated once they touch the fibers of a mask and inhaled. Maybe that takes one breath, maybe 10, I don't know.
It may be that they behave as predicted, but since everyone wears loose fitting masks (even when they think they have a form fitting n95), the air flowing through the gaps is enough to render them useless. Perhaps as I mentioned above if we used a true form fit [1] and then apply surgical tape along the entire perimeter of the mask, that may reduce virions inhaled. I don't know. Maybe even a sealed n95 isn't enough and we need an n99. Or a PAPR.
Or that space suit Shi Zengli wears. These are all fairly straightforward things we could be testing.
For close to three years we have seen every single claim on mask efficacy fail.
The US would see Covid "brought to it's knees" if 80% wore masks. Most of the country got close to 90% and Covid exploded anyway.
Germany was a "Master Class In Science" for their masking and protocols. Then covid exploded anyway.
Texas was "throwing gas on fire" when they dropped mask mandate March of 2021. Gases plummeted at rates identical to their neighbors for the next 3 months.
"Cases will explode and the airline industry will be crippled with the FAA dropping mask mandates". Didn't happen.
"South Koea stopped the virus through masks" now they have among the highest excess deaths in the world.
"China beat Covid through masks and lockdowns". Turn on the news now.
What is telling about all of the studies is that none of them are ever replicated, when so many of them could easily be re-run. Why do we have 350 different studies, all weak, rather than replicating several strong studies? I think the answer is obvious, because that won't support the conclusion we made back in March 2020.
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[1] Consider that the proper fit testing for an n95 when being exposed to patients with Tuberculosis (a bacteria magnitudes larger than Covid 19), from the guidelines:
"A qualitative fit test, a pass/fail approach is used. An individual dons the mask, and a test material is placed in the surrounding ambient air; then, the user reports whether it passes through the respirator. For example, saccharin aerosols are detectable by their sweet taste if the respirator does not effectively remove them (e.g., because of leakage at the face seal surface). Although NIOSH recommends against it, irritant smoke is also occasionally used in a qualitative fit testing procedure."
Perhaps if we went to that extreme we may see benefit? These are questions we should be exploring.
'"Yet here you conclude "Mask mandates in schools work" based on a nearly identical study, with the same flawed design, and the same glaring flaws."' I read the NEJM study. I have no idea where the first study you cited came from. Based on reading the former, though, I see no resemblance whatsoever between the two, much less anything the qualifies for the phrase "nearly identical."
On the one hand, you give us a short summary of an unidentified study with a laughably small sample size and no indication of what actual conclusion the author(s) reached. On the other hand, we have a study of 72 school districts involving 294,084 students and 46,530 staff and what looks to me like fairly rigorous statistical analysis. Granted, it has been quite a while since I was in the business of statistical analysis and research design, but even so it seems pretty clear that calling the two "nearly identical" comes very close to fabrication.
Perhaps you should take a more disinterested attitude towards this yourself, Michael. As it is, you seem to be doing some serious misrepresentation and cherry picking of information.
That does not appear to be the case based on the information at hand, and repeating it without data to support your claim doesn't change that. That's obvious from examining the one to which we actually have a link and comparing it with the short summary of the still-unidentified one you quoted.
It is *possible*, I suppose, that they "suffer from identical flaws," but based on the information you have provided, this is obviously not true. Perhaps you could provide a link so we can all reach an informed decision?
Sorry Stephen I wasn't transparent in my original post, I was adopting the style of John Allen Paulos, where to illustrate the absurdity of a claim in the media, I constructed a theoretical counterfactual as a steelman. I initially thought it was obvious of my intention, but that mistake is on me.
I thought for brevity the approach might be effective to create a hypothetical scenario to illustrate the absurdities of the Boston study without having to analyze it in detail (again).
As you rightly pointed out last night, my example had a "laughably small sample size" (n = 2), which is the same sample size on the experimental group had in the NEJM study (2 school districts retained masks) and n = 17 was the districts that lifted mask mandates 2 weeks after state order removed (see figure 1 of the study).
The point I failed to effectively make is that skepticism and critique has been largely one-directional throughout the pandemic.
I am making the point that papers like Kansas Mask, Missouri Salon, this Boston School paper, all have obvious problems, are easy to pick apart, yet the pro-mask segment of science seems unconcerned as they cite these uncritically.
On the other hand, this segment of science suddenly becomes concerned with confounders, study design, replication, sample sizes when it comes to papers and ideas they view as heretical.
Earlier I used "Danmask" as an example - again, I don't find it a particularly strong study - but just look how much pushback and scrutiny that paper received while far worse papers like "Effectiveness of Face Mask or Respirator Use in Indoor Public Settings for Prevention of SARS-CoV-2 Infection — California, February–December 2021" get published by the CDC.
I don't think Ivermectin does much other than help people in Africa (or apparently possibly help against lice according to the CDC), but Ivermectin is a good example of how the hammer of skepticism is one-directional. Every paper suggesting benefit receives massive scrutiny while Kansas Mask study, et al, get a free pass. It's evidence of bias, when skepticism should be applied equally across the board.
Example, consider this paper which was requested by authors after a huge blowback where authors pull it noting "As in any retrospective study, we could not control for all the confounding variables, mainly severity of disease in patients treated with either ivermectin or remdesivir...We were very clear in the abstract conclusions that our results are only showing an “association”, they are not definitive, and further randomized clinical trials must be done to prove the efficacy of Ivermectin."
Where do you see these concessions made about the flaws of retrospective studies and need for randomization in mask studies?
You are misrepresenting (or simply confusing) what n means in these cases, Michael. In the still-unidentified study you cited, the total value of n was 19 individual cases. Individuals and school districts are not the same. In the school district study, you have 72 school districts involving 294,084 students and 46,530 staff and what looks to me like fairly rigorous statistical analysis.
This is the sort of thing that makes me strongly suspect the honesty of your intentions. Well...that and the kind of thing being pushed on the Substacks your follow.
The study groups by school districts. 2 school districts kept mandates. N = 2. See Figure 1.
It's a poor study with and received several critiques which were unanswered. That is frustrating as science should be a continued back and forth. When you propose something, you should welcome critique and strive to chip away errors.
Instead we have one-directional skepticism. This gets a pass Danmask gets grilled.
Doctor Strange: "Well...that and the kind of thing being pushed on the Substacks your follow."
Which of my 45 paid subscriptions do you take issue with? Anna Khalid's Banished? The Fifth Column? The Free Press? Lexicon Valley? Noah Smith's Noahpinion? Privatdozent? ParentData? Unbiased Science Podcast? Michael Shermer's Skeptic? Stuart Ritchies Science Fictions? Matt Taibbi? Mary Pat Campbell's Mortality with Meep? Technically? Matt Yglesias Slow Boring?
Or perhaps my paid subscriptions to The New York Times, The Atlantic, Wall Street Journal, Washington Post, The Guardian, and New Yorker you take issue with?
Or, is your issue that I listen to as many voices on complex topics as I can, rather than just sticking with "my team"? Sounds like that might be the issue?
First, it's become more common for the control arm to have many more participants than the treatment arm, so that's not an outlier. However, n=2 and n=17 are generally red flags for me overall, even in difficult to recruit, dangerous, or in-silica studies.
That said, the Boston school study on the efficacy of masks was hard to follow because it was retrospective, observational and uncontrolled. Still, the overall numbers do support the conclusion. Creating this as a prospective and well-controlled study would have drawn fire from too many sources but using available data in a responsible manner only makes sense.
If I'm not mistaken you've already taken exception to the notation that the premise behind the N95 is actually electrostatic binding of charged particles... because the masks do have pores allowing the wearer to breathe through them. This doesn't restrict the matter that both aerosolized droplets and the viral particles themselves are charged particles and that the electrostatic charge is somewhat stronger than the turbulent flow past said particles, bound to filaments in the mask.
Masks work as elements of layered defenses, when done best. Early in the pandemic, cloth masks were being recommended because high-quality (N95, KN95, KN94) masks were in scarce supply. I'll refer you to https://pubmed.ncbi.nlm.nih.gov/33300948/ for efficacy on a variety of masks. Entrapping virons is not generally the issue as they require some transport mechanism, usually a droplet, to survive.
Thanks for the thoughtful reply Gerry. I spent some more time on the Boston Mask Study, it's even worse than I initially thought. Striking problems:
1) You can see on Figure 1 that the students in the schools which would eventually lift their mask mandates had much higher cases before the mandates were lifted, indicating that whatever caused these districts to have higher cases was happening before masks removed. Yet the authors cut this off by starting the graph in figure 1 in February, though it is clear cases were much higher in January. Suspect of data drudging - moving the dates until the data shows what you want.
2) The authors apparently didn't realize that 13 of the schools they counted as "keep mandate" had successfully received an exception earlier (there was a condition that if you meet a % of vaccination you could be exempt from mask mandate).
You can cross reference this list with table S1 to see the 13 schools they missed:
3) One of the authors, when questioned on the lack of accounting for testing differences (many schools had students taking twice a week antigen tests, other schools used the CDC guidance that you only need to test for exposure when not wearing masks) argued that you should just trust her, she has a PhD on Twitter (I'm too lazy to dig this up, but if you follow EpiEllie on Twitter this sort of nonsense shouldn't come as a surprise).
4) The authors successfully organized a successful Change.Org campaign to get masks back on kids in Boston earlier that year, yet make no mention of this conflict of interest in their disclosures
5) One of the authors had penned the Op-Ed in the Boston Globe "It's too soon to lift the school mask mandate", also didn't disclose this conflict of interest
6) Just as aside, almost all of the authors are on record being supportive of masking children prior to the study.
These are all fair criticisms of the study, yet it gets passed on without critique here which is troubling. The skepticism is always one-directional. Any study, no matter how poor the quality gets a pass, so long as it supports masking. Only studies that find no benefit get grilled.
It's been awhile since I reviewed the Boston Mask Study, and I did identify weaknesses at the time. Not all pertinent studies are very well-designed; some are just large enough and controlled enough to be useful. That said, I just reread the study and have also looked for comments indicating what I might have missed. I was not impressed, as most were from either sites with known bias regarding both the pandemic and mitigation of all sorts, or in the case of the few professionals, from, again, people who have consistently been outside the norm and have disagreed with research results if it did not fit their world-view.
I recall, but cannot find immediately, a study that attempted to quantify mask efficacy in rural Africa. THAT study posed issues in design and execution unrivaled by the Boston study in that it attempted to distribute masks of poor quality (overall) to villages and then see what effect "any" mask use provided with regard to mitigation. As I recall, they found their results to be mixed. However, rural Africa suffers from a significant healthcare system shortage, a paucity of tests, and apparently, lax compliance with study requirements. THAT study posed serious problems in accountability.
You tend to cite a fair bit of the regular media, but you also cite research reports. I've generally avoided the popular press, at least until recently. Now I am more interested in sites like NYT, for their statistics. Other "popular" sites, e.g., NPR, WaPo, I only include if they appropriately represent a study, AND cite the source. I do use Twitter to follow certain experts, a truly select list who I either know, or where I'm familiar with their background, and their work. As I've served as a reviewer for professional journals, I tend to review virtually every article I read rather critically.
Thank you so much for your updates. Vital to all of us! My question is do we know when we will need/have the next booster? I got the omicron booster in October 2022. Won’t that protection wane soon? I’ve seen nothing about next steps. Anything happening?
Great article and so helpful! Have you heard any updates regarding older folks and immunocompromised people getting a 2nd bivalent booster? Many in this cohort received their bivalent boosters early September. I've had a few people asking. Thank you.
More good stuff! (Except I shoulda got Moderna...)
There are a lot of experts shamelessly sniping at each other over the "Covid creates immune deficiencies" topic. Very hard for lay people to un-puzzle.
Any chance you could do a "what we know, what we don't know" on this?
I would think with so many infections, we should see something measurable by now.
Well....there are a lot of people who claim to be experts doing this. As always, one needs to look at the data, not what any particular person says about it. Science isn't about argument from authority.
Dear Katelyn, Thank you as always for your helpful summary. I appreciate your clear updates as we navigate through the COVID maze. Happy 2023 to you and your family.
Should we continue to get boosters? I got covid last month and I am fully vaccinated/boosted. So if the hybrid immunity is stable for 8 months, should I get a booster in August?
Thank you, Dr Jetelina, for a wonderful post that connects the science in to actionable steps by subgroup! This is *exactly* the type of information that people need to restore trust! I wish the CDC had told people over 50 to get only the Moderna bivalent booster back when it first came out. I know that supplies were low, yet transmission levels were also low, so waiting a few weeks probably was okay. Unfortunately, both my parents (80+) and two sisters (50+) got Pfizer, because it was the only thing available. Three weeks later, one of my sisters got Covid (first time).
Yesterday's Wall Street Journal had an article "Where Are the Next Covid Treatments?" The article states: "One study found that half of hospitalized patients who die from Covid have a contraindication with Paxlovid." (link below) In addition to better vaccines, we also desperately need new therapies, especially since XBB.1.5 has rendered most old therapies ineffective.
At the risk of sounding like a broken record, I would refer people to a prescriber who would consider an alternative repurposed drugs off-label Rx if the patient is infected and progressively symptomatic with COVID-19 and has no access to Paxlovid. 412 case reports on the CURE ID website identifies such an effective product that has been used now for nearly 2000 patients with consistent success and safety, no rebound, and is inexpensive. So, its not an EUA drug but it can be repurposed from its original use in an emergency life and death situation and susceptible people with progressive Covid19 qualify in many instances. It has been approved for long-term use for Sickle Cell and Covid19 Rx is only a 5 day protocol. This identification of repurposed drugs is what was intended by the FDA when the website tool was designed to solicit clinicians “to more easily report real-world experiences treating Covid-19 patients who are unable to be enrolled in a clinical trial...in the COVID-19 Public Health Emergency” This is not misinformation. This is not the next fake med like ivermectin and Chloroquine/hydroxychloroquine. These 412 cases are “real-world experiences treating Covid-19”.
What is that drug? I pulled up the CURE ID website but it will take some time to work my way through it - could you please save me the suspense and effort?
From that list of 10 most reported cases for treating Covid-19 with repurposed drugs the #2 spot shows Hydroxyurea (HU) also known as hydroxycarbamide in some parts of the world, used continuously for sickle cell crisis mitigation. HU current count is 412 cases. The #1 drug reported is the discredited and politicized drug hydroxychloroquine (HCQ) at 558 case reports, however all these cases were reported well before August 2021 before a myriad of clinical trials showed no efficacy statistically and before our data gathering had been initiated. Also, interestingly, the numbers of case reports for HCQ plateaued at that time as the promoters, evidently, saw no value in “beating a dead horse“. The current 412 cases reported for the HU are less than 1/4 of those patients treated successfully, safely, without rebound infections, nor adverse drug reactions. and these positive outcome case reports continue to be gathered with each subsequent variant. Please feel free to email me to discuss further and I’ll be happy to answer any questions you might have. sullray<at>Gxxxxxcom
Most of the NIH-curated data on HU related to respiratory resolution and were not COVID specific. I'm treating COVID-19 as a vascular, primarily endothelial disease these days with a primary respiratory vector for infection. I've found no evidence save on your site for "cures" for COVID-19. Sorry: This isn't an attack. I've been looking.
Mr Creager, I’m not clear exactly what NIH curated data on HU to which you refer. We do indeed appreciate that Covid19 has profound effects on the vascular endothelium and it is our hypothesis that many organ dysfunctions can be traced to endotheliitis. Tissue hypoxia is a significant factor and HU can impact that positively just as it does in SCD. Further, an undefined antigen-antibody block of a7NAchR’s causing neurotansmission disruptions may be the source of relief by HU. An initial in vitro study by a biochemist colleague appears to confirm a link between HU and those receptors. Further in vivo studies are planned but her Institute in Kyiv is currently “preoccupied” by the invasion and winter. HU and the ACh EI Mestinon are a unique combo for treating advanced COVID19 and I doubt there is any corroborating literature from the NIH or anywhere else. Our local experience with this combo has been dramatic. Lazarus like outcomes. 2 repurposed drugs with no rebound, no ADRs and dirt cheap. That last fact is a major barrier getting a study designed.
Greetings, I liked your post today a lot, and it caused me to go from a free subscriber to paying to support your work. Unless allowing comments from non-paying subscribers causes you increased costs from SubStack, I suggest you allow comments from non-paying subscribers unless doing so invites trolling jerks. I have found other SubStack authors from leads I have gotten from the comments of other SubStackers. Up to you, obviously. Thanks for doing what you do.
I am eager for your commentary on the recent article in the Am J PUb Health (lead author Tu). The good news was that deaths, ER visits, and hospitalizations were down among the vaccinated. But by the same measure, it appears that infections were MORE common among vaccine recipients than among those with "natural" immunity. I for one am skeptical of how we even define infections, and the article is somewhat opaque on that issue. But the anti-vaxxers are running with this. "What other vaccine makes us MORE likely to get the infection?" they say. Thanks!
Thanks so much! Did they say anywhere what the magnitude of better T-cell immunity was of Moderna vs Pfizer? Similarly, any data on mixing the two (at one point the advice was mix them and then it was “it doesn’t matter”). In other words, does the Moderna advantage occur as soon as you switch to it or does having prior Pfizer vaccines impact that?
Thank you. Your posts are always so informative. I especially love your posts on risks of COVID versus risks of other illnesses/accident rates as it helps me make informed decisions for my family.
My 5 year old son was in an accident at school this past week. His finger was shut in one of those heavy, reinforced, quick to close doors that have been installed for safety measures to protect against gun violence in schools. His finger tip was torn halfway off and it broke his finger. The ER Dr said this was happening more often with these doors. He called it before we even told him what happened- he knew it was the heavy, defense doors by how bad the trauma was to his finger. This got me thinking. Our school has spent thousands updating features of the school to make it as safe as it can against gun violence, but has done little this year to stop the spread of viruses in the school. This has even created days when less than half the class was in attendance because of the illness spread (RSV wave). I’d love to have a discussion with the school about a framework of safety inclusive of health safety. Are there any ways to look at risks of say gun violence in schools vs risk of spread that could lead to poor outcomes from COVID and other viruses in school? I’d like to try to make a case for why we should, at the very least, be focused on both areas. Is there a way to compare the risks of both? You were the first person I thought of given your amazing lessons about both COVID and guns- but I also understand if this is too sensitive of a subject.
I am so sorry that this happened to your son. I think we (and policy makers) often make poor decisions because we focus on the rare and "newsworthy" occurrences vs more common but mundane ones. Not that what happened to your son is mundane for him! In my community I still see lots of people worry about school shootings when in reality my city has never had a shooting in or near a school, but almost every year at high school graduation and sometimes even at middle school moving up ceremonies, there is a memorial for a student who was lost to gun violence. But I don't hear much at all on how to prevent those deaths. We are not good at weighing the odds of things.
Excellent article! Thanks so much for all of this data rounded up in one place!
If my own history is any benefit to long Covid sufferors. March 2020 caught it. Probably either the A or B strain from China. The C strain wss reaching the east coast at roughly the same time. Received 2 Moderna vaccinations in 2021 and later, one Moderna and one Pfizer booster and finally one Moderna bivalent in 2022. Back to 2020, was told in April I could consider myself recovered. My initial illness wasn't that severe, lots of symptoms but none severe enough to warrant hospitalization. However the initial fever, etc. went away but many of the other symptoms continued or even got worse as spring passed into summer and autumn 2020. By that time I was concerned to put it mildly. I lost 70% 0f hearing in one short hour or so period. Probably a blood clot. Never regained. I had my first heart arrhythmias in early 2021 or late 2020. Now am on heart medication. Had my first neurological issues, like ocular migraine type attacks same time period. Most recent one was three days ago. And on and on. These are not hypochondriac complaints; most are verified by the testing I've been having since 2021. The point of this screed is to once again reiterate that Long Covid is nothing to dismiss lightly. No matter what ones politics are or attitudes toward masking or vaccinations, take all possible measures to avoid getting it! The pandemic is not over. In fact the worse may not have come yet.
Any news on when elders like me and my husband should get our 2nd bivalent vaccination? We're in our mid-to-late 70s. Our primary care doc says she doesn't know. We had our bivalent vaccinations September 8, 2022, just over four months ago. Our protection's waning!
I have the same question. I’m over 50 and am coming up on 4 months since my first bivalent booster. Recommendations for when to get your next booster appear to be a thing of the past. Does that mean we should wait or just go ahead and get another? If the latter, how often?
Based on what I've been reading lately, it'll likely be after 6-8 months but I've seen no CDC or FDA recommendations.
And if there’s nothing in 6 months (2 months after what is assumed to be waning immunity), just go in for another? There’s unfortunately no guidance on offer as to what to do regularly from here on out.
There's some recently published evidence that the current booster is responding to even the new variants... and there remains benefit from the original composition of the ancestral vaccine, an element in the bivalent vaccine itself. There's ongoing work on new vaccines, too. I'm still looking forward to pan-coronavirus vaccine success at some point in the future.
Katelyn, Lengthy post, please give it some thought. Note that outside of the mask hypothesis we have nearly identical politics, so don't reject my critique as some MAGA nonsense.
_______
"A recent study showed that people (n = 2) taking a daily regimen of Ivermectin had 5 fewer cases per 100 than the control group (n = 17). Perhaps of note, the group taking Ivermectin was tested much less than the control arm, but the authors of the study didn't mention this difference."
Should we conclude "Ivermectin works"?
Of course not. The difference in testing alone invalidates the entire study, not to mention the extremely small sample sizes, nor the fact a retrospective study is bottom tier of science.
Yet here you conclude "Mask mandates in schools work" based on a nearly identical study, with the same flawed design, and the same glaring flaws.
Katelyn, please consider that the mask hypothesis may be incorrect. It could be that the 100 years of science showing masks didn't stop viruses was correct all along, and the recent deluge of weak studies showing benefit may be merely that - a deluge of weak studies. I know you are 2+ years deep into the hypothesis, and the sunk cost fallacy can be powerful, but that is still 6 years less than William Farr took to realize his error on Cholera. If you bother reading this I am sure you will want to drop the hundreds of studies you have on hand showing efficacy. I will address that at the end and show the quality of a study is inversely proportional to the efficacy of masks, indicating that we let bias dictate our outcome.
If you go back to first principles, the very premise that a mask could stop virions seems unlikely. They may make intuitive sense because you think breathing through something must perform some filtering effect, but that is because we are very poor at understanding incredibly small (or large) things.
The moment you scale a virion to something human size, say a beachball, then the burden of the mask hypothesis becomes clear. When scaled to a beachball, the micropore in an n95 is scaled to the size of the Epcot Center Buckyball, the micropore in the surgical mask is scaled to the size of the entire Magic Kingdom, and the micropore in a cloth mask is scaled to the size of downtown Orlando.
Framed another way, you could place roughly 3,000 covid virions side by side in a single micropore of an n95.
Here you may be tempted to interject "but they travel on larger droplets" or "what about the electrostatic effects"?
These are the claims the hypothesis has to prove. For a trapped virion in a mask, how many breaths does it take to dislodge/nebulize the virion so it breaks free? How long does the electrostatic charge last in a cloth mask (certainly what the children in the Boston study were wearing)? In a Surgical mask? Short of wearing a form fitted n95, with surgical tape around the sides, most of your breathing will be pulling in air from the path of least resistance - the gaps against your nose, the sides of the mask, where your chin meets - when scaled to the beachball, these gaps scale between the size of the Grand Canyon to the state of Texas. How can masks prevent virions entering your lungs when a significant amount of your breath is pulling air through the sides and gaps?
The claim is extraordinary, so where is the extraordinary evidence?
Is the study you cited from Boston "extraordinary"?
1/2
2/2
Try to be disinterested and consider the following timeline, and recheck your hypothesis:
1) We discovered viruses in the 1890s only because some unseen pathogen far smaller than bacteria was passing through ceramic Chamberland filters. (the pore sizes of these filters are 40 times smaller than n95 micropores, smaller than bacteria)
2) We attempted to use masks in the 1918 flu, they didn't work, and it became conventional wisdom they couldn't stop the flu, hence we never used them again for this purpose.
3) The use of masks in medicine has been confined to the operating theater, where they were seen as a tool in achieving an aseptic environment, though RCTs have found they made no difference preventing infection (from bacteria, which again are magnitudes larger than viruses). It seems you were not aware of this based on your comments last month in your interview with Dr. Wachter
https://yourlocalepidemiologist.substack.com/p/the-state-of-covid-and-the-triple/comment/10895219
4) While some Asian cultures adopted masks after SARS, in western medicine they were regarded as useless and even among Asians they were largely for reasons having little to do with stopping viruses and more about fashion, anxiety, allergies, and a cultural desire to be fade to the background and not be noticed. As recent as 2016 it was even considered rude in South Korea to wear a mask. Japan itself had a terrible flu year in 2018, and even had mask psychologist to help people addicted to their masks.
5) Without evidence (yet), a large part of the scientific community and MSM made a complete 180 on mask efficacy in March of 2020. There are a number of reasons this happened: part political, part hypothesis, but I suspect mostly because the dynamics of power require that leaders propose something - anything - in face of a crisis. Even if the solution proposed is of no real value (like telling people to build bomb shelters in the Cold War, avoid mosquitos in early days of AIDS, "go shopping" like GWB proposed following 9/11), leaders know that the public needs something to indicate they have a plan and can be trusted (and re-elected).
6) In support of this hypothesis, those making the extraordinary claim pointed to countries like Japan, South Korea, and China - arguing that the correlation of masks must be casual, as they were not seeing large Covid cases. No one seemed to point out their low testing rates may be why they weren't seeing large number of cases, though it was mentioned in a passing story on Japan early in the pandemic.
7) I can't stress enough how important it is to remember that the argument of masks hinged on the fact that they worked in Japan, South Korea, and China. This is important for two reasons: #1 there was near zero coverage of the obvious counterfactual - all the Nordic countries had the lowest masking rates in the world and had either identical or better outcomes, and #2, the collective silence on why China, South Korea, and Japan exploded in covid cases later on - did the masks stop working? Or could it be, we jumped the gun on assuming casual inference?
Now let's address the mountain of evidence that came in showing mask efficacy starting in April of 2020 through today. I took the original list of 85 articles you used to support this hypothesis on November 5th 2020, and have added to it since (I'm at around 350 or so).
I understand how tempting it can be to have hundreds of studies supporting a hypothesis and assume the hypothesis is correct. I argue this is why physicians employed bloodletting, mercury, electroshock and even "daily aspirin for all" - they had a mountain of studies supporting their treatments, but none of them truly RCT.
So let us review at 100 feet what we have with the hundreds of pro-mask studies, and why they can't be trusted.
1) Starting in 2020 we had clear bias towards outcome.
You can verify this by plotting the studies, with the X axis being the quality of the study - beginning with X = 0 as opinion pieces, moving along axis you get Computer Models, experiments like Bill Nye blowing on candles, mannequin studies, case control studies, and eventually to RCT. Y Axis is then efficacy.
Quick example:
In an early opinion piece (X = 0 ) Robert Redfield says "If All Americans Wore Masks 'We Could Drive This Epidemic to the Ground" (Y=10, high impact)
Missouri hairdressers who wore cloth masks and didn't pass Covid to the clients who responded to a survey (X = .5) had 100% success rate (Y = 10) blocking Covid.
Kansas Mask Study, which picked arbitrary dates to compare counties with and without mask mandates, didn't bother to analyze adoption of masks, didn't account for testing differences, or any other confounder, found 100% difference, though when it was published a simple replication of the claim finds identical outcomes. X = 1, Y = 10
"Identifying airborne transmission as the dominant route for the spread of COVID-19" by Zhang et al became the go-to study to cite by the press in June 2020, showed large benefit (Y = 8) but quality was so poor (X = -3) that it was immediately requested for retraction by scientists who still thought masks worked, but this study was so poor it couldn't be trusted (note that you included this as number #4 in your original list, but failed to include the retraction request)
Yet when we finally move along the X axis and get RCTs, notably Bangladesh and Danmask, we find negligible benefit in the former and none in the latter.
I argue: When we find our evidence becomes weaker the stronger the study, it is evidence of bias. In truly disinterested science the slope should be near zero as we move from each tier of the evidence pyramid.
As further evidence of bias, note that the Danmask study, which was preregistered (rarely done for any other study) struggled to get their paper published in a journal. While I find many flaws in the Danmask study and don't pretend it is a perfect paper, it is lightyears better than Missouri Salon, Kansas Study, Tennessee schools, and roughly 72 of the 85 articles you listed 2+ years ago and almost everything since.
If the authors of Danmask were rejected so many times, despite being highly credentialed and submitting a preregistered and peer reviewed study, how many lesser known authors had to "file-drawer" any paper not showing mask efficacy?
Or worse, how many of those authors (intentionally or not) data drudged their study until it found a positive signal for mask. Most school studies used this method - they manipulated the dates studied - just like Kansas Mask study - to get the effect they expected to see. If you doubt this, rerun these studies yourself - they always far apart once you move the dates. This is likely why when journalist David Zweig asked to review the data in these studies he was refused.
Additionally I argue, if one is so confident of their claims, they should have no problem responding to reporters, replicating their work, openly sharing their data sets, seeking feedback to cut away errors.
Instead we see the exact opposite. These authors are defensive, and skeptical scrutiny is opposed. This is precisely what Carl Sagan outlined as qualities of people pushing pseudoscience.
2) The Gish Gallop
A Gish Gallop is when an extraordinary claim is not backed by extraordinary evidence, rather an extraordinary volume of weak evidence.
This was the strategy the infamous creationist Duane Gish used to employ when debating, he would drop hundreds of studies, which individually were poor in quality, but as sum-of-the-parts were nearly impossible to refute without succumbing to Brandolinis Law - the effort to disprove bullshit is magnitudes higher than the effort to create bullshit.
I present for consideration Katelyn, that you may have been Gish Galloped early in the pandemic, and are now trapped by a combination of sunk cost fallacy and whatever it is that caused William Farr to not see the obviousness of germ theory for 9 years.
You are barely at year 3, there is still time to step back, embrace the art of scientific skepticism, and see if 250 weak studies are extraordinary evidence, or an extraordinary example of the failure of how we organize scientific discovery. If the latter, there is a huge career to be made improving scientific discovery and addressing the perverse incentives which allowed us to create hundreds of (probably) nonsense studies arguing little kids wearing masks makes any difference in the trajectory of a viral pandemic.
(Happy to give footnotes/citations on any claim I made above)
Cutting to the chase, studies that focus on aerosols and droplets as vehicles for the virus simply make the most sense. SARS-Cov2 virus and variants have no means of propelling from one warm host to another. The vehicle that permits that is moisture. The aerosols and the bulk of the viruses that are confined to the carrier do not disburse beyond the appropriate type and properly fitted mask. As to whether a mask is better for the carrier or the prospective hosts in the same airspace, intuitively its unmasked people that are the delivery systems as well as the raison d’etre we all suffer from these variant viruses in my opinion and others. Mr D’Ambrosio If you don’t accept the aerosol/droplet science and find the masking rituals “inconvenient” or “annoying” then its possible you contribute to a high risk environment for everyone around you. It also may explain why we might anticipate another 2-3 years of excess deaths from COVID19 as long as there are plenty of unvaccinated and/or unmasked folks. The 3 W’s remain the next best defense. Vaccines and boosters remain valuable until the science tells us otherwise. Changing recommendations from our Health Agencies isn’t due to lies or deceit, its simply a broader knowledge base and better understanding of the mechanisms involved. Communicating those changes more concisely is Dr Jetelina’s task with the CDC going forward and I join the many subscribers who applaud every bit of the expanding knowledge she has painstakingly provided for her faithful readers.
One other thing to consider is that the material used in an N95 or legitimate KN95 is not a pure filtration material but carries an innate electrostatic charge which attracts and binds particles... and aerosols,,, to the fibers. Note that this is part of the basis for changing these masks frequently. This was something we had to ignore early in the pandemic when supplies were low and a used N95, properly worn by someone used to fit-testing and wearing them properly, beat no decent electrostatic options.
Good point Mr Creager. I personally use the Armbrust surgical masks: 3-ply, ASTM Level 3, electrostatic barrier made in U.S. even if they don't appear on "official" lists. Good fit and comfort. Reasonably priced. Their KN95 have similar specs. Disclaimer: I'm only a fan, not affiliated in any way. Interested in good protection in closed environments in light of a highly infectious virus. Check them out. You'll be please. End of unabashed product promo. ;>)
I use BNX, US manufactured, and easy for me to fit and fit-test. I spent years in surgical masks and learned about appropriate fitting requirements along time ago. BNX also has a KN95 with the only difference being ear loops. My affiliation: purchased/user.
Ray and Gerry: Thanks, that's useful information. I have bookmarked both those sites.
Excellent point Gerry, and that raises several questions we should be investigating. Including but not limited to:
"What % of virions get trapped by the charge, what % pass through?"
"How long does the charge last? [1]"
"Can repeated breaths dislodge the virion from the charge?"
In addition to simple questions:
"What % of the air we breathe is passing through the gaps?"
"How many virions do we typically inhale, what % are captured by various mask types, and what is the number of virions which can trigger an infection?" (if the answers are, for example, 10,000, 9,000, and 100, respectively, then we have an explanation why real world results don't match mannequin studies)
The point I am trying to make is that as long as we continue to stick our head in the sand on how poorly these are working in the real world, we deny ourselves practical answers and better understanding of viral transmission.
For example, it may be that not wearing goggles matters more than we thought. I recall one of the studies on the original list Katelyn shared [2] in November of 2020 showed that eye protection had similar efficacy to masks. Perhaps that is true and may be part of the reason masks didn't work outside of laboratory and observational studies?
I really don't think I am making a controversial argument. I am merely proposing that the pre-March 2020 hypothesis may have been correct all along. Consider attached hastily made graph, where on the Y axis is efficacy, and X axis lists 10 tiers of masks, ranging from "Fake Masks" (mesh products sold as gags) to eventually the industrial Positive Pressure Personnel Suits worn in BSL4 labs.
https://imgur.com/a/lrOWhF4
I think we all agree on the efficacy of the outliers - nearly 0 efficacy all the way to the left for Fake Masks and Gaitors, nearly 100% efficacy all the way to the right on X axis for PPPS.
We are debating the plot points for everything in-between those tails. The blue curve approximates the consensus prior to March 2020 while the red curve indicates the sudden shift which happened in March 2020.
Perhaps the blue curve was correct all along.
________________
[1] "N95 Masks' Efficiency Can Be Restored With Electricity: Smart Masks May Follow"
https://spectrum.ieee.org/one-day-medical-workers-might-plug-in-their-smart-masks
Excerpt: "N95 and other medical-grade masks rely on two filtration methods: mechanical filtering by mask fibers, and electrostatic filtering, in which stationary electric charges attract and ensnare tiny 0.3-micron particles such fluid droplets containing viruses. The masks are specified for single-use only because even after a day, the electrostatic charges in the mask leak out into the air and the mask becomes less effective at filtering out particles. That gradual loss of efficiency is even worse in countries like India where high humidity speeds the loss of static charge to the air."
[2] "Physical distancing, face masks, and eye protection to prevent person-to-person transmission of SARS-CoV-2 and COVID-19: a systematic review and meta-analysis"
https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)31142-9/fulltext
Excerpt: "Face mask use could result in a large reduction in risk of infection (n=2647; aOR 0·15, 95% CI 0·07 to 0·34, RD −14·3%, −15·9 to −10·7; low certainty), with stronger associations with N95 or similar respirators compared with disposable surgical masks or similar (eg, reusable 12–16-layer cotton masks; pinteraction=0·090; posterior probability >95%, low certainty). Eye protection also was associated with less infection (n=3713; aOR 0·22, 95% CI 0·12 to 0·39, RD −10·6%, 95% CI −12·5 to −7·7; low certainty)"
Based on observational evidence, the vast majority of masks I've seen worn in the last 6 months are incorrectly fitted and unlikely to provide any protection. I attribute this to the misinformation that "masks are theater" when there's evidence that masks do, in fact, work as an element of a layered defensive system. And, despite your note earlier, those cities with mask mandates that did not end them prematurely, favored better in the 1918-1922 influenza pandemic than those who either never mounted a mandate, or ended it early due to complaints similar to what we are still hearing today. I'm assuming you were interested in https://www.healthaffairs.org/do/10.1377/forefront.20200508.769108/full/#:~:text=Masks%20failed%20in%201918%20to,in%20response%20to%20COVID%2D19, or a similar article. Note that the limitations cited for mask wearing, using them for too long, poor fit and improper wear, remain issues today. Use of eye protection evolved pretty rapidly to use for aerosol-generating procedures. We also learned early-on that there was little or no benefit to use of full face shields, especially in place of some form of masking. Yet, the myth persists today that face shields somehow prevent fine-droplet aerosols from reaching the wearer. This is best described as unfortunate.
Another point made in the Health Affairs article on masks in 1918 was that their wear was "uncomfortable". Having spent close to 20 years in masks at least 5 days a week, and often for in excess of 12 hours per day, I can assure you, you can get used to it. A long time ago, I learned about infection-control precautions, and whether we later determine all our efforts were indeed futile, or not, that's how we attempted to control disease transmission in clinical facilities. This included simple barrier protection over clothing, masks, and gloves, and sometimes PPPS, although I never had to actually use that gear save in training in the facilities I worked in . Mask wearing, even properly, isn't impossible, nor must it be uncomfortable. This past week, while attending a meteorological conference, I reverted from simple KN95 (fitted and fit-tested daily) to N95s because they were for me, more comfortable.
100% agree with your opening statement. Will reply to rest tomorrow, have a good night Gerry.
Ray,
The physicist Peter Woit, in a critique of string theory, asked "what point does theory depart the realm of testable hypothesis and come to resemble something like aesthetic speculation, or even theology? ... A theory which can't predict anything is of no value."
Similarly the mask hypothesis is unable to predict anything with any measure of accuracy, it can only be validated through retrospective analysis like the Boston study. Worse than String Theory though, it does lend itself to falsification.
Here are 7 example I gave last night to another commenter:
1) It was predicted that if 80% of the country (US) wore masks, Covid would be crushed. 90% wore them, cases skyrocketed anyway.
2) Germany was a "Master Class in Science" for communicating, among other things, the value of masking, which their population adopted. Cases exploded anyway.
3) It was predicted that the high mask use in Asia was responsible for their avoidance of Covid outbreaks. Covid overwhelmed them regardless.
4) Nursing homes had extremely high mask rates among staff and patients, yet Covid swept through.
5) Conversely, it was predicted that countries that didn't mask up would have a horrible outcome, yet these countries with the lowest mask use (Sweden, Norway, Finland, Denmark) all have the lowest excess deaths in the world. (In your response you made the claim "...we might anticipate another 2-3 years of excess deaths from COVID19 as long as there are plenty of unvaccinated and/or unmasked folks" which this falsifies)
6) It was predicted that removing the mask mandate in Texas March of 2021 was "throwing gas on fire", instead the Covid rates dropped identically to neighboring states.
7) When schools across the US dropped mask mandates in early 2022, it was "too soon". Yet again, cases continued to plummet, and parents soon found what many Europeans discovered in 2021 or Scandinavians in 2020 - it didn't seem to make much difference.
If the science on this was serious, proponents of the theory would be doing their best to understand why these predictions failed.
When a hypothesis is made and then falsified, we revisit the hypothesis to find out what went wrong and either adjust or discard the hypothesis.
This theory has been repeatedly falsified in the real world, while proponents of the theory ignore the counterfactuals and instead promote these poor studies. This is why you have seen, even in "blue" areas, mask rates plummet - the public has heard incredible claims for 2 years that didn't match what they saw with their own eyes. A bit of "cried wolf" or "chicken little" syndrome perhaps?
To your point "it has no means of propelling from one host to another", extremely small objects don't need to self propel to travel great distances. Applying Stokes Law to particles of this size - even when traveling with molecules of water - estimates can vary between .5 to 5 miles even in ambient conditions.
You can stress test this point by watching the movement of the tiniest dust particles visible to the naked eye (the kinds you only see when light is shining through) and watch it float around the room - then consider that the particle you are looking at could fit between 500 million and 16 billion virions inside it. Extrapolate from there.
At no point did I say I find these "inconvenient" or "annoying", I couldn't care less. The practice has ended in Cleveland much like the rest of the Western world.
I do find it interesting that you call masking a "ritual", as I agree that actions based on faith rather than hard evidence are akin to religious belief systems.
Just to clarify, are you proposing that virus particles travel through the air by themselves, without being attached to anything? How do they do that?
I am proposing we need to return to the Mertonian norms of science - specifically disinterestedness and organized skepticism. From there we can better understand the behavior of invisible pathogens you need an electron microscope to see, and find out what strategies actually work, and which slices of the "Swiss Cheese Model" are useless.
It may be they travel on their own. It may be that they travel on something larger but are easily separated once they touch the fibers of a mask and inhaled. Maybe that takes one breath, maybe 10, I don't know.
It may be that they behave as predicted, but since everyone wears loose fitting masks (even when they think they have a form fitting n95), the air flowing through the gaps is enough to render them useless. Perhaps as I mentioned above if we used a true form fit [1] and then apply surgical tape along the entire perimeter of the mask, that may reduce virions inhaled. I don't know. Maybe even a sealed n95 isn't enough and we need an n99. Or a PAPR.
Or that space suit Shi Zengli wears. These are all fairly straightforward things we could be testing.
For close to three years we have seen every single claim on mask efficacy fail.
The US would see Covid "brought to it's knees" if 80% wore masks. Most of the country got close to 90% and Covid exploded anyway.
Germany was a "Master Class In Science" for their masking and protocols. Then covid exploded anyway.
Texas was "throwing gas on fire" when they dropped mask mandate March of 2021. Gases plummeted at rates identical to their neighbors for the next 3 months.
"Cases will explode and the airline industry will be crippled with the FAA dropping mask mandates". Didn't happen.
"South Koea stopped the virus through masks" now they have among the highest excess deaths in the world.
"China beat Covid through masks and lockdowns". Turn on the news now.
What is telling about all of the studies is that none of them are ever replicated, when so many of them could easily be re-run. Why do we have 350 different studies, all weak, rather than replicating several strong studies? I think the answer is obvious, because that won't support the conclusion we made back in March 2020.
__________
[1] Consider that the proper fit testing for an n95 when being exposed to patients with Tuberculosis (a bacteria magnitudes larger than Covid 19), from the guidelines:
"A qualitative fit test, a pass/fail approach is used. An individual dons the mask, and a test material is placed in the surrounding ambient air; then, the user reports whether it passes through the respirator. For example, saccharin aerosols are detectable by their sweet taste if the respirator does not effectively remove them (e.g., because of leakage at the face seal surface). Although NIOSH recommends against it, irritant smoke is also occasionally used in a qualitative fit testing procedure."
Perhaps if we went to that extreme we may see benefit? These are questions we should be exploring.
@M. D’Ambrosio: Perhaps the Mitroffian “counternorms” have superceded those Mertonian types.
https://en.m.wikipedia.org/wiki/Mertonian_norms
I agree that appears to be what has happened - especially "organized dogmatism" and "Self-interestedness".
Likely explains the problem. Will reply to a comment from Gerry Creager in a bit, please weigh in.
'"Yet here you conclude "Mask mandates in schools work" based on a nearly identical study, with the same flawed design, and the same glaring flaws."' I read the NEJM study. I have no idea where the first study you cited came from. Based on reading the former, though, I see no resemblance whatsoever between the two, much less anything the qualifies for the phrase "nearly identical."
On the one hand, you give us a short summary of an unidentified study with a laughably small sample size and no indication of what actual conclusion the author(s) reached. On the other hand, we have a study of 72 school districts involving 294,084 students and 46,530 staff and what looks to me like fairly rigorous statistical analysis. Granted, it has been quite a while since I was in the business of statistical analysis and research design, but even so it seems pretty clear that calling the two "nearly identical" comes very close to fabrication.
Perhaps you should take a more disinterested attitude towards this yourself, Michael. As it is, you seem to be doing some serious misrepresentation and cherry picking of information.
Both studies suffer identical flaws. They don’t know the testing rates of each arm of the study.
1 am or would respond in more detail. Happy to dig in further over email if easier - substack comments pretty limiting.
That does not appear to be the case based on the information at hand, and repeating it without data to support your claim doesn't change that. That's obvious from examining the one to which we actually have a link and comparing it with the short summary of the still-unidentified one you quoted.
It is *possible*, I suppose, that they "suffer from identical flaws," but based on the information you have provided, this is obviously not true. Perhaps you could provide a link so we can all reach an informed decision?
Sorry Stephen I wasn't transparent in my original post, I was adopting the style of John Allen Paulos, where to illustrate the absurdity of a claim in the media, I constructed a theoretical counterfactual as a steelman. I initially thought it was obvious of my intention, but that mistake is on me.
I thought for brevity the approach might be effective to create a hypothetical scenario to illustrate the absurdities of the Boston study without having to analyze it in detail (again).
As you rightly pointed out last night, my example had a "laughably small sample size" (n = 2), which is the same sample size on the experimental group had in the NEJM study (2 school districts retained masks) and n = 17 was the districts that lifted mask mandates 2 weeks after state order removed (see figure 1 of the study).
The point I failed to effectively make is that skepticism and critique has been largely one-directional throughout the pandemic.
I am making the point that papers like Kansas Mask, Missouri Salon, this Boston School paper, all have obvious problems, are easy to pick apart, yet the pro-mask segment of science seems unconcerned as they cite these uncritically.
On the other hand, this segment of science suddenly becomes concerned with confounders, study design, replication, sample sizes when it comes to papers and ideas they view as heretical.
Earlier I used "Danmask" as an example - again, I don't find it a particularly strong study - but just look how much pushback and scrutiny that paper received while far worse papers like "Effectiveness of Face Mask or Respirator Use in Indoor Public Settings for Prevention of SARS-CoV-2 Infection — California, February–December 2021" get published by the CDC.
I don't think Ivermectin does much other than help people in Africa (or apparently possibly help against lice according to the CDC), but Ivermectin is a good example of how the hammer of skepticism is one-directional. Every paper suggesting benefit receives massive scrutiny while Kansas Mask study, et al, get a free pass. It's evidence of bias, when skepticism should be applied equally across the board.
Example, consider this paper which was requested by authors after a huge blowback where authors pull it noting "As in any retrospective study, we could not control for all the confounding variables, mainly severity of disease in patients treated with either ivermectin or remdesivir...We were very clear in the abstract conclusions that our results are only showing an “association”, they are not definitive, and further randomized clinical trials must be done to prove the efficacy of Ivermectin."
Where do you see these concessions made about the flaws of retrospective studies and need for randomization in mask studies?
https://www.sciencedirect.com/science/article/pii/S1201971221009887
You are misrepresenting (or simply confusing) what n means in these cases, Michael. In the still-unidentified study you cited, the total value of n was 19 individual cases. Individuals and school districts are not the same. In the school district study, you have 72 school districts involving 294,084 students and 46,530 staff and what looks to me like fairly rigorous statistical analysis.
This is the sort of thing that makes me strongly suspect the honesty of your intentions. Well...that and the kind of thing being pushed on the Substacks your follow.
The study groups by school districts. 2 school districts kept mandates. N = 2. See Figure 1.
It's a poor study with and received several critiques which were unanswered. That is frustrating as science should be a continued back and forth. When you propose something, you should welcome critique and strive to chip away errors.
Instead we have one-directional skepticism. This gets a pass Danmask gets grilled.
Doctor Strange: "Well...that and the kind of thing being pushed on the Substacks your follow."
Which of my 45 paid subscriptions do you take issue with? Anna Khalid's Banished? The Fifth Column? The Free Press? Lexicon Valley? Noah Smith's Noahpinion? Privatdozent? ParentData? Unbiased Science Podcast? Michael Shermer's Skeptic? Stuart Ritchies Science Fictions? Matt Taibbi? Mary Pat Campbell's Mortality with Meep? Technically? Matt Yglesias Slow Boring?
Or perhaps my paid subscriptions to The New York Times, The Atlantic, Wall Street Journal, Washington Post, The Guardian, and New Yorker you take issue with?
Or, is your issue that I listen to as many voices on complex topics as I can, rather than just sticking with "my team"? Sounds like that might be the issue?
First, it's become more common for the control arm to have many more participants than the treatment arm, so that's not an outlier. However, n=2 and n=17 are generally red flags for me overall, even in difficult to recruit, dangerous, or in-silica studies.
That said, the Boston school study on the efficacy of masks was hard to follow because it was retrospective, observational and uncontrolled. Still, the overall numbers do support the conclusion. Creating this as a prospective and well-controlled study would have drawn fire from too many sources but using available data in a responsible manner only makes sense.
If I'm not mistaken you've already taken exception to the notation that the premise behind the N95 is actually electrostatic binding of charged particles... because the masks do have pores allowing the wearer to breathe through them. This doesn't restrict the matter that both aerosolized droplets and the viral particles themselves are charged particles and that the electrostatic charge is somewhat stronger than the turbulent flow past said particles, bound to filaments in the mask.
Masks work as elements of layered defenses, when done best. Early in the pandemic, cloth masks were being recommended because high-quality (N95, KN95, KN94) masks were in scarce supply. I'll refer you to https://pubmed.ncbi.nlm.nih.gov/33300948/ for efficacy on a variety of masks. Entrapping virons is not generally the issue as they require some transport mechanism, usually a droplet, to survive.
Thanks for the thoughtful reply Gerry. I spent some more time on the Boston Mask Study, it's even worse than I initially thought. Striking problems:
1) You can see on Figure 1 that the students in the schools which would eventually lift their mask mandates had much higher cases before the mandates were lifted, indicating that whatever caused these districts to have higher cases was happening before masks removed. Yet the authors cut this off by starting the graph in figure 1 in February, though it is clear cases were much higher in January. Suspect of data drudging - moving the dates until the data shows what you want.
2) The authors apparently didn't realize that 13 of the schools they counted as "keep mandate" had successfully received an exception earlier (there was a condition that if you meet a % of vaccination you could be exempt from mask mandate).
You can cross reference this list with table S1 to see the 13 schools they missed:
https://www.cbsnews.com/boston/news/massachusetts-schools-mask-mandate-lifted-list-dese/
Example of one of the schools lifting it: https://www.kingphilip.org/important-mask-update-2/
3) One of the authors, when questioned on the lack of accounting for testing differences (many schools had students taking twice a week antigen tests, other schools used the CDC guidance that you only need to test for exposure when not wearing masks) argued that you should just trust her, she has a PhD on Twitter (I'm too lazy to dig this up, but if you follow EpiEllie on Twitter this sort of nonsense shouldn't come as a surprise).
4) The authors successfully organized a successful Change.Org campaign to get masks back on kids in Boston earlier that year, yet make no mention of this conflict of interest in their disclosures
https://twitter.com/EpiEllie/status/1429102872470433795
5) One of the authors had penned the Op-Ed in the Boston Globe "It's too soon to lift the school mask mandate", also didn't disclose this conflict of interest
https://www.bostonglobe.com/2022/02/11/opinion/its-too-soon-lift-school-mask-mandate/
6) Just as aside, almost all of the authors are on record being supportive of masking children prior to the study.
These are all fair criticisms of the study, yet it gets passed on without critique here which is troubling. The skepticism is always one-directional. Any study, no matter how poor the quality gets a pass, so long as it supports masking. Only studies that find no benefit get grilled.
That's not how science is supposed to work.
It's been awhile since I reviewed the Boston Mask Study, and I did identify weaknesses at the time. Not all pertinent studies are very well-designed; some are just large enough and controlled enough to be useful. That said, I just reread the study and have also looked for comments indicating what I might have missed. I was not impressed, as most were from either sites with known bias regarding both the pandemic and mitigation of all sorts, or in the case of the few professionals, from, again, people who have consistently been outside the norm and have disagreed with research results if it did not fit their world-view.
I recall, but cannot find immediately, a study that attempted to quantify mask efficacy in rural Africa. THAT study posed issues in design and execution unrivaled by the Boston study in that it attempted to distribute masks of poor quality (overall) to villages and then see what effect "any" mask use provided with regard to mitigation. As I recall, they found their results to be mixed. However, rural Africa suffers from a significant healthcare system shortage, a paucity of tests, and apparently, lax compliance with study requirements. THAT study posed serious problems in accountability.
You tend to cite a fair bit of the regular media, but you also cite research reports. I've generally avoided the popular press, at least until recently. Now I am more interested in sites like NYT, for their statistics. Other "popular" sites, e.g., NPR, WaPo, I only include if they appropriately represent a study, AND cite the source. I do use Twitter to follow certain experts, a truly select list who I either know, or where I'm familiar with their background, and their work. As I've served as a reviewer for professional journals, I tend to review virtually every article I read rather critically.
Thank you so much for your updates. Vital to all of us! My question is do we know when we will need/have the next booster? I got the omicron booster in October 2022. Won’t that protection wane soon? I’ve seen nothing about next steps. Anything happening?
Great article and so helpful! Have you heard any updates regarding older folks and immunocompromised people getting a 2nd bivalent booster? Many in this cohort received their bivalent boosters early September. I've had a few people asking. Thank you.
Still grateful for all you do and how well you do it.💗
More good stuff! (Except I shoulda got Moderna...)
There are a lot of experts shamelessly sniping at each other over the "Covid creates immune deficiencies" topic. Very hard for lay people to un-puzzle.
Any chance you could do a "what we know, what we don't know" on this?
I would think with so many infections, we should see something measurable by now.
Well....there are a lot of people who claim to be experts doing this. As always, one needs to look at the data, not what any particular person says about it. Science isn't about argument from authority.
Yep. Need solid data AND solid analysis. Always.
The "what does it mean" interpretation is where things can get hairy. That's why I'm asking our favorite epidemiologist to weigh in!
Dear Katelyn, Thank you as always for your helpful summary. I appreciate your clear updates as we navigate through the COVID maze. Happy 2023 to you and your family.
Should we continue to get boosters? I got covid last month and I am fully vaccinated/boosted. So if the hybrid immunity is stable for 8 months, should I get a booster in August?
Thank you, Dr Jetelina, for a wonderful post that connects the science in to actionable steps by subgroup! This is *exactly* the type of information that people need to restore trust! I wish the CDC had told people over 50 to get only the Moderna bivalent booster back when it first came out. I know that supplies were low, yet transmission levels were also low, so waiting a few weeks probably was okay. Unfortunately, both my parents (80+) and two sisters (50+) got Pfizer, because it was the only thing available. Three weeks later, one of my sisters got Covid (first time).
Yesterday's Wall Street Journal had an article "Where Are the Next Covid Treatments?" The article states: "One study found that half of hospitalized patients who die from Covid have a contraindication with Paxlovid." (link below) In addition to better vaccines, we also desperately need new therapies, especially since XBB.1.5 has rendered most old therapies ineffective.
https://www.wsj.com/articles/where-are-the-next-covid-treatments-vaccine-booster-shots-doctors-pandemic-paxlovid-treatment-fda-antibodies-11673203403
At the risk of sounding like a broken record, I would refer people to a prescriber who would consider an alternative repurposed drugs off-label Rx if the patient is infected and progressively symptomatic with COVID-19 and has no access to Paxlovid. 412 case reports on the CURE ID website identifies such an effective product that has been used now for nearly 2000 patients with consistent success and safety, no rebound, and is inexpensive. So, its not an EUA drug but it can be repurposed from its original use in an emergency life and death situation and susceptible people with progressive Covid19 qualify in many instances. It has been approved for long-term use for Sickle Cell and Covid19 Rx is only a 5 day protocol. This identification of repurposed drugs is what was intended by the FDA when the website tool was designed to solicit clinicians “to more easily report real-world experiences treating Covid-19 patients who are unable to be enrolled in a clinical trial...in the COVID-19 Public Health Emergency” This is not misinformation. This is not the next fake med like ivermectin and Chloroquine/hydroxychloroquine. These 412 cases are “real-world experiences treating Covid-19”.
What is that drug? I pulled up the CURE ID website but it will take some time to work my way through it - could you please save me the suspense and effort?
From that list of 10 most reported cases for treating Covid-19 with repurposed drugs the #2 spot shows Hydroxyurea (HU) also known as hydroxycarbamide in some parts of the world, used continuously for sickle cell crisis mitigation. HU current count is 412 cases. The #1 drug reported is the discredited and politicized drug hydroxychloroquine (HCQ) at 558 case reports, however all these cases were reported well before August 2021 before a myriad of clinical trials showed no efficacy statistically and before our data gathering had been initiated. Also, interestingly, the numbers of case reports for HCQ plateaued at that time as the promoters, evidently, saw no value in “beating a dead horse“. The current 412 cases reported for the HU are less than 1/4 of those patients treated successfully, safely, without rebound infections, nor adverse drug reactions. and these positive outcome case reports continue to be gathered with each subsequent variant. Please feel free to email me to discuss further and I’ll be happy to answer any questions you might have. sullray<at>Gxxxxxcom
Most of the NIH-curated data on HU related to respiratory resolution and were not COVID specific. I'm treating COVID-19 as a vascular, primarily endothelial disease these days with a primary respiratory vector for infection. I've found no evidence save on your site for "cures" for COVID-19. Sorry: This isn't an attack. I've been looking.
Mr Creager, I’m not clear exactly what NIH curated data on HU to which you refer. We do indeed appreciate that Covid19 has profound effects on the vascular endothelium and it is our hypothesis that many organ dysfunctions can be traced to endotheliitis. Tissue hypoxia is a significant factor and HU can impact that positively just as it does in SCD. Further, an undefined antigen-antibody block of a7NAchR’s causing neurotansmission disruptions may be the source of relief by HU. An initial in vitro study by a biochemist colleague appears to confirm a link between HU and those receptors. Further in vivo studies are planned but her Institute in Kyiv is currently “preoccupied” by the invasion and winter. HU and the ACh EI Mestinon are a unique combo for treating advanced COVID19 and I doubt there is any corroborating literature from the NIH or anywhere else. Our local experience with this combo has been dramatic. Lazarus like outcomes. 2 repurposed drugs with no rebound, no ADRs and dirt cheap. That last fact is a major barrier getting a study designed.
Ray sullray<at>gxxxxxxom
Greetings, I liked your post today a lot, and it caused me to go from a free subscriber to paying to support your work. Unless allowing comments from non-paying subscribers causes you increased costs from SubStack, I suggest you allow comments from non-paying subscribers unless doing so invites trolling jerks. I have found other SubStack authors from leads I have gotten from the comments of other SubStackers. Up to you, obviously. Thanks for doing what you do.
I am eager for your commentary on the recent article in the Am J PUb Health (lead author Tu). The good news was that deaths, ER visits, and hospitalizations were down among the vaccinated. But by the same measure, it appears that infections were MORE common among vaccine recipients than among those with "natural" immunity. I for one am skeptical of how we even define infections, and the article is somewhat opaque on that issue. But the anti-vaxxers are running with this. "What other vaccine makes us MORE likely to get the infection?" they say. Thanks!
Thanks so much! Did they say anywhere what the magnitude of better T-cell immunity was of Moderna vs Pfizer? Similarly, any data on mixing the two (at one point the advice was mix them and then it was “it doesn’t matter”). In other words, does the Moderna advantage occur as soon as you switch to it or does having prior Pfizer vaccines impact that?
Thank you for you level headed, articulate, fact-based, clear information.