Thank you! Such awesome data! Per my personal experience, masks work! Family of four; we wore masks everywhere we went when necessary. We started out with cheap ones then got double fabric, then N95’s! We never got sick, fat maybe...lol but when we took off masks, we started getting sick. Head colds, allergies, the flu! So MASKS WORK!
What I don't understand is why the U.S., with its massive resources, has not studied the bejesus out of this question. After all the social upheaval we shouldn't have to cite Bangladeshi studies. I'm firmly pro-mask but I also am skeptical of forcing ineffective (cloth) measures on adolescents at such a social cost without proof.
The Bangladesh (WHO) study was convenient, easy for folks on the ground to create and complete, and a target of opportunity. There have been a number of engineering analyses of mask efficacy, but few RCTs because it was politicized so quickly. Cloth masks are more effective, with the right materials, than some of the procedure masks, especially if worn properly. The "cloth" masks I wore early in the pandemic included a layer of HEPA filtration material, improving efficacy. That particular design was offered by the original designer/inventor of the N95 mask at 3M.
Thank you for this summary. In my personal experience, and that of my family, masks work! We all wear KF94 masks and have not gotten covid. The kids attend school, birthday parties, etc. We are out in the world and even though most people around us no longer wear masks we continue to be very well protected (as evidenced by no COVID).
Maybe if enough people comment here, Dr. Jetelina can whip up a Cochrane level analysis in support of well-fitting N95 (or similar) masks against Covid 😉
So here’s my data point:
Family doc, personally insisted on wearing my own N95 as far back as February 2020 (had some leftover from H1N1 fears), in small rooms with patients. Up to date vax always. No covid
Wife Ob Gyn, similar story, except that labor and delivery is by itself an aerosolizing event. No Covid.
Daughter up to date with vax and boosters, wears an N95 at school (her choice, we don’t insist, she’s just a smart freethinking (stubborn?) little girl). Despite class and teachers perpetually sick with something including Covid... no Covid.
We will get Covid someday, maybe I have it right now and asymptomatic... but hard to argue with anecdotes like this right?
Also, asymptomatic spread was “known” on Twitter quite earlier than this timeline, as was the de facto spread via aerosols when looking at epidemiology. Statements of fact were withheld because of logistical and liability reasons, and many health care workers lost their jobs (and lives) because they refused to compromise with flimsy mask mandates from hospital systems prohibiting personal N95 use. When our health system finally procured and offered 1 surgical mask per person per day, it was presented to us like a golden calf. By that time I had already secured a bunch of N95s, which I cycled in paper bags that dried out on a clothesline in my basement.
Good mask, good fit, NO QUESTION this works for the individual in my humble opinion and experience.
Welcome back from Turkey, I can only imagine what you witnessed. 😔
It was probably late June 2020 when I started questioning the large droplet and fomite theories and embraced aerosol spread. By then, I was hearing a lot from clinicians who had similar thoughts. It took awhile for the Redfield CDC to accept the proposition officially. Birx and Fauci were pushing a rope uphill with the concepts of asymptomatic spread and aerosol transmission by that time, too.
Ryan: glad to see this report from you. Great information! Here’s one thing that continues to concern me, and despite my best efforts, it’s really hard to get clear info. That is, for our purposes, eg, popping into drug stores, grocery stores, or even longer things, like going to art museums when not crowded, we opt for a properly authenticated Powecom KN95 mask, fitting it as tightly as the earloop design will allow. We tried using Aura N95 masks for these purposes, but while they are, within the N95 range, more comfortable, we found the headband design quickly became impractical. (We do use our Aura N95s when going on public transportation.) We did get Covid this January, but it was from a small unmasked dinner gathering where we subsequently learned one who attended had Covid without knowing it and gave it to all attending, and we shall never repeat the folly of that. Until that gathering, we had been Covid free using the procedures I describe. What I’d like to get a better fix on is how much slippage in protection there is as between an N95 and a KN95/KF94, assuming all are worn with as tight a fit as possible. Of course there is some, but despite many efforts to research this, I can’t seem to get a handle on how much. Any thoughts?
Hi Susan- I agree with Gerry below, and I think the filtration differences in the masks you described are negligible. The fit becomes the most important issue. As an employed physician in a hospital system I had a mandatory fit test while wearing several types of N95 masks, and the Aura fit my face the best with no leaks. Maybe a decent, homemade proxy for this would be to wear a mask and see if your glasses fog up while you’re breathing! Not sure though.
I really am troubled by people latching on to recent studies highlighted here and thinking the conclusion is that masking does not work for the careful. If you’re sloppy, inconsistent, and choosing weak materials and fits as a community, of course the zoomed out studies will be disappointing. But for the individual like myself, who could have had Covid from multiple known and unknown exposures (I see sick people, too), I rely on my N95 and absolutely know it works.
If I had more time and reach I might do a post about how masking is along a continuum, from worthless gators to well fitting elastomeric N99s. Fit matters, as does context and environment. SARS CoV2 has evolved to become insanely contagious, orders of magnitude above the original wild type I think, so some masks might have held up in the beginning but not anymore, too.
I think we're in violent agreement. I, too, have been formally fit-tested. The Aura was the "best" fit for me of the ones offered, but the BNX mask I use at home is more comfortable and maintains a decent fit.
The "Do my glasses fog" test is reasonable in most settings, I suspect. The other option to improve fit is a second mask, such as a simple surgical or procedure mask. This is less to add filtration, but does often improve fit.
Along with the continuum of worthless gaters to well-fitted N99s, there's an orthogonal consideration: Masks are one, if significant part, of a continuum of protective measures in public health. Masking, distancing, hand washing, isolation when necessary, quarantine when necessary, vaccination, these all play a role. Individual elements are not as effective as employing the spectrum of controls.
My visit to the Palo Alto MC included their masking with tape the top edge, then my glasses weren't fogged. Being a physicist, I appreciate their writing, "iI's physics.".
bc .... thinks tape all edges, because he has a beard.
Ryan: very grateful to you, as well as Gerry, for responding, and with such an incredible clarity. It’s a relief to have confirmation that “fit matters, as well as context and environment,” as is what the evolution of the virus means in terms of choice (and fit) of mask. I think what many folks do, and who can blame them in this ever changing environment, is to judge based on personal experience, rather than an understanding of the science. So, for example, I still see folks in my building who, while clearly wishing to be careful, are still using cloth masks. And thanks, too, for confirmation on the “fog” test as a potentially reasonable proxy (which, as I am always reminding my spouse, cannot be achieved with a KN95 if you don’t get the crease out--as Lindsey Marr once said about that crease: people don’t have beaks).
I have not seen any research on KN95/KF94 vs N95, but the main difference is the dual head band for the typical N95 providing a more secure fit. I can usually achieve a decent fit with a KN95 but I've been wearing masks for years in settings where it really was important. Practice helps. Most of the KN/KF masks I've seen really are difficult to get a good and consistent fit on. I've found a company that makes both N95 and KN95, with the sole difference being the ear-strap vs headband. For my face, those fit well and remain comfortable. I am fairly confident that, in that mask, I'm very close to equivalent but I've not gone on a test stand to confirm this. I just know I have no leak around my nose/eyes and chin.
Gerry: Thanks, and understood it’s just your experience, no interest/stake in the company. Much appreciated that you’ve taken the time to weigh in on all this. It’s been really helpful.
Thank you! I wear an well-fitting N95 everywhere and believe it reduces (not eliminates) the chances I will catch or transmit COVID. Data supplied seems to support this. I don't want to be a vector in the chain of transmission. I'm sad to see masks not required in certain settings like Memory Care facilities. The staff and visitors are not masked in Memory Care and they continue to have outbreaks, currently the SIXTH outbreak where my loved one resides. And outbreaks are hard to control in this setting and extremely hard on this population. I wrote to my local Public Health department about this topic.
The vast majority of evidence (obviously inconclusive due to data limitations but still suggestive) points to masks absolutely working to reduce transmission in real-life settings which you have pointed out. It doesn't take a genius to know if you are coughing/sneezing/feeling like crap and you feel compelled to be in a crowded indoor setting that a mask would help to reduce the spread of your spit. It's why we teach preschoolers to cover their face with their arms when they are coughing or sneezing. I cannot help be astounded by the push back that still exists (and has indeed seemed to grow) on this issue and the stigmatization of this extremely non-invasive and easy intervention. But then again people fought against seat belts and not being able to drink and drive so there's that.
I buy into your comment about the wrongness of fighting against drinking and driving and would add not stopping at stop signs or red lights, but would not use seat belts as an example. Wearing seat belts clearly doesn’t protect others, and if not, it should not be mandated because that violates individual freedom to take risks. Even though I think such risk-taking is silly.
Word! The anecdotes given by a doctor in this thread are ridiculous~I am VERY glad his family has not been hit by COVID in a serious way. HOWEVER, yes this is also anecdotal, I have folks very close to me, and my age, whose families HAVE been severely affected by COVID. Factors such as housing situations, types of jobs, access to good health care period, on and on.
That is why public health is so important, along with research, development of vaccines, and SCIENCE education.
> “no evidence of a difference” is different from “evidence of no difference.”
Such a critical distinction that it seems too many people either don't understand, or choose to conveniently ignore. My 10th grade geometry teacher (who taught logic as part of proofs) would hand out failing grades to a large percentage of the population...
At the risk of being contrarian...I respond not because I expect to persuade Paul, but rather for those who may come along and read, to point out the flaws.
If Paul's responses were private, I would simply ignore. Since they're public, they get a response.
I see your point but have simply preferred to label him for what he is - a troll. When i did that I got an huge amount of likes. If those who didn’t “like” read how many agreed with me, it should give them pause.
Calling somebody names is preaching to the choir, and does nothing to inform those whose position may still be malleable. His behavior is definitely troll-esque, but the words can still influence others' evaluation of the scenario.
Your response is a non-sequiter. Regardless of what you've convinced yourself about masking, absence of evidence is not evidence of absence. Not finding evidence against something is not all the same as finding evidence against something. It's basic logic.
It's hard to reason or dialogue with someone hung up on contrarian concepts that most people find illogical. Let the best man win - in this case let he who is without mask bet who will be first become ill with Covid19. Now excuse me as I check my mask as I enter my first public building of the day.
There is clear evidence of efficacy- several studies were linked in the article. There are fewer studies showing non-efficacy, and they tend to have methodological issues. But lets say they balanced.
If we follow your logic that there is no evidence in either direction, the consequences of following your course of action (not using masks at all) has a far greater potential negative impact than your irritation of putting a piece of paper over your face in crowded settings or where people are vulnerable if they do work to mitigate spread. I would understand if the mask had to be stapled on or had to be on 24/7 but that simply isn't the case. Even in offices or medical settings people get breaks and can remove them for some "fresh air". Also some masks are better than others and not so difficult to breathe through without sacrificing much on the filtration. This goes back to your comparison of masks (a piece of paper or melt-blown fiber you wear with strings that is there to help others) to medication (a chemical compound which can cause serious reactions or interactions which help only yourself). There are some pretty clear differences.
Thank you Katelyn for your thorough review of the mask question. I am a retired surgical pathologist, and throughout the pandemic I have often wondered about aerosol and droplet contamination from virus contaminated ambient air to a person’s eyes. I may have missed this being addressed, but I have not seen this discussed much. Adherence of the air borne viral particles to the conjunctiva of the eyes and subsequently via tears down through the nasolacrimal ducts to the nasal cavity and its mucous membranes seems a likely transmission mode that would circumvent even N95 mask protection. Perhaps personal Rx eyeglasses or safety glasses would intervene to some degree in the movement of the viral particles to the eyes. Your thoughts on this would be greatly appreciated.
Most of the clinicians I know actually went past safety glasses very quickly and directly to full face shields or positive pressure full face respirators in aerosolizing procedures.
I'm sorry but the "it depends" seems disingenuous. Masks work to reduce COVID writ large, period. Individual masking leads to societal reduction in infections, and societal reduction of infection leads to each person getting sick less. Communal action leads to individual benefit.
Which of the studies that found masking beneficial do you find compelling?
I've read almost all of them in detail, they are mostly of poor quality, such as the recent Boston School Mask Study in NEJM. That the RCTs and now the meta analysis of RCTs are not finding efficacy seems to affirm what we have seen on worldwide (and call back to pre-2020 mask guidance) - masks didn't appear to make any difference for South Korea, Japan, China, Portugal, the US, etc - nor did the countries which weren't really into masking (Nordic countries, Africa) have a worse outcome.
Too bad the rest of the world doesn't understand the complexity of the issue. I knew from Day One, only I could protect myself, so I always followed the most recent recommendations on how to wear a mask, what type of mask should be worn etc.
I was in a group that made over 50,000 masks. At the time, it was the best protection. Now I wear a KN95 (I'll accept the slightly higher risk vs an N95 as I am very careful, you get it.) Look at 100 people wearing a mask-we KNOW few are wearing it properly, wearing a high quality mask, wearing it consistently etc.. I DO know neither hubby nor I have had symptomatic Covid. Family and friends who were nearly religious about avoiding covid and GOT covid could point to a specific incident when they knowingly (and understandably) let their guard down.
After 3+ years and being fully vaxed and boosted, I too sometimes let my guard down, evaluate the risk and will expand my activities. So, I know it's more likely I'll get Covid, but I'll still try to avoid it while expanding my life and improving my mental health.
Thank you for your mask-making efforts. My wife made hundreds and donated them to the Tribe in Oklahoma, a group that was essentially ignored by the State government.
So, folk have posted pro and con regarding mask wearing which I have found wearing! Logic tells me the following: Covid is mainly transmitted through droplets and is highly contagious; putting a barrier between me and those droplets would seem to be the most logical and simple solution! Hence, I remain a Covid "virgin" as they say. I have had numerous very close, inside exposures- even with someone coughing and sneezing mask less right next to me! I ALWAYS wear a KN94 mask to all inside activities...especially as I have received numerous, post meetings, emails apologizing for exposing me..and my immune-compromused husband thru me...to Covid! Aarrgg...I don't need RCTs to tell me what logic says: wear a mask and stay safe! Will I ever attend a meeting ( and I have to go to many) in the future without a mask....that all will depend upon the efficacy of future vaccines for this ( I am fully vaccinated as well). My family has also not had any flu or colds since we started masking. It's just LOGICAL! So, thank you Katelyn for attempting to share the science- but the logic wins by a landslide for me.
We need a new group, let's call it "Virgins United". I find it funny to read articles about these miraculous situations where people never got Covid. DUH, it's because we're scrupulously careful!! Does it have a down side, of course, but I prefer good health to bad health.
My husband and I had avoided COVID got our vaxes in April 2021, and 1st boosts in Dec 2021. Masked from the get-go. I researched and found masks with pockets and found filters which would filter down to the .3 microns. Then got KN95s. Well, just before boosters became widely recommended, and I mean just weeks~we were both 62 at that time, March 2022 I had my annual checkup, our primary care doc said "no worries just wait for the BI valent booster" !!
Everything started opening up around here in late March/April. In early May my husband got it then I got it a week later. He did not get Paxlovid but I have a history of URI including a lot of bronchitis etc, so I did. It helped. He was sick longer than I was.
I discovered after doing more research that the KN95s we had been wearing might not be adequate despite my research. More likely is that my husband has a fullsome beard and everyone around us had stopped masking. I found N95s and have used them since.
We got our 2nd boosts in August 2022 just before the bivalent came out. We have worn the N95s consistently since we were both sick. Our doc said we could wait 6 months for the best B and T cell response, but we are still careful as my husband visits and cares for his 93 year old mother.
The basic idea of masking is: yes it may help prevent you from getting sick, BUT the main reason you wear them is to reduce the chance of spreading it to others.
just to add: there are many vulnerable folks who are still getting COVID and if they were in better shape might not die, but if they have underlying conditions and now those monoclonal anti bodies are not helpful anymore, well......
People tend to deny a simple truth about the world: it's all about probability and outcome (watch the 1978 movie "Heaven Can Wait" for an amusing take). Your question, in my mind, has been asked and the outcome provides the answer: populations where the societal norm was to wear a mask (no matter how effective) did much better than those lacking that norm.
While that is a widely believed claim, it is actually incorrect.
Of the countries which tracked excess deaths, South Korea, praised for their mask culture, had among the highest excess death rates in the world (+15%), ranking 5th highest excess deaths out of the 36 countries tracked.
By contrast, he Nordic countries, which had the least mask adherence in the world, all place at the bottom (average of +5% with Sweden (+3.5%) and Norway (+5.4%) holding the lowest increases in deaths.
This claim can be replicated with the data at mortality.org which pools from each countries CDC equivalent.
You're mixing apples and oranges here with mortality data and case spread. But re. mortality, are your claims accounting for age-adjustment as well as prevalence of co-morbidities? Also wondering about how new this all still is. Current studies are showing several potential long-range outcomes from infection. It may take a few more years to see how this pans out in coronary and pulmonary disease as well as cognitive disorders.
Mortality data is the only metric which isn't influenced by unknown confounders, bias, testing rates, etc.
It's a simple and reliable metric to judge population level impact, and was often cited in the MSM in 2020 and 2021 when the early numbers were backing their claims that Sweden was doing it wrong, South Korea doing it right. Now that the data no longer supports that hypothesis, excess death hasn't been cited as much it seems.
I would love to have more detail on comorbidities from these countries and get to go through line-by-line through the death records like we can with CDC, but that information isn't available.
As for the question "well what about the long term consequences", I propose something obvious - if a country has high mortality like South Korea, that country will have a corresponding spike in whatever indirect/long term effects there are. It seems silly to propose that while the masks in South Korea didn't stop them from having a record breaking 100% increase in deaths Spring of 2022, the masks may somehow save them from Long Covid.
Great post. Neat as a pin. Nicely constructed. Too bad that the talking heads on cable TV news shows will very likely never be able to: (a) Comprehend why this is a great post that was nicely constructed and neat as a pin OR (b) Provide any refreshing "clean-up" of this issue for lay folks.
Thank you for providing this arc in how thinking has evolved around the value of wearing masks as new information became known.
I’m still masking, and I hate it but do it anyway. Is it fair to say, that when a virus is extremely contagious, masks primarily *delay* infection, but sooner or later, if you’re out and about enough, even if you’re wearing the right mask, you’re going to get Covid? All it takes is one unlucky airplane ride or jury duty sitting next to the wrong person?
Also, I’m headed to London soon and hear cases are on the rise again in the UK. So why are they ending the bivalent booster? Seems like odd timing.
Wait, I didn't hear they were ending the bivalent booster?! Am curious to hear the answer to your question.
I also don't know about the delaying COVID question. Almost everyone I know has gotten COVID, but those who always wear masks seem to be most likely to be in the "never had COVID" group. But, at least among people I know, they are also the most likely to still be curtailing their activities to an extent - e.g. no social gatherings unless outside - so hard to say.
I've done a little more reading, and I'm unclear whether the United Kingdom has ended (as of February 12) the booster for everyone or just those under 50. If I'm understanding correctly, they will offer an updated booster this Fall, but only for a very limited group of high risk people. Probably not the under 50 crowd unless immunocompromised. It will be curious to see whether the US follows a similar approach.
As far as masks go, about a year ago, when more people wore them to indoor events, I knew plenty of people who got covid even though they were also wearing a mask. For all the folks in the "never had covid" group that I know today, they still mask, and they also don't participate in a lot of indoor activities, even everyday ones like grocery shopping. Instead, they have groceries delivered or pick them up curbside. So for people who haven't yet had covid, from my perspective it's really hard to tell how much of this is behavior vs vaccine protection.
It's all anecdotal, but our family has never participated in the Covid Precautions, mainly because if it was as contagious as claimed, infection was inevitable (given my wife is a surgeon it seemed certain she would bring home from the hospital at some point).
Therefore, we lived life the past 3 years as we lived the 40 years before that. No masks unless required, had our kids in school, they stayed in all of their extra curricular activities, had sleepovers, parties, vacations, dined out frequently, etc.
We all eventually got it once at different times, but for our family was indistinguishable from the other colds we have all had in our lifetimes. It's anecdotal, sure, but I can't help sorry for the remaining people who appear to be gripped by hypochondria.
You have others of us who have anecdotally lost family members and suffered from coronary complications after infection, and we are subject to the whims of those who have chosen to "live their lives like they always did" and are not taking any measures to mitigate spread. So do feel sorry for us, since we have to abridge our own lifestyles due to the decisions made by others unwilling to take very simple and non-invasive steps to help stop spread in crowded indoor areas. It is not "just a cold" for many and the R0 is very high.
You are at year 3, entering year 4. I mean this honestly, curiously, and with respect - how many years is reasonable to "abridge your lifestyle"?
And do you truly believe that if others abridged, anything would be different?
I feel like China demonstrated once and for all - it doesn't matter what you do, Covid join Taxes and Deaths of certainties.
It seems to me that given the choice of an abridged life where I eventually get Covid, and a "live like I always did" and get covid, the latter seems the more sensible pick.
Every day you see another article like this and I wonder "was it worth it?" (he thinks so)
Interesting, your choice of avoiding an 'abridged life'. I'm 82, and still have a small effect on the directions the next 3 generations after me take. To get that effect, is a bit like driving a car a car with many passengers, on a very busy road So I continue in an abridged manner, and can see the young'uns developing wonderfully in their lives. That is why the discomfort of a mask in public is worthwhile to me.
Realistically, doesn't seem like we will have something soon. Influenza like viruses have proven notoriously difficult to vaccinate and medicate. The low efficacy of Flu vaccines, despite our best attempts, haven't been very good. TamiFlu and other therapeutics, haven't delivered on their promise. We spent a lot of time and money testing hundreds of drugs the last 3 years, and all we have to show for it is the occasional monoclonal antibody that gets withdrawn for lack of efficacy after a few months and Paxlovid which doesn't appear to have impacted all-cause mortality (the only metric I trust). Not trying to be pessimistic, just pragmatic.
For your second question, the TL;DR is only my wife got 1 dose of Moderna, the rest of us hedged our bets.
My wifes dose of Moderna December 2020 knocked her out for 2 days, had to cancel surgeries and miss work which is unheard of for her. We chalked her reaction up to the fact she has Crohn's Disease which she manages through rigorous exercise. She declined on further doses which her hospital was ok with, but still wanted me to get it when I became eligible which I had planned on doing.
As the weeks ticked by my facebook feed became inundated with posts from friends remarking on how terrible the vaccine made them feel, which they reasoned must mean a Covid infection would be worse. This gave me pause and I kept pushing it off as I was too busy to be sick, and again, after a year of living completely normally I should have been infected a dozen times over, so I kept delaying it.
Fall of 2021 my daughter came down with a low grade fever (99), she was 11 at the time and this was a week or two before her age group would be approved, she tested positive. Now my wife was sure I would pay the price for delaying the vaccine.
I thought this was likely too, but thankfully I never got sick, even though I was around my daughter and took care of her that day or two she had symptoms of a minor cold.
Strangely at that time when my daughter got Covid, my wife also got very sick for a few days and had to miss work once again, but she never tested positive on two separate PCR tests nor several rapid tests. So, whatever she had was some other virus which coincidently hit her when my daughter got Covid.
After my daughter got it and I didn't, my wife and I stopped thinking about me getting Covid vaccine, especially since all of the "doing it right" countries/states with strong vaccination rates had case rates explode (Vermont, California; Portugal, Israel, South Korea).
When I finally got Covid 8 months later (June 2022), as I said above, it was just a migraine headache + fever which lasted 24 hours. No breathing issue, no sore throat, no loss of taste/smell. Weird.
I'm certainly not the paragon of health like my wife - I rarely exercised during the pandemic, I eat poorly (though I have one of those metabolisms where I can't really get fat), and used to smoke a pack a day in my 20's.
As for my son (now 7), he's had several colds throughout the pandemic, perhaps one of those was Covid, but the few times we wasted the 10 bucks on a rapid test it was negative and we just treated it like we did the colds my daughter had between 2009 - 2019, that is, keep them home while sick and 24 hours after fever, hydrate them, and use antibiotics as needed.
I have not heard anything about the ending of the bivalent booster. Indeed I, like all over 50s, will expect to be given an annual autumn booster.
@BayDog
I queried my medical colleague (retired I.D. and Epidemiologist) in the UK about your "....UK cases on the rise and ending the bivalent booster" and here is his reply:
"Little appears in our news about COVID case numbers. I am not aware of our hospitals being under pressure from a rapid increase in related admissions.
I wonder where the correspondent received his/her information from?"
Thanks so much for double checking! I was reading this: "COVID-19 infections continued to increase in England, increased in Wales and Scotland, and continued to decrease in Northern Ireland, in the week ending 7 February 2023." Link below. I believe this from the government website, so hopefully not misinformation!
One factor you didn't include is the buffering effect on an epidemic in a community. If you think that (say) 90% of the community will get the disease without masks (in a short time frame) or with masks (spread out over a longer time frame), then wearing masks appears to spread out the peak of infections, allowing the community to minimize overwhelming its health care. Even if everyone gets the disease eventually, fewer would be infected during times when health care was less efficient.
Also, in this novel disease, if an individual can postpone his/her own infection, then he/she has a better chance that some miracle prevention or treatment will improve his/her outcome.
That’s easily falsified. If you look at graphs of infections by region there’s no corresponding effect of mask usage. It appears to be seasonal regardless of intervention.
Even if this hypothesis was valid, suppose wearing a mask delayed infection by x, then you still get the peak at time+x.
Michael, your hypothetical assumes that x is a constant, a scalar number. More likely there is (or, if you prefer, would be) a randomly-distributed (from a statistical perspective) delay in time of infection, so the delayed infections would occur during an interval of time.
Victor, with genuine respect (I recognized your name from smoking cessation research I believe), we now have 3 years of data falsifying the theory. Since the models couldn't predict anything, the observational studies fail quick replication tests, and the outcome of any region is indistinguishable between mask use, why not consider that the previous 100 years of knowledge on masks was correct all along?
I'm not sure how much time you've spent giving the literature on masks a close read, but I encourage you to re-read these papers with some skepticism.
I've been building on top of the 70 papers Katelyn posted Nov of 2020 since then in this google sheet:
Re Meta-analysis and the distinction between no evidence of benefit vs. evidence of no benefit, see:
Smith & Pell. Parachute use to prevent death and major trauma related to gravitational challenge: systematic review of randomised controlled trials. BMJ 2003; 327 doi: https://doi.org/10.1136/bmj.327.7429.1459
The parachute analogy honestly is lazy, and the fact that we have done RCTs before and after Covid 19, still unable to find efficacy, demonstrates how silly this analogy is by comparing it something which has micropores thousands of times larger than the micropore in an n95 mask.
Because we're at high risk for a bad Covid outcome, we don't do the following things indoors, and we'd like to know if it's safe to start doing them with a KN95 or N95 on, assuming almost everyone else is unmasked, it is probably crowded and distancing impossible, and there may not be good air circulation: ride the subway; go to a play, dance performance, art opening, meeting, or similar event or party; get a haircut at a salon; sing with other people; exercise with other people.
Hi, Kessler: I share your concerns, and with a preface, am answering with my own thinking (and worries about what to think!)
I am quite concerned about the confusion about masks coming out of the Cochrane study--I personally know of a number of friends and neighbors it has thrown off course with regard to how and when to use masks. We really do need clear public facing guidance, particularly for those of us at higher risk because of age and other conditions.
So many of us spent countless hours following various ID people, watching the Mask Nerd’s demos, scouring trustworthy websites to assure our masks were HIFi and authentic, learning about aerosols from experts like Linsey Marr, the list goes on. It may be that the studies are equivocal, and I think Dr. Jetelina and her colleague have once again laid that out as clearly as is possible. Somehow, though, there needs to be a way to translate this into guidance for each of us as individuals and for the public as a whole.
What I assume, at present, is as follows, and am interested in the views of others here:
1) HIFi masks (N95s, KN95s, and KF94s), if worn properly, do contribute to protecting the wearer from infection, as well as protecting others from onward transmission.
2) In indoor settings, the extent of protection for the mask-wearer will depend on a number of variables such as how many people are wearing masks, what type of masks they are wearing, and whether they are wearing them properly, along with ventilation, crowdedness, and length of time spent in the indoor space.
Where this leaves those of us who want or need to avoid infection in assessing risk is highly problematic, and the best guidance available would be helpful to have. My questions are the same as Kessler’s, which I quote below, together with my best guess for myself:
ride the subway: we wear Aura N95s, limit our time on the subway as much as possible, and try to avoid times when the subway is most likely to be crowded (we don’t always succeed in avoiding crowds)
go to a play, dance performance, art opening: we would be willing to attend, wearing a KN95 mask, but would assess crowd and ventilation level to the extent possible (hard with prepaid events, of course); we also freely go to art museums and galleries, following the same principles and knowing if we start to feel uncomfortable, we can leave
Go to a party: we do not go to any indoor gatherings unmasked unless they are small, we know the people involved, and everyone does cadence testing or at least day of the gathering. This hasn’t come up, but we wouldn’t go to a party, which we assume would involve drink and/or food, as we could be the only people masked.
get a haircut at a salon: I have done this wearing a KN95 mask, if not crowded, even where mask wearing by the staff is suboptimal. With the advent of XBB.1.5, I am now concerned about this and unsure what to do (and I need a haircut!)
sing with other people: not relevant, but I would not.
We avoid indoor settings almost all the time, except for necessary medical visits. I would say to your first comment that we still feel wearing masks will provide us with protection, but our confidence in that belief has been reduced.
I cannot speak for your situation, obviously, but I'm at higher risk for bad Covid outcome (recent lung damage from other infection, uncontrolled asthma, rheumatological damage), and I've started attending twice-monthly choir events in a singing mask where others are unmasked. I'm up-to-date on Covid vaccines, and, honestly, the mask is as much for others' protection as my own. My young school-age children mean I could be carrying respiratory germs pretty much at any time, and other participants in these events are quite frail themselves!
I'm aware that some are at much higher risk of bad Covid outcome than someone like me. My choice may not be appropriate for others at greater risk.
I will say that, if you sing in a mask, you want a fairly roomy one, and it'll likely be impractical to have a tight seal. The typical singing mask seems to have a boxy duck-bill shape (think of a duck bill that's halfway open), and disposable masks of that shape are prohibitively expensive for me. So I use cloth singing masks. I figure that cloth masks at least baffle my respiratory spray if I'm contagious (and I might be) and give a place other than my mucous membranes for others' large droplets (with their potentially-higher viral payload) to land.
Thank you! Such awesome data! Per my personal experience, masks work! Family of four; we wore masks everywhere we went when necessary. We started out with cheap ones then got double fabric, then N95’s! We never got sick, fat maybe...lol but when we took off masks, we started getting sick. Head colds, allergies, the flu! So MASKS WORK!
What I don't understand is why the U.S., with its massive resources, has not studied the bejesus out of this question. After all the social upheaval we shouldn't have to cite Bangladeshi studies. I'm firmly pro-mask but I also am skeptical of forcing ineffective (cloth) measures on adolescents at such a social cost without proof.
The Bangladesh (WHO) study was convenient, easy for folks on the ground to create and complete, and a target of opportunity. There have been a number of engineering analyses of mask efficacy, but few RCTs because it was politicized so quickly. Cloth masks are more effective, with the right materials, than some of the procedure masks, especially if worn properly. The "cloth" masks I wore early in the pandemic included a layer of HEPA filtration material, improving efficacy. That particular design was offered by the original designer/inventor of the N95 mask at 3M.
Re HEPA: https://aaqr.org/articles/aaqr-21-02-sc-0043 and
https://www.wired.com/story/the-physics-of-the-n95-face-mask/
So, yes! A great idea to include a layer of electreted HEPA material in a cloth mask.
bc ... funded by the similar inventor's grant (Cottrell), and contrary to Strunk and White, he loves neologisms.
https://en.wikipedia.org/wiki/Electrostatic_precipitator
Thank you for this summary. In my personal experience, and that of my family, masks work! We all wear KF94 masks and have not gotten covid. The kids attend school, birthday parties, etc. We are out in the world and even though most people around us no longer wear masks we continue to be very well protected (as evidenced by no COVID).
Maybe if enough people comment here, Dr. Jetelina can whip up a Cochrane level analysis in support of well-fitting N95 (or similar) masks against Covid 😉
So here’s my data point:
Family doc, personally insisted on wearing my own N95 as far back as February 2020 (had some leftover from H1N1 fears), in small rooms with patients. Up to date vax always. No covid
Wife Ob Gyn, similar story, except that labor and delivery is by itself an aerosolizing event. No Covid.
Daughter up to date with vax and boosters, wears an N95 at school (her choice, we don’t insist, she’s just a smart freethinking (stubborn?) little girl). Despite class and teachers perpetually sick with something including Covid... no Covid.
We will get Covid someday, maybe I have it right now and asymptomatic... but hard to argue with anecdotes like this right?
Also, asymptomatic spread was “known” on Twitter quite earlier than this timeline, as was the de facto spread via aerosols when looking at epidemiology. Statements of fact were withheld because of logistical and liability reasons, and many health care workers lost their jobs (and lives) because they refused to compromise with flimsy mask mandates from hospital systems prohibiting personal N95 use. When our health system finally procured and offered 1 surgical mask per person per day, it was presented to us like a golden calf. By that time I had already secured a bunch of N95s, which I cycled in paper bags that dried out on a clothesline in my basement.
Good mask, good fit, NO QUESTION this works for the individual in my humble opinion and experience.
Welcome back from Turkey, I can only imagine what you witnessed. 😔
(Clarification - many healthcare workers lost their lives b/c of improper PPE, either not available or actively discouraged)
horrid~
It was probably late June 2020 when I started questioning the large droplet and fomite theories and embraced aerosol spread. By then, I was hearing a lot from clinicians who had similar thoughts. It took awhile for the Redfield CDC to accept the proposition officially. Birx and Fauci were pushing a rope uphill with the concepts of asymptomatic spread and aerosol transmission by that time, too.
Ryan: glad to see this report from you. Great information! Here’s one thing that continues to concern me, and despite my best efforts, it’s really hard to get clear info. That is, for our purposes, eg, popping into drug stores, grocery stores, or even longer things, like going to art museums when not crowded, we opt for a properly authenticated Powecom KN95 mask, fitting it as tightly as the earloop design will allow. We tried using Aura N95 masks for these purposes, but while they are, within the N95 range, more comfortable, we found the headband design quickly became impractical. (We do use our Aura N95s when going on public transportation.) We did get Covid this January, but it was from a small unmasked dinner gathering where we subsequently learned one who attended had Covid without knowing it and gave it to all attending, and we shall never repeat the folly of that. Until that gathering, we had been Covid free using the procedures I describe. What I’d like to get a better fix on is how much slippage in protection there is as between an N95 and a KN95/KF94, assuming all are worn with as tight a fit as possible. Of course there is some, but despite many efforts to research this, I can’t seem to get a handle on how much. Any thoughts?
Hi Susan- I agree with Gerry below, and I think the filtration differences in the masks you described are negligible. The fit becomes the most important issue. As an employed physician in a hospital system I had a mandatory fit test while wearing several types of N95 masks, and the Aura fit my face the best with no leaks. Maybe a decent, homemade proxy for this would be to wear a mask and see if your glasses fog up while you’re breathing! Not sure though.
I really am troubled by people latching on to recent studies highlighted here and thinking the conclusion is that masking does not work for the careful. If you’re sloppy, inconsistent, and choosing weak materials and fits as a community, of course the zoomed out studies will be disappointing. But for the individual like myself, who could have had Covid from multiple known and unknown exposures (I see sick people, too), I rely on my N95 and absolutely know it works.
If I had more time and reach I might do a post about how masking is along a continuum, from worthless gators to well fitting elastomeric N99s. Fit matters, as does context and environment. SARS CoV2 has evolved to become insanely contagious, orders of magnitude above the original wild type I think, so some masks might have held up in the beginning but not anymore, too.
I think we're in violent agreement. I, too, have been formally fit-tested. The Aura was the "best" fit for me of the ones offered, but the BNX mask I use at home is more comfortable and maintains a decent fit.
The "Do my glasses fog" test is reasonable in most settings, I suspect. The other option to improve fit is a second mask, such as a simple surgical or procedure mask. This is less to add filtration, but does often improve fit.
Along with the continuum of worthless gaters to well-fitted N99s, there's an orthogonal consideration: Masks are one, if significant part, of a continuum of protective measures in public health. Masking, distancing, hand washing, isolation when necessary, quarantine when necessary, vaccination, these all play a role. Individual elements are not as effective as employing the spectrum of controls.
My visit to the Palo Alto MC included their masking with tape the top edge, then my glasses weren't fogged. Being a physicist, I appreciate their writing, "iI's physics.".
bc .... thinks tape all edges, because he has a beard.
Ryan: very grateful to you, as well as Gerry, for responding, and with such an incredible clarity. It’s a relief to have confirmation that “fit matters, as well as context and environment,” as is what the evolution of the virus means in terms of choice (and fit) of mask. I think what many folks do, and who can blame them in this ever changing environment, is to judge based on personal experience, rather than an understanding of the science. So, for example, I still see folks in my building who, while clearly wishing to be careful, are still using cloth masks. And thanks, too, for confirmation on the “fog” test as a potentially reasonable proxy (which, as I am always reminding my spouse, cannot be achieved with a KN95 if you don’t get the crease out--as Lindsey Marr once said about that crease: people don’t have beaks).
I have not seen any research on KN95/KF94 vs N95, but the main difference is the dual head band for the typical N95 providing a more secure fit. I can usually achieve a decent fit with a KN95 but I've been wearing masks for years in settings where it really was important. Practice helps. Most of the KN/KF masks I've seen really are difficult to get a good and consistent fit on. I've found a company that makes both N95 and KN95, with the sole difference being the ear-strap vs headband. For my face, those fit well and remain comfortable. I am fairly confident that, in that mask, I'm very close to equivalent but I've not gone on a test stand to confirm this. I just know I have no leak around my nose/eyes and chin.
Gerry: re your more recent, excellent comment, is the company you spotted that makes both the N95 and KN95 BNX?
BNX. I've been happy with both the KN and N variants, depending on setting and how I assess the risk.
https://www.amazon.com/Certified-Particulate-Respirator-Protective-TC-84A-9362/dp/B094DYKP3S
I have no interest or stake in the company, save I like their products. Period.
Gerry: Thanks, and understood it’s just your experience, no interest/stake in the company. Much appreciated that you’ve taken the time to weigh in on all this. It’s been really helpful.
Gerry: thanks so much for weighing in. Yes, getting the fit as tight as possible really important.
Thank you! I wear an well-fitting N95 everywhere and believe it reduces (not eliminates) the chances I will catch or transmit COVID. Data supplied seems to support this. I don't want to be a vector in the chain of transmission. I'm sad to see masks not required in certain settings like Memory Care facilities. The staff and visitors are not masked in Memory Care and they continue to have outbreaks, currently the SIXTH outbreak where my loved one resides. And outbreaks are hard to control in this setting and extremely hard on this population. I wrote to my local Public Health department about this topic.
https://lauraspandemicponder.com/2023/02/17/letter-to-boulder-county-public-health-3/
The real problem is that the genie is out of the bottle with "proof" that requires advanced knowledge of statistical tests and measures (such as risk-ratios) and use of RCTs to be able to critically examine the conclusions that most people just don't have. That "study" was riddled with methodological issues, which can be read here https://theconversation.com/yes-masks-reduce-the-risk-of-spreading-covid-despite-a-review-saying-they-dont-198992
The vast majority of evidence (obviously inconclusive due to data limitations but still suggestive) points to masks absolutely working to reduce transmission in real-life settings which you have pointed out. It doesn't take a genius to know if you are coughing/sneezing/feeling like crap and you feel compelled to be in a crowded indoor setting that a mask would help to reduce the spread of your spit. It's why we teach preschoolers to cover their face with their arms when they are coughing or sneezing. I cannot help be astounded by the push back that still exists (and has indeed seemed to grow) on this issue and the stigmatization of this extremely non-invasive and easy intervention. But then again people fought against seat belts and not being able to drink and drive so there's that.
I buy into your comment about the wrongness of fighting against drinking and driving and would add not stopping at stop signs or red lights, but would not use seat belts as an example. Wearing seat belts clearly doesn’t protect others, and if not, it should not be mandated because that violates individual freedom to take risks. Even though I think such risk-taking is silly.
Word! The anecdotes given by a doctor in this thread are ridiculous~I am VERY glad his family has not been hit by COVID in a serious way. HOWEVER, yes this is also anecdotal, I have folks very close to me, and my age, whose families HAVE been severely affected by COVID. Factors such as housing situations, types of jobs, access to good health care period, on and on.
That is why public health is so important, along with research, development of vaccines, and SCIENCE education.
The anecdote you mention is actually supportive of your position.
> “no evidence of a difference” is different from “evidence of no difference.”
Such a critical distinction that it seems too many people either don't understand, or choose to conveniently ignore. My 10th grade geometry teacher (who taught logic as part of proofs) would hand out failing grades to a large percentage of the population...
> It is possible that masks increase viral transmission
Please present evidence for this hypothesis.
"Paul" has been a ccontrarian on this blog, to say the least. Perhaps if no one responds to him, he will get bored and wander away?
At the risk of being contrarian...I respond not because I expect to persuade Paul, but rather for those who may come along and read, to point out the flaws.
If Paul's responses were private, I would simply ignore. Since they're public, they get a response.
I see your point but have simply preferred to label him for what he is - a troll. When i did that I got an huge amount of likes. If those who didn’t “like” read how many agreed with me, it should give them pause.
Calling somebody names is preaching to the choir, and does nothing to inform those whose position may still be malleable. His behavior is definitely troll-esque, but the words can still influence others' evaluation of the scenario.
Your response is a non-sequiter. Regardless of what you've convinced yourself about masking, absence of evidence is not evidence of absence. Not finding evidence against something is not all the same as finding evidence against something. It's basic logic.
It's hard to reason or dialogue with someone hung up on contrarian concepts that most people find illogical. Let the best man win - in this case let he who is without mask bet who will be first become ill with Covid19. Now excuse me as I check my mask as I enter my first public building of the day.
Thus, in the case of the cochrane study cited above, it's equally useful to anti-maskers as to pro-maskers--which is to say that it isn't.
There is clear evidence of efficacy- several studies were linked in the article. There are fewer studies showing non-efficacy, and they tend to have methodological issues. But lets say they balanced.
If we follow your logic that there is no evidence in either direction, the consequences of following your course of action (not using masks at all) has a far greater potential negative impact than your irritation of putting a piece of paper over your face in crowded settings or where people are vulnerable if they do work to mitigate spread. I would understand if the mask had to be stapled on or had to be on 24/7 but that simply isn't the case. Even in offices or medical settings people get breaks and can remove them for some "fresh air". Also some masks are better than others and not so difficult to breathe through without sacrificing much on the filtration. This goes back to your comparison of masks (a piece of paper or melt-blown fiber you wear with strings that is there to help others) to medication (a chemical compound which can cause serious reactions or interactions which help only yourself). There are some pretty clear differences.
Yes! the precautionary principle. Not the Wikipedia definition, but the "Act Up" one, which Fauci accepted! The Gaia people also.
https://www.nytimes.com/2022/12/31/opinion/anthony-fauci-hiv-aids-act-up.html
Sigh.
So you'd've denied AZT from AIDS people?
When the "thing" is only inconvenient, you rail against it?
Thank you Katelyn for your thorough review of the mask question. I am a retired surgical pathologist, and throughout the pandemic I have often wondered about aerosol and droplet contamination from virus contaminated ambient air to a person’s eyes. I may have missed this being addressed, but I have not seen this discussed much. Adherence of the air borne viral particles to the conjunctiva of the eyes and subsequently via tears down through the nasolacrimal ducts to the nasal cavity and its mucous membranes seems a likely transmission mode that would circumvent even N95 mask protection. Perhaps personal Rx eyeglasses or safety glasses would intervene to some degree in the movement of the viral particles to the eyes. Your thoughts on this would be greatly appreciated.
Cheers, Michael
KB - Was it this one?
https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)31142-9/fulltext
Or this one?
https://academic.oup.com/jid/article/201/4/491/861190
I know that feeling. I think I'm building a database for that tomorrow.
I'm still building the database. The schema has been rewritten a few times already. You'd think I knew how to do this...
Thank you. Does that mean “very little benefit” as added protection against infection?
Most of the clinicians I know actually went past safety glasses very quickly and directly to full face shields or positive pressure full face respirators in aerosolizing procedures.
Thanks. Another good one.
I'm sorry but the "it depends" seems disingenuous. Masks work to reduce COVID writ large, period. Individual masking leads to societal reduction in infections, and societal reduction of infection leads to each person getting sick less. Communal action leads to individual benefit.
Which of the studies that found masking beneficial do you find compelling?
I've read almost all of them in detail, they are mostly of poor quality, such as the recent Boston School Mask Study in NEJM. That the RCTs and now the meta analysis of RCTs are not finding efficacy seems to affirm what we have seen on worldwide (and call back to pre-2020 mask guidance) - masks didn't appear to make any difference for South Korea, Japan, China, Portugal, the US, etc - nor did the countries which weren't really into masking (Nordic countries, Africa) have a worse outcome.
Too bad the rest of the world doesn't understand the complexity of the issue. I knew from Day One, only I could protect myself, so I always followed the most recent recommendations on how to wear a mask, what type of mask should be worn etc.
I was in a group that made over 50,000 masks. At the time, it was the best protection. Now I wear a KN95 (I'll accept the slightly higher risk vs an N95 as I am very careful, you get it.) Look at 100 people wearing a mask-we KNOW few are wearing it properly, wearing a high quality mask, wearing it consistently etc.. I DO know neither hubby nor I have had symptomatic Covid. Family and friends who were nearly religious about avoiding covid and GOT covid could point to a specific incident when they knowingly (and understandably) let their guard down.
After 3+ years and being fully vaxed and boosted, I too sometimes let my guard down, evaluate the risk and will expand my activities. So, I know it's more likely I'll get Covid, but I'll still try to avoid it while expanding my life and improving my mental health.
Thank you for your mask-making efforts. My wife made hundreds and donated them to the Tribe in Oklahoma, a group that was essentially ignored by the State government.
So, folk have posted pro and con regarding mask wearing which I have found wearing! Logic tells me the following: Covid is mainly transmitted through droplets and is highly contagious; putting a barrier between me and those droplets would seem to be the most logical and simple solution! Hence, I remain a Covid "virgin" as they say. I have had numerous very close, inside exposures- even with someone coughing and sneezing mask less right next to me! I ALWAYS wear a KN94 mask to all inside activities...especially as I have received numerous, post meetings, emails apologizing for exposing me..and my immune-compromused husband thru me...to Covid! Aarrgg...I don't need RCTs to tell me what logic says: wear a mask and stay safe! Will I ever attend a meeting ( and I have to go to many) in the future without a mask....that all will depend upon the efficacy of future vaccines for this ( I am fully vaccinated as well). My family has also not had any flu or colds since we started masking. It's just LOGICAL! So, thank you Katelyn for attempting to share the science- but the logic wins by a landslide for me.
We need a new group, let's call it "Virgins United". I find it funny to read articles about these miraculous situations where people never got Covid. DUH, it's because we're scrupulously careful!! Does it have a down side, of course, but I prefer good health to bad health.
My husband and I had avoided COVID got our vaxes in April 2021, and 1st boosts in Dec 2021. Masked from the get-go. I researched and found masks with pockets and found filters which would filter down to the .3 microns. Then got KN95s. Well, just before boosters became widely recommended, and I mean just weeks~we were both 62 at that time, March 2022 I had my annual checkup, our primary care doc said "no worries just wait for the BI valent booster" !!
Everything started opening up around here in late March/April. In early May my husband got it then I got it a week later. He did not get Paxlovid but I have a history of URI including a lot of bronchitis etc, so I did. It helped. He was sick longer than I was.
I discovered after doing more research that the KN95s we had been wearing might not be adequate despite my research. More likely is that my husband has a fullsome beard and everyone around us had stopped masking. I found N95s and have used them since.
We got our 2nd boosts in August 2022 just before the bivalent came out. We have worn the N95s consistently since we were both sick. Our doc said we could wait 6 months for the best B and T cell response, but we are still careful as my husband visits and cares for his 93 year old mother.
The basic idea of masking is: yes it may help prevent you from getting sick, BUT the main reason you wear them is to reduce the chance of spreading it to others.
just to add: there are many vulnerable folks who are still getting COVID and if they were in better shape might not die, but if they have underlying conditions and now those monoclonal anti bodies are not helpful anymore, well......
People tend to deny a simple truth about the world: it's all about probability and outcome (watch the 1978 movie "Heaven Can Wait" for an amusing take). Your question, in my mind, has been asked and the outcome provides the answer: populations where the societal norm was to wear a mask (no matter how effective) did much better than those lacking that norm.
While that is a widely believed claim, it is actually incorrect.
Of the countries which tracked excess deaths, South Korea, praised for their mask culture, had among the highest excess death rates in the world (+15%), ranking 5th highest excess deaths out of the 36 countries tracked.
By contrast, he Nordic countries, which had the least mask adherence in the world, all place at the bottom (average of +5% with Sweden (+3.5%) and Norway (+5.4%) holding the lowest increases in deaths.
This claim can be replicated with the data at mortality.org which pools from each countries CDC equivalent.
You're mixing apples and oranges here with mortality data and case spread. But re. mortality, are your claims accounting for age-adjustment as well as prevalence of co-morbidities? Also wondering about how new this all still is. Current studies are showing several potential long-range outcomes from infection. It may take a few more years to see how this pans out in coronary and pulmonary disease as well as cognitive disorders.
Mortality data is the only metric which isn't influenced by unknown confounders, bias, testing rates, etc.
It's a simple and reliable metric to judge population level impact, and was often cited in the MSM in 2020 and 2021 when the early numbers were backing their claims that Sweden was doing it wrong, South Korea doing it right. Now that the data no longer supports that hypothesis, excess death hasn't been cited as much it seems.
I would love to have more detail on comorbidities from these countries and get to go through line-by-line through the death records like we can with CDC, but that information isn't available.
As for the question "well what about the long term consequences", I propose something obvious - if a country has high mortality like South Korea, that country will have a corresponding spike in whatever indirect/long term effects there are. It seems silly to propose that while the masks in South Korea didn't stop them from having a record breaking 100% increase in deaths Spring of 2022, the masks may somehow save them from Long Covid.
Great post. Neat as a pin. Nicely constructed. Too bad that the talking heads on cable TV news shows will very likely never be able to: (a) Comprehend why this is a great post that was nicely constructed and neat as a pin OR (b) Provide any refreshing "clean-up" of this issue for lay folks.
Thank you for providing this arc in how thinking has evolved around the value of wearing masks as new information became known.
I’m still masking, and I hate it but do it anyway. Is it fair to say, that when a virus is extremely contagious, masks primarily *delay* infection, but sooner or later, if you’re out and about enough, even if you’re wearing the right mask, you’re going to get Covid? All it takes is one unlucky airplane ride or jury duty sitting next to the wrong person?
Also, I’m headed to London soon and hear cases are on the rise again in the UK. So why are they ending the bivalent booster? Seems like odd timing.
Wait, I didn't hear they were ending the bivalent booster?! Am curious to hear the answer to your question.
I also don't know about the delaying COVID question. Almost everyone I know has gotten COVID, but those who always wear masks seem to be most likely to be in the "never had COVID" group. But, at least among people I know, they are also the most likely to still be curtailing their activities to an extent - e.g. no social gatherings unless outside - so hard to say.
I've done a little more reading, and I'm unclear whether the United Kingdom has ended (as of February 12) the booster for everyone or just those under 50. If I'm understanding correctly, they will offer an updated booster this Fall, but only for a very limited group of high risk people. Probably not the under 50 crowd unless immunocompromised. It will be curious to see whether the US follows a similar approach.
As far as masks go, about a year ago, when more people wore them to indoor events, I knew plenty of people who got covid even though they were also wearing a mask. For all the folks in the "never had covid" group that I know today, they still mask, and they also don't participate in a lot of indoor activities, even everyday ones like grocery shopping. Instead, they have groceries delivered or pick them up curbside. So for people who haven't yet had covid, from my perspective it's really hard to tell how much of this is behavior vs vaccine protection.
It's all anecdotal, but our family has never participated in the Covid Precautions, mainly because if it was as contagious as claimed, infection was inevitable (given my wife is a surgeon it seemed certain she would bring home from the hospital at some point).
Therefore, we lived life the past 3 years as we lived the 40 years before that. No masks unless required, had our kids in school, they stayed in all of their extra curricular activities, had sleepovers, parties, vacations, dined out frequently, etc.
We all eventually got it once at different times, but for our family was indistinguishable from the other colds we have all had in our lifetimes. It's anecdotal, sure, but I can't help sorry for the remaining people who appear to be gripped by hypochondria.
You have others of us who have anecdotally lost family members and suffered from coronary complications after infection, and we are subject to the whims of those who have chosen to "live their lives like they always did" and are not taking any measures to mitigate spread. So do feel sorry for us, since we have to abridge our own lifestyles due to the decisions made by others unwilling to take very simple and non-invasive steps to help stop spread in crowded indoor areas. It is not "just a cold" for many and the R0 is very high.
You are at year 3, entering year 4. I mean this honestly, curiously, and with respect - how many years is reasonable to "abridge your lifestyle"?
And do you truly believe that if others abridged, anything would be different?
I feel like China demonstrated once and for all - it doesn't matter what you do, Covid join Taxes and Deaths of certainties.
It seems to me that given the choice of an abridged life where I eventually get Covid, and a "live like I always did" and get covid, the latter seems the more sensible pick.
Every day you see another article like this and I wonder "was it worth it?" (he thinks so)
https://thebanter.substack.com/p/after-three-years-covid-finally-got
Not being argumentative, or debate your opinion, I generally am interested in this mindset as I am a very risk adverse person.
Interesting, your choice of avoiding an 'abridged life'. I'm 82, and still have a small effect on the directions the next 3 generations after me take. To get that effect, is a bit like driving a car a car with many passengers, on a very busy road So I continue in an abridged manner, and can see the young'uns developing wonderfully in their lives. That is why the discomfort of a mask in public is worthwhile to me.
I understand your logic even if I don't yet follow it. Fingers crossed we'll have something better soon - but how long do we have to wait?
Were you and your family vaccinated before each of you got covid?
Realistically, doesn't seem like we will have something soon. Influenza like viruses have proven notoriously difficult to vaccinate and medicate. The low efficacy of Flu vaccines, despite our best attempts, haven't been very good. TamiFlu and other therapeutics, haven't delivered on their promise. We spent a lot of time and money testing hundreds of drugs the last 3 years, and all we have to show for it is the occasional monoclonal antibody that gets withdrawn for lack of efficacy after a few months and Paxlovid which doesn't appear to have impacted all-cause mortality (the only metric I trust). Not trying to be pessimistic, just pragmatic.
For your second question, the TL;DR is only my wife got 1 dose of Moderna, the rest of us hedged our bets.
My wifes dose of Moderna December 2020 knocked her out for 2 days, had to cancel surgeries and miss work which is unheard of for her. We chalked her reaction up to the fact she has Crohn's Disease which she manages through rigorous exercise. She declined on further doses which her hospital was ok with, but still wanted me to get it when I became eligible which I had planned on doing.
As the weeks ticked by my facebook feed became inundated with posts from friends remarking on how terrible the vaccine made them feel, which they reasoned must mean a Covid infection would be worse. This gave me pause and I kept pushing it off as I was too busy to be sick, and again, after a year of living completely normally I should have been infected a dozen times over, so I kept delaying it.
Fall of 2021 my daughter came down with a low grade fever (99), she was 11 at the time and this was a week or two before her age group would be approved, she tested positive. Now my wife was sure I would pay the price for delaying the vaccine.
I thought this was likely too, but thankfully I never got sick, even though I was around my daughter and took care of her that day or two she had symptoms of a minor cold.
Strangely at that time when my daughter got Covid, my wife also got very sick for a few days and had to miss work once again, but she never tested positive on two separate PCR tests nor several rapid tests. So, whatever she had was some other virus which coincidently hit her when my daughter got Covid.
After my daughter got it and I didn't, my wife and I stopped thinking about me getting Covid vaccine, especially since all of the "doing it right" countries/states with strong vaccination rates had case rates explode (Vermont, California; Portugal, Israel, South Korea).
When I finally got Covid 8 months later (June 2022), as I said above, it was just a migraine headache + fever which lasted 24 hours. No breathing issue, no sore throat, no loss of taste/smell. Weird.
I'm certainly not the paragon of health like my wife - I rarely exercised during the pandemic, I eat poorly (though I have one of those metabolisms where I can't really get fat), and used to smoke a pack a day in my 20's.
As for my son (now 7), he's had several colds throughout the pandemic, perhaps one of those was Covid, but the few times we wasted the 10 bucks on a rapid test it was negative and we just treated it like we did the colds my daughter had between 2009 - 2019, that is, keep them home while sick and 24 hours after fever, hydrate them, and use antibiotics as needed.
I have not heard anything about the ending of the bivalent booster. Indeed I, like all over 50s, will expect to be given an annual autumn booster.
@BayDog
I queried my medical colleague (retired I.D. and Epidemiologist) in the UK about your "....UK cases on the rise and ending the bivalent booster" and here is his reply:
"Little appears in our news about COVID case numbers. I am not aware of our hospitals being under pressure from a rapid increase in related admissions.
I wonder where the correspondent received his/her information from?"
Perhaps one of you is misinformed??
Thanks so much for double checking! I was reading this: "COVID-19 infections continued to increase in England, increased in Wales and Scotland, and continued to decrease in Northern Ireland, in the week ending 7 February 2023." Link below. I believe this from the government website, so hopefully not misinformation!
https://www.ons.gov.uk/peoplepopulationandcommunity/healthandsocialcare/conditionsanddiseases/articles/coronaviruscovid19latestinsights/infections
Also, "Patients Admitted in England" (to hospital) on the rise, but not at all time high:
https://coronavirus.data.gov.uk
And to be clear, the booster is being discontinued (under 50) in the United Kingdom, *not* in the US:
https://www.theguardian.com/world/2023/feb/04/people-in-england-aged-49-and-younger-urged-to-get-free-covid-booster
One factor you didn't include is the buffering effect on an epidemic in a community. If you think that (say) 90% of the community will get the disease without masks (in a short time frame) or with masks (spread out over a longer time frame), then wearing masks appears to spread out the peak of infections, allowing the community to minimize overwhelming its health care. Even if everyone gets the disease eventually, fewer would be infected during times when health care was less efficient.
Also, in this novel disease, if an individual can postpone his/her own infection, then he/she has a better chance that some miracle prevention or treatment will improve his/her outcome.
That’s easily falsified. If you look at graphs of infections by region there’s no corresponding effect of mask usage. It appears to be seasonal regardless of intervention.
Even if this hypothesis was valid, suppose wearing a mask delayed infection by x, then you still get the peak at time+x.
Michael, your hypothetical assumes that x is a constant, a scalar number. More likely there is (or, if you prefer, would be) a randomly-distributed (from a statistical perspective) delay in time of infection, so the delayed infections would occur during an interval of time.
Victor, with genuine respect (I recognized your name from smoking cessation research I believe), we now have 3 years of data falsifying the theory. Since the models couldn't predict anything, the observational studies fail quick replication tests, and the outcome of any region is indistinguishable between mask use, why not consider that the previous 100 years of knowledge on masks was correct all along?
I'm not sure how much time you've spent giving the literature on masks a close read, but I encourage you to re-read these papers with some skepticism.
I've been building on top of the 70 papers Katelyn posted Nov of 2020 since then in this google sheet:
https://docs.google.com/spreadsheets/d/1ahaJui6Af0kGYMwHgAtnKCE6-bHbCLxnrQxuMC0kygA/edit?usp=sharing
Appreciate feedback, thanks for the comment
Re Meta-analysis and the distinction between no evidence of benefit vs. evidence of no benefit, see:
Smith & Pell. Parachute use to prevent death and major trauma related to gravitational challenge: systematic review of randomised controlled trials. BMJ 2003; 327 doi: https://doi.org/10.1136/bmj.327.7429.1459
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC300808/#:~:text=The%20parachute%20is%20used%20in,of%20jumping%20from%20an%20aircraft.
The parachute analogy honestly is lazy, and the fact that we have done RCTs before and after Covid 19, still unable to find efficacy, demonstrates how silly this analogy is by comparing it something which has micropores thousands of times larger than the micropore in an n95 mask.
https://www.bmj.com/rapid-response/2011/10/31/its-unfair-use-parachute-analogy
This is effing brilliant.
Because we're at high risk for a bad Covid outcome, we don't do the following things indoors, and we'd like to know if it's safe to start doing them with a KN95 or N95 on, assuming almost everyone else is unmasked, it is probably crowded and distancing impossible, and there may not be good air circulation: ride the subway; go to a play, dance performance, art opening, meeting, or similar event or party; get a haircut at a salon; sing with other people; exercise with other people.
Hi, Kessler: I share your concerns, and with a preface, am answering with my own thinking (and worries about what to think!)
I am quite concerned about the confusion about masks coming out of the Cochrane study--I personally know of a number of friends and neighbors it has thrown off course with regard to how and when to use masks. We really do need clear public facing guidance, particularly for those of us at higher risk because of age and other conditions.
So many of us spent countless hours following various ID people, watching the Mask Nerd’s demos, scouring trustworthy websites to assure our masks were HIFi and authentic, learning about aerosols from experts like Linsey Marr, the list goes on. It may be that the studies are equivocal, and I think Dr. Jetelina and her colleague have once again laid that out as clearly as is possible. Somehow, though, there needs to be a way to translate this into guidance for each of us as individuals and for the public as a whole.
What I assume, at present, is as follows, and am interested in the views of others here:
1) HIFi masks (N95s, KN95s, and KF94s), if worn properly, do contribute to protecting the wearer from infection, as well as protecting others from onward transmission.
2) In indoor settings, the extent of protection for the mask-wearer will depend on a number of variables such as how many people are wearing masks, what type of masks they are wearing, and whether they are wearing them properly, along with ventilation, crowdedness, and length of time spent in the indoor space.
Where this leaves those of us who want or need to avoid infection in assessing risk is highly problematic, and the best guidance available would be helpful to have. My questions are the same as Kessler’s, which I quote below, together with my best guess for myself:
ride the subway: we wear Aura N95s, limit our time on the subway as much as possible, and try to avoid times when the subway is most likely to be crowded (we don’t always succeed in avoiding crowds)
go to a play, dance performance, art opening: we would be willing to attend, wearing a KN95 mask, but would assess crowd and ventilation level to the extent possible (hard with prepaid events, of course); we also freely go to art museums and galleries, following the same principles and knowing if we start to feel uncomfortable, we can leave
Go to a party: we do not go to any indoor gatherings unmasked unless they are small, we know the people involved, and everyone does cadence testing or at least day of the gathering. This hasn’t come up, but we wouldn’t go to a party, which we assume would involve drink and/or food, as we could be the only people masked.
get a haircut at a salon: I have done this wearing a KN95 mask, if not crowded, even where mask wearing by the staff is suboptimal. With the advent of XBB.1.5, I am now concerned about this and unsure what to do (and I need a haircut!)
sing with other people: not relevant, but I would not.
exercise with other people: only with my spouse.
We avoid indoor settings almost all the time, except for necessary medical visits. I would say to your first comment that we still feel wearing masks will provide us with protection, but our confidence in that belief has been reduced.
I cannot speak for your situation, obviously, but I'm at higher risk for bad Covid outcome (recent lung damage from other infection, uncontrolled asthma, rheumatological damage), and I've started attending twice-monthly choir events in a singing mask where others are unmasked. I'm up-to-date on Covid vaccines, and, honestly, the mask is as much for others' protection as my own. My young school-age children mean I could be carrying respiratory germs pretty much at any time, and other participants in these events are quite frail themselves!
I'm aware that some are at much higher risk of bad Covid outcome than someone like me. My choice may not be appropriate for others at greater risk.
I will say that, if you sing in a mask, you want a fairly roomy one, and it'll likely be impractical to have a tight seal. The typical singing mask seems to have a boxy duck-bill shape (think of a duck bill that's halfway open), and disposable masks of that shape are prohibitively expensive for me. So I use cloth singing masks. I figure that cloth masks at least baffle my respiratory spray if I'm contagious (and I might be) and give a place other than my mucous membranes for others' large droplets (with their potentially-higher viral payload) to land.