18 Comments
founding

Good conversation, a few notes:

1) Nice to see you explore viral interference, would like a longer post/dive into that after you wrap up your upcoming Long Covid post. I think if you dispassionately explore the evidence, flu disappeared in places without masks just masked places in 2020 so I hope you reevaluate your hypothesis. It's not like Flu surged in Sweden, Florida, and South Dakota while remained at bay in California, South Korea, or Germany. Additionally, almost everyone at that time in 2020 was using homemade cloth masks, occasionally surgical masks, few if any n95 - we now know the efficacy of those are very poor so I don't see how to conclude that masking impacted flu in 2020. Open to evidence of course.

2) Around 33 minute mark you comment: "I keep thinking of 'why does my surgeon wear a mask when I am in surgery' you know, it must do something, it has to work".

Surgeons don't wear masks to prevent spreading viruses. You can verify this easily by realizing that your surgeon was not wearing his/her mask during consultation, preop, postop, or follow-ups when rounding.

They wear masks to reduce chance of bacterial infection at the surgical site, as after the risk of the surgery itself and anesthesia, post operative infections are the biggest threat and why prior to the adoption of aseptic principles and antibiotics surgery was often a death sentence.

Prior to Covid, several studies were done to assess if the surgical mask reduced bacterial infections, and it turned out they did not [1][2][3]. Out of a combination of tradition- like the business man who wears a tie even though it offers no function - it conveys seriousness, and, the fact surgeons are regularly getting sprayed with blood and bodily fluid, the mask was worn, but it was never about stopping the surgeon from giving the flu to the patient. That is a post-hoc story invented in 2020 which has no basis in reality.

For example, here is my wife, a vascular surgeon, grinning ear to ear with a patient who finally got discharged following a ruptured abdominal aortic aneurysm he suffered over the previous Thanksgiving (and if you are familiar with the morbidity of the AAA, it is absolutely amazing she was able to save him). Since this was pre-March 2020, neither were wearing masks outside of the OR, but you can be damn sure she had one on while blood spewed everywhere in her desperate attempt to save him. Had to throw out that pair of scrubs and shoes! :)

https://imgur.io/a/X2ePJIR

____________________________

[1] Postoperative wound infections and surgical face masks: A controlled study

https://link.springer.com/article/10.1007/BF01658736

"It has never been shown that wearing surgical face masks decreases postoperative wound infections. On the contrary, a 50% decrease has been reported after omitting face masks. The present study was designed to reveal any 30% or greater difference in general surgery wound infection rates by using face masks or not"

"Masks may be used to protect the operating team from drops of infected blood and from airborne infections, but have not been proven to protect the patient operated by a healthy operating team"

[2] Unmasking the surgeons: the evidence base behind the use of facemasks in surgery

https://www.ncbi.nlm.nih.gov/labs/pmc/articles/PMC4480558/

"In the modern era, there has also been a scarcity of experimental evidence to support the effectiveness of facemasks in the prevention of surgical site infections. The earliest retrospective studies7 failed to demonstrate any statistically significant improvement in surgical site infection rates following the use of masks. "

[3] Disposable surgical face masks for preventing surgical wound infection in clean surgery

https://pubmed.ncbi.nlm.nih.gov/24532167/

"Three trials were included, involving a total of 2113 participants. There was no statistically significant difference in infection rates between the masked and unmasked group in any of the trials."

Expand full comment

I am sorry that your work and your blog to help us through our concerns with COVID have caused harassment and threats. I do not understand the mindset of people any more. This should not be happening. If someone is not interested in the information, just do not read it, not harass people who are helping many of us.

Expand full comment

Your UCSF Grand Rounds was terrific

There aren’t enough superlatives to thank you for your work over these past few years Your work has supported my work professionally as I’m in the trenches caring for a vulnerable population and facing skeptics

Expand full comment
founding

You're amazing - so glad I found my way to your newsletter! Thank you for all you do.

Expand full comment

Agree with KB. Give yourself some time off. Don't burn the candle at both ends!

Expand full comment

Thank you for "pulling back the curtain" on what it's like to try to balance work and home lives and for rolling with the Sharpie. You are a role model, full stop.

PS--"Bluey" is FABULOUS!

Expand full comment

Thank you for the conversation with Dr. Wachter, it was good to hear you speak.

I have to comment, I don't think you can hear this too often: I am so sorry for the harassment you have gotten for writing your blog. There is no excuse for this terrible behavior. I applaud your courage and determination to continue disseminating your valuable message.

Expand full comment
founding

Thanks for the UCSF video. Very informative. Epidemiology advice needs to be personable. This did the trick! Thanks. The CDC is NEVER personable.

Expand full comment

Good afternoon Katelyn, Thank you so very much for this fascinating newsletter. I have been following you for many months now and always find your offerings helpful. It was wonderful to see you you "in person" with Dr. Bob Wachter, who I listened to when he hosted Andy Slavitt's In The Bubble podcast in 2021. Kudos to you both. I was very sorry to hear that you have been doxed, etc., and just want to encourage you to continue to be your thoughtful wise self. You have been a guiding light to me (69 year old non-scientist) in navigating these COVID years (and now RSV and flu). I rely on your newsletter (I don't do Twitter). Thanks again.

Expand full comment

Thanks for a great presentation and discussion with Dr. Wachter and for all you have done to educate us over the last few years. You don’t seem to share the concern voiced by Anthony Leonardi @fitterhappierAJ has that covid can have a negative effect on t cells. I don’t have a science background and may be incorrectly describing this, but I think he is saying covid can age or degrade t cells. Between this and the risk of long covid, shouldn’t people of all ages being trying harder to avoid infections? Or is Leonardi’s hypothesis incorrect and infections help build that hybrid immunity you referenced? Thanks for your help understanding this!

Expand full comment

This was very interesting, not just related to your initial presentation but the discussion on scientific communication. Thanks for all you do. I’m sorry about all of the terrible things that have happened to you.

I do wonder if the prevalence of RSV in kids is cutting down on some of the asymptomatic paths of Covid right now that we saw last winter.

Expand full comment

I just watched the video with Dr. Bob Walker. What a great presentation! Thank you for all of your diligent and hard work. You are a treasure to all of us.

Expand full comment

Side note: the art work is exquisite, truly.

Expand full comment

I just came across this site. It allows people to report their positive at home

Tests. Looks like a collaboration with NIH.

Hopefully It will add some more insight into the actual Covid cases. https://makemytestcount.org/

Expand full comment

Bluey is great! I’m glad you took that time. I see it with grandchildren.

I just finished watching your talk with Dr. Wachter- thanks to you both! I continue to value your work.

Expand full comment

HELP! I CAN'T FIND ANY PREPRINTS OR RESEARCH TO MEASURE amplification cycle settings for detecting "enough" virus to be "sick". Hi, I am (a tiny school, first in our state to do weekly surveillance in 2020!) seeing a problem with double positive (fresh binax in asymptomatic and symptomatic kids, enough to make me worry) rapids and negative PCR. I saw this once before with calibration of amplification cycles to consider "positivity" here locally about a year ago with Omicron. I talked to the lab and they are checking on this; will rerun cycles and try to increase amp cycles to see; will rerun with bio fire; have you seen any data on the currently circulating variants and the efficacy of PCR machines to detect positive "enough" samples to identify "who is sick?" so we can remove from school?

Expand full comment