A Physician Ramble on Covid

 

I have a visceral distrust of government mandates, probably like most people on Ricochet. In addition, I think Fauci’s early lying to a free people that masks don’t work in order to preserve them for healthcare workers was abominable and sowed seeds of distrust in public health that are bearing fruit today. That being said, derided, discouraged, hated, or mandated, masks work to decrease the spread of COVID.

I am a doctor. My wife is a doctor. We have seen countless COVID-positive patients. Before the vaccines were available, we were protected by nothing but masks and we did not get COVID. Masks work at decreasing the spread of COVID and other respiratory illnesses. Masks — regular old surgical masks — are all that most people providing care to COVID patients in the hospital wear. N95 masks are typically reserved for times when an invasive airway procedure is planned.

Though there were some COVID cases among caregivers, we did not see nurses, doctors, or respiratory therapists decimated. Masks are used in hospitals against other respiratory illnesses as well –RSV, flu, etc. I have been protected from RSV for 30 years by surgical masks–nothing more. Masks work to decrease spread of respiratory illnesses and are a mainstay in their care in hospitals. Do you believe your own doctor or your doctor friends who recommend masks based on decades of experience or do you demand a randomized controlled trial in the middle of a pandemic in order to be persuaded that the general welfare is best benefitted by masking.

The COVID vaccines work as well. Thanks be to God, President Trump, and Operation Warp Speed that the vaccine rollout happened when it did and mitigated the worst phase of the COVID illness in Dec 2020 – Jan 2021. Daily new cases in the US peaked at ~308,000 around January 8. By mid-February, daily case rate was down to 65,000–an 80% drop–due to the vaccine. The need for boosters and lack of best understanding as to when those should be administered does not take away from vaccine efficacy.

Humility as to the limits of our knowledge is one of my big takeaways from Dr. Thomas Sowell and a chief reason that centrally planned economies cannot work. I agree that the elites in charge do not have all (most) of the answers and that at best, their motivations are mixed. In regard to public health guidance, I agree that the CDC turnarounds throughout COVID have been dizzying.

However, shouldn’t humility about the limits of knowledge work in the other direction too? Shouldn’t humility about the limits of knowledge serve as a fetter to broad proclamations about COVID insight based on Google “research?” Shouldn’t unprecedented notification that the nearby university hospital is full and canceling elective surgeries — as well as all the private hospitals in a city — prompt a personal response other than a comparison that COVID is no worse than the flu? Shouldn’t conservatives, of all people, recognize a connection between our personal behavior and the public good?

Starting 20 years ago on “Oprah,” I recognized an aspect of the loss of hierarchy (identified by Richard Weaver in 1948 in “Ideas Have Consequences”) when a world expert on a phenomenon with a depth and breadth of knowledge of a topic would be sat next to a single sufferer of the phenomenon whose emotions were equated to a life of study and concentrated attention to the issue.

Can we still acknowledge that someone may know more about something than I do even if I do not like what they are saying, the way they are saying it, or them?  They may be right despite themselves. Should you be so self-assured that you are safe from a bad case of COVID because you never get the flu either and hence a COVID vaccine is unwarranted though you are 56 years old and have five people depending on you in the middle of a pandemic?

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  1. Arahant Member
    Arahant
    @Arahant

    I’ve had too many doctors try to kill me to trust them. Do I wear the masks where requested or required? Sure. Am I getting vaccinated? No. It isn’t that I’m against them. My wife is vaccinated. But I know I’m a mutant, and I’m the type of mutant who reacts badly to medications. I seldom leave the house. CoViD will have to come and find me, because I’m not looking for it.

    • #1
  2. David Foster Member
    David Foster
    @DavidFoster

    Yet the information that has been promulgated by government sources has mostly emphasized the effectiveness of masks in protecting other people from the wearer than in protecting the wearer from other people…If cloth masks are that effective in protecting doctors/nurses in clinical settings, that would seem to go against that point.

    • #2
  3. David Carroll Thatcher
    David Carroll
    @DavidCarroll

    Do masks work?  I follow the science (not just anecdotal reports), and not just the studies done during the pandemic.

    Association of American Physicians and Surgeons.

    Annals of Internal Medicine here and here.

    Swiss Policy Research journal.

     

     

     

     

    • #3
  4. Buckpasser Member
    Buckpasser
    @Buckpasser

    Why should society have to wear masks forever?  That’s what masks mean.

    • #4
  5. Hoyacon Member
    Hoyacon
    @Hoyacon

    Do Masks Work?

    In sum, of the 14 RCTs [Randomized Controlled Trials] that have tested the effectiveness of masks in preventing the transmission of respiratory viruses, three suggest, but do not provide any statistically significant evidence in intention-to-treat analysis, that masks might be useful. The other eleven suggest that masks are either useless—whether compared with no masks or because they appear not to add to good hand hygiene alone—or actually counterproductive. Of the three studies that provided statistically significant evidence in intention-to-treat analysis that was not contradicted within the same study, one found that the combination of surgical masks and hand hygiene was less effective than hand hygiene alone, one found that the combination of surgical masks and hand hygiene was less effective than nothing, and one found that cloth masks were less effective than surgical masks.

    • #5
  6. KentForrester Moderator
    KentForrester
    @KentForrester

    Doc, I appreciate your calm and reasoned approach to these matters.  I’m awfully glad to hear your knowledgeable voice among the cacophony of voices on all sides of these issues.  Thanks. 

    • #6
  7. David Foster Member
    David Foster
    @DavidFoster

    A lot of studies, of varying quality, on the effectiveness of mask-wearing…CDC has usefully summarized them here:

    https://www.cdc.gov/coronavirus/2019-ncov/science/science-briefs/masking-science-sars-cov2.html

    Goldman Sachs did a study back in June 2020 using multivariate statistical techniques:

    https://www.goldmansachs.com/insights/pages/face-masks-and-gdp.html

    …don’t know if they’ve since updated it.

    A study which attempts to evaluate masks via their actual wearing behavior rather than via edicts:

    https://marginalrevolution.com/marginalrevolution/2021/06/the-best-mask-wearing-study-so-far.html

    City Journal critique of the studies in the CDC summary:

    https://www.city-journal.org/do-masks-work-a-review-of-the-evidence?wallit_nosession=1

     

     

    • #7
  8. D.A. Venters Member
    D.A. Venters
    @DAVenters

    Modern medicine has taken an impressive array of scalps over the past century or so – smallpox, polio, measles, tuberculosis, even AIDS, just to name a few.

    Internet forums and YouTube videos have conquered no illnesses.  Scoreboard shows a big goose egg for them. 

    Just something to keep in mind. 

    • #8
  9. Hoyacon Member
    Hoyacon
    @Hoyacon

    D.A. Venters (View Comment):

    Modern medicine has taken an impressive array of scalps over the past century or so – smallpox, polio, measles, tuberculosis, even AIDS, just to name a few.

    Internet forums and YouTube videos have conquered no illnesses. Scoreboard shows a big goose egg for them.

    Just something to keep in mind.

    I suppose that’s true, but I don’t see the relevance here.  The links above are not really akin to random people on social media.

    • #9
  10. EJHill Podcaster
    EJHill
    @EJHill

    Gromrus: Do you believe your own doctor or your doctor friends who recommend masks based on  decades of experience or do you demand a randomized controlled trial in the middle of a pandemic in order to be persuaded that the general welfare is best benefitted by masking. 

    Do you believe doctors in the field using Ivermectin or do you OR just dismiss all therapeutic possibilities and demand a randomized controlled trial in the middle of a pandemic?

    • #10
  11. WillowSpring Member
    WillowSpring
    @WillowSpring

    uGromrus: Masks work at decreasing spread of COVID and other respiratory illnesses. Masks — regular old surgical masks — are all that most people providing care to COVID patients in the hospital have on.

    Thank you for this look at things.  I have felt for a long time that the only real instructions have been “Wear a mask” or in the case of Marylands Gov. Hogan, “Wear a damn mask!”.  Unless you do a lot of poking around, there aren’t any real instructions on how to wear it – what I guess you could call “Mask Hygiene”.  That is probably a big difference between the health professionals and the general population.  The situation with kids would be even worse – it is good that they seem to be bad carriers .

    • #11
  12. DonG (2+2=5. Say it!) Coolidge
    DonG (2+2=5. Say it!)
    @DonG

    Gromrus: The COVID vaccines work as well.

    You need to define “work”.  When I look at the case data, the numbers were already declining when the vaccine rollout started.  From the latest data it looks like the vaccines might help in reducing severity of cases.  However a good study is needed that accounts for the health status of those vaccinated/not-vaccinated.   The vaccinated population is self-selected and thus not a randomized sample. 

    • #12
  13. Brian Watt Member
    Brian Watt
    @BrianWatt

    Congrats, Doc. You just posited an argument for the permanent wearing of masks.

    Because if it’s not COVID it will be another respiratory malady making the rounds with attendant hysteria.

    And never mind the damage posed by continued mask wearing for bacterial and fungal infection from masks that are not routinely cleaned. And ignore how the immune system works by building up resistance to harmful viruses and bacteria by allowing the body’s antibodies to react to them when people actually breathe and go about their daily lives.

    Prolonged and continued mask wearing is actually harmful to the body’s immune system and psychologically harmful especially for children and prevents younger children from reading another person’s face. 

    Well done.

    • #13
  14. Brian Watt Member
    Brian Watt
    @BrianWatt

    Not a day goes by that I don’t see someone walking down a neighborhood street with nary another soul around them on a hot summer day (for the last week it’s been in the 90s here) wearing a damn face mask. COVID is not nuclear fallout.

    • #14
  15. BDB Coolidge
    BDB
    @BDB

    My bottom line is that the government has far overstepped, and I don’t care about COVID.

    Let the things run its course.  That’s what’s going to happen anyway.  No reason to cripple ourselves while drawing out the process.

    The D variant seems to be the most contagious yet, and is also the least lethal.  This is the way of these things.  How long have we kept the window open for the less-lethal variants by masking up?

    • #15
  16. Charlotte Member
    Charlotte
    @Charlotte

    Thanks for the post.

    My current covid-related grievance is that I have to wear a mask even though I am vaccinated (and delighted to be so!). Leaving aside the issue of proof, what is this about? If other people want to wear a mask and/or not get vaccinated that’s fine by me. If they get covid it’s their problem, not mine. I’d prefer to err on the side of each person taking responsibility for his own health and risk tolerance. The same question would apply to those who have already had covid. What benefit is gained from masks in those cases?

    I’m asking honestly. This has vexed me for some time. If the answer is that you could still transmit covid even if you have had it and/or have received the vaccination, then when would masks ever go away?

    • #16
  17. OldPhil Coolidge
    OldPhil
    @OldPhil

    Hoyacon (View Comment):

    Do Masks Work?

    In sum, of the 14 RCTs [Randomized Controlled Trials] that have tested the effectiveness of masks in preventing the transmission of respiratory viruses, three suggest, but do not provide any statistically significant evidence in intention-to-treat analysis, that masks might be useful. The other eleven suggest that masks are either useless—whether compared with no masks or because they appear not to add to good hand hygiene alone—or actually counterproductive. Of the three studies that provided statistically significant evidence in intention-to-treat analysis that was not contradicted within the same study, one found that the combination of surgical masks and hand hygiene was less effective than hand hygiene alone, one found that the combination of surgical masks and hand hygiene was less effective than nothing, and one found that cloth masks were less effective than surgical masks.

    I tend to just look at the time period when virtually everyone was masked-up and locked-down to the max — November through February or so — and see that it turned out to be the absolute worst period for cases, hospitalizations, and deaths. 

    • #17
  18. BDB Coolidge
    BDB
    @BDB

    We catch the flu every year.  We catch the cold whenever.  The differences between COVID and these mass murderers does not justify the price.

    And it certainly does not justify the sweeping government power grabs.

    Once the COVID passport machinery is built, all that remains is to adjust the dials on it.  Now the government has a fill in the blank internal passport control system.

    Count me out.

    • #18
  19. Hoyacon Member
    Hoyacon
    @Hoyacon

    Charlotte (View Comment):

    Thanks for the post.

    My current covid-related grievance is that I have to wear a mask even though I am vaccinated (and delighted to be so!). Leaving aside the issue of proof, what is this about? If other people want to wear a mask and/or not get vaccinated that’s fine by me. If they get covid it’s their problem, not mine. I’d prefer to err on the side of each person taking responsibility for his own health and risk tolerance. The same question would apply to those who have already had covid. What benefit is gained from masks in those cases?

    I’m asking honestly. This has vexed me for some time. If the answer is that you could still transmit covid even if you have had it and/or have received the vaccination, then when would masks ever go away?

    Piggybacking—wasn’t the conventional wisdom for quite awhile that masks helped to prevent transmission from the wearer, but did not really protect the wearer?  Or is this, like so much, not operative now?

    • #19
  20. Gromrus Member
    Gromrus
    @Gromrus

    Charlotte (View Comment):

    Thanks for the post.

    My current covid-related grievance is that I have to wear a mask even though I am vaccinated (and delighted to be so!). Leaving aside the issue of proof, what is this about? If other people want to wear a mask and/or not get vaccinated that’s fine by me. If they get covid it’s their problem, not mine. I’d prefer to err on the side of each person taking responsibility for his own health and risk tolerance. The same question would apply to those who have already had covid. What benefit is gained from masks in those cases?

    I’m asking honestly. This has vexed me for some time. If the answer is that you could still transmit covid even if you have had it and/or have received the vaccination, then when would masks ever go away?

     

    Hospitals are having to add tents: 

    https://www.wapt.com/article/second-field-hospital-opening-outside-ummc/37329830#

    https://abcnews.go.com/US/video/texas-hospital-turns-overflow-tents-delta-variant-fuels-79404801

    https://www.wbbjtv.com/2021/08/04/mobile-hospital-unit-helps-jackson-madison-county-general-hospital/

    Many hospitals are full but not adding tents.

    If hospitals are full then ERs are full with patients waiting for a bed.  If you have a heart attack or trauma/wreck, your care will be delayed.

    Because hospitals are full, elective surgeries ( including elective procedures — some diagnostic) are being cancelled. Thus the current COVID surge, even if not fatal for most of those patients, potentially impacts all of us. 

    If we all act like we might get or spread COVID right now we may help the situation. 

    • #20
  21. Susan Quinn Contributor
    Susan Quinn
    @SusanQuinn

    Left out of the equation is the psychology of those who assess mask wearing. Even doctors have biases, preferences, theories and conclusions that may be mostly based on their experience and ideas instead of on actual science. I mean no disrespect doctor, but you have fears and concerns like everyone else, and those may inihibit your being fully objective on the topic.

    • #21
  22. DrewInWisconsin, Oaf Member
    DrewInWisconsin, Oaf
    @DrewInWisconsin

    Gromrus: Before the vaccines were available, we were protected by nothing but masks and we did not get COVID.

    We also were protected by nothing but masks, and we got it. Several of my co-workers faithfully wore masks. They also got it. Everyone I know who got it also wore masks every time they went out in public.

    I’m not convinced masks work.

    In fact, I’m half-convinced that masks collect the virus and make transmission easier. They certainly collect a lot of other crud one doesn’t want in his lungs.

    • #22
  23. Gromrus Member
    Gromrus
    @Gromrus

    OldPhil (View Comment):

    Hoyacon (View Comment):

    Do Masks Work?

    In sum, of the 14 RCTs [Randomized Controlled Trials] that have tested the effectiveness of masks in preventing the transmission of respiratory viruses, three suggest, but do not provide any statistically significant evidence in intention-to-treat analysis, that masks might be useful. The other eleven suggest that masks are either useless—whether compared with no masks or because they appear not to add to good hand hygiene alone—or actually counterproductive. Of the three studies that provided statistically significant evidence in intention-to-treat analysis that was not contradicted within the same study, one found that the combination of surgical masks and hand hygiene was less effective than hand hygiene alone, one found that the combination of surgical masks and hand hygiene was less effective than nothing, and one found that cloth masks were less effective than surgical masks.

    I tend to just look at the time period when virtually everyone was masked-up and locked-down to the max — November through February or so — and see that it turned out to be the absolute worst period for cases, hospitalizations, and deaths.

    The current estimated number of US active cases is 7 million. The peak number in January ’21 was ~9 million. The current mortality rate is much lower for multiple reasons which is fantastic. However, hospitals are full. This impacts everyone. 

    • #23
  24. Gromrus Member
    Gromrus
    @Gromrus

    BDB (View Comment):

    We catch the flu every year. We catch the cold whenever. The differences between COVID and these mass murderers does not justify the price.

    And it certainly does not justify the sweeping government power grabs.

    Once the COVID passport machinery is built, all that remains is to adjust the dials on it. Now the government has a fill in the blank internal passport control system.

    Count me out.

    We have never had hospitals full from colds or flu. It is not an appropriate comparison. 

    • #24
  25. Brian Watt Member
    Brian Watt
    @BrianWatt

    Gromrus (View Comment):

    OldPhil (View Comment):

    Hoyacon (View Comment):

    Do Masks Work?

    In sum, of the 14 RCTs [Randomized Controlled Trials] that have tested the effectiveness of masks in preventing the transmission of respiratory viruses, three suggest, but do not provide any statistically significant evidence in intention-to-treat analysis, that masks might be useful. The other eleven suggest that masks are either useless—whether compared with no masks or because they appear not to add to good hand hygiene alone—or actually counterproductive. Of the three studies that provided statistically significant evidence in intention-to-treat analysis that was not contradicted within the same study, one found that the combination of surgical masks and hand hygiene was less effective than hand hygiene alone, one found that the combination of surgical masks and hand hygiene was less effective than nothing, and one found that cloth masks were less effective than surgical masks.

    I tend to just look at the time period when virtually everyone was masked-up and locked-down to the max — November through February or so — and see that it turned out to be the absolute worst period for cases, hospitalizations, and deaths.

    The current estimated number of US active cases is 7 million. The peak number in January ’21 was ~9 million. The current mortality rate is much lower for multiple reasons which is fantastic. However, hospitals are full. This impacts everyone.

    Where is your proof that hospitals are full? Please give a hospital-by-hospital accounting throughout the United States. Take your time.

    • #25
  26. D.A. Venters Member
    D.A. Venters
    @DAVenters

    Hoyacon (View Comment):

    D.A. Venters (View Comment):

    Modern medicine has taken an impressive array of scalps over the past century or so – smallpox, polio, measles, tuberculosis, even AIDS, just to name a few.

    Internet forums and YouTube videos have conquered no illnesses. Scoreboard shows a big goose egg for them.

    Just something to keep in mind.

    I suppose that’s true, but I don’t see the relevance here. The links above are not really akin to random people on social media.

    Fair enough. I should have been clearer that my main point is “Listen to your doctor. Don’t try to judge for yourself the quality of the information you find when it involves areas that require a great deal of expertise.”  

    The same applies for areas beyond medicine. Studies are out there that support all kinds of conclusions, even ones conducted by doctors and well meaning experts. But they may still be flawed or lead people to the wrong conclusions. 

    The extensive medical education they receive, the lengthy training, the continuing education, the practical experience of treating patients – all of those things provide doctors with a filtering mechanism for this information that laymen don’t have. Let that filter work. 

    • #26
  27. BDB Coolidge
    BDB
    @BDB

    Gromrus (View Comment):

    BDB (View Comment):

    We catch the flu every year. We catch the cold whenever. The differences between COVID and these mass murderers does not justify the price.

    And it certainly does not justify the sweeping government power grabs.

    Once the COVID passport machinery is built, all that remains is to adjust the dials on it. Now the government has a fill in the blank internal passport control system.

    Count me out.

    We have never had hospitals full from colds or flu. It is not an appropriate comparison.

    Please pardon the link to msn, but…

    Many people avoided seeing their primary care physicians during the pandemic. Now, hospitals are packed to the brim. Doctors said the reason is a backlog in care.

    https://www.msn.com/en-us/health/medical/new-mexico-hospitals-are-full-not-from-covid-19-patients/ar-AALn5EY

    • #27
  28. Gromrus Member
    Gromrus
    @Gromrus

    Brian Watt (View Comment):

    Gromrus (View Comment):

    OldPhil (View Comment):

    Hoyacon (View Comment):

    Do Masks Work?

    In sum, of the 14 RCTs [Randomized Controlled Trials] that have tested the effectiveness of masks in preventing the transmission of respiratory viruses, three suggest, but do not provide any statistically significant evidence in intention-to-treat analysis, that masks might be useful. The other eleven suggest that masks are either useless—whether compared with no masks or because they appear not to add to good hand hygiene alone—or actually counterproductive. Of the three studies that provided statistically significant evidence in intention-to-treat analysis that was not contradicted within the same study, one found that the combination of surgical masks and hand hygiene was less effective than hand hygiene alone, one found that the combination of surgical masks and hand hygiene was less effective than nothing, and one found that cloth masks were less effective than surgical masks.

    I tend to just look at the time period when virtually everyone was masked-up and locked-down to the max — November through February or so — and see that it turned out to be the absolute worst period for cases, hospitalizations, and deaths.

    The current estimated number of US active cases is 7 million. The peak number in January ’21 was ~9 million. The current mortality rate is much lower for multiple reasons which is fantastic. However, hospitals are full. This impacts everyone.

    Where is your proof that hospitals are full? Please give a hospital-by-hospital accounting throughout the United States. Take your time.

    OK, many hospitals are full then, if you prefer that. 

    My hospital, a university hospital and the largest in my city and area is full. Many hospitals in my area of the country are full and adding tents.    

    • #28
  29. BDB Coolidge
    BDB
    @BDB

    Bastiat again:

    In the economic sphere an act, a habit, an institution, a law produces not only one effect, but a series of effects. Of these effects, the first alone is immediate; it appears simultaneously with its cause; it is seen. The other effects emerge only subsequently; they are not seen; we are fortunate if we foresee them.

    There is only one difference between a bad economist and a good one: the bad economist confines himself to the visible effect; the good economist takes into account both the effect that can be seen and those effects that must be foreseen.

    I do not presume that those who argue the “pro-COVID” case are dishonest or evil, except those in positions of power or those in a position to benefit from the transfer of power.  Even then my presumption is prudent, not heartfelt, and just that — a presumption.

    Instead, I feel that most of the COVID cheerleaders have been stampeded into a rational-sounding panic by the plainly apparent costs and risks.  This is done by refusing to discuss, or even to acknowledge, the other side of the ledger.

    A friend of mine had his chemotherapy delayed for MONTHS because the hospitals were no longer interested in preventing cancer.  Insert dancing nurses video here.  And so on.  So my immediate previous comment with the news story about why some hospitals are full.

    Our economy, liberty, and familes are too great a price to pay for marginally better chances against a marginally lethal virus.

    BRING. IT. ON.

    • #29
  30. DrewInWisconsin, Oaf Member
    DrewInWisconsin, Oaf
    @DrewInWisconsin

    Last November we hit our peak COVID hospitalization in Wisconsin at 2,150. This was still not “full.” The worst I saw in one region of the state at peak was a 92% capacity.

    COVID hospitalizations are currently up, to about 600 from a July low of 80. (Obviously nowhere near last year’s peak.) And as you can see, this is nowhere near “full.” 95% of Wisconsin hospitals have an immediate bed availability.

    Data here.

    The case numbers are up — yep. The seven day average of COVID deaths for Wisconsin is still remarkably low, at about 2. And that is down from a brief jump in May. Otherwise, it’s been this low since March.

    What does the average “case” of COVID look like?

    • #30