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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?
Published in Healthcare
I accept that masks and other tools and techniques may reduce person-to-person virus transmission. I.e., masks may be effective. Therefore, medical professionals use them in many circumstances.
But I am one who also sees that universal mask wearing imposes costs on people on society. Therefore, I expect to see some pretty strong evidence that masks are extremely effective, and that such effectiveness matters in material ways on health, to justify imposing the costs of masks onto people and society. So far I have seen no such evidence.
The vast majority of the population does not have, and is not capable of spreading Covid at any given moment. So imposing masking and other Covid-oriented mitigation measures on the population as a whole imposes costs on a many people for which those costs provide no benefit. Before the Covid era, the doctors and other medial professionals I saw did not wear masks unless the patient was known to be or suspected of carrying a contagious disease, and even then use was spotty. And as far as I could tell, did not wear them for hours and hours at a time unless they were in a surgery facility involved in a lengthy surgical procedure.
Finally, medical professionals receive training and have protocols and procedures concerning the use of masks, respirators, gloves, etc., to minimize the inadvertent spreading of bacteria and viruses. The general public has shown it is incapable of consistently following such protocols and procedures.
So, I’m not going to argue that masks are worthless with respect to the transmission of a virus. But I continue to argue that the downsides of universal masks (and other physical barriers between people) outweigh the potential advantages.
Here is another comparison graph. This is not a lab experiment, this is the result of millions of individual outcomes in real life. The two countries are roughly similar in climate, which turns out to be the most important fact in their Covid outcomes. Masks, lockdowns, etc. do not appear to be significant factors in these numbers. In fact, we are comparing the lawless rogue state (Sweden) against a state with some of the most stringent rules in Europe. If there were no identifying notes on the graph, could you have guessed which was which?
Small print says it’s WHO data. Nice!
Our “Republican” governor in Massachusetts has followed suit. It’s now either get the jab or lose your job if you are a state employee. Massachusetts, the Spirit of America it says on our license plates. A sick joke at this point.
What’s really interesting about the push to vaccinate is what exactly is the rush?
Novavax has completed phase 3 of a recombinant vaccine (think flu vaccines) with good results. Their starting point isn’t as high as Pfizer at 90%, but Pfizer isn’t really that high 3 months in. Their testing has been more thorough. People skeptical of the mRNA vaccine will have another option relatively soon.
So why are businesses and governments pushing so hard for us to get these specific vaccines?
I told my husband to inform us work that he’s waiting for the Novavax to be available.
Ivermectin& HCQ have NEVER been proven to be effective against any coronavirus- the work you are referring to is IN VITRO work using doses that aren’t achievable in humans.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8203399/
The one notable exception to this was in treating mild cases of COVID.
Dosing IS considered the biggest concern with outpatient care, however that is because not enough studies have been done to determine proper dosing and the existent potential for toxicity.
Why haven’t those studies been done? It isn’t because it doesn’t work (96% of studies showed it was an effective treatment in clinical trials).
Almost all of the positive trials are of low quality- the most important supportive trial quoted in the reference you provide has been withdrawn b/c of serious evidence of fraud (Elgazzar). Unfortunately, the better trials typically do not show effectiveness. The two best ongoing trials are the PRINCIPLE study and the ACTIV study- hopefully they will settle the question.
I’ve been vaccinated. and get a booster any day, hopefully tomorrow.
I’m sick to death of having to treat 80 patients a day in UC clinic because they didn’t bother to get vaccinated and are now concerned they have Covid. Another week or 2 like this and I’m gone.
Same here. Again our clinical experience is showing about an 8/1 infection rate for unvaccinated to vaccinated and for hospitalization.
I have no doubt this is a temporary spike, and things will start to trend down again maybe soon. I sure as hell hope so, because I and the people I work with are exhausted, We saw 83 patients yesterday in 12 hours. That rate is not sustainable. Burn out is very real.
But the stupid in arguing that we aren’t seeing what we are seeing, and that it could be improved with a higher vaccination rate is insane.
Here is an article from NY Magazine, not exactly a right wing publication:
The Science of Masking Kids at School Remains Uncertain
Contrast this with the dogmatic assertion that at all times and in all cases “masks matter”.
Also contrast this with the rest of the world.
So quit your job.
I’m sick of having to deal with the harms of drug abuse, absentee fatherhood and (yes) overreaching nanny state in my job. But it’s my job. If I can’t handle it I will leave. What I won’t do is attempt to use the state to coerce people into doing something that I think will make my job easier.
Funny how much you pretend to care about the quality of research and the effectiveness of interventions….
Unless we’re talking about masks. Then all that high-minded garbage goes right out the window. Because we have to try something, right? Let’s mandate vitamin D and exercise… Whoops, we’ll need extensive research proving effectiveness for that one. Forgot. This is so confusing!
Nope no data at all that masks work- none at all- that is especially true if you not only don’t look for it but also actively refuse to consider the data….just a few off the top of my head that support the effectiveness of mask use in the community ….
https://www.pnas.org/content/117/51/32293
https://jamanetwork.com/journals/jama/fullarticle/2776536?
utm_source=silverchair&utm_campaign=jama_network&utm_content=covid_weekly_highlights&utm_medium=email
https://www.sciencedaily.com/releases/2020/04/200403132345.htm
https://www.cdc.gov/mmwr/volumes/70/wr/mm7010e3.htm
https://www.factcheck.org/2021/03/scicheck-posts-distort-cdc-study-supporting-masks-mandates-to-reduce-covid-19/
https://www.factcheck.org/2021/03/scicheck-the-evolving-science-of-face-masks-and-covid-19/
https://www.medrxiv.org/content/10.1101/2021.08.13.21261989v1.full
https://pubmed.ncbi.nlm.nih.gov/33124541/
https://www.preprints.org/manuscript/202004.0203/v3
https://academic.oup.com/cid/article/71/16/2139/5848814
https://www.healthaffairs.org/doi/10.1377/hlthaff.2020.00818
https://link.springer.com/article/10.1007%2Fs11606-020-06067-8
https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)31142-9/fulltext
it is easier to do studies on the effectiveness of medical therapy for an ongoing illness (ie HCQ or ivermectin for COVID) rather than a preventative therapy for a serious disease (masks for COVID). That is because it is unethical to do the study that would best settle the question- ie a challenge study of the effectiveness of masks.
You are already a party to coercing Kozak into treating people. You aren’t required by law to handle any case that comes thru your door, however due to EMTALA (a typical unfunded mandate pushed on hospitals/doctors by lawyers/ legislators) Kozak must treat these patients.
Here is some aggregate data from places that have similar climates but very different mask rules
This is how masks (don’t) affect cases in the real world.
Yes, I’ve seen the garbage list that you have saved and post every time you want to pretend you know what you’re talking about. It isn’t any more persuasive the 50th time.
A lot of people have read those “studies.” Funny thing, in spite of all those links, there are zero examples of masks working in real life. Go figure. Keep wearing yours, though.
https://www.city-journal.org/do-masks-work-a-review-of-the-evidence
But all the theoretical model based studies say masks work!!
Absolutely untrue- I have never posted this list before- counselor sophistry maybe your strong suit but facts are not. Several studies show masks work in real life-but you must read them to see that-the studies are in Germany and the US and are included in the list I provided. The VAST MAJORITY of medical experts support the use of masks and while they are not ironclad they are the second best defense we have (vaccines being the first). It is hard to understand the mask & vaccine denial out there when these are the best steps we have to combat the virus. They are cheap & safe and have far fewer adverse effects than the alternatives. Mask effectiveness is not great but it works both as personal (respiratory) protection and to protect others (source control) and is likely additive in both regards. There is little doubt that the delta variant will render low quality masks less effective-but that doesn’t necessarily mean ineffective. You best bet is to avoid infection since the therapies we have for the virus are quite limited. The data is overwhelming that the unvaccinated face substantially greater risk-just today it was announced that longtime conservative radio host Phil Valentine died at age 61 following a lengthy battle with COVID-19, after spending most of the pandemic casting doubt on the efficacy of masks and vaccines.
One logical fallacy after another. You prove the wisdom of our founding fathers, who knew that power concentrated in the hands of “well intentioned” fools was more dangerous than anything else. Not sure how well intentioned you are, though. Just foolish.
One logical fallacy after another. You prove the wisdom of our founding fathers, who knew that power concentrated in the hands of “well intentioned” fools was more dangerous than anything else. Not sure how well intentioned you are, though. Just foolish.
Of course, even from a “masks may have some effect” perspective, the consideration of tradeoffs is not such a difficult task… For anyone capable of getting past a disproportionate level of personal fear, that is:
https://cafehayek.com/2021/08/the-coming-of-the-tyranny-of-tiny-risks.html
I heard a guy on the radio today say that even if masks only had a “5% impact,” then a mandate is still worth it.
Actually you are committing the logical fallacies- I never mentioned mask mandates….straw man often or is it a reverse motte and Bailey ?
Thanks for reintroducing that article to which I linked early in this thread. I’ve already learned that studies are best interpreted by the medical professionals, and not those of us who consider ourselves reasonably intelligent, but no one seems to have addressed the City Journal piece.
From what I’m seeing, even the doctors are in disagreement. And no one can answer why I should trust one over another.
In these circumstances, intelligent people are left to exercise their own judgement.
https://dailysceptic.org/2021/08/22/face-masks-dont-work-against-respiratory-viruses-so-why-did-so-many-public-authorities-impose-mask-mandates/
Please actually read the articles cited by the City Journal article and you will see the conclusions of the author are very shaky. I say this as a longtime subscriber to, and fan of, the City Journal. There are a number of problems with the article- here are just a few:
The studies he lists are for the flu- there are studies out there for the use of masks to reduce the transmission of a coronavirus- as an example:
https://gh.bmj.com/content/5/5/e002794 mask inCOVID(worked as prevention)
https://wwwnc.cdc.gov/eid/article/10/2/03-0730_article. Mask w/ SARS
The author cites two articles which he claims show masks do not work- calling them the Bangkok and Hong Kong studies. But in fact the cited articles do NOT support the claim that mask use is ineffective in the community. The “Bangkok” study was, essentially, a study to see if mom wearing a mask would prevent her from getting the FLU from her child. The big problem was (and many experts have noted this) the mother and child slept in the same room at night and NEITHER WORE A MASK. So this was a study of NOT wearing masks much of the time while in close contact with an infected child. Everybody agrees that not wearing a mask much of the time while exposed will not protect you. I need not mention that not only was the mask only worn for a few hours/day but that also it was used only AFTER diagnosis and therefore after the mother was ALREADY exposed. The Hong Kong study (also of the flu) concludes: “Hand hygiene and facemasks seemed to prevent household transmission of influenza virus when implemented within 36 hours of index patient symptom onset. These findings suggest that nonpharmaceutical interventions are important for mitigation of pandemic and interpandemic influenza.”. Seems to me the authors support masks. The author of the City journal article mischaracterizes the problems with the famed Danish mask study- it’s inability to detect not only significant respiratory protection by masks but it’s COMPLETE inability to detect source control by masks (a favorite strategy of anti- maskers). The author does an elaborate two-step around MacIntyre’s work and never mentions that MacIntyre believes her studies’ reevaluation was appropriate (and that reevaluation was consistent with cloth masks providing significant protection) but he fails to mention MacIntyre has strongly supported the use of masks in several subsequent articles- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7191274/
So you disagree with the author’s summation of the studies, which strongly implies that City Journal was irresponsible in publishing the piece?