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With regard to the current state of affairs, are you wearing them? If not, at what point will you?
Masks
- Thread starter Speed Racer
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Kevlar helmet and body armor--oh wait, are we talking about precautions for swine flu or downtown Milwaukee . . .
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Why would you unless you're sick yourself? The regular surgery masks don't protect you. The N-95 masks might make some difference, but I doubt people are running around in them in the ER (are you?). Even then the flu virus is smaller than 0.3 microns and will likely pass through, through it probably helps with droplet transmission. I'm not saying you should get wet sloppy kisses from your patients, but in terms of precautions, seeing people run around in general surgery masks is kind of silly.
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Masks don't help, though we make the patients wear them so presumably they're not getting droplets everywhere.
Just wash your hands after every patient contact and it should reduce your risk.
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Sorry, duplicate post.
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Haha! Outdated neckwear fail!
Still, as I haven't said in a year, there is NO evidence that ties, no matter how filthy, have anything to do with infection.
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You need one of those orthopedic space suits.
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Yes, but there is plenty of evidence (so what if it's anecdotal) that ties are uncomfortable around my neck, no matter how clean.
As with most physicians, I like the research best that agrees with me.
Take care,
Jeff
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Cochrane review came out recently. Our hospital and local system recently removed mask requirement in hospital after past 3 years. Welcome change, but feels a little odd like you’re naked. No shoes, no shirt, no service. Pants and masks optional though.
Posting this here as don’t feel we need a whole new thread. All the more recent mask threads were closed. I do agree they became political and devolved. Interesting to go back and see this brief thread in 2009. I imagine based upon H1N1.
Here’s to hoping the next pandemic isn’t for a long time.
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You're responding to a 13 year old post and a poster who hasn't logged in since 2011....
BillBill1219
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But the thread was bumped today
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It's funny the OP references swine flu in 2009 but weirdly still fits the current question of when the hell can we stop wearing masks
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Still masking in the hospital but still managed to get influenza and several colds this season.
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I love a good date for when ‘emergencies’ can end.
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I feel that. And I'm not interested in defending them. But they stated that they were making the decision based on current and predicted circumstances and the 30 day notice was essentially to provide a runway for all the healthcare organizations in the state to stand down current policies and adopt new ones. As someone who until the end of 2022 was one of the people who had to do that work, I appreciate the heads up. It's the complete opposite of 2020 and 2021 when we'd literally get a new pronouncement at 4:55pm on Friday evening that was to be implemented at 0700 on Monday and we spent a good chunk of the weekend trying to figure out WTF to do.
TBH, I expected masks in healthcare to be a 5+y thing here.
valianteffort
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Because I know you all were wondering, the price of PAPRs has gone down for a peak covid high of 3000 dollars for a used machine to now 300-400 dollars used. I suggest you all load up on the machines prior to the next pandemic and you may have a higher annualized return double to triple that of the SP500.
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Same here
Without diving into the component studies, 2 thoughts immediately jump out.
1. How many people wear the mask properly to begin with? It's not that masks don't work... it's that wearing a mask wrongly with your nose hanging out doesn't work. I don't think many people are going to suddenly say that their surgeon doesn't need to wear a mask or voluntarily and knowingly go and treat flu patients without a surgical mask.
2. What portion of the control group was wearing masks? Is this like the ProCESS trial? Early goal directed therapy doesn't work ...because standard of care now roughly falls in line with EGDT. Is this "Mask mandates don't work... because 80% of the people wear a mask in the mandate group, but 70% in areas without mandates"?
I still want one of those Tesla PAPRs...Because I know you all were wondering, the price of PAPRs has gone down for a peak covid high of 3000 dollars for a used machine to now 300-400 dollars used. I suggest you all load up on the machines prior to the next pandemic and you may have a higher annualized return double to triple that of the SP500.
Seriously, though, did anyone actually see or use any of those promised PAPRs that the various car companies were promising to make, or did all of those turn out to be vaporwear?
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Interesting comparison to EGDT and the ProCESS trial. Not the same though. Masks more so came and went. Components of EGDT stuck around.
Comparing societies with high versus low percentage of mask use helps answer this question. That’s what the Cochran review did. Good luck conducting a population study accessing percentage wearing correctly and whether that influenced spread. We all anecdotally know masks aren’t universally worn correctly. That’s why they were shown in meta analysis to not affect viral spread. Whether or not they work individually (in perpetuity) is a separate question regarding if you think living in a masked bubble for the rest of your life is beneficial. And then it becomes political.
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I think with most political issues nowadays the answer to that requires nuance. Nuance doesn’t play well when we treat politics like a sport, you’re expected to root for your team always, and the teams always take the most extreme view possible.
It’s like asking if you want to live in a society that requires you to boil water to clean it?
No, but I do think that there are times where a boil water advisory is necessary and appropriate.
Do I want to permentantly wear a mask?
No, but if you’re telling me that there’s a novel, contagious, and deadly infectious disease in society and that we should, for a limited time, wear a mask, then sure. Masking is a lot more effective than the TSA.
But I guess 3000 dead is a tragedy, 1 million plus is a statistic. …and unlike removing our shoes and throwing out water bottles, the masking is largely over.
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And yet all these people still getting away with not paying their student loans...
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Unless they are actually unemployed, this is a stupid move.
You've had three years where every cent you put towards those loans goes entirely to principal. If you have the means and aren't paying at least some amount into that, it's financial stupidity of an impressive degree.
All generic "you" of course
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Where should we take this thread next: guns, abortions, or kindergartner's books?
C'mon folks.
C'mon folks.
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Heartily disagree, although I guess in your eyes I'm stupid to an impressive degree and probably worth ignoring.
Immediately out of residency, instead of paying down 0% loans, I instead was able to buy a house at locked in historically low rates that I don't plan on giving up anytime soon, was able to quickly build up a suitable emergency fund, and make some serious headway into retirement savings during a relative down market, and very recently (within the last month) finally refinanced those 0% loans to<3.4% which I plan on taking as long as I can to pay off, as long as that rate remains sub-inflation. And all of this while saving several tens of thousands of dollars in interest.
Yes, those loans could instead be paid off, but if the alternative would now be buying a house at 6.5% or continuing to rent, not having as much emergency savings, not having as much money working for me to generate long term wealth....well, I guess I'm okay being stupid, because the math agrees with me in the long run.
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With all due respect, given the average physician income, you likely would have been able to continue to do all those things anyway. The issue is going to come up that people with incomes much lower than a physician's income haven't been paying student loans for several years. How many do you think still budget their student loans into their lives (or even budget at all)? How many of these people live paycheck to paycheck? While they may have felt some relief with not having the payments, starting these monthly payments back up is going to wreck a lot of people.
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I'm pretty sure VA was referring to people who chose to spend money frivolously instead of paying down their loan obligations.
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I think we have different philosophies on wealth building. I see debt, particularly student loan debt, as a high liability. Best to get rid of it, not keep it like a pet. The fact that the federal government has high subsidized it the last few years has encouraged people to believe this liability doesn’t exist and effectively funneled tons of cash into the economy during a downturn.
I see wealth building best by limiting my liabilities allowing me to focus on my income, which is how I build wealth the best, rather than leveraging my home student loans.
Sure, I can see that viewpoint, but that wasn't really how it was phrased. Doctor income or not, I haven't been paying student loans and fall into the "all these people" camp that was referred to. Agreed that it's not financially responsible to expand your spending to meet your income when you have outstanding debt, I don't think anyone would argue that.
And sure, I could have done both, I'm highlighting I intentionally chose not to because even in the past 2 years, the decisions I've made will either harm me by $14,000 (max amount of interest of my loan if paid off over the next 5 years), or benefit me by potentially hundreds of thousands (assuming nominal stock market returns, but who knows these days, amiright) by the time I can withdraw retirement funds. That's a risk I'm willing to take, especially as I still end up ahead by tens of thousands courtesy of the interest pause no matter what I do.
This is a bit disingenuous, I feel. A low interest loan that worst case scenario will be gone within 5 years and that I could pay of at any point by liquidating a taxable account hardly seems a high liability, or more condescendingly, a pet. I understand where you are coming from, and those in the staunch WCI/Dave Ramsey camps will probably never agree with what I'm doing, but I look at one of my coworkers as nuts for choosing to pay off a low interest house loan over beefing up retirement accounts, especially as he's not anywhere close to retirement. Different strokes, I guess. Those loans also don't limit me in the slightest from focusing on my income, so I'm right there with you.
Again, for the general public that is living paycheck to paycheck and can't save even an emergency fund, sure, I agree. But I'm not even on the fringes here, I'm well within normal territory if you look at any sort of typical investing advice. Many will advocate investing over paying off <4% loans any day of the week.
I'm with you. I don't go out of my looking for MORE low interest loans, but I had some student loans around 2% and was paying them slowly. Very slowly. And I rarely find reason to throw extra money at a mortgage that is around 3%. That said, as you mentioned, it is easier to be nonchalant about this if you have enough in various taxable accounts, Ibonds, and cash savings to be able to pay said debts off on short notice if somehow needed.
Mathematically it would be MORE advantageous for me to have chased MORE super low interest loans for leverage, but I do find that concerning on a psychological level I guess...
I think this all depends on your interest rate. I refinanced my loans when the Fed started raising rates. I gave up essentially a year of 0% interest for 10 years of 2.25%. The refinance rates I'm seeing now is at least a full percent higher.
Ultimately I view debt as a tool. The SP500 has an average return of 8-9%. I can buy T-Bonds/notes with 1 year to maturity with a yield to worst of 4-5%. Why would I pay down student loans quicker when I could instead put that money into financial instruments that will either likely return much better long term or guarenteed slightly better (even after taxes) return? Sure, the US Government could default on the bonds... but if they do then the outstanding student loan is going to be the least concerning thing we have to worry about.
I do agree that psychologically, I would feel a little better if I payed down my student loans or paid off my car loan (somewhere under 2% interest). However mathmatically these aren't the best long term.
I was so on the fence about refinancing, at one point I had a rate that with discounts would have been about 1.5% and I've been repeatedly kicking myself for not taking that when I had the chance, but this was before any loan forgiveness details were revealed. As it is I was happy to get under 3.5 last month because I had submitted my application before the last rate hike. Coulda shoulda woulda. May still get 20k forgiven so we'll see.
I'm kicking myself for only doing a 10 year plan.
I never bothered keeping tabs on PSLF because my residency and fellowship were both at for profit hospital systems. However even if I would have applied, I'd still need another 2 years to get there, which would mean leaving my current job. I guess the VA or the local university/county hospital self employees their ICU physicians.
Edit: Looking into the limited wavier further... it looks like if you had to have 120 qualifying payment opportunities by the October deadline to qualify. If you didn't meet it then, then the wavier doesn't carry forward.
Edit 2: Never mind, it didn't waive the employer aspect. It only waived needing to be employed by the government of a non-profit AT THE TIME OF APPLICATION. So I still would have had, at best, 12 months of qualifying employment (intern year, county hospital).
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Yeah I got into PLSF when Biden widened the payment structure (I actually had an extra year of payments with that change, though a bunch were $0 Covid payments so I didn't get a refund), but my wife didn't because she paid on time from around 2004-2007 (before 2007 doesn't count) then had enough part-time breaks in the past couple years it didn't hit 120 payments under those rules. Its enough of an uncertain game to be a little maddening, and hard to blame anyone for a choice they made 8-12 years ago under those rules...
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Back to the original topic, hot off the press response to the recent Cochrane review on masking:
Here’s Why the Science Is Clear That Masks Work
In which the computer programmer-turned-sociology professor-turned-overhyped columnist opines that, despite the clear paucity of evidence in their favor, masks were an important component of the public health response to the pandemic, yet somehow concludes that there is strong evidence in their favor, and thus committing the very same error of which she criticizes the Cochrane review. I understand that titles are typically written by editors and not authors, but it really should've been titled "The science is not clear at all that masks work, but it was a necessary and useful intervention anyway".
My hospital system just released their new masking policy this past week, it basically makes masking recommended for patients experiencing respiratory symptoms, optional for all other patients/visitors, and required for clinicians. I obviously come at this with a bias, but it seems like another small step in the subjugation of us into the servant class.
Here’s Why the Science Is Clear That Masks Work
In which the computer programmer-turned-sociology professor-turned-overhyped columnist opines that, despite the clear paucity of evidence in their favor, masks were an important component of the public health response to the pandemic, yet somehow concludes that there is strong evidence in their favor, and thus committing the very same error of which she criticizes the Cochrane review. I understand that titles are typically written by editors and not authors, but it really should've been titled "The science is not clear at all that masks work, but it was a necessary and useful intervention anyway".
My hospital system just released their new masking policy this past week, it basically makes masking recommended for patients experiencing respiratory symptoms, optional for all other patients/visitors, and required for clinicians. I obviously come at this with a bias, but it seems like another small step in the subjugation of us into the servant class.
My impression of the data--
a well-fit N95 is extremely protective for a lot of things.
Various other versions of masking are less protective, to the point of being pointless or performative in some cases.
As well, if you mask at work but everyone in public life goes to crowded events while ill and only ever wears masks in hospital, the "protective" effect to to wearer is going to be rather muted. Likely still offers protection to vulnerable patients.
Anyway, I have enjoyed getting URIs an order of magnitude less often while working more than pre-pandemic. My personal 3 years of data convinces me that masking (of some nature) in a crowded germ-tank of an ER makes a lot of sense for me.
I am curious how Joint Commission, which will regulate the font you use, the pen you use to obtain consent, time-out procedures, glove availability etc eventually feels about hospital masking... clearly I don't care about their opinion, but I am curious how it ends up (politically)... by which I mean it'll be interesting if they shrug their shoulders about masks but freak out about a bottle of spring water at the nurses station.
a well-fit N95 is extremely protective for a lot of things.
Various other versions of masking are less protective, to the point of being pointless or performative in some cases.
As well, if you mask at work but everyone in public life goes to crowded events while ill and only ever wears masks in hospital, the "protective" effect to to wearer is going to be rather muted. Likely still offers protection to vulnerable patients.
Anyway, I have enjoyed getting URIs an order of magnitude less often while working more than pre-pandemic. My personal 3 years of data convinces me that masking (of some nature) in a crowded germ-tank of an ER makes a lot of sense for me.
I am curious how Joint Commission, which will regulate the font you use, the pen you use to obtain consent, time-out procedures, glove availability etc eventually feels about hospital masking... clearly I don't care about their opinion, but I am curious how it ends up (politically)... by which I mean it'll be interesting if they shrug their shoulders about masks but freak out about a bottle of spring water at the nurses station.
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"The Joint Commission is not prescriptive where staff can have food or drink in work areas. The Joint Commission references OSHA's Bloodborne Pathogen Standard (1910.130) applies to occupational exposure to blood or other potentially infectious materials in healthcare settings. All organizations must follow this requirement. Standard LD.04.01.01 requires that health care organizations follow licensure requirements, laws, and regulations, including OSHA's Bloodborne Pathogens Standard. "
This is from the joint commission website (000001219)
I used to print out copies of this and tape them to the wall during our "dry run" days leading up to our JAHCO visits. Some of our clipboard nurses didn't like it. That said, anytime someone tells you that you can't have food/drink in the ED because it's a JAHCO violation, they're wrong and should be educated to that effect.
Now, if your workstation is routinely also used to store blood samples or otherwise do things that would trigger OSHA issues, you're still SOL. I highly doubt that to be the case though.
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Likewise. However, I think the JC only mandates that hospitals form policies that align w/ their standards, and then penalizes hospitals if they or staff do not adhere to their own standards. So it's up to the hospital.
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I wondered the same thing - I'm no longer required to wear a mask in the hospital. Does this mean I'll soon be relieved of rubbing a dab of alcohol on my hands before and after entering a room where I touch nothing?
Probably not.
"Many commentators have claimed that a recently-updated Cochrane Review shows that 'masks don't work', which is an inaccurate and misleading interpretation.
It would be accurate to say that the review examined whether interventions to promote mask wearing help to slow the spread of respiratory viruses, and that the results were inconclusive. Given the limitations in the primary evidence, the review is not able to address the question of whether mask-wearing itself reduces people's risk of contracting or spreading respiratory viruses. "
"For example, in the most heavily-weighted trial of interventions to promote community mask wearing, 42.3% of people in the intervention arm wore masks compared to 13.3% of those in the control arm."
TLDR: Don't read into the review too much other than we need more information.
It would be accurate to say that the review examined whether interventions to promote mask wearing help to slow the spread of respiratory viruses, and that the results were inconclusive. Given the limitations in the primary evidence, the review is not able to address the question of whether mask-wearing itself reduces people's risk of contracting or spreading respiratory viruses. "
"For example, in the most heavily-weighted trial of interventions to promote community mask wearing, 42.3% of people in the intervention arm wore masks compared to 13.3% of those in the control arm."
TLDR: Don't read into the review too much other than we need more information.
