What do I need to know about coronavirus?

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WilcoWorld said:
I agree that it is right and good to point out the proportionality of problems. We could save MANY more lives per dollar by addressing access to clean drinking water and malaria prevention worldwide than we will with remdesivir or HFNC. That is a calculation that should come into play when public health officials are setting budgets or when I'm deciding where to send charitable donations.

However, we need to avoid falling into a rhetorical trap that goes like this; There are OTHER problems out there that are BIGGER. If you care about people you should focus on helping the most people. Because you are not focusing on the biggest problem, you shouldn't bother working on your smaller problem. fin

This argument leads to nihilism. I know that no matter what I do or how hard I work, when I die there will be problems that are yet to be fixed. I don't see that as a reason to try to make the world a better place while I'm alive.

So, yeah - I agree with you and General Veers that year over year worldwide TB and malaria are huge problems. I agree with you that we can and should do a better job of addressing them (especially if we accept Globalist economic policy, but that's a different convo). Furthermore, the fact that the US media and public are so ignorant of these problems is evidence of our self-centeredness, an aspect of our culture that is at the root of many of our problems today. But I disagree with claims that because TB is a bigger killer than covid we should therefore not worry about covid.
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Agreed 100%. That is why I am not changing my stance on Mask wearing. And hopeful that it will also lead to less TB.

We are very self centered in our views for sure. Focus only what’s most affecting this country and egocentrically try to make it the world focus.

Subsaharan deaths from Covid are still very low and they went on lockdowns too for Covid just like the West. Instead of continuing to focus more so on the TB and Malaria. Which probably doesn’t even get that much focus as it’s just part of life in those countries.

Clearly modeling after the west is the way to go. Very sad.
 
chocomorsel said:
You are a doctor who really believes the stuff you type about this?
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Ah, that familiar old refrain: You can't possibly be a doctor and believe X!

The reality is that there are lots of doctors who question the efficacy of lockdowns and masks, especially cloth masks and reused surgical masks that are not worn or cared for properly by the general public as well as question the rationale and ethics of mandating universal masking in public for a widespread highly infectious respiratory virus. Attempts to make cases go to zero and stay at zero have failed everywhere. It's fairly obivous that the virus cannot be eradicated by simply keeping everyone in their houses or making them wear masks in public. Sure, lock everyone down for 180 days. What happens on day 181? A single case starts it all over again. The solution is what, exactly? Keep masks on everyone at all times regardless if it makes any sense until the end of time? Make everyone work from home and do online school forever? At what point do we admit that this pandemic is now endemic and we are going to have to live with this new disease?

Years from now, I feel that physicians will look back and be ashamed by their hair-on-fire politically motivated acceptances of lockdowns and mask mandates and attempts to shut down debate as to what we are trying to accomplish, potential harms of such policies, or review of evidence that they may not actually be that effective. To speak against the narrative is anathema, and that is where this "You can't possibly be a doctor and believe X" attitude comes from. Lots of doctors think the mask hysteria has gotten out of control and that the collateral consequences of lockdowns may be worse than COVID, but they aren't posting about it vocally on social media because doing so risks having the mob come after them. Other doctors are just conservatives and believe in personal responsibility and prudence when it comes to risk vs. reward decision making. Perhaps if you have a double lung transplant, then choosing to go to a crowded bar is not a good decision. Perhaps making everyone wear random facial coverings (that they can remove as soon as they sit down) confers a false sense of security to the truly vulnerable and is causing more harm than good.

Seen on social media the other day: COVID is like eating raw cookie dough. We know the risks, now let us live our lives!
That about sums it up IMO.
 
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KHE88 said:
Seen on social media the other day: COVID is like eating raw cookie dough. We know the risks, now let us live our lives!
That about sums it up IMO.
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You do, but do they? Part of our training and practice every day IS to explain benefits, risks and alternatives. On top of that, public risk mitigation and management.

How many of the icu patients family understood doing “everything” to their loved ones? We preach patient autonomy every day, how many times we try to talk them out of something because they don’t get “it”.

I am not agreeing/disagreeing with you. I live in the NE, where everyone went crazy. I had the opportunity to travel outside of the region recently, about 6 hours away and not around the coast. The “feeling” of the community is certainly very different, so I do think there should be policy differences in different regions/areas. However, at the same time, just wear the mask. Even if it only cuts transmission 1%, why not just do it? Because it really really affecting your personally liberty? I don’t get it.
 
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IMGASMD said:
You do, but do they? Part of our training and practice every day IS to explain benefits, risks and alternatives. On top of that, public risk mitigation and management.

How many of the icu patients family understood doing “everything” to their loved ones? We preach patient autonomy every day, how many times we try to talk them out of something because they don’t get “it”.

I am not agreeing/disagreeing with you. I live in the NE, where everyone went crazy. I had the opportunity to travel outside of the region recently, about 6 hours away and not around the coast. The “feeling” of the community is certainly very different, so I do think there should be policy differences in different regions/areas. However, at the same time, just wear the mask. Even if it only cuts transmission 1%, why not just do it? Because it really really affecting your personally liberty? I don’t get it.
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Sure. A necessary part of that is understanding what the risk is (both for the public and physicians), and this is something that has been intentionally obfuscated. Perhaps the most important data point is what the risk of death from COVID is by age and pre-existing condition. This data is very difficult to find, and I have to believe that is intentional. Some fierce Googling will eventually produce a French site, which is the best I've seen so far: Demographics of COVID-19 Deaths - Data & metadata

Instead, searching the internet provides you with in-your-face see-we-told-you-so anecdotal accounts along the lines of "9 year old perfectly healthy boy dies from COVID." In a country of 350 million people, a one in a million chance is naturally going to produce some anecdotal accounts. Most people with a high school education can understand what a 1 in 10,000 risk of death if you are infected means and make necessary risk vs. reward choices as to how to go about their daily lives based off of that. But the general public is having a hard time getting to that data and are just seeing CNN's death count on their TV 24/7.

The argument about "just wearing the mask" even if only helps a little isn't quite that clear cut. It's a slippery slope, and furthermore, where does it end? Why haven't we been doing it all along for other respiratory illnesses? We know we can't eradicate the flu virus from the planet permanently as there will always be a reservoir but maybe we can prevent infections such that an 80 year old doesn't get it and die this year but instead gets it and dies next year. Should we wear masks and ban crowds forever because they might help a little? Or maybe we should explore this a little further in regards to the impact it has on human interaction in a free society especially when it comes to young people going through school and trying to start their careers. There are multiple other points worth discussing notably the vastly differing efficacy of certain types of masks and how the public wears and cares for them. Saying "just wear the mask" is saying "don't ask questions and do as you're told." At the grocery store yesterday, I saw a sign that said "Mask UP to shut DOWN covid" Shut it down? That sign is implying we can eradicate the virus by wearing a mask in the grocery store. There is no evidence at all to support the notion that that is possible. Nobody wants to think critically about this issue because of the power of the visible symbol of the mask.

And I should add as a disclaimer, although I have no idea why in the world why I should need to do this (but apparently I do), that these are MY opinions and do not represent that of SDN.
 
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KHE88 said:
Ah, that familiar old refrain: You can't possibly be a doctor and believe X!

The reality is that there are lots of doctors who question the efficacy of lockdowns and masks, especially cloth masks and reused surgical masks that are not worn or cared for properly by the general public as well as question the rationale and ethics of mandating universal masking in public for a widespread highly infectious respiratory virus. Attempts to make cases go to zero and stay at zero have failed everywhere. It's fairly obivous that the virus cannot be eradicated by simply keeping everyone in their houses or making them wear masks in public. Sure, lock everyone down for 180 days. What happens on day 181? A single case starts it all over again. The solution is what, exactly? Keep masks on everyone at all times regardless if it makes any sense until the end of time? Make everyone work from home and do online school forever? At what point do we admit that this pandemic is now endemic and we are going to have to live with this new disease?

Years from now, I feel that physicians will look back and be ashamed by their hair-on-fire politically motivated acceptances of lockdowns and mask mandates and attempts to shut down debate as to what we are trying to accomplish, potential harms of such policies, or review of evidence that they may not actually be that effective. To speak against the narrative is anathema, and that is where this "You can't possibly be a doctor and believe X" attitude comes from. Lots of doctors think the mask hysteria has gotten out of control and that the collateral consequences of lockdowns may be worse than COVID, but they aren't posting about it vocally on social media because doing so risks having the mob come after them. Other doctors are just conservatives and believe in personal responsibility and prudence when it comes to risk vs. reward decision making. Perhaps if you have a double lung transplant, then choosing to go to a crowded bar is not a good decision. Perhaps making everyone wear random facial coverings (that they can remove as soon as they sit down) confers a false sense of security to the truly vulnerable and is causing more harm than good.

Seen on social media the other day: COVID is like eating raw cookie dough. We know the risks, now let us live our lives!
That about sums it up IMO.
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The research for the mask is there. And why are people making such a big deal about wearing masks?
No, I don’t understand how any physician would be opposed to mask wearing to decrease risk of transmission.
 
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KHE88

You've put a lot of time into expressing the questions I have as well. Whenever I ask these questions, I get accused of wanting to kill old people.

I think liberty is more important than life, and it's important to question actions made by politicians who are addicted to power. It's always slippery slope from liberty to tyranny. We have to be always vigilant. Yes, mask-wearing and lockdowns do infringe our civil liberties, and can lead to more egregious actions by those in charge.
 
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chocomorsel said:
The research for the mask is there. And why are people making such a big deal about wearing masks?
No, I don’t understand how any physician would be opposed to mask wearing to decrease risk of transmission.
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It's actually not. No one takes an actively infected covid patient, and has them breathe on uninfected with different types of masks to see which ones get infected.

Also the theoretical "asymptomatic superspreader" is a myth that has yet to be verified. Asymptomatic spread is the justification for universal mask-wearing, otherwise we'd just use the reasonable step of telling people with symptoms, and people at risk to wear them.
 
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Usually I hate CNN but they had an interesting story about droplets and masks. Seems the surgical masks to a lot better than "bandanas" at controlling droplets. The caveat is that they are using water mixed with glycerine droplets. Although it might block droplets, it doesn't tell us anything about blocking airborne viral spread, which is the justification for universal masking.

 
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GeneralVeers said:
It's actually not. No one takes an actively infected covid patient, and has them breathe on uninfected with different types of masks to see which ones get infected.

Also the theoretical "asymptomatic superspreader" is a myth that has yet to be verified. Asymptomatic spread is the justification for universal mask-wearing, otherwise we'd just use the reasonable step of telling people with symptoms, and people at risk to wear them.
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There was actually a recent study comparing the different types of masks and their efficacy in trapping droplets.
See above.
 
chocomorsel said:
The research for the mask is there. And why are people making such a big deal about wearing masks?
No, I don’t understand how any physician would be opposed to mask wearing to decrease risk of transmission.
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The research is actually not there. High level evidence that masks lower death rates would (as an example) be a prospective study of large comparable groups (large numbers are needed with such low death rates) where one group is universally masked and one is not. Instead, what we have is some data that shows that masks lower droplet production, which should not be surprising. Of course this is a novel virus, but we can look at states like California where mask mandates and lockdowns have been more intense than other parts of the country and note that their numbers have been poor. In fact, up until a few months ago, it was thought that widespread masking really wasn't effective, and I posted data and a number of studies supporting this idea before, which was not well-received, so I will not do it again. Yet, it suddenly became "settled science" (a term that should always raise eyebrows) and asking questions was verboten.

And I have already explained why wearing masks might be a bigger deal that some think and how physicians might be opposed to mask mandates (I'm not opposed to voluntairly mask wearing, but I am opposed to government issued mandates towards individuals and businesses without very good evidence that not doing so would result in apocalyptic level results, such as a death rate of 10+%). When all this started, I was actually very concerned because early data seemed to indicate that the death rate could be as high as 3-4%. I was very worried and tried to raise my concerns to my employer and was shut down. Ironically, now we know the death rate is much lower than this, likely much much lower and largely harmless to immunocompetent people, yet this new understanding is not widely discussed and now my employer is forcing me to wear a mask to walk to the bathroom by myself. This reactionary approach is a problem.

But I digress... Let me ask you a couple of pointed questions.

Suppose I accept your premise that masks meaningfully decrease the risk of transmission of covid.
At what point do you personally feel it would be appropriate for people to no longer have to wear masks in public and resume normal social acitivies including attending church, concerts, traveling in groups/crowds, etc.? Would this only be appropriate if the virus were completely eradicated? Or would you be more comfortable if there were a certain prevelance limit? What is that limit? If the virus becomes endemic and remains widespread like the seasonal flu, do you think it is acceptable that we continue to wear masks and socially distance for the rest of our lives?

I ask because we still seem to be living with this mindset of "when we all get through this together" as the local car dealership was advertising on the radio months ago. In my opinion, this has become magical thinking and we need to move on from anger (it's China's fault!), denial (it will go away when summer hits), depression (liquor stores are an essential business), and bargaining (we'll be ok if we wear masks from the hostess stand to our table and leave a seat open on airplanes) to acceptance.
 
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KHE88 said:
Suppose I accept your premise that masks meaningfully decrease the risk of transmission of covid.
At what point do you personally feel it would be appropriate for people to no longer have to wear masks in public and resume normal social acitivies including attending church, concerts, traveling in groups/crowds, etc.? Would this only be appropriate if the virus were completely eradicated? Or would you be more comfortable if there were a certain prevelance limit? What is that limit? If the virus becomes endemic and remains widespread like the seasonal flu, do you think it is acceptable that we continue to wear masks and socially distance for the rest of our lives?

I ask because we still seem to be living with this mindset of "when we all get through this together" as the local car dealership was advertising on the radio months ago. In my opinion, this has become magical thinking and we need to move on from anger (it's China's fault!), denial (it will go away when summer hits), depression (liquor stores are an essential business), and bargaining (we'll be ok if we wear masks from the hostess stand to our table and leave a seat open on airplanes) to acceptance.
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I'll give this a shot.

First, if the flu shot wasn't a thing you bet your ass I'd wear a mask during flu season. So as soon as we get even a halfway decent COVID vaccine, I'd be OK with making masks optional.

Second, we have increasing evidence suggesting that the reason some people don't get all that sick is some pre-existing coronavirus immunity. Its looking like they're the ones that get this as a bad cold. So if enough people get this, it then just becomes another bad cold coronavirus. So either of those things will work. Its not herd immunity in the traditional sense, but its almost a weakening of the virus.
 
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KHE88 said:
The research is actually not there. High level evidence that masks lower death rates would (as an example) be a prospective study of large comparable groups (large numbers are needed with such low death rates) where one group is universally masked and one is not. Instead, what we have is some data that shows that masks lower droplet production, which should not be surprising. Of course this is a novel virus, but we can look at states like California where mask mandates and lockdowns have been more intense than other parts of the country and note that their numbers have been poor. In fact, up until a few months ago, it was thought that widespread masking really wasn't effective, and I posted data and a number of studies supporting this idea before, which was not well-received, so I will not do it again. Yet, it suddenly became "settled science" (a term that should always raise eyebrows) and asking questions was verboten.

And I have already explained why wearing masks might be a bigger deal that some think and how physicians might be opposed to mask mandates (I'm not opposed to voluntairly mask wearing, but I am opposed to government issued mandates towards individuals and businesses without very good evidence that not doing so would result in apocalyptic level results, such as a death rate of 10+%). When all this started, I was actually very concerned because early data seemed to indicate that the death rate could be as high as 3-4%. I was very worried and tried to raise my concerns to my employer and was shut down. Ironically, now we know the death rate is much lower than this, likely much much lower and largely harmless to immunocompetent people, yet this new understanding is not widely discussed and now my employer is forcing me to wear a mask to walk to the bathroom by myself. This reactionary approach is a problem.

But I digress... Let me ask you a couple of pointed questions.

Suppose I accept your premise that masks meaningfully decrease the risk of transmission of covid.
At what point do you personally feel it would be appropriate for people to no longer have to wear masks in public and resume normal social acitivies including attending church, concerts, traveling in groups/crowds, etc.? Would this only be appropriate if the virus were completely eradicated? Or would you be more comfortable if there were a certain prevelance limit? What is that limit? If the virus becomes endemic and remains widespread like the seasonal flu, do you think it is acceptable that we continue to wear masks and socially distance for the rest of our lives?

I ask because we still seem to be living with this mindset of "when we all get through this together" as the local car dealership was advertising on the radio months ago. In my opinion, this has become magical thinking and we need to move on from anger (it's China's fault!), denial (it will go away when summer hits), depression (liquor stores are an essential business), and bargaining (we'll be ok if we wear masks from the hostess stand to our table and leave a seat open on airplanes) to acceptance.
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Exactly what @VA Hopeful Dr said.
 
VA Hopeful Dr said:
I'll give this a shot.

First, if the flu shot wasn't a thing you bet your ass I'd wear a mask during flu season. So as soon as we get even a halfway decent COVID vaccine, I'd be OK with making masks optional.

Second, we have increasing evidence suggesting that the reason some people don't get all that sick is some pre-existing coronavirus immunity. Its looking like they're the ones that get this as a bad cold. So if enough people get this, it then just becomes another bad cold coronavirus. So either of those things will work. Its not herd immunity in the traditional sense, but its almost a weakening of the virus.
Click to expand...

I appreciate you giving it a shot. It's hard to identify what prevalence limit is ok, but numbers and data matter because decisions of public policy always involved figuring out exactly what limit is ok (e.g., what speed limit is ok/what level of traffic deaths are we wiiling to tolerate to allow people to get where they need to go).

It appears that you are ok with government issued mask mandates as long as there is not a vaccine. How good is halfway decent? 40% effectiveness or so like the flu? What if there is never an effective vaccine? If you are otherwise healthy, I'm surprised you would wear a mask during flu season. I don't get the flu vaccine (for reasons I will not get in to, but I have a valid and always accepted exmption) and I do not wear a mask. I had the flu once in the past 10 years. It wasn't great but it was over in 4 days and I certainly stayed away from people at home and got Tamiflu as soon as I became sypmtomatic. But I never had the thought to wear a mask in public. Maybe I'm nuts. I think the flu vaccine is a good idea for many people, and I think people, especially healthcare workers should stay at home if they have ILI. However, I think we give a lot of credence to the flu vaccine, which lets face it, isn't that great.

With regards to your latter point, it sounds like you are saying that you'd be fine going back to the pre-covid normal if enough people got this at covid-19 became the "cold type 2" or something. I agree with you in this regard given that immunity to covid seems to be fairly robust. When a young healthy peson gets covid and recovers, that's one less person who can get it in the future. That's not necessarily a bad thing. Maybe a good thing even. Wouldn't keeping people in masks and locked down be counter-productive to this goal? Wouldn't it make more sense to protect the vulnerable and let the young and healthy live their lives, get the cold type 2, and develop immunity? Food for thought.
 
KHE88 said:
I appreciate you giving it a shot. It's hard to identify what prevalence limit is ok, but numbers and data matter because decisions of public policy always involved figuring out exactly what limit is ok (e.g., what speed limit is ok/what level of traffic deaths are we wiiling to tolerate to allow people to get where they need to go).

It appears that you are ok with government issued mask mandates as long as there is not a vaccine. How good is halfway decent? 40% effectiveness or so like the flu? What if there is never an effective vaccine? If you are otherwise healthy, I'm surprised you would wear a mask during flu season. I don't get the flu vaccine (for reasons I will not get in to, but I have a valid and always accepted exmption) and I do not wear a mask. I had the flu once in the past 10 years. It wasn't great but it was over in 4 days and I certainly stayed away from people at home and got Tamiflu as soon as I became sypmtomatic. But I never had the thought to wear a mask in public. Maybe I'm nuts. I think the flu vaccine is a good idea for many people, and I think people, especially healthcare workers should stay at home if they have ILI. However, I think we give a lot of credence to the flu vaccine, which lets face it, isn't that great.

With regards to your latter point, it sounds like you are saying that you'd be fine going back to the pre-covid normal if enough people got this at covid-19 became the "cold type 2" or something. I agree with you in this regard given that immunity to covid seems to be fairly robust. When a young healthy peson gets covid and recovers, that's one less person who can get it in the future. That's not necessarily a bad thing. Maybe a good thing even. Wouldn't keeping people in masks and locked down be counter-productive to this goal? Wouldn't it make more sense to protect the vulnerable and let the young and healthy live their lives, get the cold type 2, and develop immunity? Food for thought.
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First, the flu vaccine even in bad years has pretty good mortality benefits. New CDC Study Shows Flu Vaccine Reduces Severe Outcomes in Hospitalized Patients | CDC

Second, pretty sure masks have better data than Tamiflu outside of the ICU. Tamiflu and Relenza: getting the full evidence picture
 
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Pretty obvious at this point that the rona is running out of new people to infect per new case counts decreasing in the places making headlines a month ago (Texas, Florida). It wasn’t the masking and social distancing. We’ll reach herd immunity long before a vaccine is rolled out. Meanwhile, we’ll continue to have stupid masking/distancing mandates through December by my estimation because it “saves lives”, all the while people continue to rebel against authority with unmasked illicit freedom parties.

We’ve likely undercounted cases by a factor of 10x or more if antibody and T cell assays were conducted on the entire population.
 
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VA Hopeful Dr said:
First, the flu vaccine even in bad years has pretty good mortality benefits. New CDC Study Shows Flu Vaccine Reduces Severe Outcomes in Hospitalized Patients | CDC

Second, pretty sure masks have better data than Tamiflu outside of the ICU. Tamiflu and Relenza: getting the full evidence picture
Click to expand...

Sure, the flu vaccination is known to make the illness less severe. It's not great in that lots of older people who are getting the flu vaccine are still ending up hospitalized and dying. I would call that a "not so great" vaccine (as compared to something like Hep B), but that's certainly subjective.

In regards to your second point, the link you posted doesn't seem to support your claim regarding masks vs. Tamiflu. I don't know how you got that "masks are worse than Tamiflu outside of the ICU" from what I posted. Regardless, you might want to read the CDC guidelines on this topic, specifically the admission that there isn't data to support a recommendation for widespread community mask use by asymptomatic persons including those at high risk for complications and that antivirals are a "useful adjunct" in the community: Interim Guidance for the Use of Masks to Control Seasonal Influenza Virus Transmission | CDC

Although I wouldn't be super surprised if those guidelines magically change in the coming months without any new data to drive that change.
 
KHE88 said:
Sure, the flu vaccination is known to make the illness less severe. It's not great in that lots of older people who are getting the flu vaccine are still ending up hospitalized and dying. I would call that a "not so great" vaccine (as compared to something like Hep B), but that's certainly subjective.

In regards to your second point, the link you posted doesn't seem to support your claim regarding masks vs. Tamiflu. I don't know how you got that "masks are worse than Tamiflu outside of the ICU" from what I posted. Regardless, you might want to read the CDC guidelines on this topic, specifically the admission that there isn't data to support a recommendation for widespread community mask use by asymptomatic persons including those at high risk for complications and that antivirals are a "useful adjunct" in the community: Interim Guidance for the Use of Masks to Control Seasonal Influenza Virus Transmission | CDC

Although I wouldn't be super surprised if those guidelines magically change in the coming months without any new data to drive that change.
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No vaccine is great in the elderly.

The Tamiflu thing wasn't to tout masks it was to say that Tamiflu is almost entirely worthless as a response to saying you don't worry about the flu since Tamiflu is an option.
 
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VA Hopeful Dr said:
No vaccine is great in the elderly.

The Tamiflu thing wasn't to tout masks it was to say that Tamiflu is almost entirely worthless as a response to saying you don't worry about the flu since Tamiflu is an option.
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The flu vaccine doesn't work great to prevent infections in the young and healthy either. Regardless, what constitutes a great vaccine is a matter of opinion, and you are clearly a huge fan of the flu vaccine, and that's fine.

I did not say that I don't worry about the flu because I've got Tamiflu in my back pocket. I didn't say anything even close to that. I am noticing a theme here with picking and choosing what to respond to here and misrepresenting it to try and catch me in a "gotcha!"

I do find it funny that the CDC admits there is not enough evidence to support even a recommendation (let alone a mandate) for asymptomatic people to wear masks in the community to prevent the flu, but that the media and others touts the recommendation for community masking to prevent the coronavirus (a brand new virus) as a settled question and not open for debate. Funny, for sure.
 
First, I find it absolutely hilarious how the mods are only asking the pro-mask side to tone down the politics, while ignoring the anti-mask crowd making statements that assume that everyone who supports masks must be doing so to take a swipe at Trump.

KHE88 said:
Years from now, I feel that physicians will look back and be ashamed by their hair-on-fire politically motivated acceptances of lockdowns and mask mandates and attempts to shut down debate as to what we are trying to accomplish, potential harms of such policies, or review of evidence that they may not actually be that effective.
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What's it like to assume that anyone who disagrees with you is doing so for political motives?

If I suggest that injecting disinfectants would be bad, is that political?

How about advising against ingesting poisonous plants, such as oleander?

If I really wanted to dunk on Trump, wouldn't I suggest things that would increase the death count... like ingesting poisonous plants?
 
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GeneralVeers said:
It's actually not. No one takes an actively infected covid patient, and has them breathe on uninfected with different types of masks to see which ones get infected.
Click to expand...

I mean... sure... and there's no actual attempts at studying the effectiveness of parachutes (Smith, Pell. BMJ, 2003)

So I guess the best we can do is...
" There was a significant decline in daily COVID-19 growth rate after the mandating of face covers in public, with the effect increasing over time after the orders were signed. Specifically, the daily case rate declined by 0.9, 1.1, 1.4, 1.7, and 2.0 percentage points within 1–5, 6–10, 11–15, 16–20, and 21 or more days after signing, respectively. All of these declines were statistically significant (p<0.05 or less). In contrast, the pre-event trends in COVID-19 case growth rates were small and statistically insignificant. "
 
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Siggy said:
First, I find it absolutely hilarious how the mods are only asking the pro-mask side to tone down the politics, while ignoring the anti-mask crowd making statements that assume that everyone who supports masks must be doing so to take a swipe at Trump.
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If you're talking about me, you've clearly again missed the point. I was actually responding to a different message. I think that any physician, on any "side" of this discussion that's injecting politics into this public health disaster is an an embarrassment to the profession.

That's not going to stop anybody of course. So carry on all.
 
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Siggy said:
First, I find it absolutely hilarious how the mods are only asking the pro-mask side to tone down the politics, while ignoring the anti-mask crowd making statements that assume that everyone who supports masks must be doing so to take a swipe at Trump.



What's it like to assume that anyone who disagrees with you is doing so for political motives?

If I suggest that injecting disinfectants would be bad, is that political?

How about advising against ingesting poisonous plants, such as oleander?

If I really wanted to dunk on Trump, wouldn't I suggest things that would increase the death count... like ingesting poisonous plants?
Click to expand...

Amen.
If trump would've gotten on board with mask wearing when it became accepted in this country I sure as hell would still be wearing a mask even though I hate the guy lol. It really has nothing to do with politics.
My parents live in a very red area (I just looked it up and 60% of their county voted for trump in 2016), but thankfully they're reporting that everyone is wearing masks in stores, their groups of friends are being careful, indoor dining is still closed, etc.

There is a middle ground between shutting down society to everything (which I don't think anyone in this thread is advocating for) and having everything open like normal with no masks or precautions at all and calling covid a hoax.

I think as physicians we should be for those measures that can potentially help protect especially the vulnerable. It's a novel virus so of course we don't have all the answers. And if in 5 years we find out masks do nothing, I will have no regrets for wearing one for now while we're still figuring things out and will admit that the information we have now is incorrect.

So sure maybe in an ideal world the vulnerable could be shut off to society and not have to leave their house ever, but that's not how it works. People have to work to survive, go to medical appointments, etc. It's a novel virus so we're going to continue to buy time until our immune systems adapt, there's a vaccine, there's better understanding about the virus and there are better treatment options.
 
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gutonc said:
If you're talking about me, you've clearly again missed the point. I was actually responding to a different message. I think that any physician, on any "side" of this discussion that's injecting politics into this public health disaster is an an embarrassment to the profession.

That's not going to stop anybody of course. So carry on all.
Click to expand...


Well, if I had to pick a specific post, I'd say it was this one. However if the shoe fits...
 
Siggy said:
First, I find it absolutely hilarious how the mods are only asking the pro-mask side to tone down the politics, while ignoring the anti-mask crowd making statements that assume that everyone who supports masks must be doing so to take a swipe at Trump.



What's it like to assume that anyone who disagrees with you is doing so for political motives?

If I suggest that injecting disinfectants would be bad, is that political?

How about advising against ingesting poisonous plants, such as oleander?

If I really wanted to dunk on Trump, wouldn't I suggest things that would increase the death count... like ingesting poisonous plants?
Click to expand...
Siggy said:
I mean... sure... and there's no actual attempts at studying the effectiveness of parachutes (Smith, Pell. BMJ, 2003)

So I guess the best we can do is...
" There was a significant decline in daily COVID-19 growth rate after the mandating of face covers in public, with the effect increasing over time after the orders were signed. Specifically, the daily case rate declined by 0.9, 1.1, 1.4, 1.7, and 2.0 percentage points within 1–5, 6–10, 11–15, 16–20, and 21 or more days after signing, respectively. All of these declines were statistically significant (p<0.05 or less). In contrast, the pre-event trends in COVID-19 case growth rates were small and statistically insignificant. "
Click to expand...

Ummmm... wow you're really all over the place here. Briefly...

(1) You quoted my post then brought up the president out of nowhere (I did not) and then offered up a number of strawmen and wild assumptions. I don't really have an interest in defending tangentially-related stupid stream-of-consciousness soundbites from a president who likes to run his mouth off teleprompter about nonsense as it's not really pertinent to anything I wrote. I will however note that when you are talking about government-issued mandates that this is political by nature as it involves the government compelling you to do something. With regards to the federal government (since you brought up the president), this isn't even a point of debate. The federal government does not have the constitutional authority to mandate mask wearing in public on the national level and such a mandate would not plausbily fall anywhere close to being under something that which could be issued by executive order. Hard stop. No debate. This is called federalism and is outlined in the constitution (and rightly so), and even if the federal government had the legal authority to issue such a mandate over state and local objections, it would be virtually impossible to enforce this on a national level with federal troops.

(2) With regards to the mods, I received a slap on the wrist for doing exactly the opposite as what you suggest (suggesting that there is a dearth of quality data supporting widespread masking of asymptomatic people and providing a number of links suggesting masks may not be effective in preventing transmission and/or deaths). I was accused of peddling conspiracy theories and now feel compelled to clarify that everything I post is my opinion only. Fine, but if you read the "updated member agreement" you can tell very clearly where the site admin stands on the mask debate (it's not up for debate, masks save lives. Period).

(3) With regards to the parachute study analogy... the death rate from intentionally unopened parachutes is 100%. The death rate from COVID-19 among younger healthy people minding their own regular business breathing air without cloth in front of their face is at most 0.1-0.2% from current available data (see INED link I posted above for data). Given large numbers of untested asymptomatic or mildly people who have recovered, the true death rate is likely an order magnitude or more less than this. I cannot grant the premise to respond to a comparison that invokes a hypothetical study with an anticipated 100% death rate in one arm to one that potentially shows around a 0.01-0.1% death rate in potentially both arms.

With regards to masks slowing the growth rate, that's all well and good if they meaningfully prevent infections for a very long period of time. If masking everyone lowers the odds that someone gets it from a trip to Kroger from 1:50 trips to 1:55 trips, then all you've done is saved them 5 trips to the store of being COVID-free. The idea that you can "mask UP to shut DOWN covid" is based in a false premise unless commonly used masks and masking methods in the community somehow prevent infection indefinitely for a highly contagious respiratory virus. I am not aware of any data that they do and would love to see that presented. Remember, the original goal of intervention was to flatten the curve. That was achieved. We have somehow devolved into this fantasy where the goal is now to stave off deaths from COVID indefinitely until a vaccine/cure is produced if we only do X, Y, and/or Z.

Cheers.
 
Speaking, of data... from the CDC, 25% of young adults seriously contemplated suicide in June.

25%.

www.cdc.gov

Mental Health, Substance Use, and Suicidal Ideation During the ...

This report describes mental health challenges faced by communities during the COVID-19 pandemic.
www.cdc.gov www.cdc.gov

Even if all of that excess was purely due to fear over contracting the virus and not due to secondary effects from lockdowns and restrictions on social interactions, increased substance use, loss of employment, and stunted career/family development, is such a high rate of suicide contemplation really commensurate with a disease with a death rate around 0.1% at most for that age cohort?

I go back to what I said about everyone being embarrassed years down the road about their about their hair-on-fire reactions to this whole mess, and I think in the coming months we are going to see the pendulum swing back the other way. Except on airplanes. I have a suspicion masks will remain on airplanes forever despite evidence that the actual risk is lower than the perceived risk due to air circulation and filtration and the fact that this crisis has highlighted that the TSA is just more not-very-effective security theater implemented to get us all flying again and not worrying after 9/11 (Funny that when passenger volume goes way down and TSA has more time, they can find dramatically more guns in luggage)
 
gutonc said:
If you're talking about me, you've clearly again missed the point. I was actually responding to a different message. I think that any physician, on any "side" of this discussion that's injecting politics into this public health disaster is an an embarrassment to the profession.

That's not going to stop anybody of course. So carry on all.
Click to expand...

Politics is always involved in any issue this big, with this much money and power at stake. Literally trillions of dollars are being printed and being handed out like candy. It's also been a handy entry into discussing policy goals like "universal basic income".

You can't say politics aren't involved, when there's a clear difference in how R and D states instituted lockdowns as well as reopenings, not to mention school openings.
 
KHE88 said:
The flu vaccine doesn't work great to prevent infections in the young and healthy either. Regardless, what constitutes a great vaccine is a matter of opinion, and you are clearly a huge fan of the flu vaccine, and that's fine.

I did not say that I don't worry about the flu because I've got Tamiflu in my back pocket. I didn't say anything even close to that. I am noticing a theme here with picking and choosing what to respond to here and misrepresenting it to try and catch me in a "gotcha!"

I do find it funny that the CDC admits there is not enough evidence to support even a recommendation (let alone a mandate) for asymptomatic people to wear masks in the community to prevent the flu, but that the media and others touts the recommendation for community masking to prevent the coronavirus (a brand new virus) as a settled question and not open for debate. Funny, for sure.
Click to expand...
Yeah I'm just being snarky about Tamiflu. I just truly hate the stuff. And the flu vaccine isn't great by any means, but the risk of death/hospitalization from flu if you're vaccinated is significantly lower than if you're not. For me personally, that's all I want from a COVID vaccine and all of this new T-cell work coming out suggests that's a real possibility. Don't get me wrong, if we manage to produce a COVID vaccine that reliably prevents infection in the first place I'd be thrilled. But if we end up with flu vaccine 2.0, I'll be satisfied.

The data behind masks is certainly quite weak, no argument there at all. The problem is, we won't ever get great evidence for the reason Veers mentions. What we do have is lots of different ways of looking at it that all support the idea that masks significantly reduced transmission (the MIT droplet study, all of the high risk times that didn't result in transmission because everyone was wearing a mask, mask mandates reducing new cases pretty rapidly, and so on). You compare that with the essentially zero risk of harm to wearing a mask and the risk/benefit math clearly benefits wearing them.

If you're against mask mandates for a political reason (government overreach), I can respect that. I think you're wrong (public nudity laws?), but that has nothing to do with medicine or science and so as doctors our thoughts from that perspective are no more valuable than anyone elses.

But the "we don't have good data on masks so we shouldn't wear/require them" viewpoint is more our area so what we say here matters. What data we do have (admittedly weak), says they help. Outside of select patients (chronic lung and severe psych mainly), there is basically zero risk so for us to be actively against masks from a science perspective seems like a very bad thing to me.

From my PCP perspective it's kind of like the idea that elderberry syrup reduces severity of cold/flu infections. The evidence for it is fairly weak, but I've never seen or heard of an adverse reaction to the stuff so I will often recommend it either in addition to accept medical treatment or if there is no medical treatment indicated.

Edit: As an aside, I do appreciate that we've managed to keep this very civil. That seems to be more and more uncommon in today's climate.
 
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gutonc said:
I think that any physician, on any "side" of this discussion that's injecting politics into this public health disaster is an an embarrassment to the profession.
Click to expand...
Whether you you think it "embarrassing" or not, politics affects everything we do in Medicine, including a great majority of what physicians claim reduce their job satisfaction. HIPAA, EMTALA, ACA, CARES, insurance interference, Joint Commision, DEA policy, what drugs we can prescribe, socialized medicine, whether doctors can strike or not, whether hospitals can hoard profits or not, EHRs, "pay for performance," all enter our world via politics.

COVID-19 is no different. Lockdowns, whether masks are mandated or not, whether your hours were cut during the pandemic and your income dropped or not, whether family members lost jobs, your kids can go to school or not, how quickly we'll get a vaccine, what research is funded and published, who wins elections, all affect physicians and our patients, including our work and personal lives, via politics.

Having an attitude that "Medicine is separate from politics" is at best naive or ignorant, negligent at worst. In my opinion, having a strong opinion on these matters is not an "embarrassment to the profession," it's our responsibility. What's an embarrassment, is not having an opinion on these matters. Even more embarrassing, is not knowing these Medical issues and their consequences, are inexorably intertwined with politics whether we like it or not.
 
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Do I think:
Government should have availability to mandate masks, (no, not with current data probably not ever)
Businesses can mandate masks, yes all day every day
masks work (perhaps, data is not the best but it is all we have a this point)

Will I wear a mask, yes. I look at it from many different angles but explain it to my patients as: I see it as opening a door for someone else. Do I really have to? no. Does it help? possibly. Does it hurt? probably not. I don't mind being a gentle/man/woman/person. If data goes another way I will change my mind, but for now I consider it a courtesy.
 
yeasports said:
Do I think:
Government should have availability to mandate masks, (no, not with current data probably not ever)
Businesses can mandate masks, yes all day every day
masks work (perhaps, data is not the best but it is all we have a this point)

Will I wear a mask, yes. I look at it from many different angles but explain it to my patients as: I see it as opening a door for someone else. Do I really have to? no. Does it help? possibly. Does it hurt? probably not. I don't mind being a gentle/man/woman/person. If data goes another way I will change my mind, but for now I consider it a courtesy.
Click to expand...

I generally agree; but unfortunately, our courtesy is being co-opted and both politically and socially weaponized.
 
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RustedFox said:
I generally agree; but unfortunately, our courtesy is being co-opted and both politically and socially weaponized.
Click to expand...
Yes, I know I being used, not much I can do, soy un perdedor. I do have the luxury of being from a part of the US were the pressure is low; I live in a state that is rather conservative and not liable to change under any circumstances making us unimportant. If I remember correctly you live in a possible swing state, the pressure must be terrific.
 
RustedFox said:
I generally agree; but unfortunately, our courtesy is being co-opted and both politically and socially weaponized.
Click to expand...
Again...by both sides. Which is what I ultimately find so frustrating.

I'll step away from this discussion now. And to be clear, I was speaking as an individual physician here, not as a moderator. Hopefully I've earned enough "street cred" in this forum over the years for that to be acknowledged and understood.
 
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All the talk about mortality neglects to account for long term damage, IMO. We don't know what kind of a toll this virus takes on the body's organs. These types of articles terrify me:

www.biorxiv.org

SARS-CoV-2 infection of human iPSC-derived cardiac cells predicts novel cytopathic features in hearts of COVID-19 patients

COVID-19 causes cardiac dysfunction in up to 50% of patients, but the pathogenesis remains unclear. Infection of human iPSC-derived cardiomyocytes with SARS-CoV-2 revealed robust transcriptomic and morphological signatures of damage in cardiomyocytes. These morphological signatures include a...
www.biorxiv.org www.biorxiv.org
COVID-19 causes cardiac dysfunction in up to 50% of patients, but the pathogenesis remains unclear. Infection of human iPSC-derived cardiomyocytes with SARS-CoV-2 revealed robust transcriptomic and morphological signatures of damage in cardiomyocytes. These morphological signatures include a distinct pattern of sarcomere fragmentation, with specific cleavage of thick filaments, and numerous iPSC-cardiomyocytes that lacked nuclear DNA. Human autopsy specimens from COVID-19 patients also displayed marked sarcomeric disruption and similar fragmentation, as well as prevalently enucleated cardiomyocytes. These striking transcriptomic and cytopathic changes provide a roadmap to understand the mechanisms of COVID-19 cardiac damage, search for potential treatments, and determine the basis for prolonged cardiac morbidity observed in this pandemic.
Click to expand...

I have no idea if the bolded is something to actually be concerned about but the thought of COVID virions stripping my heart's DNA out like some old copper wiring freaks me the F out!!!

Who can say how common this damage is or if the young & healthy are spared. There was a rash of college football players with myocarditis and that MLB pitcher who has to sit out (at least) the season because his heart was too weak to pitch. And Im sure there's countless similar cases that never get reported because they never went to the doctor or the dr didn't look for it. Will they make a full recovery or is the reduced functioning permanent?

Too many unanswered questions to gamble with one's health in my opinion, but we all know how much unsolicited opinions are worth ............
 
Fart Daddy Smooth said:
All the talk about mortality neglects to account for long term damage, IMO. We don't know what kind of a toll this virus takes on the body's organs. These types of articles terrify me:

www.biorxiv.org

SARS-CoV-2 infection of human iPSC-derived cardiac cells predicts novel cytopathic features in hearts of COVID-19 patients

COVID-19 causes cardiac dysfunction in up to 50% of patients, but the pathogenesis remains unclear. Infection of human iPSC-derived cardiomyocytes with SARS-CoV-2 revealed robust transcriptomic and morphological signatures of damage in cardiomyocytes. These morphological signatures include a...
www.biorxiv.org www.biorxiv.org


I have no idea if the bolded is something to actually be concerned about but the thought of COVID virions stripping my heart's DNA out like some old copper wiring freaks me the F out!!!

Who can say how common this damage is or if the young & healthy are spared. There was a rash of college football players with myocarditis and that MLB pitcher who has to sit out (at least) the season because his heart was too weak to pitch. And Im sure there's countless similar cases that never get reported because they never went to the doctor or the dr didn't look for it. Will they make a full recovery or is the reduced functioning permanent?

Too many unanswered questions to gamble with one's health in my opinion, but we all know how much unsolicited opinions are worth ............
Click to expand...
90% of people needing heart transplant need it due to viral myocarditis, usually Coxsackie. I would not be surprised, at all, if something similar happened.
 
I've known 10 friends/co-workers with COVID who have recovered. So far no long-term morbidity. I think the scare over morbidity is a last-ditch effort to induce terror in people, since the mortality isn't living up to what was originally foretold.
 
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Fart Daddy Smooth said:
All the talk about mortality neglects to account for long term damage, IMO. We don't know what kind of a toll this virus takes on the body's organs. These types of articles terrify me:

www.biorxiv.org

SARS-CoV-2 infection of human iPSC-derived cardiac cells predicts novel cytopathic features in hearts of COVID-19 patients

COVID-19 causes cardiac dysfunction in up to 50% of patients, but the pathogenesis remains unclear. Infection of human iPSC-derived cardiomyocytes with SARS-CoV-2 revealed robust transcriptomic and morphological signatures of damage in cardiomyocytes. These morphological signatures include a...
www.biorxiv.org www.biorxiv.org


I have no idea if the bolded is something to actually be concerned about but the thought of COVID virions stripping my heart's DNA out like some old copper wiring freaks me the F out!!!

Who can say how common this damage is or if the young & healthy are spared. There was a rash of college football players with myocarditis and that MLB pitcher who has to sit out (at least) the season because his heart was too weak to pitch. And Im sure there's countless similar cases that never get reported because they never went to the doctor or the dr didn't look for it. Will they make a full recovery or is the reduced functioning permanent?

Too many unanswered questions to gamble with one's health in my opinion, but we all know how much unsolicited opinions are worth ............
Click to expand...
The vast majority of people with known COVID-19 recover uneventfully. There's also a huge portion (up to 6x's diagnosed cases) estimated to have infection so mild they never even get diagnosed or have any symptoms at all. But now you're saying "up to 50% of those people," after having no outward effects other than self limited URI/flu symptoms, suddenly have clinically significant heart damage so severe it's stripping the DNA out of their heart cells in a way that it's going to silently lurk in them for years and kill them without warning someday like a "old copper wiring" in a ticking time bomb?

I could be wrong. COVID-19 has surprised me more than once. But it sounds like bull***t to me.
 
I think there will undoubtedly be longterm morbidity from COVID but primarily among those who are survivors of severe disease. It's well established there are significant morbidity associated with surviving critical illness, eg ARDS and MOF. There's no reason to expect any less from the same as secondary to COVID. Could be worse with pulmonary microvascular thrombosis
 
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Apollyon said:
90% of people needing heart transplant need it due to viral myocarditis, usually Coxsackie. I would not be surprised, at all, if something similar happened.
Click to expand...
I agree with this on the face of it. And yes, otherwise benign viruses can sometime (rarely) cause myocarditis, and severe cases at that. I don't doubt COVID-19 can do this in a minority of cases. But those patients are usually noticeably sick, with symptoms like detectable heart failure, arrhythmias, chest pain (from associated pericarditis) or shortness of breath. I have a hard time believing it's clinically significant in "50%" as the article states. Something about "50% have significant heart damage" and ">50% recover uneventfully" seem incompatible.
 
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Birdstrike said:
I agree with this on the face of it. And yes, otherwise benign viruses can sometime (rarely) cause myocarditis, and severe cases at that. I don't doubt COVID-19 can do this in a minority of cases. But those patients are usually noticeably sick, with symptoms like detectable heart failure, arrhythmias, chest pain (from associated pericarditis) or shortness of breath. I have a hard time believing it's clinically significant in "50%" as the article states. Something about "50% have significant heart damage" and ">50% recover uneventfully" seem incompatible.
Click to expand...
Months ago, there was something about depressed EF for a while (a month?) after acute illness. I posted something very similar about 90% etc, but I haven't looked back for it.
 
I think Emergency Physicians theorizing on the long term complications of a disease that's less than a year old is...interesting.
 
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