"I am glad you feel the report regarding family members is not useful.I agree and brought it up only I response to your claiming that it contained “damming evidence” in your post of Sept 3 “Masks - Covid-19 - HCQ - Let's Debate”
I stand by my interpretation of those data. Any data which are inconsistent are damning. Mask work this way but not that way? I always look for data to be consistent and those aren’t. But it isn't a trial; it's just a story of strange people who wear masks at home.
“We agree that there is no great study saying masks work. My contention is that even when they do not “catch” the virus, they disperse and diffuse it, thereby reducing the inoculum. Up until your reply to my post, I thought that was a pretty standard goal of treating infectious disease (several citations in #4). If you have information that size of inoculum is not important please let us know.”
Masks re-direct the air people exhale. Masks don’t diffuse the air in any way. The question, of course, isn’t how the masks work, it is “Do masks work?”. First, find out if they work in preventing or reducing transmission and then look into the mechanism(s) of protection. That’s the way we are supposed to do things. Test empirically, don’t guess at some mechanism(s) when we don’t even know if that thing is efficacious.
Your reference stated that inoculum affected severity of disease. It doesn’t, at least in most cases. As for inoculum, that’s well worked out in animal models and other examples of infectious disease. I remember talking to Ron Desrosiers, a famous SIV researcher, about it. They played around with changing the inoculum. SIV, a cousin of HIV-2, causes an AIDS-like illness in macaques, which are not even their natural host. Macaques only get SIV, when humans either corral them with sooty mangabeys OR we give it to them. Anyhow, Dr. Desrosiers, I am pretty sure it was he who did this study, but it might’ve been another SIV researcher, said “all you need is one live virus”. He further explained to me, think about we are giving different doses, of live virus, 1, 10, 100, 1,000, 10,000. And infected monkey has over 1,000,000 viruses per ml of blood and several liters of blood. Do the math.
Once a person is infected, the virus replicates logarithmically. Also, think about for a Darwinian perspective. For instance, it is estimated that coronaviruses produce 1,000 new virions per infected cell. As long as the virus that infects a person is equally pathogenic as the other, then 1 virus is going to catch up to 10,000 very quickly. So, one virus infects a cell causing the release of 1,000 new infectious virions. Then, each of those 1,000 are capable of infecting 1,000 other cells and then you have 1 million virion in just 2 rounds.
It takes only one, lit match to start a devastating forest fire.
Once again inoculum reduction has not been demonstrated to occur in Covid+ pts wearing a surgical mask. And inoculum isn’t the right term, inoculum is the amount of virus, bacteria, etc. that a person is actually ingests or is "inoculated" with. If surgical masks drastically reduced the amount SARS-CoV-2 excreted by an infected individual, then that would probably reduce transmission. One, they probably don’t and, two, there are no clinical data showing this theory is even close to correct.
“Finally, I may have missed it, but I’m wondering if you support the CDC recommendations regarding masks?:
“CDC recommends that people wear masks in public settings and when around people who don’t live in your household, especially when other social distancing measures are difficult to maintain.”
No, I don’t support masks for the reasons mentioned. The careless reuse of masks probably puts HCWs, at least, at increased risk. Masks have been tried in trials on other viruses and haven’t worked. There is no trial and nothing close to clinical data showing masks work in this disease, especially in the community, where everyone wears a different mask and wears it differently. "Dont just do something. Stand there." There are many, many examples in Medicine, where interventions, based on common sense, backfired big time. Others were simply prove a waste of time.
Do surgical pts get shaved anymore?
The truth is we know what to do, we just won’t do it. We have the knowledge and the tools to end this thing.
We know the high-risk groups, diabetics, prediabetics and severely obese.
We know HCQ works as pre-exposure prophylaxis.
This thing should have been over a long time ago.
And also, this thing should have killed far fewer Americans, if we had only followed the data honestly.
There is something seriously wrong with this country.
I cut my teeth during the AIDS epidemic, which was much, much worse btw.
I still run my own AIDS/HIV clinic.
Back in the 1980’s and early 1990’s, many, many drug trials failed.
No Republican ever celebrated these failures.
In mid-March, the second person I prescribed HCQ to was a relative. Incidentally, after just one dose, she felt much better. I found that weird, but have since been told that by several pts. My relative told her friends about her diagnosis and treatment. One friend then called her repeatedly and told her about the dangers of HCQ. The person who called has no experience, education or training in Medicine; she just hates a certain politician. What does hatred of a person have to do with fighting a disease? How does hatred turn a lay-person into a medical professional, who incorrectly speaks to the dangers of a treatment? I absolutely don’t understand this type of behavior, which was and is sadly common.
Nothing close to that happened with AIDS. No right-winged lay person (non-doctor) called their friend up and said don’t take that HIV drug, it will kill you.
Ironically, as I learned since March, HCQ is one of the safest drugs used chronically.
I love America, but I am deeply disappointed in her.
The need to hate has consumed many of us at a time when we were under attack. Instead of coming together, those hate-filled used the pandemic to further divide us and, in doing so, they abandoned scientific thinking.
But the real tragedy is much worse, their hate allowed the pandemic to kill so many thousands more than it should have.
Y'all need to listen to Dave Grohl more often before it's too late -
Hook me up a new revolution
Cause this one is a lie
We sat around laughing and watched the last one die.
Stephen
I am neither a Republican nor a Democrat.
Agree, most non N-95 masks merely re-direct the air people exhale (I’m sure you have seen the numerous, pretty cool looking videos on the subject). For instance, as you like to point out, they redirect the air surgeons exhale from the patients wound. Isn’t that the point of wearing them when unable to maintain distance?
If we agree that a person may be infectious and not realize it, then redirecting their exhalation up, sideways, and down, away from you rather than at you, should lower the concentration of virus you inhale.
You are right, inoculum was a poor choice of words. I should have been referring to the concentration of virus per cubic unit of air inhaled. Especially if you are directly in the “plume” of exhaled breath. A mask is similar to distancing, in that by redirecting and dispersing the plume of exhaled droplets and aerosols, it allows for dilution of the virus in the air, including the air you inhale, thereby reducing the risk of an infection.
Decreasing the dose of virus you inhale should reduce the risk of your becoming infected, I doubt you would disagree with that.
Question: Do you believe that maintaining physical (“social”) distance is an effective method of reducing the transmission of the virus?
If I led you to believe I was discussing that the size of dose correlates with the severity of the clinical disease, I apologize (although there are certainly those who believe that- it is another, more esoteric topic). I thought we were discussing how asking the general population to wear a mask, as part of a program including distancing and hand washing, is a standard method of public health management of respiratory infectious diseases, COVID included (1,2)). Wearing a mask is considered a low risk maneuver, it is a physical barrier, not a systemic medication, and generally considered to be without serious side effects. There are countries that have been relatively effectively reducing the transmission of COVID, and they all include wearing masks as part of the program. It seems to me that given the low risk of mask wearing (thousands of surgeon, anesthesiologists, nurses, industrial workers, have been wearing them all day for years), removing them from the infection control program without good data to the contrary is not prudent. The majority of ID experts not only the US, but across the world, regardless of their political system, allies, and enemies believe this.
HCQ is another topic.
1. https://www.thelancet.com/journals/lancet/article/PIIS0140-6736%2820%2931142-9/fulltext
2. This is nonscientific review for the interested layman: https://www.vox.com/future-perfect/21299527/masks-coronavirus-covid-19-studies-research-evidence