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Bleeding over from CE thread so masks can be discussed. I decided to collect some evidence, please discuss masks here but try to do so in a sciency way. There's a huge tension here. Proving things is hard. The rigor of evidence expected of science is much higher than the rigor used in normal decision making. It must be, or you'd never leave the house. My objectives here areas follows:
To these objectives, please make references clear: is this a peer-reviewed reference? Is this an academic source, or a popular source? Editorial, journalism, or a study? I don't make the rules, so I won't tell you you can or can't post, but if you're going to argue against mask-use in any way, you should be showing up with evidence, preferably backed by clinical trial, or you may be risking harm and that might not constitute being excellent to one another. Not sure how to read a paper? Read this: https://www.science.org/content/article/how-seriously-read-scientific-paper. If you have better advice on this, share it. Not sure if the stats match up? Ask! I'm no expert, but exploring methods will make us stronger at discerning evidence! OP recommendations welcome!
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Dec 8, 2021 21:45
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masking arguments out of the CE thread.
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I read a few articles. Where I stand right now: based on Abaluck et al, I feel pretty confident that encouraging any mask use is good, that surgical masks are better than cloth masks. My intuition suggests N-95 masks will likely be as good or better than surgical masks against COVID-19, but evidencing that effect among casual non-professional users is a difficult task. N-95 masks are probably not worse than surgical masks, but I haven't been presented evidence that they're better. More specific thoughts below: The Impact of Community Masking on COVID-19: A Cluster-Randomized Trial in Bangladesh Authors: Jason Abaluck, Laura H. Kwong, Ashley Styczynski, Ashraful Haque, Md Alamgir Kabir, Ellen Bates-Jefferys, Emily Crawford, Jade Benjamin-Chung, Salim Benhachmi, Shabib Raihan, Shadman Rahman, Neeti Zaman, Stephen Luby, Mushfiq Mobarak, Mohammad Ashraful Haque, Md Alamgir Kabir, Ellen Bates-Jefferys, Shabib Raihan, Shadman Rahman, Neeti Zaman Publishing date: 1 Sep 2021 Publisher: Innovations for Poverty-Action (study) Peer-reviewed?: Unknown Where to access: https://www.poverty-action.org/publication/impact-community-masking-covid-19-cluster-randomized-trial-bangladesh
Pro mask wearing in general: Yes, well evidenced. Pro N-95 / KN-95: Not examined Pro surgical mask: Yes, well evidenced. Recommendations are well reasoned: cheaper than cloth masks. Not compared to N-95. Pro cloth mask: Inconclusive. May have some benefit--but cannot be disentangled from the differences due to promotion and behavioral effects of mark-wearing. Greater high-risk behaviors due to mask mandates: none evidence though, even if they were, I would only feel comfortable generalizing to the culture and people where it was studied. Other thoughts: This is an awesome study. This study tells us that promoting masks makes a difference and that surgical grade masks can make a difference. Something to be aware of is that a study recruiting 300,000 participants wasn't powerful enough to show us what effect cloth masks have, though an effect is suggested--this is difficult work and getting answers is not easy or cheap. I couldn't find a completed clinical trial, applied generally comparing N-95 masks and other masks for COVID-19, but I can for healthcare workers and influenza. Surgical mask vs N95 respirator for preventing influenza among health care workers: a randomized trial Authors: Mark Loeb, Nancy Dafoe, James Mahony, Michael John, Alicia Sarabia, Verne Glavin, Richard Webby, Marek Smieja, David J D Earn, Sylvia Chong, Ashley Webb, Stephen D Walter Publishing date: 4 Nov 2009 Publisher: JAMA (study) Peer-reviewed?: Presumably Where to access: https://clinicaltrials.gov/ct2/show/NCT00756574?term=N-95&recrs=e&draw=4&rank=2 -> https://pubmed.ncbi.nlm.nih.gov/19797474/ I don't have access to the full article, so at least this exploration will go faster: Results: "Between September 23, 2008, and December 8, 2008, 478 nurses were assessed for eligibility and 446 nurses were enrolled and randomly assigned the intervention; 225 were allocated to receive surgical masks and 221 to N95 respirators. Influenza infection occurred in 50 nurses (23.6%) in the surgical mask group and in 48 (22.9%) in the N95 respirator group (absolute risk difference, -0.73%; 95% CI, -8.8% to 7.3%; P = .86), the lower confidence limit being inside the noninferiority limit of -9%" Pro mask wearing in general: N/ Pro N-95 / KN-95: not evidenced over surgical mask, only studied influenza. Pro surgical mask: not evidenced over 95s, only studied influenza Pro cloth mask: not studied Greater high-risk behaviors due to mask mandates: not studied Other thoughts: a strong difference would have been good to see, but this study's design doesn't really tell us much of anything--all they hoped to show was that N95 masks weren't worse than surgical masks at protecting against influenza. Filtration Efficiency, Effectiveness, and Availability of N95 Face Masks for COVID-19 Prevention Authors: Caitlin M. Dugdale, MD1,2; Rochelle P. Walensky, MD, MPH1,2 Publishing date: 4 Nov 2009 Publisher: JAMA Internal Medicine (editorial) Peer-reviewed?: No, not a study Where to access: https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2769441 Not a study to digest, but there's some important discussion of N-95 related to other interventions here: quote:Importantly, the effectiveness of any mask also depends heavily on its real-world use; variability in mask filtration during clinical care may fluctuate more by mask adherence and fit than by marginal differences in laboratory-based filtration efficiency. In practicality, when worn properly, N95 masks are suffocating, uncomfortable, and difficult to tolerate for long durations. Best practices for N95 use require intermittent, individualized fit testing and a seal check on donning. Mask fit varies by facial shape and body habitus, and thus, once fit tested, ensuring fidelity to the same manufacturer and size is essential. Filtration efficiency of an N95 mask can also be compromised by even small amounts of facial hair in the area of the seal. Prolonged use of tightly fitting masks may result in facial bruising and abrasions, but bandages over these areas, such as the commonly seen wound barriers over the nasal bridge, interrupt the mask seal. Although a recent clinical trial6 reported similar and suboptimal self-reported adherence between outpatient health care personnel randomized to wear N95 masks vs medical masks (89% vs 90%), the study also demonstrated no difference in cases of laboratory-documented influenza—albeit a different respiratory virus—between the 2 groups. Acknowledging that adherence is likely higher amid the COVID-19 pandemic, mask efficiency observed in the laboratory likely reflects an upper bound of the effectiveness that would be observed in clinical settings. This paragraph is important because it explains the limits of N-95 masks: mainly that to reach full effectiveness, they have to be individually fit tested, seal checked and instructions must be adhered to.
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Dec 8, 2021 21:46
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Loucks posted:I confess I'm curious what "science" would be required to advocate for the use of disposable N95 respirators or elastomeric respirators with P100 filters. The filtration standards are public record. The FUD that surrounds non-institutional respiratory PPE use is entirely overblown, as fit testing procedures are also public record and not difficult to perform in the case of elastomerics. Or is the idea that the burden of proving that e.g., a translucent Disney-branded neck gaiter is less effective than a NIOSH-certified respirator falls on the person making that claim? I've tried for almost two years now to convince people to wear at least N95s, and while some people are receptive to published safety standards a disappointing percentage just get mad and point at CDC's guidance that people strap just about anything they can find across their faces as evidence that wearing actual PPE is crazy. I'm sympathetic. But all of these things are tied up among surprisingly difficult moral quandaries. Determining which action fits your morals become easier with a greater understanding of fact and my hope is that, by using evidence, we can remove some of the emotion from the question. Some of this is scientific, some of this is philosophical. Whether it seems that way or not, you're asking people to weigh their moral values based on an imperfect understanding of fact. With different assumptions will come different conclusions, but they'll be enforced as norms via social isolation. We should expect some emotion. The big factor people often have to weigh is, "how much is enough?" You can always be more safe. N95 masks are probably safer than surgical masks which are probably safer than translucent Disney-branded neck gaiters. Fitted N95 masks used no more than once per patient exposure are probably safer than unfitted N-95 masks worn for several days. Self contained breathing apparatuses are probably safer. Never leaving the house, separating from and family members or friends who do go outside of the house and only receiving delivered goods after they've been left outside under sun exposure is probably even better--at least from this one particular threat. More data and better studies can help us refine these normative positions and make more convincing arguments. I've personally landed on buying a bunch of KN95 masks and reusing them. But the reason I landed on that was mostly tied to that act being easy enough--if I couldn't find them couldn't afford them, wasn't willing to take them from the market, then I might pursue cloth masks like I did in the first several months of the pandemic. If had unlimited money and no concerns, I might keep a stockpile of hundreds and change several a day--I'm fairly certain that my strategy was heavily based on access, but unless I intentionally acknowledge the bias, I'm likely to justify it post hoc with all sorts of reasons.
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Dec 8, 2021 23:54
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