Coronavirus

[RichardGibbons]

Can you show me a randomized clinical study of Hydroxychloroquine of about 400 mg per day (approved dosage already for other diseases by FDA) for 5 -14 days.  Preferably with Zinc.  Given early in the infection.

 

Can you  cite me one?

 

I'm going to go with this one, rather than finding random permutations of doses of Hydroxychloroquine and other substances. "Oh, what about Hydroxychloroquine and Vitamin C?  What about with Vitamin D? And water? And potatoes? And fire ants! Nobody's tried fire ants yet!  Why can't you show me a study with fire ants!"

 

 

[Investor20]

Can you show me a randomized clinical study of Hydroxychloroquine of about 400 mg per day (approved dosage already for other diseases by FDA) for 5 -14 days.  Preferably with Zinc.  Given early in the infection.

 

Can you  cite me one?

 

I'm going to go with this one, rather than finding random permutations of doses of Hydroxychloroquine and other substances. "Oh, what about Hydroxychloroquine and Vitamin C?  What about with Vitamin D? And water? And potatoes? And fire ants! Nobody's tried fire ants yet!  Why can't you show me a study with fire ants!"

 

I cannot find any details about patients given the medicine.  If you have it please share.

 

There are broadly two sets of data/claims

1) When given very early, even prophylactically HCQ alone works.  That is the contention of Ford Health System why for them it worked.

2) NYU Grossman study said HCQ+Zinc+Azithromycin worked but not without Zinc.  Many doctors say HCQ works by increasing availability of Zinc inside the cells where virus resides. Even with Zinc, NYU said it worked early and not later in disease progression.

 

The Zelenko group from NY gives it very early, in a primary care physician and claims that it needs to be given even before they get the test result because by the time test results come and hospitalization, the virus has spread too much.

 

The ICMR in India published studies prophylactically with only 400 mg once per week and showed decreased number of healthcare workers getting infected after several weeks of administration.

https://www.indiatoday.in/india/story/4-hydroxychloroquine-hcq-doses-coronavirus-healthcare-workers-icmr-1684112-2020-06-01

4 or more hydroxychloroquine doses reduced risk of coronavirus in healthcare workers: ICMR study

 

So besides your sarcastic statements, without knowing which patients are given the medicine such as oxygen levels and without any study with HCQ+Zinc, how can you conclude it doesnt work?

[mattee2264]

 

Hi Gregmal. I'm seeing the same thing in the UK. The younger generation are happy mingling on the beach and in the parks and outside pubs with little effort to distance themselves from their friends or even complete strangers. The older generation are back to seeing friends and family. A lot of people are also booking foreign holidays following the introduction of air bridges.

 

On the other hand most people are still working from home and even at rush hour the subway is probably only at 10-20% of normal volume. And while the job market is picking up unemployment levels are still high.

 

It is a difficult situation. It is one thing to give people the choice of going to bars and restaurants and turning a blind eye when they fail to socially distance. But quite another thing to force people to go back to the office which I think ultimately does have to happen to get the economy back to full speed.

 

[Liberty]

 

Around 60% of countries now require public mask usage.

 

Countries representing 85% of the world's population either require public mask usage or mask-wearing is nearly universal.

 

The US is not part of those countries.

 

https://masks4all.co/what-countries-require-masks-in-public/

[Cigarbutt]

............................................

 

Now, can someone explain to me why would WHO and government organizations prioritize an expensive IV drug that needs to be given in a hospital including 10 day IV courses over a tablet that is generic and so cheap that it is essentially free, that can be given at home for clinical studies?

Disclosure: i just erased a sarcastic comment and reformulated this post. i also have an interest (an interest to understand the interest) in conspiracy theories. i think the phenomenon may have played a role in the recent relative virus performance in the US.

-How do you deal with commitment and confirmation bias?

[Investor20]

............................................

 

Now, can someone explain to me why would WHO and government organizations prioritize an expensive IV drug that needs to be given in a hospital including 10 day IV courses over a tablet that is generic and so cheap that it is essentially free, that can be given at home for clinical studies?

Disclosure: i just erased a sarcastic comment and reformulated this post. i also have an interest (an interest to understand the interest) in conspiracy theories. i think the phenomenon may have played a role in the recent relative virus performance in the US.

-How do you deal with commitment and confirmation bias?

 

Its not a theory.  It is a simple question of asking for a randomized controlled clinical trial that studied HCQ (with Zinc) that studied in proper patient population, that is a population with early infection or prophylaxis. 

 

This after I gave four retrospective studies showing big mortality death decreases of 40-80%, adding Zinc giving better results and administering early giving better results and a large decrease in infections with a prophylactic study from India. For example, the Beth Israel study had 6800 patients with HZ ratio of 0.53 (1 being no effect) of mortality with Hydroxychloroquine.  This is not a theory.

[Cigarbutt]

............................................

Now, can someone explain to me why would WHO and government organizations prioritize an expensive IV drug that needs to be given in a hospital including 10 day IV courses over a tablet that is generic and so cheap that it is essentially free, that can be given at home for clinical studies?

Disclosure: i just erased a sarcastic comment and reformulated this post. i also have an interest (an interest to understand the interest) in conspiracy theories. i think the phenomenon may have played a role in the recent relative virus performance in the US.

-How do you deal with commitment and confirmation bias?

Its not a theory.  It is a simple question of asking for a randomized controlled clinical trial that studied HCQ (with Zinc) that studied in proper patient population, that is a population with early infection or prophylaxis. 

This after I gave four retrospective studies showing big mortality death decreases of 40-80%, adding Zinc giving better results and administering early giving better results and a large decrease in infections with a prophylactic study from India. For example, the Beth Israel study had 6800 patients with HZ ratio of 0.53 (1 being no effect) of mortality with Hydroxychloroquine.  This is not a theory.

Humble opinion: There has been growing evidence (weighted appraisal and odds point of view) that hydroxychloroquine is 1- unlikely (alone or in combination) to cause a significant improvement in CV contexts (treatment and prevention), 2- likely to cause significant side effects in a small number of cases, especially when used in combination and 3- focus on the CV group will cause difficult supply or even shortage in the patient population that benefits from it.

Isn't it reasonable then for researchers to face a higher burden of proof when looking for funding?

Recently, Hertz tried to issue shares post chapter 11 filing and the burden of proof was so high that the SEC caused the process to derail. The unacknowledged goal was to protect the investor against his or her biases.

Do you think there is anything else going on with the WHO and other government organizations?

[Investor20]

............................................

Now, can someone explain to me why would WHO and government organizations prioritize an expensive IV drug that needs to be given in a hospital including 10 day IV courses over a tablet that is generic and so cheap that it is essentially free, that can be given at home for clinical studies?

Disclosure: i just erased a sarcastic comment and reformulated this post. i also have an interest (an interest to understand the interest) in conspiracy theories. i think the phenomenon may have played a role in the recent relative virus performance in the US.

-How do you deal with commitment and confirmation bias?

Its not a theory.  It is a simple question of asking for a randomized controlled clinical trial that studied HCQ (with Zinc) that studied in proper patient population, that is a population with early infection or prophylaxis. 

This after I gave four retrospective studies showing big mortality death decreases of 40-80%, adding Zinc giving better results and administering early giving better results and a large decrease in infections with a prophylactic study from India. For example, the Beth Israel study had 6800 patients with HZ ratio of 0.53 (1 being no effect) of mortality with Hydroxychloroquine.  This is not a theory.

Humble opinion: There has been growing evidence (weighted appraisal and odds point of view) that hydroxychloroquine is 1- unlikely (alone or in combination) to cause a significant improvement in CV contexts (treatment and prevention), 2- likely to cause significant side effects in a small number of cases, especially when used in combination and 3- focus on the CV group will cause difficult supply or even shortage in the patient population that benefits from it.

Isn't it reasonable then for researchers to face a higher burden of proof when looking for funding?

Recently, Hertz tried to issue shares post chapter 11 filing and the burden of proof was so high that the SEC caused the process to derail. The unacknowledged goal was to protect the investor against his or her biases.

Do you think there is anything else going on with the WHO and other government organizations?

 

But you wont cite any study with the requirements. HCQ preferably with Zinc.  Early in infection or prophylaxis. Doses about what is used in NYU grossman study.

 

I gave 5 studies before in this thread.  Here is one more from South Korea.  There is no control arm but according to the authors patients in long term care centers with lot of infections usually end up with lot of infections. But here with HCQ 400 mg for fourteen days

 

Researchers from Samsung Medical Center in Seoul and Pusan National University Hospital in Busan said they have completed post-exposure prophylaxis (PEP) using hydroxychloroquine (HCQ) on 184 patients and 21 care workers at a long-term care hospital (LTCH) in Busan where they were exposed to COVID-19 after massive infections were reported there.

 

At the end of 14 days of quarantine, follow-up PCR tests on the study participants were all negative, indicating that those who received PEP did not develop COVID-19.

[mcliu]

Would the mainstream media purposely report negative studies of hydroxychloroquine and ignore positive studies just to show that Trump was wrong?  ???

[Edward]

Would the mainstream media purposely report negative studies of hydroxychloroquine and ignore positive studies just to show that Trump was wrong?  ???

 

At this point we are talking Pravda levels of misinformation on mainstream media. I was born in the USSR so I can tell you all it's quite comparable.

 

Additionally, if you want to understand the current political atmosphere, the following is the best lecture on the matter in my humble opinion:

 

[Gregmal]

Would the mainstream media purposely report negative studies of hydroxychloroquine and ignore positive studies just to show that Trump was wrong?  ???

 

At this point we are talking Pravda levels of misinformation on mainstream media. I was born in the USSR so I can tell you all it's quite comparable.

 

Additionally, if you want to understand the current political atmosphere, the following is the best lecture on the matter in my humble opinion:

 

 

Absolutely. I wouldn't even rely on the like of Fox, CNN, or MSNBC for the weather. People like Maddow, Hannity, Lemon, Acosta, Megan Kelly, Anderson Cooper, Chris Cuomo, Limbaugh, etc are truly enemies of the United States and the lowest forms of life, period. They are the biggest reasons for there growing divide in America. they have basically monetized the dividing of America.

[Guest]

Would the mainstream media purposely report negative studies of hydroxychloroquine and ignore positive studies just to show that Trump was wrong?  ???

 

At this point we are talking Pravda levels of misinformation on mainstream media. I was born in the USSR so I can tell you all it's quite comparable.

 

Additionally, if you want to understand the current political atmosphere, the following is the best lecture on the matter in my humble opinion:

 

 

Man, I'm just a few mins in and this guy is awesome.

[Peregrine]

Toronto’s public health department basically outright said that any death is marked as a COVID death as long as the person tested positive for COVID. So if you died in a car accident yet tested positive for COVID that’s still counted in the death count? How can anyone trust the numbers anymore?

 

[Liberty]

https://voxeu.org/article/unmasked-effect-face-masks-spread-covid-19

 

Different German cities made masks mandatory at different points in time. This study uses a synthetic control methodology and finds that requiring face masks to be worn decreased the growth rate of COVID-19 cases by about 40% in Germany.

[Investor20]

https://voxeu.org/article/unmasked-effect-face-masks-spread-covid-19

 

Different German cities made masks mandatory at different points in time. This study uses a synthetic control methodology and finds that requiring face masks to be worn decreased the growth rate of COVID-19 cases by about 40% in Germany.

 

Some of you always demanded randomized controlled studies for HCQ, irrespective of how many studies showed positive results for HCQ.

 

So let me present the RCT for cloth masks

 

https://bmjopen.bmj.com/content/5/4/e006577

 

Conclusions This study is the first RCT of cloth masks, and the results caution against the use of cloth masks. This is an important finding to inform occupational health and safety. Moisture retention, reuse of cloth masks and poor filtration may result in increased risk of infection. Further research is needed to inform the widespread use of cloth masks globally. However, as a precautionary measure, cloth masks should not be recommended for HCWs, particularly in high-risk situations, and guidelines need to be updated.

 

Below is cited by CDC in their guidelines:

https://pubmed.ncbi.nlm.nih.gov/24229526/

 

Conclusion: Our findings suggest that a homemade mask should only be considered as a last resort to prevent droplet transmission from infected individuals, but it would be better than no protection.

[Cigarbutt]

Toronto’s public health department basically outright said that any death is marked as a COVID death as long as the person tested positive for COVID. So if you died in a car accident yet tested positive for COVID that’s still counted in the death count? How can anyone trust the numbers anymore?

i think this is misinformation and perhaps disinformation.

https://www.scientificamerican.com/article/how-covid-19-deaths-are-counted1/

https://www.cdc.gov/nchs/covid19/coding-and-reporting.htm

 

Given the evolving evidence (balancing reasons that could lead to over- and under- reporting) and excess mortality inputs, at this point, some underestimation of reported deaths is likely.

[clutch]

This was a good watch:

 

"How Hong Kong beat coronavirus and avoided lockdown"

 

You realize that almost every single measure taken by the people and the government would not be possible in the US...

[Liberty]

https://voxeu.org/article/unmasked-effect-face-masks-spread-covid-19

 

Different German cities made masks mandatory at different points in time. This study uses a synthetic control methodology and finds that requiring face masks to be worn decreased the growth rate of COVID-19 cases by about 40% in Germany.

 

Some of you always demanded randomized controlled studies for HCQ, irrespective of how many studies showed positive results for HCQ.

 

So let me present the RCT for cloth masks

 

https://bmjopen.bmj.com/content/5/4/e006577

 

Conclusions This study is the first RCT of cloth masks, and the results caution against the use of cloth masks. This is an important finding to inform occupational health and safety. Moisture retention, reuse of cloth masks and poor filtration may result in increased risk of infection. Further research is needed to inform the widespread use of cloth masks globally. However, as a precautionary measure, cloth masks should not be recommended for HCWs, particularly in high-risk situations, and guidelines need to be updated.

 

Below is cited by CDC in their guidelines:

https://pubmed.ncbi.nlm.nih.gov/24229526/

 

Conclusion: Our findings suggest that a homemade mask should only be considered as a last resort to prevent droplet transmission from infected individuals, but it would be better than no protection.

 

Ok, first, the study isn't saying what you think it's saying: "this study was to compare the efficacy of cloth masks to medical masks in hospital healthcare workers (HCWs). The null hypothesis is that there is no difference between medical masks and cloth masks." (common sense would probably bet against the null hypothesis here)

 

There's a big difference between a healthcare worker in a hospital and John Doe on the street, and if you can get a medical-grade mask instead of a cloth mask, you should use that. No question. The goal is to reduce R0 below one, so masks could be only very partially effective (and I think they're more than that) and yet make a huge difference (especially if both/more nodes wear them, as they compound), as Taleb pointed out in one of his pieces on masks.

 

Second, it's one piece of evidence. There's also overwhelming evidence that they work in practice for regular people who aren't in hospitals or highly risky areas, and I wouldn't be surprised to see the studies catch up with over months and years, but we don't exactly have time to wait around. So a study like this shifted my priors a little bit, but not much, and in the meantime, let's use our brains and look at what works in practice based on a mechanistic understanding of what is going on.

[Liberty]

Tread:

 

Here's the truth. The COVID-19 outbreak, is not ONE outbreak spread evenly across the US. It is MANY outbreaks spread unevenly. You need to look at state data, or better, county data to really understand what's going on.

 

...

 

This is the heart of Simpson's paradox. If you pool data without regard to the underlying causality, you'll get erroneous results.

 

...

 

The truth is simple, and horrifying. We are about to have dozens of NYCs around the country. The next 8 weeks are going to brutal, no matter what we do. ICUs overflowing, ventilators rationed, hundreds of thousands of deaths.

 

Unfortunately, the virus is still here and we've failed to manage it with mis-step after mis-step since the beginning. I have no agenda. I'm a doctor, a scientist, a tech founder, a husband, and a father. I'm simply sad that it's come to this. Stay safe.

[Peregrine]

Toronto’s public health department basically outright said that any death is marked as a COVID death as long as the person tested positive for COVID. So if you died in a car accident yet tested positive for COVID that’s still counted in the death count? How can anyone trust the numbers anymore?

i think this is misinformation and perhaps disinformation.

https://www.scientificamerican.com/article/how-covid-19-deaths-are-counted1/

https://www.cdc.gov/nchs/covid19/coding-and-reporting.htm

 

Given the evolving evidence (balancing reasons that could lead to over- and under- reporting) and excess mortality inputs, at this point, some underestimation of reported deaths is likely.

 

Disinformation from a public health source?

 

Here's the excess mortality graph provided by the CDC: https://www.cdc.gov/nchs/nvss/vsrr/covid19/excess_deaths.htm

 

Saw a peak in early April that has since subsided. For the last week, it has fallen below the trend line.

 

Agree that there's probably an undercount, but there's also a general acceptance that deaths from cold and other influenza-like illnesses are undercounted as well. Plus, how do we separate that from the increase in deaths that we've seen as a result of lockdown (people delaying treatments and not going to the hospital when they should, deferment of elective procedures, overdoses, suicides, etc) How do we understand the true lethality of this virus when there's this level of ambiguity?

 

Btw, it doesn't look like it's just Toronto either - seems like the standard practice is to list all deaths for which the deceased tested positive as a COVID death. Here's Illinois's Department of Public Health explaining how they count: "Technically, if you died of a clear alternate cause, but you had COVID-19 at the same time - it's still listed as a COVID death," Dr. Ezike answered. "Everyone who's listed as a COVID death doesn't mean that was the cause of death, but they had COVID at the time."

 

https://www.wandtv.com/news/why-and-how-covid-19-deaths-are-tracked-in-illinois/article_2085ddaa-93e8-11ea-b1c2-7fd058d907cf.html

 

 

 

 

[Investor20]

Toronto’s public health department basically outright said that any death is marked as a COVID death as long as the person tested positive for COVID. So if you died in a car accident yet tested positive for COVID that’s still counted in the death count? How can anyone trust the numbers anymore?

i think this is misinformation and perhaps disinformation.

https://www.scientificamerican.com/article/how-covid-19-deaths-are-counted1/

https://www.cdc.gov/nchs/covid19/coding-and-reporting.htm

 

Given the evolving evidence (balancing reasons that could lead to over- and under- reporting) and excess mortality inputs, at this point, some underestimation of reported deaths is likely.

 

Disinformation from a public health source?

 

Here's the excess mortality graph provided by the CDC: https://www.cdc.gov/nchs/nvss/vsrr/covid19/excess_deaths.htm

 

Saw a peak in early April that has since subsided. For the last week, it has fallen below the trend line.

 

Agree that there's probably an undercount, but there's also a general acceptance that deaths from cold and other influenza-like illnesses are undercounted as well. Plus, how do we separate that from the increase in deaths that we've seen as a result of lockdown (people delaying treatments and not going to the hospital when they should, deferment of elective procedures, overdoses, suicides, etc) How do we understand the true lethality of this virus when there's this level of ambiguity?

 

Btw, it doesn't look like it's just Toronto either - seems like the standard practice is to list all deaths for which the deceased tested positive as a COVID death. Here's Illinois's Department of Public Health explaining how they count: "Technically, if you died of a clear alternate cause, but you had COVID-19 at the same time - it's still listed as a COVID death," Dr. Ezike answered. "Everyone who's listed as a COVID death doesn't mean that was the cause of death, but they had COVID at the time."

 

https://www.wandtv.com/news/why-and-how-covid-19-deaths-are-tracked-in-illinois/article_2085ddaa-93e8-11ea-b1c2-7fd058d907cf.html

 

Florida and Texas never had excess deaths more than once a while Flu season.  Its NY, NJ and surrounding states that contributed to much of the excess deaths.

[Investor20]

https://voxeu.org/article/unmasked-effect-face-masks-spread-covid-19

 

Different German cities made masks mandatory at different points in time. This study uses a synthetic control methodology and finds that requiring face masks to be worn decreased the growth rate of COVID-19 cases by about 40% in Germany.

 

Some of you always demanded randomized controlled studies for HCQ, irrespective of how many studies showed positive results for HCQ.

 

So let me present the RCT for cloth masks

 

https://bmjopen.bmj.com/content/5/4/e006577

 

Conclusions This study is the first RCT of cloth masks, and the results caution against the use of cloth masks. This is an important finding to inform occupational health and safety. Moisture retention, reuse of cloth masks and poor filtration may result in increased risk of infection. Further research is needed to inform the widespread use of cloth masks globally. However, as a precautionary measure, cloth masks should not be recommended for HCWs, particularly in high-risk situations, and guidelines need to be updated.

 

Below is cited by CDC in their guidelines:

https://pubmed.ncbi.nlm.nih.gov/24229526/

 

Conclusion: Our findings suggest that a homemade mask should only be considered as a last resort to prevent droplet transmission from infected individuals, but it would be better than no protection.

 

Ok, first, the study isn't saying what you think it's saying: "this study was to compare the efficacy of cloth masks to medical masks in hospital healthcare workers (HCWs). The null hypothesis is that there is no difference between medical masks and cloth masks." (common sense would probably bet against the null hypothesis here)

 

There's a big difference between a healthcare worker in a hospital and John Doe on the street, and if you can get a medical-grade mask instead of a cloth mask, you should use that. No question. The goal is to reduce R0 below one, so masks could be only very partially effective (and I think they're more than that) and yet make a huge difference (especially if both/more nodes wear them, as they compound), as Taleb pointed out in one of his pieces on masks.

 

Second, it's one piece of evidence. There's also overwhelming evidence that they work in practice for regular people who aren't in hospitals or highly risky areas, and I wouldn't be surprised to see the studies catch up with over months and years, but we don't exactly have time to wait around. So a study like this shifted my priors a little bit, but not much, and in the meantime, let's use our brains and look at what works in practice based on a mechanistic understanding of what is going on.

 

What the studies are saying is its very possible to get infected with the cloth masks and spread the infection.

 

That is to use them as a "last resort" without diluting other aspects such as ventilation and distancing.

 

Unforunately, unlike in S. Korea or Japan, ventilation is not highlighted in western countries.

 

And I dont think from my interaction most people understand that the mask is simply "a last resort" but they should really act as if they dont have a cloth mask.

 

For example, taking S. Korean guidelines (most S. Koreans actually use N95 mask which are much better than cloth mask)

https://www.weforum.org/agenda/2020/05/south-korea-office-coronavirus-covid19-work-enviroment/

 

Follow these guidelines when conducting in-person meetings:

 

Inform attendees that they should refrain from attending the meeting if they traveled abroad in the last 14 days or have shown symptoms such as fever, respiratory distress (sore throat, coughing, difficulty breathing, headache, muscle pain, fatigue).

 

The meeting host should check for respiratory abnormalities or fever and make sure those with symptoms don’t attend.

 

Refrain from physical contact, such as shaking hands, before or after the meeting.

 

Make sure hand sanitizer is readily available in the conference room so attendees can use it frequently.

 

Provide a well-ventilated, spacious area for the meeting and be sure to ventilate before the meeting.

 

Take a break every hour to ventilate the space by opening doors and windows.  Maintain a distance of two meters between every attendee (minimum one meter). If this cannot be met, refrain from meeting in person.

 

If the meeting is still necessary, ensure every attendee wears a mask, even when speaking.

 

Masks are up to personal discretion if ventilation and distancing can be followed.

 

From above clearly, the more important aspects are Ventilation and Distancing than masks.  Masks are last resort, but as per S. Korean guidelines one should preferably "refrain from meeting in person" if ventilation and distancing is not possible even if you have N95 mask.

[Liberty]

https://voxeu.org/article/unmasked-effect-face-masks-spread-covid-19

 

Different German cities made masks mandatory at different points in time. This study uses a synthetic control methodology and finds that requiring face masks to be worn decreased the growth rate of COVID-19 cases by about 40% in Germany.

 

Some of you always demanded randomized controlled studies for HCQ, irrespective of how many studies showed positive results for HCQ.

 

So let me present the RCT for cloth masks

 

https://bmjopen.bmj.com/content/5/4/e006577

 

Conclusions This study is the first RCT of cloth masks, and the results caution against the use of cloth masks. This is an important finding to inform occupational health and safety. Moisture retention, reuse of cloth masks and poor filtration may result in increased risk of infection. Further research is needed to inform the widespread use of cloth masks globally. However, as a precautionary measure, cloth masks should not be recommended for HCWs, particularly in high-risk situations, and guidelines need to be updated.

 

Below is cited by CDC in their guidelines:

https://pubmed.ncbi.nlm.nih.gov/24229526/

 

Conclusion: Our findings suggest that a homemade mask should only be considered as a last resort to prevent droplet transmission from infected individuals, but it would be better than no protection.

 

Ok, first, the study isn't saying what you think it's saying: "this study was to compare the efficacy of cloth masks to medical masks in hospital healthcare workers (HCWs). The null hypothesis is that there is no difference between medical masks and cloth masks." (common sense would probably bet against the null hypothesis here)

 

There's a big difference between a healthcare worker in a hospital and John Doe on the street, and if you can get a medical-grade mask instead of a cloth mask, you should use that. No question. The goal is to reduce R0 below one, so masks could be only very partially effective (and I think they're more than that) and yet make a huge difference (especially if both/more nodes wear them, as they compound), as Taleb pointed out in one of his pieces on masks.

 

Second, it's one piece of evidence. There's also overwhelming evidence that they work in practice for regular people who aren't in hospitals or highly risky areas, and I wouldn't be surprised to see the studies catch up with over months and years, but we don't exactly have time to wait around. So a study like this shifted my priors a little bit, but not much, and in the meantime, let's use our brains and look at what works in practice based on a mechanistic understanding of what is going on.

 

What the studies are saying is its very possible to get infected with the cloth masks and spread the infection.

 

That is to use them as a "last resort" without diluting other aspects such as ventilation and distancing.

 

Unforunately, unlike in S. Korea or Japan, ventilation is not highlighted in western countries.

 

And I dont think from my interaction most people understand that the mask is simply "a last resort" but they should really act as if they dont have a cloth mask.

 

For example, taking S. Korean guidelines (most S. Koreans actually use N95 mask which are much better than cloth mask)

https://www.weforum.org/agenda/2020/05/south-korea-office-coronavirus-covid19-work-enviroment/

 

Follow these guidelines when conducting in-person meetings:

 

Inform attendees that they should refrain from attending the meeting if they traveled abroad in the last 14 days or have shown symptoms such as fever, respiratory distress (sore throat, coughing, difficulty breathing, headache, muscle pain, fatigue).

 

The meeting host should check for respiratory abnormalities or fever and make sure those with symptoms don’t attend.

 

Refrain from physical contact, such as shaking hands, before or after the meeting.

 

Make sure hand sanitizer is readily available in the conference room so attendees can use it frequently.

 

Provide a well-ventilated, spacious area for the meeting and be sure to ventilate before the meeting.

 

Take a break every hour to ventilate the space by opening doors and windows.  Maintain a distance of two meters between every attendee (minimum one meter). If this cannot be met, refrain from meeting in person.

 

If the meeting is still necessary, ensure every attendee wears a mask, even when speaking.

 

Masks are up to personal discretion if ventilation and distancing can be followed.

 

From above clearly, the more important aspects are Ventilation and Distancing than masks.  Masks are last resort, but as per S. Korean guidelines one should preferably "refrain from meeting in person" if ventilation and distancing is not possible even if you have N95 mask.

 

No, that's not what it's saying. And it's not what the actual facts on the ground around the world are saying.

[Cigarbutt]

Toronto’s public health department basically outright said that any death is marked as a COVID death as long as the person tested positive for COVID. So if you died in a car accident yet tested positive for COVID that’s still counted in the death count? How can anyone trust the numbers anymore?

i think this is misinformation and perhaps disinformation.

https://www.scientificamerican.com/article/how-covid-19-deaths-are-counted1/

https://www.cdc.gov/nchs/covid19/coding-and-reporting.htm

Given the evolving evidence (balancing reasons that could lead to over- and under- reporting) and excess mortality inputs, at this point, some underestimation of reported deaths is likely.

Disinformation from a public health source?

Here's the excess mortality graph provided by the CDC: https://www.cdc.gov/nchs/nvss/vsrr/covid19/excess_deaths.htm

Saw a peak in early April that has since subsided. For the last week, it has fallen below the trend line.

Agree that there's probably an undercount, but there's also a general acceptance that deaths from cold and other influenza-like illnesses are undercounted as well. Plus, how do we separate that from the increase in deaths that we've seen as a result of lockdown (people delaying treatments and not going to the hospital when they should, deferment of elective procedures, overdoses, suicides, etc) How do we understand the true lethality of this virus when there's this level of ambiguity?

Btw, it doesn't look like it's just Toronto either - seems like the standard practice is to list all deaths for which the deceased tested positive as a COVID death. Here's Illinois's Department of Public Health explaining how they count: "Technically, if you died of a clear alternate cause, but you had COVID-19 at the same time - it's still listed as a COVID death," Dr. Ezike answered. "Everyone who's listed as a COVID death doesn't mean that was the cause of death, but they had COVID at the time."

https://www.wandtv.com/news/why-and-how-covid-19-deaths-are-tracked-in-illinois/article_2085ddaa-93e8-11ea-b1c2-7fd058d907cf.html

Florida and Texas never had excess deaths more than once a while Flu season.  Its NY, NJ and surrounding states that contributed to much of the excess deaths.

The CDC excess mortality "dashboard" adds weight to the hypothesis that the overall reported COVID-19 mortality number is somewhat correlated to the excess mortality and while the excess mortality has been relatively uneven, most states appear to report significant excess mortality. If this excess mortality is an "adequate" price to pay or if it is felt that lockdowns actually worsened the overall excess mortality (?) are different questions. But the excess mortality is what it is.

There is noise and there are mitigating factors but, just like in investing, uncertainty is the name of the game and decisions have to be made. The following is interesting as it gives some perspective on the amount of underreporting that may be occurring (the data stops in early May). Since then, many states have been reporting excess influenza deaths with an unusual pattern, suggesting that some influenza-related deaths were in fact misclassified COVID-19 deaths. They suggest that the under-reporting may lie between about 2 and 20%.

https://www.medrxiv.org/content/10.1101/2020.05.04.20090324v4.full.pdf

 

Follow-up:

The graph is not as ominous as it looks because it is a summation of heterogeneous data (some good and some bad) but it feels like a company increasing leverage while entering the zone of insolvency. It could work out OK but there may be collateral damage.

[Investor20]

Toronto’s public health department basically outright said that any death is marked as a COVID death as long as the person tested positive for COVID. So if you died in a car accident yet tested positive for COVID that’s still counted in the death count? How can anyone trust the numbers anymore?

i think this is misinformation and perhaps disinformation.

https://www.scientificamerican.com/article/how-covid-19-deaths-are-counted1/

https://www.cdc.gov/nchs/covid19/coding-and-reporting.htm

Given the evolving evidence (balancing reasons that could lead to over- and under- reporting) and excess mortality inputs, at this point, some underestimation of reported deaths is likely.

Disinformation from a public health source?

Here's the excess mortality graph provided by the CDC: https://www.cdc.gov/nchs/nvss/vsrr/covid19/excess_deaths.htm

Saw a peak in early April that has since subsided. For the last week, it has fallen below the trend line.

Agree that there's probably an undercount, but there's also a general acceptance that deaths from cold and other influenza-like illnesses are undercounted as well. Plus, how do we separate that from the increase in deaths that we've seen as a result of lockdown (people delaying treatments and not going to the hospital when they should, deferment of elective procedures, overdoses, suicides, etc) How do we understand the true lethality of this virus when there's this level of ambiguity?

Btw, it doesn't look like it's just Toronto either - seems like the standard practice is to list all deaths for which the deceased tested positive as a COVID death. Here's Illinois's Department of Public Health explaining how they count: "Technically, if you died of a clear alternate cause, but you had COVID-19 at the same time - it's still listed as a COVID death," Dr. Ezike answered. "Everyone who's listed as a COVID death doesn't mean that was the cause of death, but they had COVID at the time."

https://www.wandtv.com/news/why-and-how-covid-19-deaths-are-tracked-in-illinois/article_2085ddaa-93e8-11ea-b1c2-7fd058d907cf.html

Florida and Texas never had excess deaths more than once a while Flu season.  Its NY, NJ and surrounding states that contributed to much of the excess deaths.

The CDC excess mortality "dashboard" adds weight to the hypothesis that the overall reported COVID-19 mortality number is somewhat correlated to the excess mortality and while the excess mortality has been relatively uneven, most states appear to report significant excess mortality. If this excess mortality is an "adequate" price to pay or if it is felt that lockdowns actually worsened the overall excess mortality (?) are different questions. But the excess mortality is what it is.

There is noise and there are mitigating factors but, just like in investing, uncertainty is the name of the game and decisions have to be made. The following is interesting as it gives some perspective on the amount of underreporting that may be occurring (the data stops in early May). Since then, many states have been reporting excess influenza deaths with an unusual pattern, suggesting that some influenza-related deaths were in fact misclassified COVID-19 deaths. They suggest that the under-reporting may lie between about 2 and 20%.

https://www.medrxiv.org/content/10.1101/2020.05.04.20090324v4.full.pdf

 

Follow-up:

The graph is not as ominous as it looks because it is a summation of heterogeneous data (some good and some bad) but it feels like a company increasing leverage while entering the zone of insolvency. It could work out OK but there may be collateral damage.

 

They should also have percent dead in that plot.