Friday, May 7, 2021

Opinion: Americans will increasingly have to make their own judgments about covid-19 risks/WaPo

OMG, the WaPo has published an article that simply makes sense about masking.  CDC just admitted the truth, after 14 months, that aerosol transmission of Covid is a 'thing.' CDC's pivot to the truth, I fear, may be intended to force us to move to N95 masks--a move that has been floated in Europe for several months.  I don't think there were enough of the masks available to do this, but maybe there are now. If that occurs, here is some ammo to fight back.

FYI, Mark Mellett wrote an article citing the following from WHO last June:

Meta-analyses in systematic literature reviews have reported that the use of N95 respirators compared with the use of medical masks is not associated with any statistically significant lower risk of the clinical respiratory illness outcomes or laboratory-confirmed influenza or viral infections… The use of cloth masks (referred to as fabric masks in this document) as an alternative to medical masks is not considered appropriate for protection of health workers based on limited available evidence… At present, there is no direct evidence (from studies on COVID- 19 and in healthy people in the community) on the effectiveness of universal masking of healthy people in the community to prevent infection with respiratory viruses, including COVID-19. — “Guidance on the use of masks for the general public”, June 5th, 2020;

Opinion piece in today's WaPo:

Joseph G. Allen is an associate professor and director of the Healthy Buildings program at Harvard University’s T.H. Chan School of Public Health. He co-wrote “Healthy Buildings: How Indoor Spaces Drive Performance and Productivity.”

The questions at the end of the pandemic are shaping up to be as challenging as those at the beginning. Do I have to wear a mask outdoors? What can I do after I’m vaccinated? When can we stop wearing masks altogether? And, the big one: What about kids?

Let’s first address the easy questions. The latest guidance on outdoor masking from the Centers for Disease Control and Prevention is fine, but it doesn’t go far enough. You shouldn’t need to wear a mask outside, period.

The risk of transmission outside is extraordinarily low. Why? Because of unlimited ventilation, exposure to ultraviolet light from the sun, plenty of space and transient interactions. Even if transmission does occur, there are no superspreading events, which can only happen when the breath of one infectious person reaches the lungs of every other person in a confined space. That can’t happen outdoors.

If you want to continue to wear a mask outdoors, by all means you should. And absolutely no one should harass someone else for wearing a mask outdoors — or anywhere, for that matter. If you’re unvaccinated, standing a few extra feet from someone is still a good idea.

The other easy question: What can you do after you’re vaccinated? Whatever you feel comfortable doing. The vaccines severely limit infection, erase risk of death and stop you from spreading to others. Yes, they are not perfect, and yes, there is the extremely small chance of reinfection with mild consequences. So this comes down to a question of personal risk tolerance. So again, do whatever you feel comfortable doing.

Now the hard questions: indoor masks and kids.

The medical science says that if you’re vaccinated, you don’t need to wear a mask indoors for the same reasons above. The risk to yourself and others is low.

Social science tells us something different. In this interim phase, as vaccinations go up and cases come down, the right thing to do is wear masks indoors in public spaces until every adult has had a fair and equitable chance to be vaccinated — likely around June 1. It takes about 30 days for people to be fully vaccinated and for full protection to kick in. That means it’s reasonable to expect that we will be able to ditch indoor mask mandates by July 4. Independence Day. Seems fitting.

To be clear, the risk is still high for unvaccinated adults, so they should continue to wear a mask indoors even after July 4. And businesses may continue to require masks, either because of their own risk calculus or out of concern about perceptions and expectations of their workers and customers. That’s fine.

As for kids, they don’t need to wear a mask outside starting right now, and, after this school year is over, they shouldn’t have to wear masks inside either. Why? Their risks of getting infected are lower than adults, and it will get even lower as the vast majority of adults are vaccinated. Consider what’s happened in Israel, where more than 60 percent of adults are vaccinated. No kids under 16 have been vaccinated there, yet cases in kids have dropped 98 percent since January.

While kids can get the virus, and there are some tragic instances of kids dying, this is mercifully very rare. Data from the United States, Britain, South Korea, France and Spain all show the same thing: The risk of death for kids under 19 is about one in a million. For perspective, teenagers in the United States are 10 times more likely to die from suicide.

The truth is, for kids, covid-19 is like the flu, and we don’t make kids wear masks in school for that. (We do encourage them to get an annual vaccination, so we should do the same when the vaccines for covid-19 are ready for young kids, too.)

The reality is that the United States is entering into a new phase of the pandemic, in which decisions about things such as masking outdoors and going to a restaurant shift from being a debate about public risk to individual risk. Last year, we were struggling to protect the most vulnerable, and there was a risk of health-care systems collapsing, so we needed mask rules and top-down restrictions on what we could and couldn’t do. But, thanks to vaccines, we now can protect the most vulnerable, and overall community risk is dropping fast. The burden of decision-making about risks thus should move from the government to businesses and individuals.

Updating guidance is not an admission that past guidance was flawed; it’s good scientific practice to change recommendations based on new information. The new information is that vaccines are winning the race against the variants in the United States. Our guidance should change accordingly. And if things turn for the worse unexpectedly, we should be prepared to reinstitute more strict controls. There are no absolutes in a pandemic.


Unknown said...

The WaPo article states that the Covid vaccine will "and stop you from spreading to others". I had not heard this previously. Is that correct? I thought that aspect of the vaccine was not tested.

Anonymous said...

Meryl, this certainly reads like a "pro-vaccine" piece hidden inside a controlled opposition discussion about masks. IThe comments about no masks outdoors is spot on. And certainly children have demonstrated an ability to handle Covid.

The writer has a Biology undergrad an a Masters in public health, but is not really a medical professional - more like an HVAC guy.

My discontent was leaving out discussion of the hardest question. Approximately 50% of the population has immunity from Covid from built up from flus and common colds or from having Covid19 itself. They are unvaccinated, but do not need masks, and are likely to be injured via ADE if they actually got the vaccine - so they SHOULD NOT GET THE VACCINE.

But Mr. HVAC sees vaccine as the only solution to everything. I disagree, as do millions of others who know how to read, and know the Pharma posse cares nothing about health, as it has a one size fits all solution to everything.

People with natural immunity can die from this vaccine, cancer survivors can die, cardiac patients can die, etc. - when are America's doctors going to snap out of their stupor and actually treat patients as individualsls?? First Do No Harm.

Meryl Nass, M.D. said...

I can't get with much around here. ; }

1. I and my patients have access to drugs for Covid and so I am sanguine about getting the condition, because I know I won't be greatly harmed or get 'long Covid.'

2. Many others are considerably less anguine, and feel that the risk they perceive from the vaccine is worth it.

3. I try to give people information here and I respect other peoples' ability and right to make the decisions that best suit them. Just because I don't choose this vaccine doesn't mean I should force others to think or do the same thing. No mandates. Individual rights. Bodily autonomy. Your body is yours to do with what you wish. Mandates won't work. Abolition didn't work.

4. The manufacturers did not claim the vaccines stopped spread when they applied for their EUAs. Today Pfizer applied for a license. 50 million Americans and many millions elsewhere have already received their vaccine. Pfizer bought the medical records of every Israeli. Maybe by now Pfizer and FDA will finally know a bit about this vaccine, for example, does it reduce spread? What are all its side effects and how often tdo they occur, in different demographics, such as children?

yvette said...

The struggle to construct a coherent narrative is tangible.
Meryl, are you saying you don't support using N95 masks to protect from this virus? We unvaccinated don't all have access to the Ivermectin or a good doctor, or may want to limit our dosage of viral exposure so that if we do catch it, it doesn't have a head start. These masks are becoming more available now.

Meryl Nass, M.D. said...

Yvetter I did not say that. A properly worn N95 will reduce viral transmission--explained in many prior posts.

I am concerned that an improperly worn mask of any kind has not been shown to provide any benefits.

I am concerned that some workers, for example employees of big box stores--will be made to wear them for 8 hours a day, in lieu of improved ventilation.

Anonymous said...

Professor Allen's comments are scary and he misses the mark.

I am a nurse. I was involved in the educational system during the H1N1 pandemic of 2009; remember that? The US public health doctors wanted then President Obama to lockdown the country, but he said no; it would cause more damage than good. He was right. That flu bug was causing similar lung damage from cytokine storms that we are seeing with Covid, but the difference was the patients who were dying were young. So what was the plan? Go home and do nothing? NO! There was a multi-tierd approach to that pandemic and it worked. The public was educated to stay home when sick, wash their hands frequently, and cough into their elbow/sleeve; remember that too? Early treatment in the form of free Tamiflu was given away to low-cost clinics to head off severe symptoms, and eventually a second H1N1 flu vaccine became available. No public wearing of masks. No long-term lock downs with the accompanying shortages of food and supplies and job losses. We survived.

Fastforward to Covid. We locked down our economy causing collateral damage that we haven't even begun to realize and from which it will take decades to recover. Education for the public has been confusing and contradictory, to the point that many have lost confidence in our public health officials. It is true that Covid is different from influenza in that it also has a vascular component, but we now know how to treat that, and we should be treating this disease early, not late. However, early treatment was abandoned, even forbidden as soon as it was thought this virus was amenable to a vaccine. The vaccines are experimental and technically still in clinical trials, albeit on a massive scale, but health and educational officials are threatening to mandate them anyway, which is a clear violation of the Emergency Use Authorization and people's civil rights. To make matters worse, there is now talk about discrimination against those who want to wait for vaccination until more safety data becomes available.

The entire way in which this pandemic has been handled reeks of unprofessionalism, coercion, and manipulation. God help us.

yvette said...

Thanks Meryl - sorry, I hadn't seen (or perhaps recalled) your other thoughts on masks (I'm getting into information overload at this point). Totally agree about ventilation and workers needing to breathe. What a mess!