Coronavirus

[AlanSubie4Life]

Had to google it, b/c I knew it had been several months:

https://www.washingtonpost.com/world/2020/09/17/health-care-workers-make-up-one-seven-covid-19-cases-recorded-globally-who-says/

Sorry, 1 in 7, not 1 in 6. That's per the WHO.

This should NOT be surprising, TBH. As healthcare workers, we are usually vaccinated against all the infectious diseases we have to treat, and for those that we cannot be (Tuberculosis, etc.) we dawn PPE on a "next level" that is nothing comparable to what the general public can get. EVEN with those protections, we still have higher incidence of infections to many of the diseases we treat. Literally, in every hospital I worked in, we were required to have annual screening for TB, no exceptions allowed.

Couple things to correct you on, this is a respiratory DROPLET virus, not just a respiratory virus. That means it's not just airborne, but contaminates surfaces and lasts for a prolonged period of time on those surfaces. That is a VERY important distinction. Respiratory droplet viruses almost always have higher R0 than respiratory only viruses that cannot survive on surfaces.


Again, I didn't state masking was NOT helpful, I stated it is NOT a panacea and given how poorly implemented by the general public, should be viewed as having "DEFINED, but LIMITED" effectiveness. Seriously, how often do you 1) toss your disposable masks (in the hospital it is after EVERY room we enter we have to get a new mask) or 2) wash your "reusable" masks? The virus can survive just fine on an exposed N95 mask. Do you touch your mask with your hands? (presumed yes to this) Do you wash your hands after every time you touch your mask? (assuming it is not a disposable mask). The outside of the mask can easily be contaminated, leading to contamination of the inside of the mask.

You should view any reusable mask as a source of infection unless it is brand new, or just fresh out of the wash. ESPECIALLY now that we are talking about a virus with an R0 of 5-6, compared to the ones of the past year with an R0 of 2-3.

Thanks. This article suggests to me that masking (and the other steps taken) is EXTREMELY effective, just based on the numbers and exposure levels. About 1 in 10 cases in the US, even with extensive testing and massive exposure. Pretty amazing.

Should be even better now with vaccination. Limited dosing with masking leads to better infection suppression.

 

[bkp_duke]

Thanks. This article suggests to me that masking (and the other steps taken) is EXTREMELY effective, just based on the numbers and exposure levels. About 1 in 10 cases in the US, even with extensive testing and massive exposure. Pretty amazing.

MODERATELY effective, not EXTREMELY effective. And that was with a virus with an R0 of 2-3.

Basically, you should think of the delta variant as requiring fewer individual viral particles needed in order to cause a clinical infection in someone (i.e. symptoms).

 

[AlanSubie4Life]

compared to the ones of the past year with an R0 of 2-3.

The early estimates of R0 I saw were about 3.5.

MODERATELY effective, not EXTREMELY effective.

Let’s be honest and say it’s actually not knowable with this data. We definitely would need a better study. I was just giving my impression (guess). I have no idea how effective it actually is.

But mechanically, it makes sense that layered protection with a dose-dependent model of infection would help substantially.

It’s not necessary to have a massive reduction in Rt to eliminate the growth of cases in Florida. They won’t do it though because “masks don’t help.” Lol.

 

[bkp_duke]

The early estimates of R0 I saw were about 3.5.



Let’s be honest and say it’s actually not knowable with this data. We definitely would need a better study. I was just giving my impression (guess). I have no idea how effective it actually is.

But mechanically, it makes sense that layered protection with a dose-dependent model of infection would help substantially.

It’s not necessary to have a massive reduction in R0 to eliminate the growth of cases in Florida. They won’t do it though because “masks don’t help.” Lol.

You seem to keep missing my point: you ASSUME most people KNOW how to properly wear a mask AND keep it clean or dispose of it when contaminated. I'm saying that is patently false, as pointed out by so many people here just with casual observations of how people are wearing masks (population as a whole, not individuals).

I would bet my M.D. that most people that wear masks and yet get infected are doing so because the mask becomes contaminated. Historically, that has even been a problem for healthcare workers (as verified by "swab tests" of the masks and other surfaces when we do internal audits to see how effective we have been to keep things like TB from leaving a confined area - and TB has a much lower R0 than SARS-CoV-2 delta variant).

Everything I have seen, granted not any good "studies" has estimated Delta to be between 5-8.

Covid: Is there a limit to how much worse variants can get?

The coronavirus has changed and changed again, getting more transmissible each time.

www.bbc.com

 

[AlanSubie4Life]

The early estimates of R0 I saw were about 3.5.

I looked this up (as well). I guess it was typically initially estimated at 2.5 to 3 (I need to go back to Trevor Bedford’s very first tweets about Seattle but can’t scroll back far enough right now). I guess I always thought it was higher so I had 3.5 for the wild-type virus in my mind.

 

[AlanSubie4Life]

I would bet my M.D. that most people that wear masks and yet get infected are doing so because the mask becomes contaminated.

Maybe. But you have to compare that rate to the rate of infection if they had not been wearing masks, since that is what is relevant - not whether infection can be entirely avoided.

And you have to re-evaluate that probability given vaccination as well, for the set of people who are vaccinated, who might care about this. I would expect the odds ratio reduction to be even higher in vaccinated individuals, since they have some immunity and are likely to avoid a massive dose even if they have some mask contamination which they get exposed to occasionally.

It’s really unfortunate at this point that we don’t have crisp clear answers to this. This is what the CDC should be doing. Go to venues, test a sample of people before, monitor mask usage with video, test people after, sequence all virus to understand the sequence of infections, control for mask usage, and evaluate results. Seems like stuff that no one would research so it seems like something the CDC should do. So many opportunities to get strong results.

 

[bkp_duke]

Actually, mask usage for the vaccinated - I'm completely against that for pretty much all but active healthcare workers. The risk for vaccinated individuals, even with delta, is so low. Infections for those that have had 2 doses of vaccine is low, hospitalizations lower, and deaths practically non-existent. By your logic, we should be wearing masks for influenza, even post-vaccination on that. The death rates in post-vaccinated COVID-19 and Influenza are both asymptotically near zero.

Wife and I are vaccinated, and except for when required by a business, we are not wearing masks any longer. We understand, and accept, that there is a VERY limited chance that we could become infected, and a much smaller chance we could have symptoms. We are both fine with that.

For those that are unvaccinated, they have the legal right to not become vaccinated, but I'm not going to go out of my way any longer to try to "protect" them by masking up and limiting my activities. That ship has sailed.

CDC data and Delta varriant:

COVID-19 Vaccination

COVID-19 vaccines protect against COVID-19. Get safety info and more.

www.cdc.gov

CDC Update on the COVID-19 Pandemic and Delta Variant

En Español - enlace aquí Oregon Health Authority updated mask guidance - located here The following is provided by the Centers for Disease Control, July 27, 2021

www.co.lincoln.or.us

• Some vaccinated people can get Delta in a breakthrough infection and may be contagious.
• Even so, vaccinated individuals represent a very small amount of transmission occurring around the country.
• Virtually all hospitalizations and deaths continue to be among the unvaccinated.

Politics aside, the data do not support universal masking for vaccinated individuals.

 

[AlanSubie4Life]

I would just add that in my recent travels I have seen people crammed together in tiny stores talking in each other’s faces, and it doesn’t seem great. Hotel breakfast bars crammed with unvaccinated kids and people. It’s like COVID doesn’t exist. Pretty sure masks would help is all I am saying.

By your logic, we should be wearing masks for influenza, even post-vaccination on that.

We don’t know what the long-term consequences of infection are for COVID, while influenza is a bit better understood. I’ll wait for a better understanding before relaxing my precautions. Should not be too long. No need for me to screw it up now.

I am fully vaccinated and wear an N95 at work where 97% or more are vaccinated. Obviously I also wear it in all other places indoors as well. I’m fine with other vaccinated individuals not doing so. EDIT: My workplace now requires masking in common areas regardless of vaccination status, in response to the new CDC guidelines. It's highly recommended to mask at all times, according to their guidance. It's easy to see why they are doing this - there's no real downside to masking in the workplace.

The risk for vaccinated individuals, even with delta, is so low

About 88% against symptomatic infection in the best study with largest sample I have seen from PHE.

I don’t think there is any need for vaccinated people to mask (though I do think it would be great for them to understand their approximate risk before they make their decision), but until we have passports or other ways to distinguish (which I think would be great since everyone has easy access to vaccines now!) I think people need to mask up indoors in places with significant community transmission. An easy step and doesn’t affect anyone, really.

Restaurants are the trickiest thing - really should be outside or very well ventilated and in my travels it looks like a disaster.

 

[NikolaACDC]

Had to google it, b/c I knew it had been several months:

https://www.washingtonpost.com/world/2020/09/17/health-care-workers-make-up-one-seven-covid-19-cases-recorded-globally-who-says/

Sorry, 1 in 7, not 1 in 6. That's per the WHO.

Your WaPo article is from 9/17/2020. This one is from end of August 2020:

Op-Ed: Why a PPE shortage still plagues America and what we need to do about it

Considering that PPE was still of short supply at that time it should not be surprising that health care workers had a high rate of infection.

No WFH. Actually working with and around infected people and then not even having a good supply of PPE?

They can be the best ever in donning PPE if they don't have enough to go around.

 

[jerry33]

Your WaPo article is from 9/17/2020. This one is from end of August 2020:

Op-Ed: Why a PPE shortage still plagues America and what we need to do about it

Considering that PPE was still of short supply at that time it should not be surprising that health care workers had a high rate of infection.

No WFH. Actually working with and around infected people and then not even having a good supply of PPE?

They can be the best ever in donning PPE if they don't have enough to go around.

Are you sure it's not the price rather than the actual availability? (e.g. We won't purchase if the cost is more than X per mask)

 

[bkp_duke]

Your WaPo article is from 9/17/2020. This one is from end of August 2020:

Op-Ed: Why a PPE shortage still plagues America and what we need to do about it

Considering that PPE was still of short supply at that time it should not be surprising that health care workers had a high rate of infection.

No WFH. Actually working with and around infected people and then not even having a good supply of PPE?

They can be the best ever in donning PPE if they don't have enough to go around.

Even with PPE, healthcare workers accounted for a disproportionally high % of cases. They are only 2.5-3% of the population, but account for MULTIPLES of that in terms of infections. Even after PPE shortages were resolved.

 

[AlanSubie4Life]

They are only 2.5-3% of the population, but account for MULTIPLES of that in terms of infections. Even after PPE shortages were resolved.

This debate is pretty pointless without an actual study with detailed (good) methodology included, applied to a relevant population (the United States). It's impossible to know with what has been presented here how effective PPE use is, how much of that was just the mask, whether shortages had any impact, etc. The protection could be excellent, or it could be non-existent. We don't know.

 

[bkp_duke]

This debate is pretty pointless without an actual study with detailed methodology included, applied to a relevant population (the United States). It's impossible to know with what has been presented here how effective PPE use is, how much of that was just the mask, whether shortages had any impact, etc. The protection could be excellent, or it could be non-existent. We don't know.

Care to continue?

Risk of COVID-19 among front-line health-care workers and the general community: a prospective cohort study

In the UK and the USA, risk of reporting a positive test for COVID-19 was increased among front-line health-care workers. Health-care systems should ensure adequate availability of PPE and develop additional strategies to protect health-care workers from COVID-19, particularly those from Black...

www.thelancet.com

Seriously, you guys seem to think I'm making this stuff up.

EVEN if you want to say there was a relative PPE shortage due to pricing, etc., healthcare workers were a disproportionately large number of the infections in 2020. Multiples higher than their % of the population.

Why is this surprising? Why does the term "front line worker" not make sense?



Your argument is like . . . arguing that the soldiers in WWII storming Normandy weren't killed at a generally higher rate than "support" servicemen not on the front lines . . .

 

[AlanSubie4Life]

Your argument is like . . . arguing that the soldiers in WWII storming Normandy weren't killed at a generally higher rate than "support" servicemen not on the front lines . . .

No, the argument was that we needed data. I already said that healthcare workers had massive exposure (so obviously it would be expected that they would see higher rates of infection). Thanks for the link.

It looks like as you would expect, from this study, people working directly with COVID patients had higher risk, and those with adequate PPE had lower risk.

Note this study started in March 2020. Would be interesting to see the same results censored to the winter wave (September to December 2020) prior to the introduction of vaccines.

It would also be interesting to remove the community effects of healthcare workers, by determining where the infections were picked up, through lots of sequencing (they are more likely to hang out with other healthcare workers outside of work, which inherently puts them at higher risk since they're around higher risk individuals, unmasked). That being said, the differentiation in odds ratios amongst the different environments where these workers were suggests that it may well have been primarily workplace infections (obviously some were!).

Anyway, would be good to see more studies from the window of time where procedures were well established (and with lots of efforts made to eliminate the impact of testing availability in identifying case rates in different populations).

To me it looks like this study supports the idea that PPE is effective. It's hard to judge from this dataset how effective it might be. Obviously dose matters. While the general public might not be as good at using PPE properly, they might also be exposed to lower doses, so those effects to some extent could cancel. Just speculation of course.

 

[bkp_duke]

You argument reads that PPE = return to baseline risk (i.e. general population).

I'm arguing STRONGLY against that. It is still multiples elevated over baseline, although a large reduction from no PPE.

The disproportionally high infection rate supports this conclusion, without argument.

 

[AlanSubie4Life]

You argument reads that PPE = return to baseline risk (i.e. general population).

I'm arguing STRONGLY against that. It is still multiples elevated over baseline, although a large reduction from no PPE.

The disproportionally high infection rate supports this conclusion, without argument.

That was never my argument. The question was whether PPE was effective, right? This started with Florida, whether or not PPE use (specifically masking) would be helpful. Your argument was that masks would have limited effect due to the high R0 of Delta. You said healthcare workers who use PPE get infected at a much higher rate, relative to the general population, so that means that PPE is not useful with a respiratory droplet virus. This is not a valid conclusion as far as I can tell.

I'm definitely not convinced that statement (masks are somehow now useless) is true for Delta, at all. Clearly healthcare workers saw substantial benefit from PPE & masking (see your linked study above). So it seems to me that these benefits would transfer to the general population as well.

I can't believe we're still arguing about whether masking works, tbh. Obviously it does. Also obviously, it does not eliminate risk; sometimes it does not work.

It seems like you're arguing that masking can make things worse. That I find to be extremely doubtful. Undoubtedly people get infected because of contamination of their masks. But that doesn't mean masking is making things worse (in fact it suggests the opposite - there was virus on the mask, subsequently leading to infection due to improper mask hygiene, which was not in the lungs - this is GOOD).

 

[bkp_duke]

That was never my argument. The question was whether PPE was effective, right? This started with Florida, whether or not PPE use (specifically masking) would be helpful. Your argument was that masks would have limited effect due to the high R0 of Delta. You said healthcare workers who use PPE get infected at a much higher rate, relative to the general population, so that means that PPE is not useful with a respiratory droplet virus. This is not a valid conclusion as far as I can tell.

I'm definitely not convinced that statement (masks are somehow now useless) is true for Delta, at all. Clearly healthcare workers saw substantial benefit from PPE & masking (see your linked study above). So it seems to me that these benefits would transfer to the general population as well.

I can't believe we're still arguing about whether masking works, tbh. Obviously it does. Also obviously, it does not eliminate risk; sometimes it does not work.

It seems like you're arguing that masking can make things worse. That I find to be extremely doubtful. Undoubtedly people get infected because of contamination of their masks. But that doesn't mean masking is making things worse (in fact it suggests the opposite - there was virus on the mask, subsequently leading to infection due to improper mask hygiene, which was not in the lungs - this is GOOD).

My argument was masks are FAR LESS effective (but not completely ineffective) than many people seem to assume. My example of that was healthcare professionals (those with the BEST overall mask hygiene). The increased incidence of COVID-19 in those individuals, pre-vaccination, completely supports this argument.

My other argument was if PPE should be forced upon / required for the vaccinated population. And I STRONGLY argue against that, based upon the data. We've gone astray, obviously, but my point was that masks should not be mandated for the vaccinated population, and there is not data to support it's usage with vaccines that are as effective as we have now. Basically, the vaccinated population is not getting symptomatic infection, not getting hospitalized, and not dying. Everyone not vaccinated, they are doing that by CHOICE, so I could care less about them. They have made their decision, let them live with the consequences of that. Hell, if anything it might be a nice counterbalance to the "Idiocracy" like movie we are living out right now.

 

[madodel]

Care to continue?

Risk of COVID-19 among front-line health-care workers and the general community: a prospective cohort study

In the UK and the USA, risk of reporting a positive test for COVID-19 was increased among front-line health-care workers. Health-care systems should ensure adequate availability of PPE and develop additional strategies to protect health-care workers from COVID-19, particularly those from Black...

www.thelancet.com

View attachment 689228

Seriously, you guys seem to think I'm making this stuff up.

EVEN if you want to say there was a relative PPE shortage due to pricing, etc., healthcare workers were a disproportionately large number of the infections in 2020. Multiples higher than their % of the population.

Why is this surprising? Why does the term "front line worker" not make sense?



Your argument is like . . . arguing that the soldiers in WWII storming Normandy weren't killed at a generally higher rate than "support" servicemen not on the front lines . . .

I certainly don't think you are making it up, but I think the lack and poor quality of PPE back in early to mid 2020 had a lot to do with it. Do you not remember stories of nurses having to wear plastic bags because they had no gowns and wearing a mask for a week at a time. Hospitals were completely unprepared and not just in NYC but as COVID spread across the country every new area treated as if they had no clue what was going on. And the government sending old moldy masks with straps that crumbled out of the PPE emergency supplies didn't help either. I remember that as well.

At the same time they were taking care of of the sickest and most infectious patients. I also know that at my wife's hospital the ER didn't initially treat all ER patients as potential COVID until a few weeks into it which ended up devastating the ER staff. The initial response to this was completely hosed so yes clinical staff was clobbered by it in the beginning. So I think both issues could have been contributing. How many hospitals are still short of nurses and doctors because they got sick and just never went back? I don't know the answer to that, but many at my wife's hospital got fed up and now the hospital is chronically short of staff which is going to make it even more hellish come the Fall. And her hospital was fairly well supplied with PPE except for masks. And she told me recently they are not just short of nurses but the CEO of the hospital was cleaning rooms at one point because housekeeping staff was so low and the cafeteria still isn't fully functional because they are low on staff. I don't know if that's directly related to COVID but it's the freaking weirdest thing I've heard in a long time.

 

[AlanSubie4Life]

My argument was masks are FAR LESS effective (but not completely ineffective) than many people seem to assume.

If masks stopped half of the transmission events (worked half the time), this pandemic would be essentially over (assuming people actually went and got themselves immunized with the vaccine in a timely fashion, which is another topic).

My other argument was if PPE should be forced upon / required for the vaccinated population.

I don't think it should be forced on vaccinated individuals and I don't think it's necessary for them, but my concern is unmasked unvaccinated individuals because they increase my risk. I don't see how we differentiate without vaccine passports (which I am now in favor of). (And obviously vaccine passports are not going to happen in Florida.)

Basically, the vaccinated population is not getting symptomatic infection, not getting hospitalized, and not dying

Yes, the risk is greatly reduced. But I would prefer to not get infected and to risk bringing that infection home to my wife and family and parents. And I don't like the general increase in risk to my parents; even though they are vaccinated, they are still not comfortable with all of their normal activities due to the ongoing risk of transmission (which would be non-existent if people had actually gotten vaccinated). Thankfully they are able to do enough of what they want to be able to do to enjoy their lives. But they're not going to church, for example (which they would like to do - but unfortunately that population is completely unhinged for reasons I find to be mysterious - the vaccines are clearly a glorious gift from God via some very very smart scientists He was nice enough to make available to us).

Everyone not vaccinated, they are doing that by CHOICE, so I could care less about them.

I mean, if they had no impact on anyone else, I would agree. But clearly it increases the risk to the vaccinated.

I'm in favor of layered protection:
1) Vaccination (90%+ protection)
2) Masking for source control. (I'd guess 80% protection)
3) Reduction/elimination of transmission through NPIs and community-wide vaccination. (Theoretically ~100% protection)


Here's some preliminary data on breakthrough infections, and the potential risks:

https://twitter.com/x/status/1420489406025113601

 

[bkp_duke]

The essential "risk" is that a small % of vaccinated individuals become temporary carriers - and TEMPORARY is key to understanding. It is a transient state while their body, which is already mostly immune, fights off the asymptomatic infection (and in the process builds up an even better immunity).

Those asymptomatic, transient, vaccinated carriers are a short-term risk for the unvaccinated, which in the USA have made their choice. If there are no negative consequences to that choice, these individuals and those like-minded won't "learn" from those choices.

If someone that is vaccinated WANTS to wear a mask, more power to them. But if the government tells that group that they MUST wear a mask, that's a blatant over-reach that is not supported by the data at hand.

FYI - I would put properly-worn, disposed after one use, N95 masks at ~80% effectiveness based upon the studies we have to date on masks and aerosolization. Surgical masks are the next best thing, and everything else is a very distant third. Reusable masks that are rarely cleaned . . . only one step above face shields (practically worthless and I get a huge chuckle when I see them in public).



This study is pre-COVID-19, and really was an eye-opener for reusable mask usage:

A cluster randomised trial of cloth masks compared with medical masks in healthcare workers

The aim of 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.14 secondary-level/tertiary-level hospitals ...

www.ncbi.nlm.nih.gov

Conclusions from the study:​

"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."

This was a well-performed, randomized controlled trial, in a healthcare setting (i.e. higher than baseline infection risk).

CDC quotes this study, and generally doesn't have a favorable outlook for cloth masks (the VAST majority of those in use around the world during the pandemic):

Effectiveness of Cloth Masks for Protection Against Severe Acute Respiratory Syndrome Coronavirus 2

Effectiveness of Cloth Masks Against SARS-CoV-2

wwwnc.cdc.gov