Covid II: Medical Info and Implications

[strappinglad]

1 hour ago, pogi said:

Which suggests that people should wear masks. 

Yes, but not all masks are created equally and some so-called masks are not useful for small/virus sized  protection. " wear a mask " should come with caveats about type and effectiveness. Getting the majority to wear a mask is difficult enough. Now , to do better people will have to be concerned about type, quality, and sanitization. 

[bsjkki]

36 minutes ago, strappinglad said:

Yes, but not all masks are created equally and some so-called masks are not useful for small/virus sized  protection. " wear a mask " should come with caveats about type and effectiveness. Getting the majority to wear a mask is difficult enough. Now , to do better people will have to be concerned about type, quality, and sanitization. 

It is important to wear a mask designed for filtration, or as this study found, you are doing more harm than good. I saw a pack at Costco that was one layer and stretchy fabric. It's not going to help.

"The results of this study show that wearing a zero-filtration mask can lead to a higher deposition rate of particles smaller than 10 µm (i.e., PM10) in the upper airway for all flow rates (15 l/min–60 l/min) and mask resistance matrices considered. This seemingly counterintuitive observation may be attributed to the altered pressure and airflow fields caused by the mask, which further changes the inhalability of the particles and subsequent deposition in the upper airways. The overall lower speeds of the respirable particles after wearing a mask, as well as an increased area of respiration, can increase the chance of respirable particles to land on the face or being inhaled into the mouth and nose. This unexpected finding raises an alarm that wearing masks with very low filtration efficiencies may lead to a higher chance of deposition of ambient aerosols and thus can do more harm than protection."

[The Nehor]

So far the vaccine rollout is not going well. The slow distribution has led people to wonder what is going on. HHS secretary Alex Azar said Pfizer was having production problems. When asked for comment Pfizer responded:

Quote

Pfizer is not having any production issues with our COVID-19 vaccine, and no shipments containing the vaccine are on hold or delayed. This week, we successfully shipped all 2.9 million doses that we were asked to ship by the U.S. Government to the locations specified by them. We have millions more doses sitting in our warehouse but, as of now, we have not received any shipment instructions for additional doses.

Excuse me while I go bang my head against something.

[pogi]

15 hours ago, strappinglad said:

Yes, but not all masks are created equally and some so-called masks are not useful for small/virus sized  protection. " wear a mask " should come with caveats about type and effectiveness. Getting the majority to wear a mask is difficult enough. Now , to do better people will have to be concerned about type, quality, and sanitization. 

Recommendations to wear a mask have always come with caveats about type, quality, and sanitation.  We have always suggested that not all masks are equal and that cloth masks are only effective when clean, multilayered, and more effective when tight around the edges and covering the nose and mouth.

I have never seen any good studies which measures filtration rates with different fabric types.  Without that information, this study isn't very practical in application.  There is no good direction with fabric masks and further study is clearly needed.  But in no way does this study suggest that fabric masks can't be effective or that masks in general should be questioned.  There is also no clear threshold in this study which describes when a mask becomes ineffective and at what filtration rate.  What we do know is that even with the current recommendations and public practices, mask mandates work.  If this study could improve efficacy - awesome!  But as it is, it doesn't offer any real practical information.  We have already suggested that we shouldn't wear used surgical masks.  Nothing new.  We already knew that thin single layered, loose fitting fabric masks are not really effective.  Nothing new there.  We already understood that tight fitting masks which prevent airflow are more effective and recommended.  Nothing new there.  We already knew that when not worn and handled properly that masks could actually do more harm than good.  I don't see how this study will have any significant effect on public policy other than reinforcing what we have already taught. 

Edited December 18, 2020 by pogi

[pogi]

14 hours ago, bsjkki said:

It is important to wear a mask designed for filtration, or as this study found, you are doing more harm than good. I saw a pack at Costco that was one layer and stretchy fabric. It's not going to help.

"The results of this study show that wearing a zero-filtration mask can lead to a higher deposition rate of particles smaller than 10 µm (i.e., PM10) in the upper airway for all flow rates (15 l/min–60 l/min) and mask resistance matrices considered. This seemingly counterintuitive observation may be attributed to the altered pressure and airflow fields caused by the mask, which further changes the inhalability of the particles and subsequent deposition in the upper airways. The overall lower speeds of the respirable particles after wearing a mask, as well as an increased area of respiration, can increase the chance of respirable particles to land on the face or being inhaled into the mouth and nose. This unexpected finding raises an alarm that wearing masks with very low filtration efficiencies may lead to a higher chance of deposition of ambient aerosols and thus can do more harm than protection."

"Zero-filtration mask"?  What is that, a mesh mask?

"Low filtration efficiencies"?  Very unspecific.  What is the threshold?  What am I supposed to do with this information practically speaking?  How does a lay person know which fabric masks will be effective and which wont?  What more can we do then what we have already done - recommend multilayered fabric masks that are tight fitting? 

[strappinglad]

I guess I've seen too many videos of the things people are using as a mask. Is a pulled up turtle neck sweater good enough? How about all those folks wearing paper masks with their nose exposed ? Then there are the scarfs and the neck warmers. Oh ya, and the masks worn as beard warmers. Perhaps saying the mantra " Wear a mask " over and over is having some effect, but never underestimate the ability of folks to do the bare minimum to comply ( and disregard all the caveats ) . What ever we have been doing, it obviously isn't enough or there would be no big spike in cases almost world wide. 

[rongo]

20 minutes ago, strappinglad said:

 Oh ya, and the masks worn as beard warmers. Perhaps saying the mantra " Wear a mask " over and over is having some effect, but never underestimate the ability of folks to do the bare minimum to comply ( and disregard all the caveats ) . What ever we have been doing, it obviously isn't enough or there would be no big spike in cases almost world wide. 

1) We call that the Amish beard. 

2) We've noticed that in the virtue-signaling aspect of all this (which goes both ways; both maskers and anti-maskers virtue-signal), the only thing that most maskers care about is that some minimal effort went into visually complying. So, Amish beards, gaiters, exposed nose, exposed, mouth, etc. are all fine to most people --- but someone without anything at all? An enemy of the people!

3) Even hard lockdown areas with high mask compliance are spiking. I don't think masks/distancing are really flattening much of anything. Anecdotally, our family has noticed that the only people we personally know who have tested positive are the most compliant with masks. Small sample size, I know, but that's our immediate experience. We really don't know very many people who have tested positive. 

 

Edited December 18, 2020 by rongo

[pogi]

44 minutes ago, strappinglad said:

I guess I've seen too many videos of the things people are using as a mask. Is a pulled up turtle neck sweater good enough? How about all those folks wearing paper masks with their nose exposed ? Then there are the scarfs and the neck warmers. Oh ya, and the masks worn as beard warmers. Perhaps saying the mantra " Wear a mask " over and over is having some effect, but never underestimate the ability of folks to do the bare minimum to comply ( and disregard all the caveats ) . What ever we have been doing, it obviously isn't enough or there would be no big spike in cases almost world wide. 

There would still be spikes even with perfect compliance in public areas.  I guarantee that the reason that the vast majority of those who wear the mask improperly is not because they don't know how they should wear it.   As I discussed previously, the spike is mostly due to social family and friend contacts where masks are not worn and wear they are not required to enter a store.  There are those on this forum who refuse to wear a mask in their own home when their friends are over, for example.  If there is no one there to mandate it, they won't wear it.  That is the reason for the spike.   We need to understand however that even with perfect compliance, there would still be spikes as masks aren't perfect. There would still be spread. Relatively speaking, it would be less though.   

Edited December 18, 2020 by pogi

[rongo]

2 minutes ago, pogi said:

There would still be spikes even with perfect compliance in public areas.  I guarantee that the vast majority of those who wear the mask improperly is not because they don't know how they should wear it.   As I discussed previously, the spike is mostly due to social family and friend contacts where masks are not worn and where they are not required to enter a store.  There are those on this forum who refuse to wear a mask in their own home when their friends are over, for example.  If there is no one there to mandate it, they won't wear it.  That is the reason for the spike.   We need to understand however that even with perfect compliance, however, there would still be spikes as masks aren't perfect. There would still be spread. Relatively speaking, it would be less though.   

My city and county do not have a mask mandate, but almost all of Arizona has local mandates in place (no state mandate). However, they are all unenforced (no fines or arrests, other than for trespassing if a store asks someone to leave and they refuse). What this means in practice is that it is up to the individual. The pressure is peer pressure only. Stores that post masks required signs don't enforce it, even when pushed by customers (exceptions are the more "granola" stores, like Trader Joe's and Sprouts, who aggressively hound customers and call the police). So, it's really optional, in practice. The stores have done "due diligence," as far as liability, by posting the signs and leaving it at that. 

[pogi]

18 minutes ago, rongo said:

3) Even hard lockdown areas with high mask compliance are spiking. I don't think masks/distancing are really flattening much of anything. 

You haven't been reading this thread then.  Mask mandates have been shown to reduce transmission rates in multiple large nationwide studies. 

20 minutes ago, rongo said:

the only thing that most maskers care about is that some minimal effort went into visually complying. 

Not true.  That may be true for lay people getting paid $7 an hour to stand in front of Walmart and make sure masks are on, but that absolutely is not true about the experts and "maskers" in general.

[Rain]

18 minutes ago, rongo said:

1) We call that the Amish beard. 

2) We've noticed that in the virtue-signaling aspect of all this (which goes both ways; both maskers and anti-maskers virtue-signal), the only thing that most maskers care about is that some minimal effort went into visually complying. So, Amish beards, gaiters, exposed nose, exposed, mouth, etc. are all fine to most people --- but someone without anything at all? An enemy of the people!

That is really weird because I have never seen a pro-mask person who is ok with an exposed nose.  I have seen lots of things talking against an exposed nose.

18 minutes ago, rongo said:

3) Even hard lockdown areas with high mask compliance are spiking. I don't think masks/distancing are really flattening much of anything. Anecdotally, our family has noticed that the only people we personally know who have tested positive are the most compliant with masks. Small sample size, I know, but that's our immediate experience. We really don't know very many people who have tested positive. 

 

 

[pogi]

10 minutes ago, rongo said:

My city and county do not have a mask mandate, but almost all of Arizona has local mandates in place (no state mandate). 

If your city, county, state do not have mandates, what level of government are the "local mandates" on?  

13 minutes ago, rongo said:

However, they are all unenforced (no fines or arrests, other than for trespassing if a store asks someone to leave and they refuse). What this means in practice is that it is up to the individual. The pressure is peer pressure only. Stores that post masks required signs don't enforce it, even when pushed by customers (exceptions are the more "granola" stores, like Trader Joe's and Sprouts, who aggressively hound customers and call the police). So, it's really optional, in practice. The stores have done "due diligence," as far as liability, by posting the signs and leaving it at that. 

That's unfortunate. 

[Rain]

1 minute ago, pogi said:

If your city, county, state do not have mandates, what level of government are the "local mandates" on?  

Cities other than his.  

1 minute ago, pogi said:

That's unfortunate. 

There is a actually a group trying to do a recall for the governor because his responses/lack of.  I don't know how far that has gone.

[Calm]

5 minutes ago, pogi said:

but that absolutely is not true about the experts and "maskers" in general.

If anyone comes into my home and they are not wearing their mask properly I explain the right way and why (it is usually the nose not being covered), but it is embarrassing to do so because I feel like I am treating them like a child, so understandable to me if people feel uncomfortable about asking someone to do more than wear a mask. If not worn properly...especially after being asked, they may believe it is intentional and that if they ask for better compliance it will lead to anger, etc. 

[rongo]

3 minutes ago, Rain said:

That is really weird because I have never seen a pro-mask person who is ok with an exposed nose.  I have seen lots of things talking against an exposed nose.

People in minimum compliance are all over the place! In every store, and every possible venue. No one bats an eye, although some people may be thinking that they should pull it up. I think for most people, just the minimum visual effort suffices to show they are "team players."

[pogi]

11 minutes ago, Rain said:

Cities other than his.  

Thanks for pointing this out.  For some reason the word "almost" didn't register for me.  As in "almost all of Arizona has local mandates". 

[Rain]

4 minutes ago, rongo said:

People in minimum compliance are all over the place! In every store, and every possible venue. No one bats an eye, although some people may be thinking that they should pull it up. I think for most people, just the minimum visual effort suffices to show they are "team players."

It's not that we don't notice.  I don't say anything about masks not worn or not worn properly to anyone because I don't want to get into a confrontation so I avoid the specific people if a large store or don't go into the store.  I think that is how most people who are pro mask are. 

Edited December 18, 2020 by Rain

[rongo]

5 minutes ago, pogi said:

If your city, county, state do not have mandates, what level of government are the "local mandates" on?  

Arizona is really a libertarian, "Wild West" when it comes to civic freedoms, for the most part. Arizona officially (legally) is agnostic on masks. The state government encourages masks, distancing, and hand-washing, but it doesn't go any further than billboards and press conferences.

Counties (Boards of Supervisors) and cities (city councils and mayors) can vote to impose mandates, but I'm unaware of any with teeth --- that impose fines or arrest. Customers can be asked to leave and then be fined or arrested if they refuse (misdemeanor trespass). 

My city (Maricopa City, 54,000 people) and county (Pinal County) both refused to impose mandates. Our mayor is my former ward clerk, and he's very popular (and also has governor and presidential aspirations). He wisely (from a political standpoint) didn't impose a mask mandate, even though the city council wanted one (the city's charter gives ultimate authority to him on that). The county is very conservative, and didn't impose a county mandate. Maricopa City is divided 50/50 on masks, with both sides feeling **very** strongly about their positions, so it's been tough on the schools and the school district, because it is literally impossible to make anyone happy. But, being in Pinal County has been very advantageous for my school district. My school is in the Queen Creek/San Tan Valley area, and the populace there are overwhelmingly anti-mask. Shopping near the school is visually very different than it is where we live (many, many more people without any masks). 

As it was with the state, schools and districts were given guidance only, and no imposed mandates from the state, so it has literally been 100% the schools' choice as far as online/hybrid or in-person. This has upset a lot of people, but from where I sit, I am very grateful that there has been choice, and families can literally have whatever schooling arrangement they want for their children. 

[rongo]

16 minutes ago, Rain said:

There is a actually a group trying to do a recall for the governor because his responses/lack of.  I don't know how far that has gone.

Even anti-maskers want to recall him.  

He has not had any leadership on this (as viewed by both the left and the right), but he **has** not stood in my school system's way in being and staying in-person. So, there is that (no small thing). He's term-limited, and thinks he'll be the next senator. He is delusional. No one is happy with him. 

[pogi]

34 minutes ago, rongo said:

People in minimum compliance are all over the place! In every store, and every possible venue. No one bats an eye, although some people may be thinking that they should pull it up. I think for most people, just the minimum visual effort suffices to show they are "team players."

The way I look at it, it is my role as a public health nurse to educate.  It is not my role to enforce anything.  People have been educated by now.  I would literally have to be confronting dozens of people every single day in very uncomfortable situations as this can be a highly sensitive subject for many.  But also, I don't think it would be effective.  If I was going to speak with anybody, it would be the store owners.  I think that would mostly be a waste of time too though.  People are going to do what they are going to do, by now.  I don't even say anything to people who are not wearing a mask at all.  I avoid them, along with those who wear them below their nose, but they either have a valid medical reason not to wear the mask, or they are flipping me the bird, and in either case confronting them may not be the appropriate response, nor would it change their behavior.   You simply are wrong that maskers don't care.  We just don't know how to effectively and safely broach the subject, and quite frankly don't want to be the mask police. 

Edited December 18, 2020 by pogi

[strappinglad]

46 minutes ago, pogi said:

 We need to understand however that even with perfect compliance, there would still be spikes as masks aren't perfect. There would still be spread.

And therein lies the frustration.

[pogi]

9 minutes ago, strappinglad said:

And therein lies the frustration.

I don't know why less spread and fewer hospitalizations/deaths should frustrate anybody.

[Rain]

17 minutes ago, rongo said:

Arizona is really a libertarian, "Wild West" when it comes to civic freedoms, for the most part. Arizona officially (legally) is agnostic on masks. The state government encourages masks, distancing, and hand-washing, but it doesn't go any further than billboards and press conferences.

Counties (Boards of Supervisors) and cities (city councils and mayors) can vote to impose mandates, but I'm unaware of any with teeth --- that impose fines or arrest. Customers can be asked to leave and then be fined or arrested if they refuse (misdemeanor trespass). 

They can now.  For awhile the governor/state said cities were not allowed to make their own rules. 

17 minutes ago, rongo said:

My city (Maricopa City, 54,000 people) and county (Pinal County) both refused to impose mandates. Our mayor is my former ward clerk, and he's very popular (and also has governor and presidential aspirations). He wisely (from a political standpoint) didn't impose a mask mandate, even though the city council wanted one (the city's charter gives ultimate authority to him on that). The county is very conservative, and didn't impose a county mandate. Maricopa City is divided 50/50 on masks, with both sides feeling **very** strongly about their positions, so it's been tough on the schools and the school district, because it is literally impossible to make anyone happy. But, being in Pinal County has been very advantageous for my school district. My school is in the Queen Creek/San Tan Valley area, and the populace there are overwhelmingly anti-mask. Shopping near the school is visually very different than it is where we live (many, many more people without any masks). 

As it was with the state, schools and districts were given guidance only, and no imposed mandates from the state, so it has literally been 100% the schools' choice as far as online/hybrid or in-person. This has upset a lot of people, but from where I sit, I am very grateful that there has been choice, and families can literally have whatever schooling arrangement they want for their children. 

I didn't realize that about the masks in the Queen Creek area.  So many people I know in Mesa are anti mask, but I actually can't remember the last time I have seen someone without a mask in a larger store or even Dollar Tree.  The only people we have seen inside without were workers in local restaurants and they quickly put one on when you enter or people eating.  

[bsjkki]

WHO updated guidance PCR testing and CT. 
 

https://www.who.int/news/item/14-12-2020-who-information-notice-for-ivd-users

“As with any diagnostic procedure, the positive and negative predictive values for the product in a given testing population are important to note. As the positivity rate for SARS-CoV-2 decreases, the positive predictive value also decreases. This means that the probability that a person who has a positive result (SARS-CoV-2 detected) is truly infected with SARS-CoV-2 decreases as positivity rate decreases, irrespective of the assay specificity. Therefore, healthcare providers are encouraged to take into consideration testing results along with clinical signs and symptoms, confirmed status of any contacts, etc.

Users of RT-PCR reagents should read the IFU carefully to determine if manual adjustment of the PCR positivity threshold is necessary to account for any background noise which may lead to a specimen with a high cycle threshold (Ct) value result being interpreted as a positive result.  The design principle of RT-PCR means that for patients with high levels of circulating virus (viral load), relatively few cycles will be needed to detect virus and so the Ct value will be low. Conversely, when specimens return a high Ct value, it means that many cycles were required to detect virus. In some circumstances, the distinction between background noise and actual presence of the target virus is difficult to ascertain. Thus, the IFU will state how to interpret specimens at or near the limit for PCR positivity. In some cases, the IFU will state that the cut-off should be manually adjusted to ensure that specimens with high Ct values are not incorrectly assigned SARS-CoV-2 detected due to background noise.”

...” 3. Consider any positive result (SARS-CoV-2 detected) or negative results (SARS-CoV-2 not detected) in combination with specimen type, clinical observations, patient history, and epidemiological information.

4. Provide the Ct value in the report to the requesting healthcare provider.”

Edited December 19, 2020 by bsjkki

[provoman]

11 hours ago, pogi said:

I don't know why less spread and fewer hospitalizations/deaths should frustrate anybody.

To be honest, I have wonder if some have tried to understand. the frustration(s).

Yes the "science" changes with more knowledge. At first it was "you don't need a mask", then it was "well maybe you should",  now the way it is presented is "mask are a god send and will save us all"

But it isnt even just that, we have discussed before that Salt Lake County had a months long UPWARD trend following its mask mandate put in place in August/September. And not just Salt Lake County nearly 40+ States have had months long upward trends despite mask mandate.

So just looking at the numbers and mask mandates, numbers continued to rise dramatically even with mask mandates. So was anything slowed?

These are types of frustrations that need to addressed, to get more people on board, but at time so many mask used in public are essentially useless or nulled by the wearing.

I was impressed that Utah finally put in place mask guideline - over mouth and nose, no exhale valves

 

Edited December 19, 2020 by provoman