Medical Discussion of Coronavirus

[ENT Doc]

Risk mitigation - if one listens closely to the vast majority of public health officials - the mask recommendations are gradated. Cloth < Surgical masks < N95. NPR had a good segment that aired today exactly on this when talking about individual choices and recommendations. We as physicians should know the difference between these types and relative risks to match the level of risk mitigation needed.

Absolutely agree that there's truly no teeth in public 'mandates' at this point.. I also dislike any labeling of any group of people -- regardless of their choice. So how to proceed? Each individual person and company making their own rules and enforcement. I absolutely believe Target and Walmart and any company has the right to make their safety rules and right to refuse entry/service based on that safety rules -- just like that individual person electing to follow or not follow those rules upon entry.

There's a nuance in personal choice and one professing the right to that has to equally defend the other person's opposite choice to the fullest degree no matter how one disagrees. It cuts both ways.

eg my current MO and what I rec to pts: : being vaccinated and masking
If I'm going into a grocery store at 3AM with no one nearby -- no mask
If I'm going into a place where I believe there's a relatively good chance of sustained exposure - like trader joe's in the mid-afternoon/weekend -- bring my valved vogmask for my protection
If I'm going to a place with known potential and high risk of sustained contact -- airplane ride/indoor concert/movie theater -- new vogmask or n95 .

Prudence based on individual risk scenarios.

Are we going to Disneyland still in 4 weeks? Yep. and bringing my mask for indoor portion of rides too.

Those are all personal choices and I’m not going to second guess them. I will second guess the fool who was in a N95 kayaking in the middle of the ocean someone mentioned the other day. As for policy though, I think we’re at the point where masking has significantly diminished utility. Those vaccinated are not likely to do poorly at all, and those not vaccinated have done so by choice. The only exception is kids, but they have a lower risk of contracting serious illness. I fall on the “kids need to go back to school” side. Last year was ridiculous, and while I can’t quantify it I suspect the lost life (suicide) and quality of life as a result of lock downs and stay at home learning will be felt for years to come.

[AR]

It is one think to give an advisory. It is another thing to mandate it.

Well, you're right in the sense that giving an advisory does pretty much nothing and a mandate actually does do something.

The choice is really mandate or no mandate. "Advisory" is a silly half-measure that does approximately nothing. For example, advising people to voluntarily mask if they aren't vaccinated is close to useless if no is checking (which they aren't).

[MaxPower]

This was always the case that you can still catch it. So do you think we should all go around wearing N95s from now on? What’s your end point? I’ve not noted any organization advocating for everyone, including vaccinated people, to wear N95 masks for traveling or indoor activity.

I think the post you initially started replying to was aimed Hatton, who is vaccinated but his also going to visit her very ill brother with multiple medical problems. In that case the risk of catching it and passing it on is much higher than if she were just going to travel and be isolating after the fact, or traveling and visiting someone who isn’t immunocompromised or with multiple co-morbidities.

[AR]

while I can’t quantify it I suspect the lost life (suicide) and quality of life as a result of lock downs and stay at home learning will be felt for years to come.

Suicides are relatively quantifiable and I'm pretty sure suicides were down in 2020 compared to 2019. I suppose they could go up later but it will be hard for anyone to tie that directly to the events of 2020.

[StarTrekDoc]

Those are all personal choices and I’m not going to second guess them. I will second guess the fool who was in a N95 kayaking in the middle of the ocean someone mentioned the other day. As for policy though, I think we’re at the point where masking has significantly diminished utility. Those vaccinated are not likely to do poorly at all, and those not vaccinated have done so by choice. The only exception is kids, but they have a lower risk of contracting serious illness. I fall on the “kids need to go back to school” side. Last year was ridiculous, and while I can’t quantify it I suspect the lost life (suicide) and quality of life as a result of lock downs and stay at home learning will be felt for years to come.

You can't correct stupid. N95 kayaking and unvaccinated 80 yo DM, OSA, CAD going to indoor concerts are equally insane by their own choice - one gets eaten by a shark while the other by a virus - nature wins.

Schools absolutely need to open. They did so successfully WITH MASKING COMPLIANCE throughout the nation in multiple settings with success.

Our two kids went back in-person schooling without issues. Going back to school as if covid doesn't exist and act as situation normal? Not the example of stupid above, but certainly not the best choice either -- there is a middle ground for grade schools that aren't eligible for vaccination yet.

As for mental strain - it has been crushing for all stakeholders. The most impacted I've seen are mid-career folk - already struggling to balance family/career/marriage. Kids ironically have been relatively okay - it's the lower SES throughout the generations that will bear the burden of covid.

[K82]

This is straight falsehood. Sweden got absolutely rocked.

Please stop.

I'm afraid it's not falsehood. It does depend on the metrics you use though. This is a good summary of what happened in Sweden:

https://www.spectator.co.uk/article/sweden-covid-and-lockdown-a-look-at-the-data

Their death rate per capita was much better than the UK as well as many other European countries including Italy, Spain and France. They did, however, have more covid cases per capita. They did poorly in regards to nursing home deaths however their rate was still better than most of Europe. Although they did worse than their nordic neighbors, Norway and Finland, the population density of those countries is much less with Sweden more approximating the UK.

Sweden had the most relaxed approach to Covid of pretty much any country. No mask mandates, no lockdowns. People could go to school in person and go to work. A side benefit of that was that their GDP in 2020 suffered much less than the UK (-3% vs -10%).

So, even though they did have more cases per capita they had a much better death rate along with other benefits of not locking down. I wouldn't call that getting "absolutely rocked". There can be debate over what the best course should be dealing with this disease but I don't think the data discounts Sweden's approach at all.

[K82]

[K82]

In thinking about this mask mandate some more.....

Every day I see pts with head trauma. Mostly from the elderly falling down or kids doing dumb stuff or MVAs. I think our nation would be better served with a national helmet mandate. It would prevent a ton of head trauma. Its not that onerous to wear a helmet and if we can save just a few lives, isn't it worth the inconvenience? The data may not entirely support it, but hey, stop being negative and think of others around you. Why should they have to pay to take care of your head trauma? So, lets all do our part and force everyone to wear helmets.

[AR]

I wear my mask alone in the car all the time. Not intentionally -- I basically forget that the thing is even on. That's probably why I find it difficult to relate to all of these mask arguments.

[CordMcNally]

I wear my mask alone in the car all the time. Not intentionally -- I basically forget that the thing is even on. That's probably why I find it difficult to identify with all these mask arguments.

I'm the opposite. I've never forgotten that I have a mask on.

[shady]

I wear my mask alone in the car all the time. Not intentionally -- I basically forget that the thing is even on. That's probably why I find it difficult to identify with all these mask arguments.

I’m in the same boat. At this point I’m so accustomed to wearing a mask that it doesn’t bother me and I struggle to relate to people arguing from either side. Similar to the above poster, I wear an n95 at work and on planes, Vog mask in busy places, and maskless for daily stuff. To each their own. Even if an n95 prevents a positive covid PCR and mild symptoms it is worth it in my opinion. Long term sequela remain a potential and the 10 days or whatever duration of being off work would be miserable on their own.

[gap55u]

Immunocompromised patients and vaccine boosters: I am checking titers for select patients. Kidney transplant, j&j was what he could get first - negative titer. In discussion with my institution’s ID folk he is getting 2 MRNA’s. Very interesting & concerning the difference between UK and Israel’s effectiveness of Pfizer against delta. We have had mild cases of Covid in fully vaccinated here. Makes me less lackadaisical about popping into the grocery store without a mask.

[pierre]

Is the risk of transmission on an airplane real or perceived? The ventilation on airplanes is great

[Huggy]

Those wearing a mask while alone in their car probably often have a reason. Rideshare drivers and some food delivery services require drivers to wear the mask even while no passenger is present. For those other delivery drivers that don't require masking while alone in the car, the driver interacts with customers frequently enough that repeatedly donning and doffing the mask would drive a person insane. Next time you see someone doing it, look to see if they have their phone propped up on a holder with their GPS running. If they don't have that, they may also be doing what I tend to do which is put on my mask before arriving to my destination if I'm in a rush so that I don't forget it. Finally, they could have just forgotten it was on, but I imagine that is less often the case.

[Huggy]

Is the risk of transmission on an airplane real or perceived? The ventilation on airplanes is great

My soon-to-be FIL, a captain, argues that airplane ventilation systems are not as great as the public likes to believe. He doesn't put any stock in them being effective at filtering out COVID. I have no clue if he's right or wrong, but that's how him and many other pilots seem to feel.