Medical Discussion of Coronavirus

[STM]

Any good recommendations for small toddler sized masks for daycare (small 2 year old kid)? Most toddler masks seem to big.
A High filtration mask would be great - she got sick constantly in daycare, even before covid.

Those KN95 masks wideopenspaces posted look nice. I bought these for my 4yo and they seem to have a good fit: https://behealthyusa.net/products/bl...small-kid-size

[Hober Mallow]

In Europe high filtration masks are available OTC.
It's a travesty we haven't done that here on a national level.

N95s are widely available now, and mostly back to pre-pandemic pricing (around $1.25 to $1.50 each).

https://www.grainger.com/search/safety/respiratory-protection/disposable-respirators-masks/general-purpose-disposable-respirators-dust-masks

https://www.mcmaster.com/masks/filter-rating~n95/

https://shop.projectn95.org/all

They are also available from Amazon, but personally I would never trust them for anything important - too likely to get a counterfeit.

[Hober Mallow]

Any good recommendations for small toddler sized masks for daycare (small 2 year old kid)? Most toddler masks seem to big.
A High filtration mask would be great - she got sick constantly in daycare, even before covid.

We're going on our first plane flight in a year and a half this weekend and bought 3M 8110S masks for our 8 year old to wear in the airport and on the plane. That's the only "real N95" I've found in a small size. It seems to fit her pretty well. It's probably too big for a 2yo though.

https://multimedia.3m.com/mws/media/1425068O/3m-particulate-respirator-8110s-n95-technical-specifications.pdf

[Tim]

Thank you for the level responses. This not a debate. Take it as more a thirst for actual data for decision making, Similar to the changes in baseball. Moneyball started it but advanced statistics had greatly changed the evaluation process of players and how effective they really are (those infield shifts were/are a shock to see the shortstop playing at second base and the second baseman in the outfield).

Cloth masks are not nearly as protective or prevent spread compared to surgical masks, both because they are typically non-fitted (a surgical mask will be able to be pinched at the nose and tight elastic around the ears) as well as the materials involved. N95/KN95 masks will give incremental improvement again. I only wear surgical/N95 masks and recommend that my patients do the same.
https://www.epa.gov/sciencematters/epa-researchers-test-effectiveness-face-masks-disinfection-methods-against-covid-19
This is what I found, currently. The results on the bottom do not address the original positions that masks protect spread but not infection. I have (and I am sure you have) read that the public masks are anywhere from 10%-40% effective for short periods in preventing spread but closer to 5% for infection. I find it astonishing that bandanas are at close to 50% effective in the study. I also have read material studies that show nylon less effective as a material, The reason given was the retention of nylon is much less that the other materials. Regarding the surgical masks, they also are stating "like tightening ear loops, placing rubber bands over the top and bottom of the mask to reduce gaps, and placing a cut-out piece of nylon stocking over the mask to seal the gaps.I don't see the public doing these modifications, especially in school age children. The mask fatigue in the public seems to be replace a mask when it is dirty or has debris. I think "any mask will do" is how the public will react. I was extremely surprise how high they ranked bandanas.
My take is similar to yours, if you are masking get the best mask you can. Teaching kids how to tie shoes is hard enough, I think teaching kids how to wear a mask effectively is a challenge. I doubt the teachers and parents have the skills.


Many respiratory viral panels will test for RSV at the same time as COVID. I can order a standalone COVID test for reasons like pre-op, or I can order a respiratory pathogen panel for undifferentiated sick person and get COVID, RSV, flu etc in a single specimen. RSV very rarely will cause radiographic pneumonia in adults, although it is a major cause of COPD exacerbations every winter which can put people in the hospital. Definitely not 160k deaths/year, at least not in the US. Definitely not rampant misdiagnosis where patient is thought to die of COVID but they actually died of RSV.
In the United States, nearly all children become infected with RSV by age 2, with 75,000 to 125,000 of them hospitalized each year. Globally, RSV affects an estimated 64 million people and causes 160,000 deaths each year.

https://www.niaid.nih.gov/diseases-c...tial-virus-rsv

https://www.texastribune.org/2021/08...ens-hospitals/

Yes the testing is available. But just as Covid and obesity seem linked, we track this. It would be difficult to distinguish RSV or Covid as the actual cause or if they were both involved. The reporting of Covid health issues has had some missteps. Like Covid 8 weeks ago and died in a traffic accident. Any Covid box is reported, and RSV is a completely different data collection system. 64m serious illnesses in the unvaccinated population seems to be significant. Anecdotally, 90% had both.


I don't know about all the countries in Europe, but I can tell you from speaking to my friend who lives in England that mask mandates for schools ended in May when Boris Johnson declared victory over COVID, and it has been EXTREMELY controversial that he has refused to reconsider that position as the UK has a big summer Delta wave just like the US. So it's wishful thinking that we are the only country with divided opinions.
Let's keep the politics out of this. The US seems to be the only country that the health authorities and the governments have made masking in schools a big issue.

Thank you for your response and advice. These are simply points that seem to be reasonable questions that relate to masks and the effectiveness in schools. In hot spots, everything possible is reasonable. The question is are they really effective in the majority of cases or more for targeted use.I wish we had better data and messaging. But that is a highly opinionated statement. Ignore it. Many thanks.

[burritos]

For the obese intubated, any consideration of just administering electrolytes(creating a fasting state) vs TPN?

[Rando]

This is some disappointing news from the Mayo Clinic. It looks like the vaccines either lose their efficacy over time (more quickly than originally though) and/or they are not much less effective against Delta variant than we’d all hoped.

https://www.axios.com/coronavirus-va...0be357070.html

From the article: There has been no data so far that has found either vaccine's protection against severe disease and death is significantly less against Delta.

In fact so far it looks like though the vaccines don't prevent Delta they do mitigate against its severe effects. So the variable values in the cascade that cases ---->hospitalizations---->deaths have changed. Delta is infecting a different (now largely vaccinated) population than we had a year ago. And the most vaccinated population is also the population that was previously most at risk of death.

Of course, Delta is much more contagious than prior COVID which increases total cases. Too many variables. I'm seeing models that are all over the place.

[OUSOONERDOC]

disagree strongly on multiple levels.



2) "Masking doesn't work" I'll keep saying this until I am blue in the face; well-fitted masks that are consistently worn to cover both nose and mouth and not leaking are extremely effective at reducing both spread and exposure to COVID. A cloth mask that slips down over your nose every 10 seconds so you yank it down under your chin=not masking, not a failure of masks.

Okay so this point makes my case perfectly. If a mask is only effective if worn "properly" what makes you think a 5 year old is going to wear their superman mask properly all day long? If you can agree that the odds of this happening for all kids grades K-6th is very low then you would probably agree that mandating that they wear them at all is pointless. As you said so yourself, if not worn properly then they aren't very effective.

[braindoc]

Any good recommendations for small toddler sized masks for daycare (small 2 year old kid)? Most toddler masks seem to big.
A High filtration mask would be great - she got sick constantly in daycare, even before covid.

Amaia kids has cloth masks for kids that have a compartment inside that you can place a filter in (or cut up level 3?) . They also have a wire over the nose part so it fits more like a surgical mask and they're washable. Its a UK store so you'll pay for shipping and it will take a while to get.

Walgreens occasionally has small sized surgical masks.

[setsail26]

For someone in primary care I hope the usefulness of masks is obvious. Kids in school, in the winter, masks on, zero influenza or RSV. Zip. Way, way fewer URIs in general. Kids out of school, masks off, every kid gets a URI and RSV has a (summer!) spike. Is COVID more contagious than flu and RSV? Yep. But to say that masks work really well for flu and other common viruses and not at all for COVID in kinda nonsense. We aren't going to get a randomized controlled trial. Kids don't mind wearing masks if parents don't make them mind. Pretty much nothing to lose and at least something to gain for have kids wear masks at school. And to say the mortality is low in kids is true, but just like being a parent of one of the 4 unvaccinated kids who die of chicken pox every year, wouldn't you feel really stupid if your kid ended up on a vent from COVID?

[Zaphod]

There was a great segment with a medical guy on CNN talking about masks and the Rand Paul suspension from YouTube. He couldn’t really say that Rand Paul was kind of correct on air, but he did go through some mask evidence.

Basically it seems cloth masks give you a few minutes of protection at best, and with a well fitting N95 mask, you can spend a full day in a closed room with a Covid patient and be protected. Wish I could find the evidence he quoted, in a nonpartisan way.
(I’ve been stuck in a hotel room for 3 days now with nothing to do but watch the news and the weather channel).

Side note: I actually believe masks work along a continuum as he described.

Absolutely, ofc they do. But that same reality of a continuum (and I think we're beyond surgical masks now) provides a lot of room for people to make bad faith arguments.

[Zaphod]

From the article: There has been no data so far that has found either vaccine's protection against severe disease and death is significantly less against Delta.

In fact so far it looks like though the vaccines don't prevent Delta they do mitigate against its severe effects. So the variable values in the cascade that cases ---->hospitalizations---->deaths have changed. Delta is infecting a different (now largely vaccinated) population than we had a year ago. And the most vaccinated population is also the population that was previously most at risk of death.

Of course, Delta is much more contagious than prior COVID which increases total cases. Too many variables. I'm seeing models that are all over the place.

Think that data is going to look better and better actually. On this forum and everything else I hear are that those in hospital are transplant, cancer, and other immunocompromised, getting the most vulnerable first, it will ease off of that smaller population and leave behind stronger ones that arent as vulnerable.

[Shant]

Kind of obvious but taping a twist tie wire inside the nose area helps with the seal for kids as does sealing with medical tape along the top.

I do not understand the provenance of the idea that we're just misdiagnosing previously existing illnesses. The symptoms and test results are different full stop. Likewise on the death certificates.

[pulmdoc]

Okay so this point makes my case perfectly. If a mask is only effective if worn "properly" what makes you think a 5 year old is going to wear their superman mask properly all day long? If you can agree that the odds of this happening for all kids grades K-6th is very low then you would probably agree that mandating that they wear them at all is pointless. As you said so yourself, if not worn properly then they aren't very effective.

Read my previous response. My kids wore their masks all day long, 5 days a week all school year. They wear masks when we go to crowded indoor places like grocery stores or museums. They wear masks the way masks are supposed to be worn, over both nose and mouth. They don't pull them down. Why not? They are wear well-fitting masks that stay over their nose, and the adults model proper mask-wearing (ie we don't pull our masks down either). My kids are not super precocious geniuses capable of pulling off feats of adult complexity in keeping a mask on their face; they just have parents who give a ************************ about teaching them the right way to do it.

[StarTrekDoc]

Vaccinated: Breakthroughs? yes. Mod/sev disease (hosp/death) -- still good.
UnVaccinated: same course as before; just higher numbers and with that - more chances of pulling spades with hosp/death: 1.6% all comers.

1.6% is good vegas odds and argument from the lay folk. Anyone in here arguing 1.6% is good in any medical setting needs to go back to med school.

Back to basics: NNT vs NNH - Have to weigh each action vs nonaction
1. Vaccinate
2. Mask and choice of
3. Mandates/passports/isolate/exclusions

Those who are still arguing the benefits of vaccination - Delta has really shown the difference on this -- even in the lowest risk children. Check out the Children Hospitals. Most those kids in there don't usually see the inside of hospitals in August. Harm?

Masking - yeah, I personally believe if you're not using a Vogmask or equivalent or N95, why not? Not like these things cost $100. They are readily available and may take some time to find the right fit, but really little excuse to not be using at the very least surgical mask that's fitted correctly - and worn correctly. Proper modeling and simple reinforcement works. Did at Hawaii. Did at Disney. Kids can and will wear correctly (if adults just help model and reinforce in the smallest/consistent manner).

--This Delta variant is a heck more contagious. We had been able to keep it mostly out of the office these past months. This past week, it's been knocking vaccinated folk out and putting several on exposure watch. No known in-clinic transmission yet, but I'm guessing it maybe coming this week/next week despite increased precautions. If so, I won't be surprised to see rumblings of boosting HCWs soon.

[Otolith]

Okay so this point makes my case perfectly. If a mask is only effective if worn "properly" what makes you think a 5 year old is going to wear their superman mask properly all day long? If you can agree that the odds of this happening for all kids grades K-6th is very low then you would probably agree that mandating that they wear them at all is pointless. As you said so yourself, if not worn properly then they aren't very effective.

I don't disagree but this isn't a 100% or 0 % effective entity.

This is not directed to you soonerdoc but to the staunch anti maskers....

The mask argument is like arguing about wiping your a$$. Wiping does not sterilize, heck it doesn't even guarantee you remove all the feces. If you don't wipe your a$$ perfectly then its not effective and you will have residual sh*t there. How many kids do it correctly? should we just have them say heck its a losing battle just stop wiping all together...

Some things in life are about reduction not perfection. Masks are like wiping sometimes its not necessary but maybe when the sh*t is real we do it....