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Do masks really help?

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  • Do masks really help?

    There has been a lot of discussion around the world regarding how best to protect yourself from Covid and along with that a lot of back and forth regarding mask use. Before Covid, there were a lot of studies that looked at the efficacy of masks during flu season and I thought that the general consensus was that it wasn't that useful. I have tried to look at studies that are evaluating the usefulness of masks and it seems that there are a lot of them that show it doesn't really help, so I don't understand why we have had this big national push to force them on everyone. I don't understand why this has become such a hot potato political topic. It seems very odd.

    Here is a list of some of the studies if you're interested:

    https://wwwnc.cdc.gov/eid/article/26/5/19-0994_article
    https://www.cebm.net/covid-19/maskin...with-politics/
    https://www.cidrap.umn.edu/news-pers...sed-sound-data
    NEJM, May issue that made headlines due to authors stating masks didn’t help much has since been taken off NEJM website.
    https://www.medrxiv.org/content/10.1....30.20047217v2
    https://www.medrxiv.org/content/10.1....01.20049528v1
    https://www.acpjournals.org/doi/10.7326/M20-6817
    https://www.medrxiv.org/content/10.1...260v1.full.pdf
    https://bmjopen.bmj.com/content/5/4/e006577
    https://www.fhi.no/globalassets/doku...eport-2020.pdf



  • #2
    Should surgeons stop using masks during surgery?

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    • #3
      Yes, they help for respiratory diseases.

      For the similar reasons I always wear a glove when I do a rectal exam.

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      • #4
        Originally posted by burritos View Post
        Should surgeons stop using masks during surgery?
        Surgeons are not using masks in surgery to prevent a virus from entering the cavity. It's to prevent spit and mucous. Masks are useful for that but the studies I listed show it doesn't help much with this virus.

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        • #5
          Originally posted by runfast00 View Post
          Yes, they help for respiratory diseases.

          For the similar reasons I always wear a glove when I do a rectal exam.
          The studies I listed suggest it doesn't make much difference. You can't seriously be comparing fecal matter with a respiratory virus, are you?

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          • #6
            Originally posted by burritos View Post
            Should surgeons stop using masks during surgery?
            not a good analogy since in some countries they dont and arent shown to make any difference. But no, they shouldnt unless they want unnecessary transfer of pts fluids onto them.

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            • #7
              Originally posted by K82 View Post

              Surgeons are not using masks in surgery to prevent a virus from entering the cavity. It's to prevent spit and mucous. Masks are useful for that but the studies I listed show it doesn't help much with this virus.
              They certainly help if EVERYONE is using them, there is no question it cuts down on amount transmitted to the environment. But good luck getting everyone to do it, again, the most important to be doing it are the least likely to use them, so kinda pointless there.

              Also, if you want a mask for self protection it has to be n95 or better, not a surgical one, which only really protects others from you. Its all pretty simple.

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              • #8
                There have been many comments, even in this message board, excoriating Dr. Fauci for “flip-flopping” on this issue.

                Initially, as you said, the evidence for the flu seemed to indicate that masks don’t help. So that was the advice given. Then some studies, especially looking at hospital settings where masks were required, seemed to indicate that masks actually do seem to help for this new disease, so the recommendation changed. Public health professionals were then accused of being inconsistent for changing their recommendation because they are unable to predict the future. Good luck ever getting another change of opinion on this subject.

                I’ve learned this in clinic many times. If you every change your opinion based on the changing course of patients illness or if your opinion contradicts another doctor’s then the patient will flip-out. And if two doctors give two different opinions then the patient’s only explanation is that one of them must be a fraud (Referring docs please don’t tell patients what tests, diagnosis or treatments the follow up doctor is going to give). People are not good at handling complexity or ambiguity.
                Last edited by Dusn; 07-19-2021, 09:07 AM.

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                • #9
                  Originally posted by K82 View Post

                  The studies I listed suggest it doesn't make much difference. You can't seriously be comparing fecal matter with a respiratory virus, are you?
                  I think masks should be a part of universal precautions, just like wearing gloves when you are exposed to blood or fecal matter.

                  A couple of years ago we started handing out masks to coughing patients during flu season at our outpatient clinic. Masks just make sense for course control with a respiratory disease even before you have the diagnosis.

                  In the clinic setting where I see patients with contagious respiratory disease universal masking just makes sense until COVID cases are <10/100,000

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                  • #10
                    I haven’t yet read the linked studies. But I remember early on white beard doc stating the simple interventions of universal masking, clean hands, not touching face seemed to curb transmission at work. I saw the same thing over the past year. Everyone I know who got COVID was able to trace it to an unmasked (generally social) exposure.

                    As for why it became such a political subject that’s a good question. Also why some people find it so burdensome to wear a mask.

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                    • #11
                      Originally posted by runfast00 View Post

                      I think masks should be a part of universal precautions, just like wearing gloves when you are exposed to blood or fecal matter.

                      A couple of years ago we started handing out masks to coughing patients during flu season at our outpatient clinic. Masks just make sense for course control with a respiratory disease even before you have the diagnosis.

                      In the clinic setting where I see patients with contagious respiratory disease universal masking just makes sense until COVID cases are <10/100,000
                      It does make sense if a pt is coughing and sneezing. We've never had asymptomatic people wear masks before, "just in case" they have something. The studies I listed have found it really doesn't help.

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                      • #12
                        Originally posted by Anne View Post
                        I haven’t yet read the linked studies. But I remember early on white beard doc stating the simple interventions of universal masking, clean hands, not touching face seemed to curb transmission at work. I saw the same thing over the past year. Everyone I know who got COVID was able to trace it to an unmasked (generally social) exposure.

                        As for why it became such a political subject that’s a good question. Also why some people find it so burdensome to wear a mask.
                        I do find it burdensome and if its really not doing any good then I would rather not wear them.

                        I also believe it can be counter productive. I have been to restaurants and watch the server grab the front of their mask to adjust it multiple times and then handle my water glass and menu.

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                        • #13
                          I would put masks in the "probably helps some" category. Is the evidence definitive enough to make them mandatory or even advisable- from a scientific trial standpoint, probably not unless you are having URI sx. The thing is that they are visible so they're easy to identify and regulate. My guess is transmission depends on some formula involving time in proximity, masks, ventilation, speaking loudly or singing, plus other virus and personal characteristics. The one that you can easily see and regulate is the one that gets regulated.


                          I will say that personal experience in a small office wearing masks, frequent hand washing and cleaning surfaces worked and no one in the office got COVID We almost always talked quietly since that's usually what you do in a doctor's office, we kept pts with URI sx out of the office and one rarely spent more than 10-15 minutes with an individual pt. So that formula seemed to work but who knows how much the masks played a role.

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                          • #14
                            There was a dramatic reduction in the transmission of influenza during the great masking:

                            The Centers for Disease Control and Prevention (CDC) recently reported that it had logged 1,316 positive flu cases in its surveillance network between September 2020 and the end of January 2021. During that same period last year, the CDC had recorded nearly 130,000 cases.

                            That drop-off is certainly multifactorial, but masking is felt to be the principal reason for the roughly hundredfold decline.

                            Incidentally, the fact that covid kept raging just goes to show how much more infectious it is than influenza...

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                            • #15
                              I think masks help if used in conjunction with others also using it, social distancing and practicing decent, but not excessive hygiene.

                              Just because a virus is small enough to pass through a surgical mask does not mean that it would. Not everyone needs an N95 mask or double or triple masking.

                              Finally having a consistent message is very important.

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