Are people still masking?

[KSera]

16 minutes ago, Penelope said:

For those that continue to mask, I am curious, what is the endgame for you? Wait for the virus to finish running through the population, and then unmask? Continue masking for years? Or, don’t know, wait and see. 
 

I continue to mask in indoor public places. I don't know exactly when I will feel like it's appropriate not to, but I expect it will be something to do with my younger kids being vaccinated and/or enough of the population to be vaccinated or have been infected that it's no longer circulating widely. With the pattern that's being seen with delta transmission right now, I don't trust that I wouldn't pick up delta and be able to transmit it to my kids or elderly parents, even if I don't get sick (or very sick) myself. I don't want to do that.

 

19 minutes ago, Penelope said:

There should never have been an expectation that people would not ever get infected after vaccination. The realistic expectation is that probably most of us will, eventually. We get vaccinated so that it will be mild or hopefully even unnoticeable. 

I don't know why the expectation is that most of us will get it eventually. We don't expect that with measles or mumps or hep B or chicken pox or all kinds of diseases once we are vaccinated. Initially, we thought the Covid vaccines were unlikely to be good enough to prevent disease the way those vaccines typically do, and that we would have to settle for being less ill (more like flu vaccines), but with the efficacy of these vaccines, and considering the risks of long covid and other long term unknowns, it seems a worthwhile and attainable goal to strive for.

[mathnerd]

1 hour ago, Penelope said:

Do you mean more transmissible? I don’t think there is any evidence it’s more virulent. It makes sense that with more transmissibility and more virus circulating again, plus slight decrease in effectiveness of vaccine, that there are more opportunities for vaccine to fail.

On the contrary, there is zero evidence that the Delta variant is less virulent. Every article that I read about mentions that this strain is more virulent and more deadly than any other so far. 

If you are asking what I mean by "virulence": as I understand it, a different strains of a virus can exhibit different levels of virulence. The virulence of a strain or mutation of a virus is defined by the degree of damage that virus can cause in the host. The more virulent the strain (or mutation) is, the higher the chances of fatality from infection.

Here is just one article that I quickly googled that refers to the Delta variant being "more virulent". There are tons of such articles, I don't want to link too many here.

Scientists are in a rush to understand the mutations. As well as being more transmissible, there seems to be evidence that Delta is more virulent than previous strains. While the original strain of SARS-CoV-2 predominantly impacted the elderly and those with underlying health conditions, Delta appears to threaten even the young and fit.

 

https://www.wired.co.uk/article/delta-variant-uk

 

Edited July 6, 2021 by mathnerd

[Penelope]

33 minutes ago, mathnerd said:

On the contrary, there is zero evidence that the Delta variant is less virulent. Every article that I read about mentions that this strain is more virulent and more deadly than any other so far. 

If you are asking what I mean by "virulence": as I understand it, a virus can exhibit different levels of virulence. The virulence of a strain or mutation of a virus is defined by the degree of damage that virus can cause in the host.

Here is just one article that I quickly googled that refers to the Delta variant being "more virulent". There are tons of such articles, I don't want to link too many here.

Scientists are in a rush to understand the mutations. As well as being more transmissible, there seems to be evidence that Delta is more virulent than previous strains. While the original strain of SARS-CoV-2 predominantly impacted the elderly and those with underlying health conditions, Delta appears to threaten even the young and fit.

 

https://www.wired.co.uk/article/delta-variant-uk

 

Nope, there is no published data that proves it is more virulent. Articles in the popular press notwithstanding.

Virulence does not include anything about transmissibility. Virulence has a specific definition.

eta you can also find articles in the press stating it is not more virulent. So there’s that. Doesn’t mean it is or it isn’t. Data isn’t there.

eta2 not so long ago, they said alpha was more virulent. Only it turns out, it isn’t, or at least not anything like what was reported at first. The observational data from England is great and better than what a lot of the world collects, but it has issues and can’t be used to conclude some of the things that are concluded from it, especially at first. Or so I read and hear. 🙂

Edited July 6, 2021 by Penelope

[mathnerd]

13 minutes ago, Penelope said:

Nope, there is no published data that proves it is more virulent. Articles in the popular press notwithstanding.

Virulence does not include anything about transmissibility. Virulence has a specific definition.

https://www.wwno.org/news/2021-07-02/what-to-know-about-the-delta-plus-covid-variant-how-serious-is-it-will-vaccines-work

A doctor (he is Louisiana's public health officer, a state that is currently feeling the brunt of Delta variant) says here that the Delta variant is "more virulent". He says, specifically:

“We know it's more virulent, meaning it's more likely to make people sick. If you get it, you're going to be more likely than the prior variant to have to go to the hospital.”

If this doctor's statement is also "popular press" in your opinion, sorry, I cannot google for more research at this time. I still maintain that there is zero evidence that the Delta variant is less (or equally) virulent than any other covid strain and many counties are advising masks indoors due to how rapidly it is spreading (and causing ICU's to fill up as well).

 

Edited July 6, 2021 by mathnerd

[Penelope]

12 minutes ago, mathnerd said:

https://www.wwno.org/news/2021-07-02/what-to-know-about-the-delta-plus-covid-variant-how-serious-is-it-will-vaccines-work

A doctor (he is Louisiana's public health officer, a state that is currently feeling the brunt of Delta variant) says here that the Delta variant is "more virulent". He says, specifically:

“We know it's more virulent, meaning it's more likely to make people sick. If you get it, you're going to be more likely than the prior variant to have to go to the hospital.”

If this doctor's statement is also "popular press" in your opinion, sorry, I cannot google for more research at this time. I still maintain that there is zero evidence that the Delta variant is less (or equally) virulent than any other covid strain and many counties are advising masks indoors due to how rapidly it is spreading (and causing ICU's to fill up as well).

 

I didn’t say it was less virulent. 
Someone else wondered about it, upthread. You and I weren’t taking about that, I didn’t think. 

I would consider that doctor’s statement you bolded an opinion, without cited evidence or any discussion of the opinion in that article. There are many other opinions that say that we don’t actually know this is true. That’s all. The journalist could have found others who would say “we don’t know,” but they like clicks. 🤷‍♀️

Here are some articles to the contrary, if you are interested. They are popular press, too, because according to the virologists I frequently listen to, there isn’t any published evidence yet. The point is that it is still being investigated. The kind of careful studies that would show increased virulence aren’t the sort of thing that happens in a couple of weeks, I’m gathering.

https://www.smh.com.au/national/nsw/delta-outbreak-is-twice-as-infectious-but-experts-unsure-if-it-s-more-deadly-20210702-p586dg.html

https://www.cnn.com/2021/06/30/health/delta-variant-covid-what-known/index.html
 

https://www.nbcnews.com/think/opinion/covid-delta-variant-hints-bigger-problem-america-ncna1272673

https://news.ucr.edu/articles/2021/06/30/how-concerned-should-we-be-about-delta-variant

There are more that state similar uncertainty in medpagetoday (have to subscribe but it’s free), The Atlantic (paywall but allows few free articles), and elsewhere. 

I thought about not posting because I don’t really want to argue, but I think there is a lot of fear and disinformation promoted by some of the media, and it bugs me. 😆 Something can be a reason for concern without reporting it in more apocalyptic terms with exaggeration about what is known, and lack of nuance. 

 

[Penelope]

1 hour ago, KSera said:

I continue to mask in indoor public places. I don't know exactly when I will feel like it's appropriate not to, but I expect it will be something to do with my younger kids being vaccinated and/or enough of the population to be vaccinated or have been infected that it's no longer circulating widely. With the pattern that's being seen with delta transmission right now, I don't trust that I wouldn't pick up delta and be able to transmit it to my kids or elderly parents, even if I don't get sick (or very sick) myself. I don't want to do that.

 

I don't know why the expectation is that most of us will get it eventually. We don't expect that with measles or mumps or hep B or chicken pox or all kinds of diseases once we are vaccinated. Initially, we thought the Covid vaccines were unlikely to be good enough to prevent disease the way those vaccines typically do, and that we would have to settle for being less ill (more like flu vaccines), but with the efficacy of these vaccines, and considering the risks of long covid and other long term unknowns, it seems a worthwhile and attainable goal to strive for.

I understand the concern about elderly parents. I hope that whether people in general continue to mask or not, they will continue to much more careful about symptoms, testing, and not exposing other people when they are ill. 
 

With the second part, I certainly don’t know, but virus becoming endemic seems to be a common opinion. It’s not that every person will get infected, but many of us could , at least over the next few years. It is not just getting enough people with immunity in the US that is necessary, but the rest of the world, and that won’t happen quickly. The virus has gotten more contagious, and the vaccines aren’t fully sterilizing. If we know that they aren’t fully sterilizing after just a few months, what happens over time? Given how long it took to get this much uptake for initial vaccination, I think getting even that many people again to get boosters on time to prevent waning immunity (whenever that is) might be a challenge. 

 

I thought that even for measles, which does have long-lasting immunity from infection or vaccination- it took until the 21st century (so 25 years) for outbreaks to stop, and that was with only having to vaccinate children, as virtually all older adolescents and adults were immune from childhood infection when the vaccine became available. As with Covid, apparently vaccinated people still catch measles when exposed and can be asymptomatic. It’s just that in the US, exposure is incredibly rare anymore. But there was still plenty of measles around for decades after we had a measles vaccine.

[KSera]

18 minutes ago, Penelope said:

I understand the concern about elderly parents. I hope that whether people in general continue to mask or not, they will continue to much more careful about symptoms, testing, and not exposing other people when they are ill. 

I hope so as well, but I think vaccinated people who have a breakthrough case would be even more likely to be asymptomatic, so as it has been throughout the pandemic, masking by “healthy” people indoors is to prevent transmission if it turns out they’re actually contagious and don’t realize it. 

[Penelope]

46 minutes ago, KSera said:

I hope so as well, but I think vaccinated people who have a breakthrough case would be even more likely to be asymptomatic, so as it has been throughout the pandemic, masking by “healthy” people indoors is to prevent transmission if it turns out they’re actually contagious and don’t realize it. 

I get the rationale, I just think at some point there is waning utility in doing so, and I see a lot of downsides to indefinite masking. I can’t see making this the norm for children and young people, especially. 
 

If only they had done some decent studies early on that gave a better idea of the utility of masking in the first place. That most of the rationale seems to be based on aerosol-blowing mannequins is a problem; the precautionary principle only works for so long when asking people to change something so substantial for such a long time. 

[Acadie]

We went out for a patio dinner tonight, and when I went inside to use the restaurant's restroom I was the only person in the whole place wearing a mask. It was packed--a couple hundred people, I'm guessing, between servers and customers. 

It freaked me out. My area has been pretty good with masking all along. I'm really concerned what we're going to see in terms of Covid cases over the next month. 

[KSera]

2 hours ago, Penelope said:

If only they had done some decent studies early on that gave a better idea of the utility of masking in the first place. That most of the rationale seems to be based on aerosol-blowing mannequins is a problem; the precautionary principle only works for so long when asking people to change something so substantial for such a long time. 

There are a lot of indications from real world studies that masking clearly and significantly reduces transmission. There was another good one just this past week or so. I'll post it when I come across it again.

[Jean in Newcastle]

Why would anyone care if I have something on my face?  Unless perhaps you are a bank, I suppose. . . My continuing to mask isn't going to hurt anyone.  It isn't going to scare little children and scar anyone mentally.  And it isn't going to hurt me any more than my RN husband masking for his work for 30 years has hurt him.  (Hint:  it hasn't hurt him at all.)

I will mask until there is more data especially on the Delta variant.  And perhaps on the Epsilon variant when it comes and the Zeta variant. . . etc.  until there is a variant which doesn't come with hospitalizations and deaths (or at least they are very rare at that point).  I can't tell the future, but if the prediction that mutations will eventually result in a much milder virus holds true, then that may not be too many years in the future.  Or on the flip side, perhaps people in the US will finally get to the point where enough are vaccinated and/or have immunity from having gotten Covid, to have herd immunity.  That will work too. 

Edited July 7, 2021 by Jean in Newcastle
left out a word

[Bootsie]

8 hours ago, mathnerd said:

https://www.wwno.org/news/2021-07-02/what-to-know-about-the-delta-plus-covid-variant-how-serious-is-it-will-vaccines-work

A doctor (he is Louisiana's public health officer, a state that is currently feeling the brunt of Delta variant) says here that the Delta variant is "more virulent". He says, specifically:

“We know it's more virulent, meaning it's more likely to make people sick. If you get it, you're going to be more likely than the prior variant to have to go to the hospital.”

If this doctor's statement is also "popular press" in your opinion, sorry, I cannot google for more research at this time. I still maintain that there is zero evidence that the Delta variant is less (or equally) virulent than any other covid strain and many counties are advising masks indoors due to how rapidly it is spreading (and causing ICU's to fill up as well).

 

Or, you could quote this portion of the same article (Kanter is the Louisian Public Health official)--so what do we know???  These two statements in the article are contradictory:

But what the delta plus variant means for the pandemic here is unclear. There is concern that it could be an even more dangerous iteration of the coronavirus, but because the variant is so new, it is not known whether the mutation makes it even more contagious or likely to cause greater illness or death, Kanter said.

“We don’t really have great data on it,” he said.

[TCB]

4 hours ago, Bootsie said:

Or, you could quote this portion of the same article (Kanter is the Louisian Public Health official)--so what do we know???  These two statements in the article are contradictory:

But what the delta plus variant means for the pandemic here is unclear. There is concern that it could be an even more dangerous iteration of the coronavirus, but because the variant is so new, it is not known whether the mutation makes it even more contagious or likely to cause greater illness or death, Kanter said.

“We don’t really have great data on it,” he said.

Delta and Delta plus are 2 different variants aren’t they? Maybe those statements are about 2 different variants?

[Kanin]

13 hours ago, Penelope said:

It’s just that in the US, exposure is incredibly rare anymore.

Side question, are you by any chance from the Syracuse, NY area? I've only ever heard "anymore" used that way by people from upstate NY. 

[Laura Corin]

23 minutes ago, Kanin said:

Side question, are you by any chance from the Syracuse, NY area? I've only ever heard "anymore" used that way by people from upstate NY. 

I hope you don't mind my asking, but what does that usage mean? Does it mean 'recently '?

Edited July 7, 2021 by Laura Corin

[Kanin]

41 minutes ago, Laura Corin said:

I hope you don't mind my asking, but what does that usage mean? Does it mean 'recently '?

I believe it means something like, "these days."

[theelfqueen]

When i use the term anymore in that way (which I do and I'm not from New York) ... it means "at one time I saw that but I see it less/not at all  now"  or something like that -not I've never seen that but I don't see it now. 

[Happy2BaMom]

Just some new news re: Delta.....

The CDC has stated the Delta variant is "more transmissible".

Delta variant now accounts for more than half of all US infections.

Hospitals in Springfield, MO - currently the nation's top hot spot - are full & having to either transfer patients out &/or borrow ventilators, & have necessitated the deployment of a national Covid surge team, all due to specifically to the rapidly increasing Delta variant. 

That said, I'm not 'into' trying to convince anyone whether Delta is this or that compared to other variants, so YMMV with all of the above.

I'm just frustrated because it'd be really nice if people did take this virus seriously & if we didn't have to go through more nightmare state-wide or regional surges (aka 2020 FL, TX, CA+) where thousands of people were dying and/or hospitalized every day.

Not sure we're gonna avoid that scenario, tho, unfortunately.

 

[Ditto]

10 minutes ago, Happy2BaMom said:

I'm just frustrated because it'd be really nice if people did take this virus seriously & if we didn't have to go through more nightmare state-wide or regional surges (aka 2020 FL, TX, CA+) where thousands of people were dying and/or hospitalized every day.

Not sure we're gonna avoid that scenario, tho, unfortunately.

I agree with you.  At this point I am almost certain that we are going to be back to a nightmare situation again in a few months.   Precious few people here are masking now and yet our vaccination rates are right at 50%.     I am getting incredibly sick of the prevalent attitude being that this virus is behind us and all is good. 

[kirstenhill]

1 hour ago, theelfqueen said:

When i use the term anymore in that way (which I do and I'm not from New York) ... it means "at one time I saw that but I see it less/not at all  now"  or something like that -not I've never seen that but I don't see it now. 

That's exactly how I use it and hear others use it.  I'm in the midwest.   Something I said to myself the other day while shopping:  "Aldi never has my favorite kind of almonds anymore!" 

[Corraleno]

11 hours ago, Bootsie said:

Or, you could quote this portion of the same article (Kanter is the Louisian Public Health official)--so what do we know???  These two statements in the article are contradictory:

But what the delta plus variant means for the pandemic here is unclear. There is concern that it could be an even more dangerous iteration of the coronavirus, but because the variant is so new, it is not known whether the mutation makes it even more contagious or likely to cause greater illness or death, Kanter said.

“We don’t really have great data on it,” he said.

Delta Plus is different from Delta, it has an additional mutation, K417N, which exists in the Beta (South Africa) and Gamma (Brazil) variants. In India, Delta Plus has already been designated as a Variant of Concern (in addition to Delta), as they believe it may be even more transmissible and more resistant to current treatments than Delta, but others have argued that Delta Plus is too new and there isn't enough real-world data yet to know if it's more dangerous than Delta. That is what Kanter is saying in the bit you quoted, he's not contradicting himself about the virulence of Delta compared to previous variants.

 

Edited July 7, 2021 by Corraleno

[KSera]

1 hour ago, kirstenhill said:

That's exactly how I use it and hear others use it.  I'm in the midwest.   Something I said to myself the other day while shopping:  "Aldi never has my favorite kind of almonds anymore!" 

We might need a s/o thread for this, because your usage above is totally normal to me, but @Penelope's "exposure is incredibly rare anymore." is totally different and not a way I use it (though I have heard it from others occasionally). But I'm trying to figure out why those two are different to me. They definitely are (to me), but why? Thinking I should diagram them both and see if that tells me 😁.

 

Oh! I might have figured it out. I think I only use anymore and it only sounds normal to me when used with a negative. So, Aldi never has almonds anymore sounds right. Aldi has almonds anymore doesn't sound right. Exposure is not rare anymore=sounds right. Exposure is rare anymore=sounds wrong.

[Terabith]

Interesting article:  https://www.medpagetoday.com/opinion/vinay-prasad/93453?xid=nl_vanayprasad_2021-07-07&eun=g1610326d0r&utm_source=Sailthru&utm_medium=email&utm_campaign=VinayPrasad_070721&utm_term=NL_Gen_Int_Vinay_AYWDRL_Small_Active

[KSera]

1 hour ago, Terabith said:

Interesting article:  https://www.medpagetoday.com/opinion/vinay-prasad/93453?xid=nl_vanayprasad_2021-07-07&eun=g1610326d0r&utm_source=Sailthru&utm_medium=email&utm_campaign=VinayPrasad_070721&utm_term=NL_Gen_Int_Vinay_AYWDRL_Small_Active

This piece doesn’t seem to have any update stating that the JAMA Study wasn’t just criticized, it was retracted. It was flawed in so many ways, including using the wrong kind of measuring device for what they were measuring. It never should’ve been printed.

I agree more studies (properly done studies) are needed and would be helpful, but to print  falsehoods from that paper in the course of arguing that is super unhelpful.

 

eta: I have a couple issues with the opinion piece in general in addition to that. It’s not that he doesn’t make some good points, but I felt he also made a number of bad ones. For a doctor to say that masks are mostly a political symbol of tribe is super frustrating to me. Masks are only political to those who make them so. Masks are a public health measure and politics never should’ve had anything to do with it. My parents are Republican to the core, and are the biggest mask advocates you’ve ever seen. They get upset about people not masking, and until recently would be upset even at seeing people outside without masks. That’s because they don’t want to get sick. It has nothing to do with their politics. The fact that he keeps using the differing recommendations of WHO and the CDC is also an issue to me. The WHO has very different considerations as they have to make recommendations for the entire world, including the developing world, where considerations are very different than in the United States.

 

Edited July 8, 2021 by KSera

[Not_a_Number]

27 minutes ago, KSera said:

This piece doesn’t seem to have any update stating that the JAMA Study wasn’t just criticized, it was retracted. It was flawed in so many ways, including using the wrong kind of measuring device for what they were measuring. It never should’ve been printed.

I agree more studies (properly done studies) are needed and would be helpful, but to print  falsehoods from that paper in the course of arguing that is super unhelpful.

 

eta: I have a couple issues with the opinion piece in general in addition to that. It’s not that he doesn’t make some good points, but I felt he also made a number of bad ones. For a doctor to say that masks are mostly a political symbol of tribe is super frustrating to me. Masks are only political to those who make them so. Masks are a public health measure and politics never should’ve had anything to do with it. My parents are Republican to the core, and are the biggest mask advocates you’ve ever seen. They get upset about people not masking, and until recently would be upset even at seeing people outside without masks. That’s because they don’t want to get sick. It has nothing to do with their politics. The fact that he keeps using the differing recommendations of WHO and the CDC is also an issue to me. The WHO has very different considerations as they have to make recommendations for the entire world, including the developing world, where considerations are very different than in the United States.

Yeah, this piece seems to have a serious bias issue. 

I have to say that while I wonder about 2-year-olds, I've seen plenty of 4- and 5-year-olds with well-fitting masks they can wear for a good long time without them sliding off their noses or mouths. We use Happy Masks for that, for example... some friends of ours have some well-fitted KN-95s or something like that. 

We've actually not been masking at playgrounds recently, but when some friends of ours preferred it, we slid the masks onto the kids and there wasn't even a word of complaint -- they are used to it and it's not particularly uncomfortable for them. 

As for whether masks help, I honestly now feel that the burden of proof is on people who say they don't, not the other way around. The virus is airborne, so the idea that containing exhalations with virus particles is totally useless is not the reasonable starting hypothesis. 

 

[Penelope]

2 hours ago, Not_a_Number said:

 

As for whether masks help, I honestly now feel that the burden of proof is on people who say they don't, not the other way around. The virus is airborne, so the idea that containing exhalations with virus particles is totally useless is not the reasonable starting hypothesis. 

 

I didn’t think that was the best piece, either, FWIW. I don’t care if people want to mask indoors in all situations for the rest of their lives, I only care if they expect others to do the same.
 

For the quote, I don’t think that is how evidence-based medicine or evidence-based public health is supposed to work. The pandemic is not quite over, but the public health emergency part of it is over. I don’t see that those who say the evidence is poor think that masks are “totally useless,” but instead that we should find out when and to what extent they are useful. That is what I think the article is saying.
 

I think it is good to acknowledge that masks aren’t completely benign for everyone: young children, special needs, hearing-impaired, maybe other conditions. There is also the psychology to consider if we are going to ask everyone to do it again. Not everyone feels it is no big deal. 
 

Also, there are things that people thought were common sense or looked great from observational data that were found to be ineffective or even harmful when studied more closely. 

 

 

[Laura Corin]

1 minute ago, Penelope said:

 The pandemic is not quite over, but the public health emergency part of it is over. 

I fear a second public health emergency as large numbers of young people become infected and a proportion of those develop debilitating Long Covid. I'm glad that it looks as if Scotland is likely to retain mask mandates for a while longer. 

[Not_a_Number]

4 minutes ago, Penelope said:

For the quote, I don’t think that is how evidence-based medicine or evidence-based public health is supposed to work. The pandemic is not quite over, but the public health emergency part of it is over. I don’t see that those who say the evidence is poor think that masks are “totally useless,” but instead that we should find out when and to what extent they are useful. That is what I think the article is saying.

This is completely unrelated to being evidence-based. You have to start with some kind of null hypothesis and I would say that currently the reasonable null hypothesis is that children aged 4 and up masking up is useful. You could certainly prove this wrong (that's the evidence-based part!), but that's my take on the current state of affairs. 

[melmichigan]

Probably in the minority here, but I just bought another long use N99 for each of us while they are on a really good sale.  I can't see us not needing them this fall/winter with my areas poor vaccination rate.  We made the switch to mostly valved masks for indoor use this summer now that essentially no one masks anymore, and with the CDC recommendations with regards to valves, we will probably stay with them from now on unless something drastically changes with the new variants. 🤞my immune system recovers quickly and this can be less of a concern.

[Not_a_Number]

2 minutes ago, melmichigan said:

Probably in the minority here, but I just bought another long use N99 for each of us while they are on a really good sale.  I can't see us not needing them this fall/winter with my areas poor vaccination rate.  We made the switch to mostly valved masks for indoor use this summer now that essentially no one masks anymore, and with the CDC recommendations with regards to valves, we will probably stay with them from now on unless something drastically changes with the new variants. 🤞my immune system recovers quickly and this can be less of a concern.

We've recently gotten some more Happy Masks. I expect to be masking indoors for another year, frankly. I'm hoping to be wrong but I'd rather act like this is true. 

[Penelope]

7 minutes ago, Laura Corin said:

I fear a second public health emergency as large numbers of young people become infected and a proportion of those develop debilitating Long Covid. I'm glad that it looks as if Scotland is likely to retain mask mandates for a while longer. 

I’m concerned about long Covid, too. That is another area where good studies are needed. 

5 minutes ago, Not_a_Number said:

This is completely unrelated to being evidence-based. You have to start with some kind of null hypothesis and I would say that currently the reasonable null hypothesis is that children aged 4 and up masking up is useful. You could certainly prove this wrong (that's the evidence-based part!), but that's my take on the current state of affairs. 

I might quibble on the age but basically agree. I would be surprised if they weren’t effective at all under any circumstances. The evidence-based comes in for how much effectiveness, and under what circumstances. From the one trial that was done, we know that they are not 50% or more effective to an adult wearer of a medical mask when there isn’t a lot of virus around. I don’t know exactly what “a lot” was in that instance, or whether it’s comparable to what we have now. 
 

I think it matters if we expect everyone to do something for a long time. It would also be really helpful in another way. If they reduce infections only by 2 or 5 or 15%, then maybe people would realize it still isn’t a good idea to do certain things if virus is high. A while back I saw numbers on social media where people were saying 80%. Maybe that’s true in a hospital with properly fitted PPE, but I don’t believe that it is close to that in the community. And maybe I’m wrong! But no one knows.

[Not_a_Number]

Just now, Penelope said:

I might quibble on the age but basically agree. I would be surprised if they weren’t effective at all under any circumstances. The evidence-based comes in for how much effectiveness, and under what circumstances. From the one trial that was done, we know that they are not 50% or more effective to an adult wearer of a medical mask when there isn’t a lot of virus around. I don’t know exactly what “a lot” was in that instance, or whether it’s comparable to what we have now. 

I think it matters if we expect everyone to do something for a long time. It would also be really helpful in another way. If they reduce infections only by 2 or 5 or 15%, then maybe people would realize it still isn’t a good idea to do certain things if virus is high. A while back I saw numbers on social media where people were saying 80%. Maybe that’s true in a hospital with properly fitted PPE, but I don’t believe that it is close to that in the community. And maybe I’m wrong! But no one knows

I think a useful thing to think about is how you could study whether they work or not. I don't think you'll wind up with an individual-level study -- you can't randomize it. So then you have to go with natural experiments, like the ones where nearby counties have mask mandates and don't. And I had the impression there was a fair amount of evidence there. 

Basically, there isn't a well-designed experiment you can run here. 

[Penelope]

21 minutes ago, melmichigan said:

Probably in the minority here, but I just bought another long use N99 for each of us while they are on a really good sale.  I can't see us not needing them this fall/winter with my areas poor vaccination rate.  We made the switch to mostly valved masks for indoor use this summer now that essentially no one masks anymore, and with the CDC recommendations with regards to valves, we will probably stay with them from now on unless something drastically changes with the new variants. 🤞my immune system recovers quickly and this can be less of a concern.

Seems like a good idea. I expect to see more people masking this winter. Maybe mandates, too, but I think we will see it either way. I hope I am wrong and that we won’t have a lot of hospitalizations and won’t feel the need to. I don’t think we will have the huge waves all over this time, though. What do I know, but that seems to be the consensus. 

Edited July 8, 2021 by Penelope

[Kanin]

On 7/7/2021 at 3:18 PM, KSera said:

We might need a s/o thread for this, because your usage above is totally normal to me, but @Penelope's "exposure is incredibly rare anymore." is totally different and not a way I use it (though I have heard it from others occasionally). But I'm trying to figure out why those two are different to me. They definitely are (to me), but why? Thinking I should diagram them both and see if that tells me 😁.

 

Oh! I might have figured it out. I think I only use anymore and it only sounds normal to me when used with a negative. So, Aldi never has almonds anymore sounds right. Aldi has almonds anymore doesn't sound right. Exposure is not rare anymore=sounds right. Exposure is rare anymore=sounds wrong.

Oh man! You totally nailed it! I've been ruminating about this distinction for at least 10 years. Start a s/o if you ever diagram it 🤓

[Terabith]

Yeah, I think most, maybe not 2 year olds, but most 3-5 year olds do just fine in masks.  What I did think was an interesting point is that we haven't done the studies to know REALLY what effects masks are having.  I am utterly convinced by what I've seen that masks are honestly shockingly effective at preventing infection in the original virus.  I'm not as convinced that they'll be as efficacious for the delta variant.  I think we should all be masking.  But I am bothered that real, genuine studies don't seem to be being done.  One of the posters here has done some convincing number crunching on different covid rates on similar school systems with and without mask mandates.  I don't want anyone to think I'm not in favor of masks.  But I really would like to see it being studied in a rigorous way!

[AmandaVT]

13 minutes ago, Terabith said:

Yeah, I think most, maybe not 2 year olds, but most 3-5 year olds do just fine in masks.  What I did think was an interesting point is that we haven't done the studies to know REALLY what effects masks are having.  I am utterly convinced by what I've seen that masks are honestly shockingly effective at preventing infection in the original virus.  I'm not as convinced that they'll be as efficacious for the delta variant.  I think we should all be masking.  But I am bothered that real, genuine studies don't seem to be being done.  One of the posters here has done some convincing number crunching on different covid rates on similar school systems with and without mask mandates.  I don't want anyone to think I'm not in favor of masks.  But I really would like to see it being studied in a rigorous way!

Very anecdotally, but we had 3 covid cases, where the infected person had been in our school in the week leading up to the positive test. There was no spread to any other person in the school. 1 teacher and 2 students, all different grades and different times of the year. We masked all year. I had been so nervous to go back to school at the beginning of the year, but each time I heard about a case that infected no one else, it helped me relax a little bit more. I'm sure they're not perfect, but I was very grateful for masks this year.

[KSera]

41 minutes ago, Penelope said:

I’m concerned about long Covid, too. That is another area where good studies are needed. 

I saw a really interesting one yesterday using FitBit data, comparing people with Covid vs people with other upper respiratory infections. It was a large study. The most dramatic result was the difference in number of days for resting heart rate to return to normal—an average of 79 days for the Covid positive, vs an average of 4 days for the other respiratory infections. That was sobering to me. 
https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2781687

 

eta: sometimes I forget which thread I’m in, because it’s not readily apparent when posting from my phone. I should probably re-post this one to the main Covid thread.

Edited July 8, 2021 by KSera

[Jean in Newcastle]

1 hour ago, Penelope said:

I didn’t think that was the best piece, either, FWIW. I don’t care if people want to mask indoors in all situations for the rest of their lives, I only care if they expect others to do the same  

 

Have you had a single individual person come up and require you to do what they are doing to protect their own health?  
 

Individual private businesses can require whatever they want in their private business. People can choose to patronize their business- or not. 
 

Individual  homeowners can require what they want from their guests. People can choose to visit them or not. (Though most people I know have been quite accommodating to everyone doing what they want - especially now that many are vaccinated. )
 

The government has a long established history of public health guidance which governs certain business health and safety practices and on occasion ramped up guidance and mandates during things like pandemics. I personally believe that I have a biblically mandated responsibility to obey the government especially since the conspiracy theories against obeying their mandates (if they do become necessary again) have been debunked over and over and over again. 

[Corraleno]

Excerpt from a recent study in Science showing that, in most environments, surgical and similar masks do in fact reduce transmission:

"Airborne transmission is one of the main pathways for the transmission of respiratory viruses, including the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (1). Wearing face masks has been widely advocated to mitigate transmission. Masks are thought to protect people in two ways: (i) source control, reducing the emission and spread of respiratory viruses through airborne droplets and aerosols, and (ii) wearer protection, reducing the inhalation of airborne respiratory viruses.

The effectiveness of masks, however, is still under debate. Compared with N95 or FFP2 respirators, which have very low particle penetration rates (~5%), surgical and similar masks exhibit higher and more variable penetration rates (~30 to 70%) (2, 3). Given the large number of particles emitted upon respiration and especially upon sneezing or coughing (4), the number of respiratory particles that may penetrate masks is substantial, which is one of the main reasons for doubts about their efficacy in preventing infections. Moreover, randomized clinical trials have shown inconsistent or inconclusive results, with some studies reporting only a marginal benefit or no effect of mask use (5, 6). Thus, surgical and similar masks are often considered to be ineffective. On the other hand, observational data show that regions or facilities with a higher percentage of the population wearing masks have better control of COVID-19 (7–9). So how are we to explain these contrasting results and apparent inconsistencies?

In this work, we develop a quantitative model of airborne virus exposure that can explain these contrasting results and provide a basis for quantifying the efficacy of face masks. We show that mask efficacy strongly depends on airborne virus abundance. On the basis of direct measurements of SARS-CoV-2 in air samples and population-level infection probabilities, we find that the virus abundance in most environments is sufficiently low for masks to be effective in reducing airborne transmission.

....

The nonlinear dependence of mask efficacy on infection risk differs from the assumption that the percentage change of infection probability as a result of mask use would be proportional to the percentage change of inhaled particle number (20). Under this assumption, wearing a mask would have the same effect on the transmission of a virus disease at any level of infection probability. Our analysis, however, shows that the efficacy of face masks depends strongly on the level of infection probability and virus abundance: Masks reduce the infection probability by as much as their filter efficiency for respiratory particles in the virus-limited regime but much less in the virus-rich regime (Fig. 3). Accordingly, experimental investigations may find low mask efficacies when they are performed under virus-rich conditions. Together with other influencing factors, like consistent and correct mask use (supplementary text, section S7.3), changes between virus-rich and virus-limited conditions may contribute to divergent results reported from laboratory studies and randomized controlled trials in different environments (20) (supplementary text, section S8).

Notably, the increasing effectiveness of mask use at low virus abundance implies synergistic effects of combining masks with other preventive measures that reduce the airborne-virus concentration, such as ventilation and social distancing. For example, ventilation can change an environment from virus-rich to virus-limited conditions, which may be particularly important for medical centers with relatively high SARS-CoV-2 abundances (Fig. 2 and supplementary text, section S6). On the other hand, not only the efficacy of face masks but also the efficacy of distancing may be reduced in virus-rich environments (supplementary text, section S6). The more measures that are used, the more effective each measure will be in containing the virus transmission. If the inhaled dose may also affect the severity of infections (14), as is currently being debated (24), masks may still be useful even if the reduced dose still leads to an infection."

https://science.sciencemag.org/content/372/6549/1439

[Penelope]

7 hours ago, KSera said:

I saw a really interesting one yesterday using FitBit data, comparing people with Covid vs people with other upper respiratory infections. It was a large study. The most dramatic result was the difference in number of days for resting heart rate to return to normal—an average of 79 days for the Covid positive, vs an average of 4 days for the other respiratory infections. That was sobering to me. 
https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2781687

 

eta: sometimes I forget which thread I’m in, because it’s not readily apparent when posting from my phone. I should probably re-post this one to the main Covid thread.

That’s an interesting way to study long Covid. Thanks for linking this.

I think what they did is neat, but I don’t think much can be concluded from it, even if you are a middle-aged female Fitbit wearer like most of the participants. They don’t include any health information about the participants. Maybe they weren’t set up to do that, but it’s kind of important. I also don’t see that they compared baseline heart rates and step counts of the two groups for any differences.  
 

It is interesting that they returned to their baseline step counts while still having elevated resting HR, but reassuring that they all did return to resting rate and that for 85% of them, the difference was a couple of beats per minute. When influenza comes back, maybe we will see more comparison studies with it. We can hope that it will be harder for researchers to find enough patients for those studies! 

[Arcadia]

@mathnerd@crazyforlatin

https://www.nbcbayarea.com/news/coronavirus/california-will-still-require-masks-inside-schools-after-cdc-relaxes-guidance/2590376/
”California state officials on Friday said they will still require masks be worn inside school facilities after the Centers for Disease Control and Prevention relaxed its guidelines by allowing vaccinated teachers and students to ditch their masks on campus.

Requiring masks be worn indoors in school settings will also ensure all kids are treated the same, the state said in a news release.

“We applaud the CDC’s commitment to ensuring that schools are fully, safely opened for in-person instruction. Given California’s science-based approach and the fact that the state’s school facilities can’t accommodate physical distancing, we will align with the CDC by implementing multiple layers of mitigation strategies, including continued masking and robust testing capacity,” California Health and Human Services Agency Secretary Dr. Mark Ghaly said in a statement. “Masking is a simple and effective intervention that does not interfere with offering full in-person instruction. At the outset of the new year, students should be able to walk into school without worrying about whether they will feel different or singled out for being vaccinated or unvaccinated – treating all kids the same will support a calm and supportive school environment.””

[mathnerd]

On 7/7/2021 at 1:17 AM, Bootsie said:

Or, you could quote this portion of the same article (Kanter is the Louisian Public Health official)--so what do we know???  These two statements in the article are contradictory:

But what the delta plus variant means for the pandemic here is unclear. There is concern that it could be an even more dangerous iteration of the coronavirus, but because the variant is so new, it is not known whether the mutation makes it even more contagious or likely to cause greater illness or death, Kanter said.

“We don’t really have great data on it,” he said.

Here is Harvard School of public health claiming that the Delta variant is much more "virulent" than other strains: the term is used more than once in this article:

https://www.hsph.harvard.edu/news/features/the-danger-of-the-delta-variant/

"It appears that, in comparison with the previously dominant virus, Delta produces higher viral loads earlier in infection, which may mean that it’s even more infectious during the period when people don’t yet realize they’re infected. It also appears that Delta is more able to cause so-called breakthrough infections in vaccinated people, although, fortunately, the resulting infections are comparatively mild."

Edited July 10, 2021 by mathnerd

[Laura Corin]

Professor Tim Spector of the Zoe Symptom Study App on continuing to wear masks

 

[Penelope]

13 hours ago, mathnerd said:

Here is Harvard School of public health claiming that the Delta variant is much more "virulent" than other strains: the term is used more than once in this article:

https://www.hsph.harvard.edu/news/features/the-danger-of-the-delta-variant/

"It appears that, in comparison with the previously dominant virus, Delta produces higher viral loads earlier in infection, which may mean that it’s even more infectious during the period when people don’t yet realize they’re infected. It also appears that Delta is more able to cause so-called breakthrough infections in vaccinated people, although, fortunately, the resulting infections are comparatively mild."

The bolded is not an example of virulence.
Virulence doesn’t mean increased infectiousness. I think most people agree that Delta is spreading more easily, though epidemiologists and virologists quibble over the term “transmissible”, because there can be many reasons for increased spread that have nothing to do with transmissibility.

Basically, virulence means assuming that if the same person were infected with one variant vs. another, one of them would consistently result in more severe disease. Those studies are harder to do well and have not been released or published for Delta; they have to do things like compare statistically matched groups, one group infected with one variant and another with another, under similar conditions of locality, hospital capacity, etc. Then they measure outcomes like hospitalization, death, percentage needing ventilator. This type of study when done for alpha vs. wild-type variant, showed that alpha was not more virulent; it still may be that alpha had some increased virulence, but the other data supporting that view had some issues. 

Hanage does say virulence a couple of times, thanks for linking. I think that with all the other virologists, immunologists, and physicians etc. who say that there is no evidence of increased virulence, maybe he shouldn’t say that so strongly. Most use words like “may” or “might be”. Given the climate of uncertainty, anyone stating virulence as fact should give citations or further explanation for that viewpoint, and he doesn’t do either.

Edited July 10, 2021 by Penelope

[SoCal_Bear]

In CA, there was plenty of masking still happening where I was in the Bay Area. In the SoCal area, less and less masking unless you stick to where there's a decent sized Asian population. Asian establishments and stores have lots of masking going on. 

I just reordered Happy Masks and got the 2-in-1 ear saving lanyards for easy on and off.

I'm just waiting for the anti-masking population here to lose their minds when they realize that masking will be required for schools.

 

Edited July 10, 2021 by calbear

[mathnerd]

1 hour ago, Penelope said:

Hanage does say virulence a couple of times, thanks for linking. I think that with all the other virologists, immunologists, and physicians etc. who say that there is no evidence of increased virulence, maybe he shouldn’t say that so strongly.

I was quoting another part as a response to someone else, not your reply specifically.

As for virulence, this is what Harvard University link says:

"Delta is highly transmissible—about 60% more so than the previously dominant Alpha, which was itself more transmissible than the original virus—and more virulent."

My entire point is that it is not just a single highly credible source that says that the Delta variant is more virulent. There are many respected medical professionals who are saying it. You can nitpick all you want and say that the person at Harvard university claiming that Delta is the most virulent strain “shouldn’t say so”, but they DO say so, not because they are lying or they have poor understanding of virus mutations. They are trying to educate people. If you read the link, they say explicitly that this variant has a much higher chance of making people ill and hence it is more virulent. 
i have seen the havoc that this strain has created: so, I would like people to understand that the Delta variant is far more virulent than other strains we have encountered so far. This information is important to anyone making decisions for how to handle Fall season for their kids. California has decided to require masks in schools in the Fall largely due to the Delta variant spreading in parts of the state rapidly.

Edited July 10, 2021 by mathnerd

[Corraleno]

3 hours ago, Penelope said:

Hanage does say virulence a couple of times, thanks for linking. I think that with all the other virologists, immunologists, and physicians etc. who say that there is no evidence of increased virulence, maybe he shouldn’t say that so strongly. Most use words like “may” or “might be”. Given the climate of uncertainty, anyone stating virulence as fact should give citations or further explanation for that viewpoint, and he doesn’t do either.

There IS evidence for increased virulence — a Scottish study found that Delta nearly doubled the risk of hospitalization compared to Alpha. I believe there is data from England corroborating that as well.

"The Cox regression analysis for time to hospital admission found that S gene-positive cases [Delta] were associated with an increased risk of COVID-19 hospital admission: hazard ratio (HR) 1.85 (95% CI 1.39–2.47) when compared to S gene-negative cases [Alpha], after adjusting for age, sex, deprivation, temporal trend, and comorbidities." 

https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(21)01358-1/fulltext

[Not_a_Number]

7 minutes ago, Corraleno said:

There IS evidence for increased virulence — a Scottish study found that Delta nearly doubled the risk of hospitalization compared to Alpha. I believe there is data from England corroborating that as well.

"The Cox regression analysis for time to hospital admission found that S gene-positive cases [Delta] were associated with an increased risk of COVID-19 hospital admission: hazard ratio (HR) 1.85 (95% CI 1.39–2.47) when compared to S gene-negative cases [Alpha], after adjusting for age, sex, deprivation, temporal trend, and comorbidities." 

https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(21)01358-1/fulltext

Right. And one can certainly pick apart the methodology if one has issues with it, but there's no point saying things like "some people say it's not," because it's simply not informative.

I'm personally really bummed there's evidence Delta is both more transmissible and more virulent 😕 . I keep hoping it mutates to something less virulent, not more.  

Does anyone have evidence that it's NOT more virulent? You have to match for traits like the paper above does, otherwise it's simply not good data. 

[Happy2BaMom]

 

On 7/10/2021 at 3:11 PM, Penelope said:

....... I think that with all the other virologists, immunologists, and physicians etc. who say that there is no evidence of increased virulence, maybe he shouldn’t say that so strongly.....

Do you have links for/from any of these professionals? (Asking sincerely, as it would be nice to know/compare.)

[ieta_cassiopeia]

I am continuing to mask.

The rest of the UK is also required to continue masking for at least another week. England will be allowed to de-mask and eliminate social distancing on July 19, and lots of people are behaving as if that's already in force. Test events, in a couple of cases involving over 100,000 people with no social distancing or compulsory masking, are already happening (the Euro 2020 final was one, the British Grand Prix next week is the other). Other parts of the UK are allowed to make their own judgements and appear to be exercising more caution.

I plan to continue masking for some time after July 19 when outside my house, simply because previous lockdown exits have shown that people tend to take more silly risks than they should in the giddy excitement of restrictions lifting. One big reason for this is that the Euros have already been linked to at least 397 extra COVID cases compared to background risk despite only having (half) results from England v Scotland so far (Scotland provided stats for the match, England so far as not), while the similarly-sized but indoor, without vaccination exemption from negative-test-to-enter but with compulsory masking, World Snooker Championship in April was associated with fewer total cases than the (low) average COVID exposure at that time (6 for the snooker tournament; the background numbers at the time would have led to 10 cases for the snooker, and about 100 for the football, depending on area). That suggests masks matter more than the indoor/outdoor distinction (although test-to-enter is a partially confounding factor).

(Note: the football article also mentions various stats for Scottish people infected through methods other than attending Wembley Stadium, including but not limited to contact with those who attended the match in person. For the sake of fairness - football attracts more of these than snooker - I have excluded them from my "at least" statistic, and only accounted those at the respective venues. I also have not counted cases from matches other than England v Scotland).

In a few weeks, once people have calmed down a bit, I'll review. Though the hospital figures are such that lockdown 4 is at least a possibility (it's currently the same number - 400 - and rate of growth as the level on October 1, which was when the government was told to start lockdown 3, and by the time a couple of hundred thousand more people have finished getting results from the trial events program, I can easily imagine the possibility it may be in the November range - when the government did impose lockdown 3 due to extreme pressure on hospitals). Note that several hospitals have already had to postpone non-emergency medical procedures due to COVID patients.