Preparing for COVID-19

[Matus]

When it comes to covering your mouth with a surgical(-like) mask - I find this study very interesting:



Sidenote - I never understoon how wearing a surgical-style mask should be of any relevant help against smog or air pollution. But as shown in the video - maks helps to stop spitting large dopplets while coughing or sneezing.

WHO updated today their recommendation on wearing a mask - but they still say that the primary (only?) reason is to protect others if you cough or sneeze. Plus you also avoid accidentally touching your face.

https://www.theguardian.com/world/2...lthy-to-wear-face-masks-says-who-after-review

 

[ian]

I was wearing a homemade mask this afternoon when I went out for a walk with my son in a sparsely populated (at least, with living people) local cemetery. Not sure what the point was.... neither of us is coughing or sneezing. But it seems to be the thing to do in my neighborhood, which is for the best, I'm sure. So I guess that's the point. If everyone's doing it, then everyone is more likely to do it.

 

[NBrewster]

Sidenote - I never understoon how wearing a surgical-style mask should be of any relevant help against smog or air pollution.

It's only marginally helpful but it's more than nothing. Not sure if you've ever been to one of the cities with just absolutely horrendous air quality, but it's literally "thick" with pollution. I spent 6 months in New Delhi, I only wore a mask on a couple of really bad days (you literally could not see across an avenue in some areas) and if you wore a mask it would be black around your mouth after wearing it for a few hours. That's "some" air pollution getting filtered out.

Regardless I still had a hacking cough for about 4 months after I got back. I don't know how people survive there long term.

 

[Michi]

Reported by (Australian) ABC News today:

"Wearing face masks is now mandatory in Morocco for anyone allowed to go out during the coronavirus outbreak.

Those who fail to comply face prison sentences of up to three months and a fine of up to 1,300 dirhams ($572), the Government said in a statement on Monday.

The masks will be sold at a subsidised price of 0.8 dirhams ($0.35) per unit.

Morocco plans to increase its daily mask production capacity to near 6 million next week from 3.3 million currently.

Morocco, which has imposed a month-long lockdown, confirmed as of Monday 1,120 coronavirus cases and 80 deaths."

It seems to me that wearing a face mask might do some good, and that it is unlikely to make things worse.

The argument that, with a face mask, people are more likely to touch their face underneath the mask doesn't seem sound to me. On average, I would expect more infections to be prevented by face masks than to be caused.

Whether any difference is substantial enough to matter is difficult to say. I do notice though that medical professionals seem extremely keen to wear them and that they complain bitterly when they can't. Seeing that they are professionals, I'm inclined to trust them.

 

[ian]

Seeing that they are professionals, I'm inclined to trust them.

Aaahh.

 

[Neyxous]

I was lucky enough to have one of those nifty canister respirators from some sand blasting i did. I kinda want to think its overkill, but better safe than sorry. It is so funny to get complements ... "Nice mask man, where did you get it?"

 

[XooMG]

In Taiwan there seem to be two common mentalities regarding masks. One is that you're protecting yourself, and evidence for that seems to be a bit shakier (like most places, there are many pseudoscientific practices and superstitions regarding health). Further, it might be a weaker motivator as the epidemic drags on and people get tired of negotiating between convenience and the feeling of personal safety.

The other popular driver is social and familial responsibility, and that seems to have slightly more influence long-term. If you go into a convenience store or crowded public place these days without the basic courtesy of shielding others from your dominant upper discharge, you'll be seen as a selfish, inconsiderate, skin-wrapped fecal sausage.

When outdoors, people are more heterogeneous in behaviour; some take masks off due to perceived lower risk, to reduce moisture buildup in the mask, or to make breathing easier. Others keep them on as a weak dust filter and mouth guard (especially when driving scooters)

If course this is just personal opinion; I haven't done the surveys and can't be very confident in my limited experience.

 

[M1k3]

Today Los Angeles implemented all essential, non-medical workers must wear non-medical grade masks at work and the employer must provide or reimburse employees for them.

 

[Marek07]

During the 1918 flu epidemic, many in the US were wearing masks.

https://edition.cnn.com/2020/04/03/americas/flu-america-1918-masks-intl-hnk/index.html

The WHO and CDC have started to change their initial opposition to the public wearing masks and some European countries have already mandated them in public. I understand Los Angeles residents are being told to wear face covering in public places from Friday. I will continue wearing mine for the foreseeable future. Initially, it was to allay the fears of patients in the oncology and radiology wards while I had a persistent cough. Now I figure I'll continue wearing it because the benefits outweigh any negatives.

 

[HRC_64]

...non-medical grade masks ...

TLDR--nobody here is "following science" because perfect isn't possible.

 

[HRC_64]

During the 1918 flu epidemic, many in the US were wearing masks.

https://edition.cnn.com/2020/04/03/americas/flu-america-1918-masks-intl-hnk/index.html

The WHO and CDC have started to change their initial opposition to the public wearing masks ...

The reality is they F*cked up on the mask guidance back in january/february.

A LOT of that opposition is/was political and not based on science or research, so this is a good thing.

1) The WHO was worried about offending 3r world countries.
2) The FEDs were worried about low stockpiles
3) The LEOs were worried about law and order issues

 

[Matus]

I find the following interesting:

Two German scientist analysed the available data and came to the conclusion that in total, only bout a6% of the infected people were identified with the tests. This percentage varies over the countries. They say that by now several tens of millions might have been infected worldwide. More details can be found here:

https://www.uni-goettingen.de/en/32...H2sa5I578P0FY_Gz4Qwve54T7gxlS0-PaY7_DHRk2n0PQ

Whether they are correct should be known in a few weeks as a large study of randomly selected households will be tested in Germany over longer period of time to see whether they have developed antibodies for the virus and will be tested several times over longer period of time.

 

[Nemo]

Once serology testing becomes widely available, it should shine another light on the actual incidence (assuming that everybody does mount an antibody response, which there is some evidence for).

 

[WildBoar]

I've read a lot of articles that mentions a pretty large mount of false negatives. I think it varies depending on the particular test (it seems there may be a lot of different ones out there, and they can vary from country to country.

 

[Nemo]

My understanding is that for PCR tests, the site of the sample is more important than the variability between test kits.

The detection rate for oropharyngeal (throat) swabs is c30%. That is, 70% false negative rate. For nasphayngeal (back of nose) swabs, it's c65% (35% FN). Unless you found these swabs quite uncomfortable, they didn't get back far enough and the detection rate will be lower. For sputum (which is hard to get because Covid produces a dry cough), sensitivity is over 80% and t's high 90s for bronco-alveolar lavage (BAL). BAL is a complicated procedure which requires bronchoscopy and temporarily impairs the oxygen transfer in an already sick patient. Bronchoscopy is aerosol generating procedure (AGP) with high risk of infecting the medical team, so you wouldn't do it without a really good reason in a patient with Covid. But the high detection rate does suggset that the false negatives have more to do with the site of sample collection than the sensitivity of the actual test kits.

 

[parbaked]

T

But the high detection rate does suggset that the false negatives have more to do with the site of sample collection than the sensitivity of the actual test kits.

Yes...my understanding is that the current test requires a really deep nasal probe with the swab to reach the detachable virus sample. If the swab probe isn't deep enough, you get a false negative. Hopefully the newer tests will have less invasive ways to obtain a usable sample...

 

[Nemo]

T


Yes...my understanding is that the current test requires a really deep nasal probe with the swab to reach the detachable virus sample. If the swab probe isn't deep enough, you get a false negative. Hopefully the newer tests will have less invasive ways to obtain a usable sample...

Indeed, if you don't get to posterior nasopharyngeal wall (which is pretty uncomfortable), your detection rate will be even less than 65%. 65% is the best case scenario for a nasophayngeal swab.

 

[bahamaroot]

And when you are testing less than half of 1% of the population, like here in the States, it's truly difficult to get concrete numbers on what you're dealing with anyway.

 

[WildBoar]

Don't fool yourself -- it is not just in the US. Most countries only have the ability to test a small percentage.

 

[turbochef422]

My wife got tested. It took 13 days to get the results and she was positive. They said, “ well your pretty much over it so that’s good”. We aren’t allowed to go anywhere for 7 days after no symptoms. We were self quarantined with the restaurant closed for the time being anyway. She originally got tested because she woke up with pink eye after speaking at a conference in Vegas and the Dr said that’s one of the symptoms. That was close to a month ago so I think we are in the clear. We both felt like we were fighting something and super tired but no symptoms some people are going through. Thankfully.

 

[Kippington]

pretty uncomfortable...nasophayngeal swab

"What I got, ya gotta get it, put it in you." - Red Hot Chili Peppers

 

[WildBoar]

My wife got tested. It took 13 days to get the results and she was positive. They said, “ well your pretty much over it so that’s good”. We aren’t allowed to go anywhere for 7 days after no symptoms. We were self quarantined with the restaurant closed for the time being anyway. She originally got tested because she woke up with pink eye after speaking at a conference in Vegas and the Dr said that’s one of the symptoms. That was close to a month ago so I think we are in the clear. We both felt like we were fighting something and super tired but no symptoms some people are going through. Thankfully.

Glad all seems okay.

One issue with people screaming for test, tests, tests is just what happened to your wife. By the time it is confirmed you have it you are almost all better (and sadly for some you may be dead). Until there is reliable testing that can be completed in 1-2 days in the volume needed the testing is just not all that critical.

 

[Bert2368]

Until there is reliable testing that can be completed in 1-2 days in the volume needed the testing is just not all that critical.

It's possible to do testing as you suggest. South Korean testing company has done it, they are exporting 400,000 test kits per week now and increasing production as fast as they can.

The system then determines whether the virus is positive, negative or inconclusive. The total running time from extraction stage to analysis takes just five to six hours to process a total of 15,000 samples, according to doctors and researchers at Seegene Medical Foundation.

https://www.google.com/amp/s/abcnew...rus-test-makers-high-demand/story?id=69958217

 

[Luftmensch]

A little late on the mask discussion... but it strikes me as a case of "perfect being enemy of the good"...

Proper medical face masks are effective (when used properly) at preventing the wearer from being infected. The mask is individual protection - the wearer is protected from the community.
Cloth face masks can be useful for minimising droplet transmission within the community. The mask is social protection - the wearer is protecting the community.

I think organisations like the CDC and WHO were perhaps too focused on using scientific studies/evidence to guide medical best practice. In hindsight, this is potentially not useful messaging for the general public. It is clear that the majority of citizens are not following proper protocol for surgical masks. It is a waste of critical resources. Had these organisations issued advice to use cloth face masks earlier, perhaps there would have been less of a run on PPE. The front line should have first access to this equipment.

In a crisis like this, relaxing advice from 'perfect' to 'good' might be a better strategy for managing public behaviour. People are anxious and that has resulted in small-scale group panic. Beyond hygiene, a component of cloth face masks that strikes me as important is the psychological aspect. Cloth face masks empower people by making them feel like they have some element of control.

I definitely think there would have been benefits from issuing the advice earlier... but... "Yeah? Well... you know... that's just like uhhh, my opinion, man." - I guess being an armchair epidemiologist/virologist is a sport we can all participate in while we are cooped up inside!

 

[Bill13]

According to data obtained from the CDC’s National Center for Health Statistics Mortality Surveillance System website, total U.S. deaths for the first three weeks of March are DOWN 10% from the average of the prior four years for the same three week period.

The average for weeks 9 through 11 for the four prior years was a total of 170,555 deaths. For weeks 9 through 11 this year, the total is 153,015, meaning 17,540 fewer people died in America during the first three weeks of March than could be reasonably expected. And the gap between historic deaths and weekly deaths is widening. For week 11, just 47,655 Americans died, 8,773 and 15% fewer than the average for week 11 in the prior four years. And while data on week 12 is not complete, it is trending similar to week 11 and will likely be down by 15% (around 8,700 deaths less than expected) even though 1,919 COVID-19 deaths were reported (in week beginning 3/22).

https://www.grassfire.com/what_tota...ears_further_raising_question_of_covid_impact

 

[Bill13]

Counter guy at the local electrical supply house said he stopped by FFX Hospital Tuesday around 3:30pm. Walked in and got his results while there. Total time 60 minutes from when he entered the door.
Looking forward to when it's available at the local CVS or grocery pharmacy.

 

[Nemo]

On the masks- there are two types of medical masks:

Surgical masks are the paper masks which are tied somewhat loosely over the face. Like you see surgeons wear in medical shows (and indeed, in real life). They are designed to stop the surgeons droplets getting onto you while they are operating on you. They trap the expiratory airflow pretty well but the inspiratory airflow is as much around the mask as through it. And they have limited filtering capacity. For Covid, they probably provide a degree of protection against droplets but little protection against micro droplets/ aerosols. There is argument around whether they make it more or less likely that someone will touch their face. They are also effective at trapping much of the expiratory airflow, so may reduce the amount of virus that an infected person (even if asymptomatic) sheds into the environment. Note that droplets fall to the ground pretty quckly, so staying 6'/2m away from people is probably more important than wearing a mask. Indeed, this is one of the arguments used against routine wearing of masks in the community: they give people a false sense of security and they don't observe spatial distancing as rigourously.

Respirators are masks which seal around the face. All of the inspiratory flow is meant to go through the mask. If the mask doesn't suck itself into your face when you breathe in, it's not properly fitted and won't work. They can be disposable or reusable (reusables look like a gas mask). In the USA, they are usually rated N95, in Europe P2. This is a technical definition describing the filtering efficeincy. There is a higher rating available (N99, N100 in USA or P3 in EU) but these are uncommonly seen in disposable medical masks IME. They can be a bit of an effort to breathe through, especially the N100/P3s, especially if you are wearing them for hours on end. The seal is uncomfortable, especially over the nose, where it tends to pinch the nostrils closed (i sometimes get sinusitis) and abrade the spot where it crosses the bridge of your nose. The particulte filters in respirators usually work by having a layer of charged polypropylene mesh which traps small particles. Sometimes you see disposable masks with an expiratory valve. These will probably provide protection for the wearer but won't filter the wearer's expiratory airflow.

The WHO says (or at least they did the last I checked) that aerosol spread is mainly confined to the medical setting (often caused by aerosol generating procedures (AGPs) such as intubation or bronchoscopy) and this is the main reason that respirators are used in this setting.

 

[Michi]

According to data obtained from the CDC’s National Center for Health Statistics Mortality Surveillance System website, total U.S. deaths for the first three weeks of March are DOWN 10% from the average of the prior four years for the same three week period.

How very illuminating. From the article you linked to:

total U.S. deaths for the first three weeks of March are DOWN 10% from the average of the prior four years for the same three week period

Translation: we went through all the historical data and cherry-picked the bit we could find that was most suitable to supporting the point we want to make.

The final data for March could show a total of 26,000 or more FEWER DEATHS in the month than would be expected without even factoring in the impact of 4,000 COVID deaths.

Aha. Yes, there were 26,000 fewer deaths in March. In a normal year, such as 2017, 2.8 million people die of all causes. Meaning that the 26,000 mentioned amount to less than 0.01%. That is one-hundredth of one percent. Surely worth pointing out, isn't it? Never mind that 26,000 is below the noise floor, and has no meaning whatsoever.

After noting that his fellow doctors are wondering where the heart attacks and strokes have gone, the doctor references an "informal twitter poll" that found "almost half of the respondents reported that they are seeing a 40 percent to 60 percent reduction in admissions for heart attacks; about 20 percent reported more than a 60 percent reduction."

Ah, yes, indeed. Let's face it: coronavirus is actually good for people! It is especially appropriate to conclude that when the data is taken from an informal Twitter poll.

In other words, the U.K. is locked down for a NET increase of as little as 6,600 or so deaths. Nobody wants to say it, but even Ferguson admits that the vast majority of those dying from COVID-19 would likely have died within the year anyways. There, we said it.

"Locked down for a net increase of as little 6,600 or so deaths." Awesome! Everything is just fine. Seeing that, as of this moment, worldometer reports 7,097 deaths from coronavirus in the UK. Oh yes, just in case you missed it: when lots of people die from coronavirus, that doesn't mean that other people stop dying from what people normally die from.

 

[ian]

According to data obtained from the CDC’s National Center for Health Statistics Mortality Surveillance System website, total U.S. deaths for the first three weeks of March are DOWN 10% from the average of the prior four years for the same three week period.

The average for weeks 9 through 11 for the four prior years was a total of 170,555 deaths. For weeks 9 through 11 this year, the total is 153,015, meaning 17,540 fewer people died in America during the first three weeks of March than could be reasonably expected. And the gap between historic deaths and weekly deaths is widening. For week 11, just 47,655 Americans died, 8,773 and 15% fewer than the average for week 11 in the prior four years. And while data on week 12 is not complete, it is trending similar to week 11 and will likely be down by 15% (around 8,700 deaths less than expected) even though 1,919 COVID-19 deaths were reported (in week beginning 3/22).

https://www.grassfire.com/what_tota...ears_further_raising_question_of_covid_impact

So, this is a weird statistic, I guess. But that article (without saying it explicitly) seems to be implying that covid-19 isn’t a big deal, and we should just relax about it. This is misguided. There could be a billion different things contributing to the differences in numbers of deaths. I wouldn't be surprised if car accidents were down a bit, what with people staying home. I'm not saying this makes up the difference or something, since the number of car accidents per year in the US is only 40,000(?) or so. But there could be many other similar factors, some related to the covid response, some completely unrelated. Writing articles that try to downplay covid using such stats is bad journalism. (I'd say it's bad science, but it's not science.)

Edit: @Michi, I do think @Bill13 is operating in good faith here. I just disagree strongly with the article. So we don't have to make it personal, right?

 

[Michi]

Edit: @Michi, I do think @Bill13 is operating in good faith here. I just disagree strongly with the article. So we don't have to make it personal, right?

@ian: If @Bill13 is posting rubbish such as this without any qualification whatsoever, then, at best, this is a misleading post that gives air time to nonsense. At worst, it is spreading conspiracy theories with no foundation in actual data. I cannot fathom why someone would choose to spread that kind of rubbish.

Either way, the post is inappropriate, IMO, and it deserves to be called out.