I'm also in a very liberal city where most places are officially maskless but people still wear masks to virtue signal or whatever.
Funny, I also had a meeting with a small cohort of students and an MD today. The MD asked me to wear a mask and I respectfully refused because a) we're literally all triple vaccinated and I could care less about the .000001% of infection and b) the rules literally say masks are 'strongly recommended'. The room got a little quiet for sure after he said sorry and took back his statement.
I'm absolutely confident I have some classmates gossiping about me not wearing a mask but I'm not losing any sleep over it. At this point, I think most people are just sheeps to the system.
Without even getting into the science behind masks, there are a lot of reasons to just go along with wearing a mask when someone respectfully asks you to do so, especially when that person is in your presence as a favor to you. That MD loses time and money every time they step into a room with med students to teach, and it's pretty reasonable to let them set the rules. Everyone has their own level of risk tolerance, and wearing a mask only when asked is a very small sacrifice.
As far as the science/justification goes, the efficacy of mask mandates on a population level is very poor, however, there is strong evidence supporting universal masking in smaller groups when compliance can be more tightly controlled (e.g., in a classroom, in the workplace). With that in mind, it makes sense to adjust mask behavior depending on the situation. General public? Very little justification. Small group of healthy young people? Very little justification. Classroom setting with a mix of younger and older people, which represents a high risk of transmission for many of the older people relative to the rest of their daily life? Good justification.
Dawg, I’m saying that because it doesn’t. And if this forum can’t handle someone with a different opinion after reading studies as a fully trained board certified physician and have a discussion about it, then maybe this isn’t a forum for doctors, scientist etc. I’m not an anti vaxxer and I didn’t say all vaccines. Just not the Covid vaccine (which is very politically and money driven). Why do you believe the science supports mandating masks and the vax in hospitals? There’s ample evidence that masks have been minimal at best at preventing spread as well as vaccines. Vaccines do have evidence that it decreases severe disease and death though which most of the studies had as their primary endpoint. But the populations that Covid is most severe to are the elderly and/or those with significant comorbid health conditions and I believe they should get the vax to prevent severe disease and/or death. Why should hospitals be threatened with loss of Medicare funding or healthcare workers fired for not mandating the vax to its employees?
Personally I just think too big a deal is being made around both masks and the vaccine. I completely agree with
@GoSpursGo that there was a stronger argument for vaccine mandates early on before variants essentially eliminated the transmission advantage of being vaccinated. If being vaccinated is primarily for your own benefit, mandates are harder to justify and recommendations are the more appropriate route. We need higher powered studies that examine the effect of vaccines on transmission for these new variants. If such a study exists, I'm unaware of it, but even a small reduction in transmission would likely justify a vaccine mandate for healthcare workers.
Similarly, with masks there is a ton of evidence that they are useful situation-by-situation, but very little evidence that they help on a population level, and I think the review cited displays this quite well. The evidence of "real world" transmission reduction is spotty. The review itself cites only 5 actual studies (i.e., not other reviews) under direct epidemiologic evidence, all are underpowered, and many don't even examine COVID transmission. You can tell the authors were scraping sources together and heavily citing other reviews. I know because I've done the same exact thing writing reviews or introduction sections of papers where the evidence is weak. There is, however, tons of evidence via modeling that with high adherence masks make a huge difference, but in practice we don't see high adherence. At
best we see 80% adherence in public settings and basically 0% adherence in private. In 2022 and beyond I doubt we'll ever break 60% compliance outside of very liberal city centers. It seems there are a lot of confounders. On a population level mask mandates do very little to curb the spread, but empowering individuals by protecting certain high risk, well-controlled settings can have an appreciable effect.
To me, this points to poor evidence for public mask mandates, but very strong evidence/justification for requiring masks in certain situations. For instance, if an attending wishes to conduct class with masks because she views class as a high risk environment for her, there is strong evidence that full compliance from the class will reduce her risk.
