Patients asking for mask exeptions

[hallowmann]

Curious—who here actually cares/cared for hospitalized pts with Covid?

Me as well. I have yet to see any situation where providing a letter excusing someone from wearing a mask in public is appropriate. I have also had multiple patients with ID that have come into my office with face masks (albeit often missing their nose) and they seem to do fine with it. They are often accompanied by a caregiver that would be at higher risk of severe complications with COVID, and because of that they aren't going to lots of big group settings.

The cases of ASD and moderate to severe ID are like cases of children. While I could see that it may be reasonable to give exception to these individuals, I've not seen a patient that needed one because either, as I described above, they're wearing masks, or they are given the same exception that children are given by all others that might request that they wear one.

As @Mass Effect said, I'm not going to give someone a letter saying they shouldn't wear a seat belt even if the immediate risk of harm is likely low. The reason is because even a low risk of harm is greater than the harm associated with the very slight inconvenience of putting on a seat belt, which every vehicle is equipped with. Its the same with masks. Even if we assume the risk is low (and to be completely honest based on how other non-fascist countries have effectively dealt with it and their outcomes, it seems clear to me that at very least mask wearing is a component of infection prevention and risk reduction), there is very little inconvenience or damage associated with the wearing of a face covering. They are readily available, given out in many medical offices and hospitals, cheap, and even if you didn't wish to buy one, chances are you have something that could double as a mask (a scarf, bandana, balaclava, T-shirt, etc.).

The problem I have with this is that we are for some odd reason conflating requiring the wearing of masks with a violation of rights. Wearing a mask in places that requires one is not a violation of rights. Having a no shoes, no service policy is not a violation of rights. As for putting others at risk, we require all sorts of things in the name of public health, public good, etc. Is throwing a piece of trash out the window an imminent threat? No, but we have anti-littering laws. The examples are numerous, and there's no outcry against it (although to be fair there was initially, until people realized it was stupid to litter when the extra energy exerted not to was minimal).

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[box8psych]

Curious—who here actually cares/cared for hospitalized pts with Covid?

I was "redeployed"/voluntold to the inpatient medical floors for 5 weeks in March/April

 

[SourceOfDenial]

I have yet to encounter an experience where I would grant a mask exemption—and the reason for asking about working directly with covid patients was, because of that experience, I don’t think I ever would grant someone an exemption. Curious if those who feel otherwise were actually on the floors or in the ICUs.

 

[deleted480308]

Curious—who here actually cares/cared for hospitalized pts with Covid?

 

[Nines]

Curious—who here actually cares/cared for hospitalized pts with Covid?

I did. Had a big outbreak in the freestanding psych hospital where I worked. Had some patients end up in the ICU. No deaths fortunately.

 

[michaelrack]

The problem I have with this is that we are for some odd reason conflating requiring the wearing of masks with a violation of rights. Wearing a mask in places that requires one is not a violation of rights. Having a no shoes, no service policy is not a violation of rights. As for putting others at risk, we require all sorts of things in the name of public health, public good, etc. Is throwing a piece of trash out the window an imminent threat? No, but we have anti-littering laws. The examples are numerous, and there's no outcry against it (although to be fair there was initially, until people realized it was stupid to litter when the extra energy exerted not to was minimal).

There's a big difference between a private business (wisely in my opinion) choosing to require masks, and the government (usually via executive order) requiring the wearing of masks and/or requiring a private business to enforce this mandate. I don't see the point of bringing up anti-littering laws- what type of right is littering? Having control of one's body is a right (not an absolute right except for apparently abortion in this country), and I think it is an abuse of emergency powers for governors to be mandating masks at this point 5 months into a health problem. If the rights of the healthy (quarantine of the sick is definitely allowed under a state's public health powers) are to be abrogated by the state governments, it should at least be by the legislature.

I should mention, however, that licensed physicians are agents of the state, and I have no problem with the government mandating masks in physician offices etc.

 

[hallowmann]

There's a big difference between a private business (wisely in my opinion) choosing to require masks, and the government (usually via executive order) requiring the wearing of masks and/or requiring a private business to enforce this mandate. I don't see the point of bringing up anti-littering laws- what type of right is littering? Having control of one's body is a right (not an absolute right except for apparently abortion in this country), and I think it is an abuse of emergency powers for governors to be mandating masks at this point 5 months into a health problem. If the rights of the healthy (quarantine of the sick is definitely allowed under a state's public health powers) are to be abrogated by the state governments, it should at least be by the legislature.

I should mention, however, that licensed physicians are agents of the state, and I have no problem with the government mandating masks in physician offices etc.

We don't let people walk around without tops (women) or bottoms (men and women). Is that a better analogy? There are lots of laws that restrict what we do with our external bodies. This isn't unique. Dress codes exist in society for the benefit of others, this is no different.

 

[deleted480308]

We don't let people walk around without tops (women) or bottoms (men and women). Is that a better analogy? There are lots of laws that restrict what we do with our external bodies. This isn't unique. Dress codes exist in society for the benefit of others, this is no different.

That’s a stretch and you know it

 

[michaelrack]

We don't let people walk around without tops (women) or bottoms (men and women). Is that a better analogy? There are lots of laws that restrict what we do with our external bodies. This isn't unique. Dress codes exist in society for the benefit of others, this is no different.

That analogy still doesn't cut it: those laws address display of the body (a form of speech) and not what actual control of the body (such as wearing a mask that impairs respiration). And laws against going topless may be unconstitutional: Women can now publicly go topless in 6 states, thanks to federal ruling.

Laws against going bottomless are consitutionally permitted abridgements of free speech, so are in a different category than laws about control of one's body: Indecent exposure in the United States - Wikipedia

 

[chocomorsel]

And what about the lives of everyone else? Wearing the mask isn't only for your safety. It's also so you don't spread your COVID germs to the rest of society. I'm pretty heartless on this issue. No exemptions.

That is the total opposite of heartless if you ask me. Thank you.

 

[chocomorsel]

Curious—who here actually cares/cared for hospitalized pts with Covid?

I do. In the ICUs. And it’s horrible. And I can’t believe educated physicians are even having arguments about this. @calvnandhobbs68, if you agree that there is clear evidence that it protects others, isn’t the mask wearer the “other” at different points in transit versus the “self”?
So how is this even a question?

I am not a psychiatrist. Just interested in psychiatry.

 

[WisNeuro]

That analogy still doesn't cut it: those laws address display of the body (a form of speech) and not what actual control of the body (such as wearing a mask that impairs respiration). And laws against going topless may be unconstitutional: Women can now publicly go topless in 6 states, thanks to federal ruling.

Laws against going bottomless are consitutionally permitted abridgements of free speech, so are in a different category than laws about control of one's body: Indecent exposure in the United States - Wikipedia

I haven't seen that this is in any way true in 99.99% of cases in the empirical literature. anything to back this myth up?

 

[Mass Effect]

There's a big difference between a private business (wisely in my opinion) choosing to require masks, and the government (usually via executive order) requiring the wearing of masks and/or requiring a private business to enforce this mandate. I don't see the point of bringing up anti-littering laws- what type of right is littering? Having control of one's body is a right (not an absolute right except for apparently abortion in this country), and I think it is an abuse of emergency powers for governors to be mandating masks at this point 5 months into a health problem. If the rights of the healthy (quarantine of the sick is definitely allowed under a state's public health powers) are to be abrogated by the state governments, it should at least be by the legislature.

I should mention, however, that licensed physicians are agents of the state, and I have no problem with the government mandating masks in physician offices etc.

So is it also wrong for states to mandate seat belt laws? How about smoking on a plane as I said earlier?

 

[Mass Effect]

That analogy still doesn't cut it: those laws address display of the body (a form of speech) and not what actual control of the body (such as wearing a mask that impairs respiration).

Oh stop. It does not impair respiration.

 

[chocomorsel]

That analogy still doesn't cut it: those laws address display of the body (a form of speech) and not what actual control of the body (such as wearing a mask that impairs respiration). And laws against going topless may be unconstitutional: Women can now publicly go topless in 6 states, thanks to federal ruling.

Laws against going bottomless are consitutionally permitted abridgements of free speech, so are in a different category than laws about control of one's body: Indecent exposure in the United States - Wikipedia

Please ask all your surgeon, anesthesiologists, Intensivists and OR nurse and tech friends if masks actually "impair respiration".
Like really. Please do. I want to see the verdict on that.

You are a doctor. Please don't preach this crap out loud to the public.

 

[chocomorsel]

Oh stop. It does not impair respiration.

Amazing I am still alive all these years I have spent wearing masks 8-16 hours a day at least five days a week for the past decade. Its a wonder I haven't suffocated to death. A complete miracle that my smoker colleagues haven't turned to dust.

 

[Candidate2017]

So is it also wrong for states to mandate seat belt laws? How about smoking on a plane as I said earlier?

I'm surprised people who dislike masking mandates aren't protesting selt belts laws, which are actual physical restraints. And there's some evidence that being morbidly obese is in itself as protective as seat belts.

Anyway, auto insurance lobbied very hard for seat belt laws; auto injuries are very costly. I'm surprised health insurance hasn't lobbied for masking laws. Probably because most COVID patients who end up with costly ICU/hospital stays are Medicare insured, a politically controlled entity.

 

[deleted480308]

So is it also wrong for states to mandate seat belt laws? How about smoking on a plane as I said earlier?

I don’t like seat belt laws either

 

[michaelrack]

I wear a mask most of the time in public, even in the gym... but I remove it for aerobic activity (treadmill/elliptical) due to its effects on respiration..... I agree that a mask won't harm the average person during normal activity. Most gyms (at least in the south) , do allow the removal of masks while exercising when social distancing is maintained

 

[michaelrack]

The World Health organization recommends against wearing a mask while working out.

Impairment of respiration is not a myth, but it's negligible under average conditions

 

[Mass Effect]

Impairment of respiration is not a myth, but it's negligible under average conditions

Then why make it part of the argument? If gyms allow you to take it off which is what the WHO recommends, then it's not relevant to the discussion at hand and inserting it into the conversation only blurs truth versus fiction.

 

[Mass Effect]

I don’t like seat belt laws either

I don't much care if people wear seat belts or not, but I have a big problem with people not wearing masks, just as I have a problem with folks doing other things that puts the rest of society (including healthcare providers who then risk their lives to save yours) at risk.

 

[Matthew9Thirtyfive]

It disturbs me that there are physicians saying there is no or weak evidence that masks help prevent the transmission of covid and it really disturbs me that any physician would claim that masks impair respiration. Holy cow.

 

[michaelrack]

N95 masks (which aren't what most are wearing) can decrease SaO2 :

These Engineers Just Solved the Biggest Problem with N95 Masks

Not bad for a couple of guys who usually create fuel cells for next-gen cars.

www.popularmechanics.com

The evidence is a less clear for surgical masks: http://scielo.isciii.es/pdf/neuro/v19n2/3.pdf . On the internet I could find lots of "studies" of doctors measuring their own pulse ox while wearing a mask- but the above equivocal study is the only real one I could find.

I feel surgical masks are safe and should be worn (out of people's own free will, not out of coercion), but I am not aware of any real evidence that they don't cause (minor) effects in O2/CO2 levels, especially in persons with COPD.
I see a lot of uninformed insults on this thread, but no one's posted any real evidence that surgical masks don't effect respiration/ventilation (And as a board certified internist I do know the difference, but I am using the words interchangeably due to the public now calling masks "respirators").

 

[michaelrack]

I must admit, the official view based on what "medical professionals say" is that surgical masks don't impair respiration:

Posts falsely claim that wearing face masks harms health

CLAIM: Face masks can decrease oxygen intake, increase toxin inhalation and shut down the immune system. AP’S ASSESSMENT: False. Medical professionals say wearing masks do none of those things. THE FACTS: Posts on social media are spreading false information about face masks as health...

apnews.com

"Videos and photos online show medical professionals getting the same normal rating on pulse oximeters, which measure oxygen saturation, with a mask on or off." I guess that's what passes for scientific evidence these days.
I realize that pulse oximetry isn't that accurate, but you'd think that someone would do a study with COPD patients (pulse ox with and without mask)... it would be helpful to also measure CO2, maybe either transcutaneously or with capnography

 

[Matthew9Thirtyfive]

N95 masks (which aren't what most are wearing) can decrease SaO2 :

These Engineers Just Solved the Biggest Problem with N95 Masks

Not bad for a couple of guys who usually create fuel cells for next-gen cars.

www.popularmechanics.com

The evidence is a less clear for surgical masks: http://scielo.isciii.es/pdf/neuro/v19n2/3.pdf . On the internet I could find lots of "studies" of doctors measuring their own pulse ox while wearing a mask- but the above equivocal study is the only real one I could find.

I feel surgical masks are safe and should be worn (out of people's own free will, not out of coercion), but I am not aware of any real evidence that they don't cause (minor) effects in O2/CO2 levels, especially in persons with COPD.
I see a lot of uninformed insults on this thread, but no one's posted any real evidence that surgical masks don't effect respiration/ventilation (And as a board certified internist I do know the difference, but I am using the words interchangeably due to the public now calling masks "respirators").

Do you know of any evidence that wearing surgical masks impairs respiration/ventilation or causes physiologic issues in healthy subjects?

It seems like there are some small studies showing that it has no effect in SpO2 and either no or clinically insignificant changes in PCO2, even when exercising. There’s also a fun one where they look at pilots in a simulated 5,000 feet environment and found no differences between wearing a mask and not wearing a mask.

I did find one study that showed a slight difference in surgeons during large operations, but even the authors admitted there was no way to determine whether that was because of the masks or because of the stress of the operation. There was also another study that showed no change in surgeons.

There are also conflicting studies about wearing an n95 with surgical masks over top. Some studies show no difference, one I found showed a difference.

So it seems like the majority of the evidence, scant as it might be, doesn’t support that healthy subjects experience impaired respiration. And having worked in the OR as a scrub tech and a first assist for 8 years, I can say I never felt like I had any impaired respiration, and the couple times I put a pulse ox on just for fun, it was always 99+.

But if you want to just talk about COPD patients, I’d be more willing to believe that it can impair respiration, though I’d still like to see even a small, equivocal study showing that (I haven’t looked).

 

[michaelrack]

Do you know of any evidence that wearing surgical masks impairs respiration/ventilation or causes physiologic issues in healthy subjects?

It seems like there are some small studies showing that it has no effect in SpO2 and either no or clinically insignificant changes in PCO2, even when exercising. There’s also a fun one where they look at pilots in a simulated 5,000 feet environment and found no differences between wearing a mask and not wearing a mask.

I did find one study that showed a slight difference in surgeons during large operations, but even the authors admitted there was no way to determine whether that was because of the masks or because of the stress of the operation. There was also another study that showed no change in surgeons.

There are also conflicting studies about wearing an n95 with surgical masks over top. Some studies show no difference, one I found showed a difference.

So it seems like the majority of the evidence, scant as it might be, doesn’t support that healthy subjects experience impaired respiration. And having worked in the OR as a scrub tech and a first assist for 8 years, I can say I never felt like I had any impaired respiration, and the couple times I put a pulse ox on just for fun, it was always 99+.

But if you want to just talk about COPD patients, I’d be more willing to believe that it can impair respiration, though I’d still like to see even a small, equivocal study showing that (I haven’t looked).

I can't find any fault with what you are saying in this post. It looks like you were able to find more studies than I could.

 

[Mass Effect]

N95 masks (which aren't what most are wearing) can decrease SaO2 :

These Engineers Just Solved the Biggest Problem with N95 Masks

Not bad for a couple of guys who usually create fuel cells for next-gen cars.

www.popularmechanics.com

Irrelevant to the discussion.

The evidence is a less clear for surgical masks: http://scielo.isciii.es/pdf/neuro/v19n2/3.pdf . On the internet I could find lots of "studies" of doctors measuring their own pulse ox while wearing a mask- but the above equivocal study is the only real one I could find.

I feel surgical masks are safe and should be worn (out of people's own free will, not out of coercion)

Why shouldn't states mandate masks when the evidence shows they reduce the risk of transmission? It really perplexes me why anti-maskers draw the line at masks while they expect everyone to follow other laws.

but I am not aware of any real evidence that they don't cause (minor) effects in O2/CO2 levels, especially in persons with COPD.

I don't see any real evidence that they do.

I see a lot of uninformed insults on this thread, but no one's posted any real evidence that surgical masks don't effect respiration/ventilation (And as a board certified internist I do know the difference, but I am using the words interchangeably due to the public now calling masks "respirators").

They're not uninformed insults. What you're seeing are rebuttals to claims that are not supported by the evidence. No one's posted that surgical masks don't effect respiration because there's no reason to believe they do and more than ample reason to believe they don't (or else critical care docs and surgeons would have been falling down in the hallways for decades now).

 

[Stagg737]

So is it also wrong for states to mandate seat belt laws? How about smoking on a plane as I said earlier?

Yes to the first for sure. If people want to be dumba***s and put their own lives at risk that’s on them. And yes to the second if it is the state mandating it and not the airline, though I think the argument of adversely affecting others is valid and
this situation justifiable since people can’t walk off a plane mid-flight to avoid a smoker.

It disturbs me that there are physicians saying there is no or weak evidence that masks help prevent the transmission of covid and it really disturbs me that any physician would claim that masks impair respiration. Holy cow.

The actual evidence based on larger studies and meta-analyses show that the hypothesis that specifically wearing any mask will prevent COVID transmission is weak and that other factors such as physical distancing and quarantining play a greater role in prevention of spread.

https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)31142-9/fulltext


Do NOT confuse this with someone advocating that people shouldn’t wear a mask or that it doesn’t play a role in prevention. They are not the same thing and playing things conservatively is in the best interest of everyone. However, if we’re going to discuss this intelligently and scientifically, specific language matters.

I only brought up the point of individual rights as a question as to how far should we be willing to go in an effort to “win the war” against this virus. Just masks? As far as China did with military quarantining of infected individuals? I brought up the point of the difference between writing an actual exemption and an explanation of an individuals medical/psychiatric condition (without advocating for an exemption), to raise the point that a doc could write that letter without actually writing an exemption and still argue that they’re not legally liable. Not to say they should do it.

I feel like a lot of the statements I’ve made are being taking too generally or being suggested that this is what I would actually do irl, neither of which accurately reflect what I’m arguing or how I believe this should be generally approached in a practical matter.

 

[WisNeuro]

From that study.

"The use of face masks was protective for both health-care workers and people in the community exposed to infection, with both the frequentist and Bayesian analyses lending support to face mask use irrespective of setting. Our unadjusted analyses might, at first impression, suggest use of face masks in the community setting to be less effective than in the health-care setting, but after accounting for differential N95 respirator use between health-care and non-health-care settings, we did not detect any striking differences in effectiveness of face mask use between settings. The credibility of effect-modification across settings was, therefore, low. Wearing face masks was also acceptable and feasible. Policy makers at all levels should, therefore, strive to address equity implications for groups with currently limited access to face masks and eye protection"

 

[deleted480308]

From that study.

"The use of face masks was protective for both health-care workers and people in the community exposed to infection, with both the frequentist and Bayesian analyses lending support to face mask use irrespective of setting. Our unadjusted analyses might, at first impression, suggest use of face masks in the community setting to be less effective than in the health-care setting, but after accounting for differential N95 respirator use between health-care and non-health-care settings, we did not detect any striking differences in effectiveness of face mask use between settings. The credibility of effect-modification across settings was, therefore, low. Wearing face masks was also acceptable and feasible. Policy makers at all levels should, therefore, strive to address equity implications for groups with currently limited access to face masks and eye protection"

I feel like their is a snuck premise between “masks work” and “govt should mandate and provide masks”

 

[WisNeuro]

I feel like their is a snuck premise between “masks work” and “govt should mandate and provide masks”

It's simply a public health measure that could slow down infection, and also likely help the economy. Also, much less restrictive than many other government mandated things. We've done it before, we'll likely do it again. If all of the "freedom" hypocrites wanted to commune up and circle jerk their hypocritical selves into a covid-driven demise, I'd be ok with that. Unfortunately, these m orons are busy infecting people who are essentially forced to deal with them.

 

[deleted480308]

It's simply a public health measure that could slow down infection, and also likely help the economy. Also, much less restrictive than many other government mandated things. We've done it before, we'll likely do it again. If all of the "freedom" hypocrites wanted to commune up and circle jerk their hypocritical selves into a covid-driven demise, I'd be ok with that. Unfortunately, these m orons are busy infecting people who are essentially forced to deal with them.

“We’ve done worse” is a bad justification, but I agree with your prediction we will do it again

 

[WisNeuro]

“We’ve done worse” is a bad justification, but I agree with your prediction we will do it again

We've done worse was not the justification at all. The justification is, now and then, we do things for the greater good. Stupidity based on political ideology is no reason to needlessly increase health risks to other people. The fact that something as simple and easy as wearing a mask in pubic is simply mind boggling. It's the same level of stupidity as believing in QAnon.

 

[deleted480308]

We've done worse was not the justification at all. The justification is, now and then, we do things for the greater good. Stupidity based on political ideology is no reason to needlessly increase health risks to other people. The fact that something as simple and easy as wearing a mask in pubic is simply mind boggling. It's the same level of stupidity as believing in QAnon.

I don’t know what qanon is so I’m not sure how good a zinger that was

 

[WisNeuro]

Unless you live in a bubble, I find that hard to believe.

 

[deleted480308]

Unless you live in a bubble, I find that hard to believe.

With all the stuff I’m honest about on here, that’s the thing you think I lie about?

 

[WisNeuro]

With all the stuff I’m honest about on here, that’s the thing you think I lie about?

I didn't say you lied, just said it's hard to believe with the ubiquity of it in the news over the year. It'd like saying that you haven't yet heard of Joe Biden, or this whole COVID thing, hence the bubble comment, which could be literal or figurative.

 

[VA Hopeful Dr]

I didn't say you lied, just said it's hard to believe with the ubiquity of it in the news over the year. It'd like saying that you haven't yet heard of Joe Biden, or this whole COVID thing, hence the bubble comment, which could be literal or figurative.

Utter nonsense.

I have only a vague idea of what qanon is, its some sort of far right wing group, right?

That's the extent of what I know about it.

 

[WisNeuro]

Qanon is indeed utter nonsense. Unfortunately it's utter nonsense that the GOP has embraced, and you'll likely see at least 2 fully fledged believers in congress next year after some primary wins.

 

[Stagg737]

From that study.

"The use of face masks was protective for both health-care workers and people in the community exposed to infection, with both the frequentist and Bayesian analyses lending support to face mask use irrespective of setting. Our unadjusted analyses might, at first impression, suggest use of face masks in the community setting to be less effective than in the health-care setting, but after accounting for differential N95 respirator use between health-care and non-health-care settings, we did not detect any striking differences in effectiveness of face mask use between settings. The credibility of effect-modification across settings was, therefore, low. Wearing face masks was also acceptable and feasible. Policy makers at all levels should, therefore, strive to address equity implications for groups with currently limited access to face masks and eye protection"

To the first, this was only concluded in regards to wearing 12-16 layer or gauze masks and was based on several studies from China during/after the SARS pandemic when cloth masks like most of the ones being used in the US were actually outlawed by the Chinese government. So not really pertinent to the policy of just wearing any mask which pretty much every mandate has. If we actually want to make policies based on scientifically backed data, then most homemade masks and the reusable ones sold at drug stores and handed out by the VA may be inadequate, as we don't have good data on this type of mask.

Also, from the final conclusion of the study:

"Our comprehensive systematic review provides the best available information on three simple and common interventions to combat the immediate threat of COVID-19, while new evidence on pharmacological treatments, vaccines, and other personal protective strategies is being generated. Physical distancing of at least 1 m is strongly associated with protection, but distances of up to 2 m might be more effective. Although direct evidence is limited, the optimum use of face masks, in particular N95 or similar respirators in health-care settings and 12–16-layer cotton or surgical masks in the community, could depend on contextual factors; action is needed at all levels to address the paucity of better evidence. Eye protection might provide additional benefits. Globally collaborative and well conducted studies, including randomised trials, of different personal protective strategies are needed regardless of the challenges, but this systematic appraisal of currently best available evidence could be considered to inform interim guidance."

The bolded is the point I've been making. Not that masks aren't helpful, but that the actual evidence showing this is weak, which is especially true for cheap and many homemade masks. I'm actually fine with the temporary mandate of masks, especially in areas that are hot spots since the risk-reward ratio is likely very, very high. Let's not pretend that this is based on solid evidence as opposed to being a generally benign conservative measure though.

If anyone has any decent scientific literature stating otherwise, I'd legitimately love to read it. Until then, I'm not going to present the above as fact when the data is not there to back it up.

 

[VA Hopeful Dr]

To the first, this was only concluded in regards to wearing 12-16 layer or gauze masks and was based on several studies from China during/after the SARS pandemic when cloth masks like most of the ones being used in the US were actually outlawed by the Chinese government. So not really pertinent to the policy of just wearing any mask which pretty much every mandate has. If we actually want to make policies based on scientifically backed data, then most homemade masks and the reusable ones sold at drug stores and handed out by the VA may be inadequate, as we don't have good data on this type of mask.

Also, from the final conclusion of the study:

"Our comprehensive systematic review provides the best available information on three simple and common interventions to combat the immediate threat of COVID-19, while new evidence on pharmacological treatments, vaccines, and other personal protective strategies is being generated. Physical distancing of at least 1 m is strongly associated with protection, but distances of up to 2 m might be more effective. Although direct evidence is limited, the optimum use of face masks, in particular N95 or similar respirators in health-care settings and 12–16-layer cotton or surgical masks in the community, could depend on contextual factors; action is needed at all levels to address the paucity of better evidence. Eye protection might provide additional benefits. Globally collaborative and well conducted studies, including randomised trials, of different personal protective strategies are needed regardless of the challenges, but this systematic appraisal of currently best available evidence could be considered to inform interim guidance."

The bolded is the point I've been making. Not that masks aren't helpful, but that the actual evidence showing this is weak, which is especially true for cheap and many homemade masks. I'm actually fine with the temporary mandate of masks, especially in areas that are hot spots since the risk-reward ratio is likely very, very high. Let's not pretend that this is based on solid evidence as opposed to being a generally benign conservative measure though.

If anyone has any decent scientific literature stating otherwise, I'd legitimately love to read it. Until then, I'm not going to present the above as fact when the data is not there to back it up.

You're actually right in that data regarding non-medical masks is very poor. We have lots of anecdotes (that Midwest salon), epidemiology (mask mandates with a sharp drop in new cases pretty quickly afterwards), surrogate markers (that MIT one that showed cloth masks reduce droplet spread while gators might actually made it worse), and so on. So no, nothing rises to level 1 evidence in our usual manner. We also know that the plural of anecdote isn't data, except that at a certain point it kinda is.

The bold part is the key. Even very weak evidence with basically zero risk is a pretty good reason to recommend it.

 

[WisNeuro]

The bold part is the key. Even very weak evidence with basically zero risk is a pretty good reason to recommend it.

Exactly, and that study explicitly states that more research is needed and even points at two high n pre-registered studies to look at this very thing. The real point is we have emerging evidence of benefit, with nearly zero downside (maybe the cost of masks) from doing it.

 

[VA Hopeful Dr]

Exactly, and that study explicitly states that more research is needed and even points at two high n pre-registered studies to look at this very thing. The real point is we have emerging evidence of benefit, with nearly zero downside (maybe the cost of masks) from doing it.

I think the point @Stagg737 was making (and he/she can correct me if I'm mistaken), was that when everyone is saying that we have great data that masks work they aren't being entirely truthful. We have some data. Outside of a pandemic, it would be considered very weak data. But since this is a pandemic, we're at the "we have to do SOMETHING" stage.

Masks are a super low risk something, so outside of the political question there's no reason not to do it. He/she even says as much:

The bolded is the point I've been making. Not that masks aren't helpful, but that the actual evidence showing this is weak, which is especially true for cheap and many homemade masks. I'm actually fine with the temporary mandate of masks, especially in areas that are hot spots since the risk-reward ratio is likely very, very high. Let's not pretend that this is based on solid evidence as opposed to being a generally benign conservative measure though.

 

[Stagg737]

I think the point @Stagg737 was making (and he/she can correct me if I'm mistaken), was that when everyone is saying that we have great data that masks work they aren't being entirely truthful. We have some data. Outside of a pandemic, it would be considered very weak data. But since this is a pandemic, we're at the "we have to do SOMETHING" stage.

Masks are a super low risk something, so outside of the political question there's no reason not to do it. He/she even says as much:

Yep, exactly what I've been trying to say. I'm not opposed to masks as a general precaution at all, especially given how stupid our general populace is as a whole. I just think we need to be transparent about why we make recommendations and accurate with the data and arguments we present.

I just also think there are other aspects worth discussing (such as the ethics of autonomy, individual vs. collective rights, etc) even if they're not what we're going to recommend and implement in practice. Taking things at face value without asking questions or being critical of the information presented only inhibits the progress that can be made in regards to reaching the best possible outcome.

 

[VA Hopeful Dr]

I just also think there are other aspects worth discussing (such as the ethics of autonomy, individual vs. collective rights, etc) even if they're not what we're going to recommend and implement in practice. Taking things at face value without asking questions or being critical of the information presented only inhibits the progress that can be made in regards to reaching the best possible outcome.

I see what you did there

 

[penpenclown]

Utter nonsense.

I have only a vague idea of what qanon is, its some sort of far right wing group, right?

That's the extent of what I know about it.

It's basically Satanic Panic 2.0, based on a bunch of far-right *****s believing in an anonymous person BSing on 4chan. Basically they think all liberal politicians, celebs, etc. are involved in a giant Satanic child trafficking ring and Trump is plotting to take them down...or something. It's somehow even more ridiculous than it sounds.

 

[WisNeuro]

It's basically Satanic Panic 2.0, based on a bunch of far-right *****s believing in an anonymous person BSing on 4chan. Basically they think all liberal politicians, celebs, etc. are involved in a giant Satanic child trafficking ring and Trump is plotting to take them down...or something. It's somehow even more ridiculous than it sounds.

Unfortunately it's crossed the line from ridiculous internet conspiracy into danger to actual people territory. Everyone remember the dude who stormed the pizza place with assault weapons looking for the child sex room at Comet? Or the fact that we will literally have people in Congress who have the Qanon conspiracy as the basis of their candidacy.

 

[NontradCA]

Where do you guys work where you have patients asking for mask exemptions? I can definitely see a large % of my patients not wearing masks, being against it and not adhering to my states recommendations, but they aren't telling me. I guess I have some really sick people, who would never argue with me about something so trivial in the context of their overall illness.

 

[WisNeuro]

Where do you guys work where you have patients asking for mask exemptions? I can definitely see a large % of my patients not wearing masks, being against it and not adhering to my states recommendations, but they aren't telling me. I guess I have some really sick people, who would never argue with me about something so trivial in the context of their overall illness.

Our state has a mask mandate in indoor public spaces. Our hospital system has mandated them longer than it's been a state mandate. My family med spouse has had a handful of asks for mask exemptions. Far as I know she's written two, and it was for people who had moderate to severe COPD, some other comorbidities, and were on oxygen. She did recommend to those people that they should isolate as much as possible anyway, as they are in the highest risk groups, but these exemptions at least made some sense.