Fauci: Double Masks make sense!

[Angry Birds]

I'm willing to be proven wrong. Just waiting on someone to drop that research showing 2 masks > 1 mask in a clinical setting. Or even, 1 mask > no mask in a clinical setting.

Of course, I'll be waiting forever as such research doesn't exist.

You did not have to wait forever:

CDC study finds two masks are better than one in slowing the spread of coronavirus, blocking around 95% of the particles​

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[Jack Donaghy]

You did not have to wait forever:

CDC study finds two masks are better than one in slowing the spread of coronavirus, blocking around 95% of the particles​

That sounds like a garbage study and involved no human beings. Could perhaps be why you didn't link the PubMed version showing statistical validity? Or, let me guess, there is no formal research report and more of a "take my word" kind of study.

 

[VA Hopeful Dr]

That sounds like a garbage study and involved no human beings. Could perhaps be why you didn't link the PubMed version showing statistical validity? Or, let me guess, there is no formal research report and more of a "take my word" kind of study.

It would be very very difficult (I might say impossible) to actually get a decent RCT on this since you'd have to follow people around to make sure they wear/don't their masks with 100% compliance.

But that's really no necessary. We know how respiratory viruses spread (primarily droplet), so if we can show that something reduces droplet spread its not exactly a leap to say that reduces spread of the virus.

 

[MedScat]

My mother works at a community clinic and they are actually making it mandatory for all employees to wear cloth masks over surgical masks starting next week. Obviously two masks will block more particles than one, it's simple barrier logic, but does that really mean we should all be required to do this? I'm really having a hard time with this one. Yes, we need to see how long immunity lasts with the vaccine but, even people who had COVID back in march are still testing positive for high titers of antibodies. Like OP said, why not 3 masks? 4? 5? Two condoms? Double glove for every procedure? I feel like I'm taking crazy pills. If you wanna wear two masks, have at it, but a requirement is friggin bold

 

[VA Hopeful Dr]

My mother works at a community clinic and they are actually making it mandatory for all employees to wear cloth masks over surgical masks starting next week. Obviously two masks will block more particles than one, it's simple barrier logic, but does that really mean we should all be required to do this?. Like OP said, why not 3 masks? 4? 5? Two condoms? Double glove for every procedure? I feel like I'm taking crazy pills.

Diminishing returns. One mask per the CDC gives you a 40% reduction. Two gives you 90%. If three only gives you 94%, probably not worth it.

Also have to see side effects. At a certain point you will start to have problems with breathing.

Don't get me wrong, I also think mandating that is stupid. I'd rather have a mandate on what kinds of masks "count".

 

[WilcoWorld]

It would be very very difficult (I might say impossible) to actually get a decent RCT on this since you'd have to follow people around to make sure they wear/don't their masks with 100% compliance.

But that's really no necessary. We know how respiratory viruses spread (primarily droplet), so if we can show that something reduces droplet spread its not exactly a leap to say that reduces spread of the virus.

WOAH man. You're making an inference! Slow down, inferences aren't allowed.

 

[MedScat]

This was the study model: "In a lab experiment, two artificial heads were placed six feet from each other and studied on how many coronavirus-sized particles were expelled and inhalled while wearing a variety of face coverings."

I find it interesting as well that the study say "Researchers found that wearing one mask, either cloth or surgical, prevented 40 per cent of incoming droplets from being breathed in"

You're telling me those dumb cloth masks are equally as effective as a surgical mask? Im calling BS.

I'm not an anti masker or covid denying or whatever but this is really getting absurd!

 

[WilcoWorld]

My mother works at a community clinic and they are actually making it mandatory for all employees to wear cloth masks over surgical masks starting next week. Obviously two masks will block more particles than one, it's simple barrier logic, but does that really mean we should all be required to do this? I'm really having a hard time with this one. Yes, we need to see how long immunity lasts with the vaccine but, even people who had COVID back in march are still testing positive for high titers of antibodies. Like OP said, why not 3 masks? 4? 5? Two condoms? Double glove for every procedure? I feel like I'm taking crazy pills. If you wanna wear two masks, have at it, but a requirement is friggin bold

I agree that many seem to have lost sight of the principle of diminishing returns. On the other hand, it sounds like you're describing a private business' decision. Private businesses should get to make their own rules, IMO

 

[MedScat]

I agree that many seem to have lost sight of the principle of diminishing returns. On the other hand, it sounds like you're describing a private business' decision. Private businesses should get to make their own rules, IMO

I agree private businesses should be able to make their own rules. I'm just saying I think this is a dumb rule.

 

[VA Hopeful Dr]

This was the study model: "In a lab experiment, two artificial heads were placed six feet from each other and studied on how many coronavirus-sized particles were expelled and inhalled while wearing a variety of face coverings."

I find it interesting as well that the study say "Researchers found that wearing one mask, either cloth or surgical, prevented 40 per cent of incoming droplets from being breathed in"

You're telling me those dumb cloth masks are equally as effective as a surgical mask? Im calling BS.

I'm not an anti masker or covid denying or whatever but this is really getting absurd!

Did the study actually define "surgical mask", because there's a bit of variety in there.

There's also some evidence that surgical masks are less effective than they could be because they don't fit all that tightly. Adding a second mask seems like it would make a decent bit of difference in that regard.

 

[Jack Donaghy]

It would be very very difficult (I might say impossible) to actually get a decent RCT on this since you'd have to follow people around to make sure they wear/don't their masks with 100% compliance.

But that's really no necessary. We know how respiratory viruses spread (primarily droplet), so if we can show that something reduces droplet spread its not exactly a leap to say that reduces spread of the virus.

My man, you need to be a little more skeptical of everything you read. You are not the least bit concerned to know the P value or research parameters associated with the CDC "study"? I most definitely AM taking crazy pills if this is the level of scrutiny that physicians apply toward treatment or prevention modalities. Just think, all those landmark studies guiding our every decision in regards to HTN, DM, MDD - totally unnecessary. Someone could have just attached a dummy head and shot some insulin into it and made a guess!

For the scientifically curious: masks have no evidence behind their effectiveness.

Nonpharmaceutical Measures for Pandemic Influenza in Nonhealthcare Settings—Personal Protective and Environmental Measures - Volume 26, Number 5—May 2020 - Emerging Infectious Diseases journal - CDC
"Although mechanistic studies support the potential effect of hand hygiene or face masks, evidence from 14 randomized controlled trials of these measures did not support a substantial effect on transmission of laboratory-confirmed influenza."

Effectiveness of Adding a Mask Recommendation to Other Public Health Measures to Prevent SARS-CoV-2 Infection in Danish Mask Wearers: A Randomized Controlled Trial: Annals of Internal Medicine: Vol 0, No 0 (acpjournals.org)
"Although the difference observed was not statistically significant, the 95% CIs are compatible with a 46% reduction to a 23% increase in infection."
-----> if you need someone to explain to you the significance of the bolded statement, I would be happy to.

"Infection with SARS-CoV-2 occurred in 42 participants recommended masks (1.8%) and 53 control participants (2.1%)"
-----> difference of ZERO POINT THREE PERCENT

For a succinctly posited conclusion, the following is an interesting read:
The Strangely Unscientific Masking of America – AIER

 

[VA Hopeful Dr]

My man, you need to be a little more skeptical of everything you read. You are not the least bit concerned to know the P value or research parameters associated with the CDC "study"? I most definitely AM taking crazy pills if this is the level of scrutiny that physicians apply toward treatment or prevention modalities. Just think, all those landmark studies guiding our every decision in regards to HTN, DM, MDD - totally unnecessary. Someone could have just attached a dummy head and shot some insulin into it and made a guess!

For the scientifically curious: masks have no evidence behind their effectiveness.

Nonpharmaceutical Measures for Pandemic Influenza in Nonhealthcare Settings—Personal Protective and Environmental Measures - Volume 26, Number 5—May 2020 - Emerging Infectious Diseases journal - CDC
"Although mechanistic studies support the potential effect of hand hygiene or face masks, evidence from 14 randomized controlled trials of these measures did not support a substantial effect on transmission of laboratory-confirmed influenza."

Effectiveness of Adding a Mask Recommendation to Other Public Health Measures to Prevent SARS-CoV-2 Infection in Danish Mask Wearers: A Randomized Controlled Trial: Annals of Internal Medicine: Vol 0, No 0 (acpjournals.org)
"Although the difference observed was not statistically significant, the 95% CIs are compatible with a 46% reduction to a 23% increase in infection."
-----> if you need someone to explain to you the significance of the bolded statement, I would be happy to.

"Infection with SARS-CoV-2 occurred in 42 participants recommended masks (1.8%) and 53 control participants (2.1%)"
-----> difference of ZERO POINT THREE PERCENT

For a succinctly posited conclusion, the following is an interesting read:
The Strangely Unscientific Masking of America – AIER

How did they control for mask compliance?

 

[RustedFox]

My man, you need to be a little more skeptical of everything you read. You are not the least bit concerned to know the P value or research parameters associated with the CDC "study"? I most definitely AM taking crazy pills if this is the level of scrutiny that physicians apply toward treatment or prevention modalities. Just think, all those landmark studies guiding our every decision in regards to HTN, DM, MDD - totally unnecessary. Someone could have just attached a dummy head and shot some insulin into it and made a guess!

For the scientifically curious: masks have no evidence behind their effectiveness.

Nonpharmaceutical Measures for Pandemic Influenza in Nonhealthcare Settings—Personal Protective and Environmental Measures - Volume 26, Number 5—May 2020 - Emerging Infectious Diseases journal - CDC
"Although mechanistic studies support the potential effect of hand hygiene or face masks, evidence from 14 randomized controlled trials of these measures did not support a substantial effect on transmission of laboratory-confirmed influenza."

Effectiveness of Adding a Mask Recommendation to Other Public Health Measures to Prevent SARS-CoV-2 Infection in Danish Mask Wearers: A Randomized Controlled Trial: Annals of Internal Medicine: Vol 0, No 0 (acpjournals.org)
"Although the difference observed was not statistically significant, the 95% CIs are compatible with a 46% reduction to a 23% increase in infection."
-----> if you need someone to explain to you the significance of the bolded statement, I would be happy to.

"Infection with SARS-CoV-2 occurred in 42 participants recommended masks (1.8%) and 53 control participants (2.1%)"
-----> difference of ZERO POINT THREE PERCENT

For a succinctly posited conclusion, the following is an interesting read:
The Strangely Unscientific Masking of America – AIER

Amigo, amigo, amigo.
Calmate.

 

[GassYous]

My man, you need to be a little more skeptical of everything you read. You are not the least bit concerned to know the P value or research parameters associated with the CDC "study"? I most definitely AM taking crazy pills if this is the level of scrutiny that physicians apply toward treatment or prevention modalities. Just think, all those landmark studies guiding our every decision in regards to HTN, DM, MDD - totally unnecessary. Someone could have just attached a dummy head and shot some insulin into it and made a guess!

For the scientifically curious: masks have no evidence behind their effectiveness.

Nonpharmaceutical Measures for Pandemic Influenza in Nonhealthcare Settings—Personal Protective and Environmental Measures - Volume 26, Number 5—May 2020 - Emerging Infectious Diseases journal - CDC
"Although mechanistic studies support the potential effect of hand hygiene or face masks, evidence from 14 randomized controlled trials of these measures did not support a substantial effect on transmission of laboratory-confirmed influenza."

Effectiveness of Adding a Mask Recommendation to Other Public Health Measures to Prevent SARS-CoV-2 Infection in Danish Mask Wearers: A Randomized Controlled Trial: Annals of Internal Medicine: Vol 0, No 0 (acpjournals.org)
"Although the difference observed was not statistically significant, the 95% CIs are compatible with a 46% reduction to a 23% increase in infection."
-----> if you need someone to explain to you the significance of the bolded statement, I would be happy to.

"Infection with SARS-CoV-2 occurred in 42 participants recommended masks (1.8%) and 53 control participants (2.1%)"
-----> difference of ZERO POINT THREE PERCENT

For a succinctly posited conclusion, the following is an interesting read:
The Strangely Unscientific Masking of America – AIER

It's pretty funny how quickly you went from "there's no research and there will never be!" to "hey that study is bad so it doesn't count!"

 

[Jack Donaghy]

It's pretty funny how quickly you went from "there's no research and there will never be!" to "hey that study is bad so it doesn't count!"

How long has it been since you've taken any of the step exams? Bad studies don't count. True story.

 

[turkeyjerky]

The CDC study used a simulated cough model. So I'm not sure it should be (although I'm sure it can and will be) extrapolated to asymptomatic people. Personally, I think the potential backlash is likely worse than the potential benefit.

 

[turkeyjerky]

Why double masking could be the new normal

CDC: Wearing a cloth mask over a surgical mask might reduce spread
News article: Shows picture of guy with N95 over cloth mask.

Guys, we've been doing this for a year now. If you feel confident to the point that you're writing news articles or yelling at people on the sidewalk, at least get your facts straight.

 

[WilcoWorld]

How long has it been since you've taken any of the step exams? Bad studies don't count. True story.

It sounds like you're claiming that more clinical experience (e.g.: time since taking the step exams) makes one less able to interpret the medical literature.

 

[RustedFox]

It sounds like you're claiming that more clinical experience (e.g.: time since taking the step exams) makes one less able to interpret the medical literature.

This had me puzzled as well.

Homeboy probably just got a good score on STEP2, so now he's Osler.

I was the same way.
But not for too long.

 

[GeneralVeers]

I love that double-masking is going to be "the new normal". We just need to get rid of the single mask "old new normal" at this point.

 

[Jack Donaghy]

It sounds like you're claiming that more clinical experience (e.g.: time since taking the step exams) makes one less able to interpret the medical literature.

Evidently, yes. You're telling me that attaching masks to a couple of dummy heads and simulating a cough is enough scientific scrutiny to guide the national recommendation (to asymptomatic people, no less) into wearing two masks. You are also telling me that you're not interested in more details of the study design or it's predictive power.

Sounds like you're not very good at interpreting medical literature.

You know a guy named Andrew Wakefield dropped a study into a prestigious, nationally recognized journal stating that the MMR vaccine clearly causes autism. It was a terrible study riddled with statistical errors and outright fraudulent data. And yet, it birthed the anti-vaxxer movement we're all stuck with today.

Calling out bad studies is important, especially when they pertain to public health and personal safety recommendations. If the CDC wants physicians to recommend wearing two masks, it needs to give physicians clinically-evidenced-based reasons to do so.

 

[VA Hopeful Dr]

Evidently, yes. You're telling me that attaching masks to a couple of dummy heads and simulating a cough is enough scientific scrutiny to guide the national recommendation (to asymptomatic people, no less) into wearing two masks. You are also telling me that you're not interested in more details of the study design or it's predictive power.

Sounds like you're not very good at interpreting medical literature.

You know a guy named Andrew Wakefield dropped a study into a prestigious, nationally recognized journal stating that the MMR vaccine clearly causes autism. It was a terrible study riddled with statistical errors and outright fraudulent data. And yet, it birthed the anti-vaxxer movement we're all stuck with today.

Calling out bad studies is important, especially when they pertain to public health and personal safety recommendations. If the CDC wants physicians to recommend wearing two masks, it needs to give physicians clinically-evidenced-based reasons to do so.

Wearing 2 masks =/= refusing childhood vaccines. Everything we do in medicine is based on risk-benefit. The risk of double masking is very very low, so you don't need a huge benefit to make the risk-benefit calculation favor benefit.

I'm somewhat ashamed I had to even type that out.

 

[Jack Donaghy]

Wearing 2 masks =/= refusing childhood vaccines. Everything we do in medicine is based on risk-benefit. The risk of double masking is very very low, so you don't need a huge benefit to make the risk-benefit calculation favor benefit.

I'm somewhat ashamed I had to even type that out.

My point was not related to equating their risks. My point was in response to this statement:

It's pretty funny how quickly you went from "there's no research and there will never be!" to "hey that study is bad so it doesn't count!"

My point is: yes that study doesn't count. Because it sucks. Just like Andrew Wakefield's study also doesn't count. Because it also sucks.

I'm not ashamed to have to type this out, but I do worry a bit about patients that have to deal with physicians who have such a low standard for and / or understanding of scientific scrutiny.

 

[GassYous]

My point was not related to equating their risks. My point was in response to this statement:

My point is: yes that study doesn't count. Because it sucks. Just like Andrew Wakefield's study also doesn't count. Because it also sucks.

I'm not ashamed to have to type this out, but I do worry a bit about patients that have to deal with physicians who have such a low standard for and / or understanding of scientific scrutiny.

Burnett's law, never fails.

 

[WilcoWorld]

Evidently, yes. You're telling me that attaching masks to a couple of dummy heads and simulating a cough is enough scientific scrutiny to guide the national recommendation (to asymptomatic people, no less) into wearing two masks. You are also telling me that you're not interested in more details of the study design or it's predictive power.

Sounds like you're not very good at interpreting medical literature.

You know a guy named Andrew Wakefield dropped a study into a prestigious, nationally recognized journal stating that the MMR vaccine clearly causes autism. It was a terrible study riddled with statistical errors and outright fraudulent data. And yet, it birthed the anti-vaxxer movement we're all stuck with today.

Calling out bad studies is important, especially when they pertain to public health and personal safety recommendations. If the CDC wants physicians to recommend wearing two masks, it needs to give physicians clinically-evidenced-based reasons to do so.

Slow down pal. I never asserted any of the claims you've ascribed to me here. And if I'm as bad at interpreting medical literature as you say, someone should let the journal that I'm on the review board for know, but please don't tell the provost at my brand name university until he's rubber stamped my promotion to full professor that the promotions committee approved last month.

 

[Jack Donaghy]

Slow down pal. I never asserted any of the claims you've ascribed to me here. And if I'm as bad at interpreting medical literature as you say, someone should let the journal that I'm on the review board for know, but please don't tell the provost at my brand name university until he's rubber stamped my promotion to full professor that the promotions committee approved last month.

How to dismiss someone with a different opinion from way up in an ivory tower:

 

[VA Hopeful Dr]

My point was not related to equating their risks. My point was in response to this statement:

My point is: yes that study doesn't count. Because it sucks. Just like Andrew Wakefield's study also doesn't count. Because it also sucks.

I'm not ashamed to have to type this out, but I do worry a bit about patients that have to deal with physicians who have such a low standard for and / or understanding of scientific scrutiny.

The study showed exactly what it said it did: 2 masks will stop more droplets than 1. Are these droplet dummies (for lack of a better word) identical to humans when it comes to producing respiratory droplets? Probably not. Is it almost certainly close enough to say that 2 masks will work better on humans at producing droplets? Of course it is. You could certainly make the argument that this one study looking purely at the mechanics of droplets isn't enough to justify requiring double masks, but that goes back to my risk-benefit post above.

Wakefield's study was garbage because he literally made up data. I could be mistaken here, but I don't think the mask study did that.

 

[WilcoWorld]

How to dismiss someone with a different opinion from way up in an ivory tower:

Nope, that's not what I did. I did not dismiss you. I have tried to engage you. But no worries, I'll stop now.

 

[GassYous]

How to dismiss someone with a different opinion from way up in an ivory tower:

lmao right after you tried to call out attendings for supposedly not knowing how to read medical literature? Can't have it both ways, friend. Anyone who whines about not having some double blinded randomized control study for everything is just stupid. There's no rct for looking both ways before crossing the street but I still do it. Imagine that.

 

[turkeyjerky]

Lol at the thought that medical students are experts at EBM. I can guarantee I had better usmle scores than Alec Baldwin up there, and I knew jacks hit about evaluating study quality until at least halfway through residency.

 

[deleted547339]

How to dismiss someone with a different opinion from way up in an ivory tower:

Dude. Residency is going to eat you alive.