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Evidence is growing, but what do we need to prove that masks slow the spread of COVID-19?

 


To unequivocally answer the question of whether face masks protect against the new coronavirus, you need to do the following:

• Recruit thousands of volunteers.

• Randomly divide them into two groups.

• Assign a group who wears a mask outside the house and a group who does not wear a mask at all times.

• Wait a few months to see who is infected. It then organizes all possible confounding variables such as compliance, mask fit, and social distance.

Not only is such research difficult to succeed, it is unethical, especially in the midst of a pandemic. Nor is it possible to determine community level effectiveness. That is, how well a mask works not only to protect individuals but also to reduce the spread of disease throughout the population. This requires multiple groups spanning multiple cities, but this does not happen.

As such, authorities considering mask delegation and citizens considering how and when to mask should act on incomplete evidence. But as the sheer volume and diversity of research increase, so does the path. Some are still in the preliminary stages and none meet the so-called gold standard for large randomized controlled trials. But collectively, they are building a compelling case of universal masking as a low-tech way to control the spread of the virus, perhaps avoiding the need for more painful restrictions.

A new study comes from a mask lab test. Let’s take a closer look at the observation report and the data where the masks were and were not adopted. There are compelling case studies including Beauty salon Missouri appears to have prevented the masking of two unconsciously infected hairdressers and dozens of customers. next, Summer camp In Georgia, more than 250 people became infected as children sang, cheered, and didn’t wear masks.

Modelers such as the University of Washington use existing data to estimate how much life most people will save if they wear a mask.

Dr. Jared Baeten, Vice Dean of the School of Public Health at the University of Washington, said: Baeten First asked Some maintain a low supply of health care workers, some have a lower prevalence of the disease, and some, like many other epidemiologists, are mainly affected by the virus. Mask values ​​for the general public are always recommended to wear masks, as they mistakenly assumed they were spread.

What changed his mind was that people seemed to be the most contagious before they felt sick and that there was no real awareness among infected people.

“It was a real sea change,” Barten said. If there is no way to know who is infected, it makes sense for everyone to wear a mask to prevent the virus from infecting others.

For the most part, the battle for public acceptance has already been won. More than three quarters of people NPR / Ipsos voting In support of state law released last week that requires public coverage Last vote It received strong support from both Republicans and Democrats. At least 30 states have adopted some type of authority, as do most of the largest cities in the United States and major retailers.

However, there is a continuation of scattered fallout, some of which is rooted in the confronting and pouring message at the beginning of the pandemic. Health authorities, including US surgeons Terrible He bought a face mask early spring and warned that improper use could endanger his health.

When the advice was reversed, anger and suspicion fueled a violent encounter. Recently a man in Pennsylvania Asked to cover his face At the cigar store, he fired a gun at the clerk and then started a shootout with the police. President Trump vowed that there was no national masking requirement, and the Governor of Georgia banned local authority.

Sheriffs are scattered in Washington state— Remember the petition — They said they wouldn’t enforce mask rules. Second-place finisher in last week’s governor primaries set mask requirements infringement freely.

Those who oppose masks claiming they aren’t working do not only quote a May article from the Journal of the American Medical Association, which advocated the use of masks in hospitals, but also added: Wearing a mask at will protect you from infection, even a little.”

The authors, including Dr. Michael Clopas from Harvard Medical College and Brigham and Women’s Hospital, wrote an explanation in June explaining what they refer to transit encounters at low risk of infection. They also acknowledged new insights, including a study from Beijing, that wearing masks was 79% effective in preventing infected presymptomatic people from spreading the virus to their families.

“For me, that was a strength. As our understanding changed, we could constantly adapt,” Klompas said.

Another new piece of evidence came from Krompas’ proprietary hospital system, which adopted universal masking for its staff in April, and the rate of positive tests dropped sharply.

“Masks don’t provide 100% protection, but they can reduce risk,” said a co-author of a recent meta-analysis of 21 studies on Mask, a physician at Amita Health St. Joseph Hospital in Chicago. A series of respiratory viruses, including one study of human influenza, SARS, and the novel coronavirus.

An illustration of previous mask research and its limitations is a 2011 experiment in which 164 pilgrims pilgrims camp in a tent were randomized into a “mask” and a “control” group. The Musk group reported less flu-like symptoms, but there was uneven compliance and laboratory tests did not make a difference in infection rates.

But, overall, Sun and his colleagues have concluded most of the evidence showing that most masks can reduce the risk of infection by about 65%.

The World Health Organization, which did not generally recommend masks until early June, commissioned its own meta-analysis to investigate 172 studies of masks and coronaviruses, including SARS and MERS. At this time, only three COVID-19 analyzes met the strict inclusion criteria.

“I came here without a fixed concept,” said Dr. Derek Chu, lead author of McMaster University in Ontario. “We searched for the most reliable information on the planet.”

Conclusion: “Using a face mask can significantly reduce the risk of infection.” However, Chu issued a warning and the level of certainty was low, largely because none of the studies met the elusive “gold standard.”

Another review, focusing only on the flu and including some of the same studies, was more vague and did not show a clear effect of masks or hand washing, but points out that there is no solid evidence.

Dr. Trish Greenhalgh, a researcher at Oxford University, is one of the loudest groups of scientists in health care, economics, sociology, and data science, promoting health agencies, electing leaders, and high-stakes. Expands the type of evidence to consider when making public health recommendations There are few downsides, like face masks during a pandemic.

Talking about Missouri’s beauty salons wearing masks is often discounted as anecdotes, but “needs a scientific explanation,” Greenhalg said in an email. Another example is a crowded flight from Wuhan to Toronto, where cough passengers did not get infected despite later positive reactions, but the planes were masked.

“The scientific scandal is the rejection of many important case studies by many reputable scientists,” Greenhalgh said.

For her, some of the most compelling evidence in support of face masks came from laboratory tests. The Florida team used a mannequin’s head to simulate coughing and sneezing, illuminating small breathing droplets, where the laser is considered to be the main route of transmission. Without the mask, the droplets moved more than 8 feet. A stitched two-layer cotton mask limited spread to 2.5 inches.

“Stopping bleeding is like a bandage,” says Mr. Greenhorg. Do you need a “random on controlled trial” of “Turn on bandages” vs “Turn off bandages when you find that bleeding has stopped? “

Another laboratory study found that surgical masks significantly reduced the amount of virus exhaled by people infected with the flu and the coronavirus that causes the cold. Yet another team used the bird flu virus as a surrogate for the new coronavirus, showing that even homemade paper and cloth masks can block more than 95% of the penetration of virus-containing aerosols.

CDC Director Robert Redfield provided his own homey analogy in a JAMA editorial last month. He asked how many had opted to undergo surgery by a surgical team who was not wearing a mask.

Like the operating room, the main focus to date has been to protect others by blocking the spray from the infected person’s mouth. However, some researchers are beginning to consider possible benefits to the wearer. Dr. Monica Gandhi, an infectious disease specialist at the University of California, San Francisco, suggests that masks can reduce the number of viral particles that people inhale, leading to a milder infection.

At the population level, the impact is beginning to be highlighted as researchers associate infection and mortality data with mask policies and timing.

Washington’s health authorities have estimated an estimated 95% in Yakima, which has helped to control the growing epidemics earlier this summer, but no causal link can be established. Researchers in Hong Kong and Germany are able to create stronger cases, reporting the reverse link between the use of masks and outbreaks, and a gradual decline in infection rates after masks are needed. did.

A comprehensive statistical analysis of nearly 200 countries still in peer review sought to analyze the effects of masks on other interventions such as lockdowns and school closures. Researchers have found countries that did not have a large outbreak within a few months, while countries that adopted masks early could control the epidemic.

Despite the weaknesses of all these analyzes, Jeremy Howard, a data scientist at the University of California, San Francisco, said recently: “The only direct data we can get about the impact of these population health interventions.” Are offered. To WHO. Frustrated by the lack of masks, Howard and other scientists set up a group called Masks4All to share data, beat skeptics, and push state demands.

Theo Voss, who leads the project, said that the modeler at UW’s Health Index Assessment Laboratory, which independently reviewed existing research, found that masks reduce virus infections by about 40%, and uncertainty ranges from 20% to 54%. It is estimated to be %. If 95% of people in the United States wear face masks, the UW model predicts that around 17,000 deaths can be avoided by 1 December.

Even financial institutions are now asserting Mask. According to a Goldman Sachs analysis, increasing mask use by 15% could potentially save additional home orders that cost $1 trillion in economics. But bankers also say that the United States is unlikely to achieve its goals without national authority.

UW epidemiologist Baeten explains mask confusion

In the United States, he was motivated to participate in the introduction of seat belts. Many claimed that they were dangerous and refused to use them. Now everyone buckles without thinking about it.

“Why do you keep discussing?” asked Baeten. “Why don’t you wear a mask?”

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