Face Masks

[theprestige]

Sorry but that's utter nonsense. No they haven't. The ignoramuses didn't even get basic physics right and based much of their infection control on one 100 yr old paper that didn't even really say what they thought. Aerosol scientists started listening to the WHO and other medicial professionals at the start of the pandemic and where aghast at the stuff that they were saying that was just plain wrong. Stuff that is *physics*, not medicine. Experts in the behaviour of small particles in the air (like viruses!) tried correcting them in various forums and in one WHO meeting literally got shouted down by medical doctors with zero training in actually relevant field. The arrogance of the medicial profession is legendary. Society treats them like Gods and it shows.

5 years in as a field they are STILL not accepting what the experts have told them. Wrong 100 years ago, still wrong.

Wrong how? It's obvious that the vast majority of medical professionals don't consider masking up as a default posture to be worth the trouble. They may not know the physics, but they know about their own sick rates.

 

[Puppycow]

Yup, remember the way that flu hospitalisations and deaths reduced when people were masking up.

Definitely, although all sorts of other policies were being taken at the same time, like no large public indoor gatherings, social distancing, having people work from home, etc. Sporting events, concerts, and other public gatherings were canceled. But there were a couple of years there where there was essentially no flu season.

 

[Planigale]

The World Health Network, if which I am a part. I may have even signed this letter, I know I was asked ... think I might have missed it with all the other goings on in my ife


Nonsense, the evidence of the efficacy of N95/FFP2 masks is overwhelming. It's physics. They are certfied to work. All the so-called evidence they don't work or there is no evidence are pretty much all "discovering" one thing - They don't work when you're not wearing them!

I recall one study in Canadian healthcare that found "no evidence". I calculated, using their own data, that even if every single potental transmission had been blocked while using a mask - the study would have found "no evidence". The methodology was incapable of finding any evidence.


They're still incredibly cost effective in healthcare. Nosocomial infections cost the US alone some $40 billion a year in direct medical costs and another $100 billion in other costs (lost work time, death etc). One study found -

The usage of FFP2 masks reduced the incidence of viral respiratory infections from 22,1% to 2,1% (p < 0.005).​

That said, I'm convinced that if we focused on HEPA and Far-UVC in Schools, healthcare, and workplaces we would quite quickly eliminate a whole range of airborne pathogens. Could you imagine never even getting a cold again?

The issue for health care policy is different from the physics of aerosols. I don't dispute that FFP2 masks are better in laboratory tests when properly used. But how much? How many lives saved per $? Is this the best investment in a LME hospital? Realistically how well in real life will they be used, to work they have to be fit tested different masks for different faces, What do you do about beards? Will people wear them in a hot & humid environment? What do you do about patients who lip read? The theory is fine but moving in to real life practice is a different issue. What about recycling or disposal? I spend a good deal of time telling people off for wearing even 'surgical' masks under their nose. Will people really wear FFP2 masks tight to their face?

 

[Darat]

If medical professionals were not washing their hands as frequently as they are supposed to would you also assume that this reflects an optimal risk-reward calculation?

Because my understanding is that there have been numerous criticisms about medical professionals failing to do so. In this case the risks are likely to be to the patients as well as to the medical professionals, and of course the same goes for masks. I don’t think it is good to simply assume that the best standards are always being consistently applied by people in that industry.

We had* an issue in the UK when it was found that doctors and nurses were not following sensible hygiene procedures in washing hands between examining patients. As part of policy to improve compliance NHS England instituted a "bare below the elbows" for staff that were examining and treating patients. The idea was to make it easier for medical staff to wash their hands, no need to keep rolling up sleeves, cuffs getting wet and cuffs etc. increasing likelihood of transmission of pathogens between patients. There was considerable pushback against this, mainly I believe from the doctors. You would have thought something as simple and as bleeding obvious as "wash your hands between patients" would be ingrained in medical professionals but obviously not. (Some of this has been superceded as I do notice that a lot more medical staff will put on gloves before examining patients.)

*My personal experience is that there is still an issue.

 

[jimbob]

We had* an issue in the UK when it was found that doctors and nurses were not following sensible hygiene procedures in washing hands between examining patients. As part of policy to improve compliance NHS England instituted a "bare below the elbows" for staff that were examining and treating patients. The idea was to make it easier for medical staff to wash their hands, no need to keep rolling up sleeves, cuffs getting wet and cuffs etc. increasing likelihood of transmission of pathogens between patients. There was considerable pushback against this, mainly I believe from the doctors. You would have thought something as simple and as bleeding obvious as "wash your hands between patients" would be ingrained in medical professionals but obviously not. (Some of this has been superceded as I do notice that a lot more medical staff will put on gloves before examining patients.)

*My personal experience is that there is still an issue.

See also the old joke about the difference between Pontius Pilate and a surgeon.

Pilate washed his hands

 

[icerat]

The issue for health care policy is different from the physics of aerosols. I don't dispute that FFP2 masks are better in laboratory tests when properly used. But how much?

It's literally on the label how much.

How many lives saved per $? Is this the best investment in a LME hospital? Realistically how well in real life will they be used, to work they have to be fit tested different masks for different faces, What do you do about beards? Will people wear them in a hot & humid environment? What do you do about patients who lip read? The theory is fine but moving in to real life practice is a different issue. What about recycling or disposal? I spend a good deal of time telling people off for wearing even 'surgical' masks under their nose. Will people really wear FFP2 masks tight to their face?

You see that text in blue? It's a link. There's a lot more.

I'm old enough to remember all the same type of ◊◊◊◊◊◊◊◊ excuses about seat belts.

Guess what - *even a badly fitted FFP2 mask decreases risk*. At a population level, the amount of transmission you need to block to have R<1 is often less than 50%. R<1 an outbreak dies out. Have outbreaks die out enough, you eliminate the virus (not: not eradication. If you don't know the difference - most people, even medical professionals don't - I can explain it)

 

[alfaniner]

I had a lot of hospital visits and a very few social events during COVID. The hospital required masks and would provide the little cheapy ones if necessary. (Many people actually already had their own at the time.) I always used an N95, but it could never get a comfortable yet tight enough seal for my comfort (especially with the beard), so I took to wearing a scarf over it. It worked great, and had the added benefit of keeping it from fogging up my glasses.
A few times I got admonished by nurses for wearing a scarf instead of a mask, then I'd pull down the outer layer and show them. Fortunately my smug face wasn't showing...
BTW, I never got COVID.

 

[wareyin]

Wrong how? It's obvious that the vast majority of medical professionals don't consider masking up as a default posture to be worth the trouble. They may not know the physics, but they know about their own sick rates.

Expertise doesn't make someone immune to human nature. Plenty of motorcyclists know helmets save lives but choose not to wear them anyway. You see the same thing with tradespeople who skip safety glasses or steel toed boots unless they are being watched.

The fact that a professional chooses comfort over a safety protocol doesn't mean the tool is broken. It just means they are human and prone to the same complacency as anyone else.

 

[8enotto]

Yeah, during the height if of the pandemic it was rather difficult for a social event to be held, if it was it was poorly attended. Speaking for my area of course. Your mileage should vary.

I got along without masks a lot as I worked mostly alone and didn't go shopping until utterly required. Few did on my job as we worked in separate areas a lot.
I didn't enter any medical facilities that I can recall during that time either. That was by choice.
I wore them when I had too. It sucked but social norms and all that.

Not sure if it was the masks, home schooling, social avoidance or pandemic mandates that had the greatest effects. The results were cases declined and everyone chose thier favorite reason why.

Most people here had home made cloth masks, the kind that were purported to be worse than not masking on this forum. And yet after the initial months numbers went way down. I doubt few washed them as often as recommended. I had one hanging on my handlebar for a solid year for easy access, I am sure it wasn't passing scrutiny. But it was there when I needed one.
No one died around me. Not one in my extended family or friend circles.

In my city there is a rather neglected HIV epidemic ongoing for two decades. The state hospitals do minimal care as required. A lot of the early on deaths were those who frequented bars with more skilled "waitresses" and the strip clubs. Our dirty little secret here. Not just the old and sick.
My long ago boss lost a few of his friends, guess where they went to party.

Human nature had many in denial that thier social habits of heavy drinking would make them more exposed.
I worked in a recycling center that processed beverage containers by the ton. I most certainly was exposed, to every strain. Thus avoiding extra social contacts made sense for me.
It's endemic now. Welcome to the future.

 

[theprestige]

Maybe I'm misunderstanding the nature of the concern.

Prior to the Covid outbreak, there was no clamor from policymakers, hospital administrators, associations of medical professionals, etc. to make masks a mandatory part of the hospital or clinic uniform.

I'm sure there were some people arguing for such a policy, but they don't seem to have been very effective.

During an epidemic, it makes sense to mask up, and the medical profession was at the forefront of this practice. But once the risk diminished, they returned to the status quo ante. Both of these decisions seem reasonable to me.

The rebuttal seems to be, "before the pandemic, medical professionals as a class were too stupid and lazy to understand the risks of their profession, and after the pandemic they were too stupid and lazy to learn the lesson of Always Be Masking." I don't buy it.

 

[wareyin]

Maybe I'm misunderstanding the nature of the concern.

Prior to the Covid outbreak, there was no clamor from policymakers, hospital administrators, associations of medical professionals, etc. to make masks a mandatory part of the hospital or clinic uniform.

I'm sure there were some people arguing for such a policy, but they don't seem to have been very effective.

During an epidemic, it makes sense to mask up, and the medical profession was at the forefront of this practice. But once the risk diminished, they returned to the status quo ante. Both of these decisions seem reasonable to me.

The rebuttal seems to be, "before the pandemic, medical professionals as a class were too stupid and lazy to understand the risks of their profession, and after the pandemic they were too stupid and lazy to learn the lesson of Always Be Masking." I don't buy it.

If you think 'they're too stupid and lazy' is the rebuttal, then you are clearly misunderstanding.

 

[ahhell]

I think the average person is just doing a risk reward calculation. Wear a mask and there is a 100% chance of discomfort and inconvenience. Don't where it and there are a lower chance of mild illness and an even lower chance of severe illness. Now, I'm not saying folks are explicitly doing that calculation but more of a subconscious thing. Also, they look around and nobody else is so they don't. Again, I don't think most of are actually thinking about it that much. I'm also not saying folks are determining risk correctly, we probably aren't.

 

[wareyin]

I think the average person is just doing a risk reward calculation. Wear a mask and there is a 100% chance of discomfort and inconvenience. Don't where it and there are a lower chance of mild illness and an even lower chance of severe illness. Now, I'm not saying folks are explicitly doing that calculation but more of a subconscious thing. Also, they look around and nobody else is so they don't. Again, I don't think most of are actually thinking about it that much. I'm also not saying folks are determining risk correctly, we probably aren't.

Agreed, which is why I pointed out the similarities with safety gear for tradespeople or helmets for motorcyclists. People downplay the actual risks all the time in favor of comfort or habit.

 

[theprestige]

If you think 'they're too stupid and lazy' is the rebuttal, then you are clearly misunderstanding.

Yep! I acknowledged that possibility.

So what am I misunderstanding? I pointed out that masking in hospitals was not a default practice in the medical community, and that this has been the case in that profession for some time. The responses I got were all arguments that some medical professionals are too stupid or lazy to know better/do better. Since I'm talking about the generally accepted practices of the profession as a whole, these rebuttals don't make sense unless they're applied to the profession as a whole.

So. What's the nature of the concern? Is it, "I can't trust/respect/be treated by a doctor who doesn't see the wisdom of masking up all the time"? If so, where does that concern come from. It wasn't a concern for you before the pandemic. Why is it a concern for you after the pandemic? What do you now know, that your GP doesn't? Why are you able to make an informed decision, but your GP isn't?

 

[theprestige]

Agreed, which is why I pointed out the similarities with safety gear for tradespeople or helmets for motorcyclists. People downplay the actual risks all the time in favor of comfort or habit.

The difference is that most trades agree that safety gear is a must, and that those who don't wear it are deviating from the profession's stated best practices. That doesn't seem to be the case for masks in hospitals.

 

[wareyin]

Yep! I acknowledged that possibility.

So what am I misunderstanding? I pointed out that masking in hospitals was not a default practice in the medical community, and that this has been the case in that profession for some time. The responses I got were all arguments that some medical professionals are too stupid or lazy to know better/do better. Since I'm talking about the generally accepted practices of the profession as a whole, these rebuttals don't make sense unless they're applied to the profession as a whole.

So. What's the nature of the concern? Is it, "I can't trust/respect/be treated by a doctor who doesn't see the wisdom of masking up all the time"? If so, where does that concern come from. It wasn't a concern for you before the pandemic. Why is it a concern for you after the pandemic? What do you now know, that your GP doesn't? Why are you able to make an informed decision, but your GP isn't?

Are you under the impression that everyone coldly and logically sits down and performs a valid risk analysis on every aspect of their profession? And that the only reason they wouldn't is because they're stupid and lazy?

That is a false choice. It ignores things like habit, social pressure, and the 'normalization of deviance.' Professionals in every high-stakes field eventually become desensitized to risks they face every day. It’s not a lack of intelligence; it’s just how the human brain handles repetitive environments.

You asked why this is a concern now when it wasn't before the pandemic. The answer is simple: we have more information now. We also have the benefit of seeing that 'generally accepted practices' are often just products of tradition rather than a continuous, active choice based on the latest data. Just because a doctor chooses to return to a 2019 status quo doesn't mean they've 'disproven' the utility of masking. It just means they're subject to the same human desire for normalcy as anyone else.

 

[wareyin]

The difference is that most trades agree that safety gear is a must, and that those who don't wear it are deviating from the profession's stated best practices. That doesn't seem to be the case for masks in hospitals.

You are actually making my point for me. Those trades only agree that safety gear is a must now because those standards were fought for and eventually codified over decades. Before that happened, experienced tradespeople mocked the idea of hard hats and safety glasses just as much as some medical professionals might roll their eyes at masks now.

The idea that the medical profession is a perfect, logical machine that always follows best practices is a fantasy. Handwashing has already been brought up in the thread. It is one of the most basic and proven safety protocol in existence, yet study after study shows that compliance in hospitals is still shockingly low. It is an ongoing struggle to get doctors and nurses to do it consistently.

Are these people too stupid or lazy to know that handwashing saves lives? Of course not. But they are human. They get busy, they get desensitized to the risk, and they fall into habits of convenience.

The fact that a profession settles into a 'generally accepted practice' does not mean that practice is the result of a constant, active choice based on the latest science. More often, it is just a collection of habits and social pressures that have become the path of least resistance. The idea that a doctor returning to the 2019 status quo is making a 'reasoned decision' ignores the fact that, as a class, the profession still hasn't even mastered the 19th-century decision to wash their hands consistently.

 

[theprestige]

Are you under the impression that everyone coldly and logically sits down and performs a valid risk analysis on every aspect of their profession?

No. I'm not even under the impression that every ABM person coldly and logically sits down and performs a valid risk analysis on every aspect of their day to day. If not masking is an unconsidered, knee-jerk preference for a doctor that's been doing that for most of his career and sees no reason to change, then why can't masking also be an unconsidered, knee-jerk preference in a layperson? And why shouldn't I consider the medical professional to likely have a much better idea of the risks and rewards of spending most of their waking life in a hospital, than a layperson?

And that the only reason they wouldn't is because they're stupid and lazy?

No, I'm under the impression that this is the only reason I've been given so far.

That is a false choice. It ignores things like habit, social pressure, and the 'normalization of deviance.' Professionals in every high-stakes field eventually become desensitized to risks they face every day. It’s not a lack of intelligence; it’s just how the human brain handles repetitive environments.

Okay? This doesn't change the fact that the profession, as a professional community, doesn't recommend ABM as best practice. When a surgeon neglects to wash his hands before surgery, we know he's fallen victim to some bad thinking. We know what the policy is supposed to be. We know he needs correction.

That's not the case for masks.

You asked why this is a concern now when it wasn't before the pandemic. The answer is simple: we have more information now. We also have the benefit of seeing that 'generally accepted practices' are often just products of tradition rather than a continuous, active choice based on the latest data. Just because a doctor chooses to return to a 2019 status quo doesn't mean they've 'disproven' the utility of masking. It just means they're subject to the same human desire for normalcy as anyone else.

I don't get this fetish for "latest data". We have a hundred years of data about sickness rates in hospitals. Knowing more about how droplets travel, or whatever, doesn't retroactively make decades of contagion spread data worse than what's actually been measured. Hospital workers in the 80s didn't get the flu, or tuberculosis, or whatever at double the recorded rate, just because we have more data on how those things spread in hospitals.

 

[8enotto]

The difference is that most trades agree that safety gear is a must, and that those who don't wear it are deviating from the profession's stated best practices. That doesn't seem to be the case for masks in hospitals.

IF you are in a place that demands it by policy or law.

Seen YT vids of Asain younger guys cutting huge trees with no ropes, harnesses, PPE or even shoes. Men working barefoot in a sawmill cutting huge slabs off monstrous sized logs. It's normal.

Here wooden ladders made on site and a general lack of PPE is normal. I purchased aluminum ladders after years of using ones I made myself of steel or steel rungs, wood risers. Still trustworthy but.... too heavy or didn't want it out in the rain. One weighs just under 50 kilos.
I couldn't afford aluminum ones for years. Couldn't be without one.
Now I feel better about getting up in trees.

I made my own tree service tools like pulley blocks and pull multipliers. I just went at least double the thickness of commercial units and used automobile parts from the junkyard I worked at. I am relatively assured that they will take more shock load than the fancy ones. Either way we use them carefully.
Nobody sells commercial models here because few would bother to spend on them.

We have helmets for limbing. But I'll be damned if I ever remember to bring them. But we're getting there slowly.

 

[wareyin]

No. I'm not even under the impression that every ABM person coldly and logically sits down and performs a valid risk analysis on every aspect of their day to day. If not masking is an unconsidered, knee-jerk preference for a doctor that's been doing that for most of his career and sees no reason to change, then why can't masking also be an unconsidered, knee-jerk preference in a layperson? And why shouldn't I consider the medical professional to likely have a much better idea of the risks and rewards of spending most of their waking life in a hospital, than a layperson?


No, I'm under the impression that this is the only reason I've been given so far.


Okay? This doesn't change the fact that the profession, as a professional community, doesn't recommend ABM as best practice. When a surgeon neglects to wash his hands before surgery, we know he's fallen victim to some bad thinking. We know what the policy is supposed to be. We know he needs correction.

That's not the case for masks.


I don't get this fetish for "latest data". We have a hundred years of data about sickness rates in hospitals. Knowing more about how droplets travel, or whatever, doesn't retroactively make decades of contagion spread data worse than what's actually been measured. Hospital workers in the 80s didn't get the flu, or tuberculosis, or whatever at double the recorded rate, just because we have more data on how those things spread in hospitals.

Your argument essentially boils down to: "If wearing masks as a policy were effective, the policy would already exist."

This is circular logic. It assumes that medical policy is a perfect, real-time reflection of scientific data, rather than a slow-moving administrative decision. Policies are lagging indicators. They are the result of years of friction between new evidence and old habits.

You mentioned that we know when a surgeon is wrong for not washing his hands because there is a policy in place. But for decades, there was no such policy. Doctors at the time argued exactly what you are arguing now: that they had been practicing for a long time, the current "best practices" didn't require it, and they didn't see the need to change. The lack of a policy didn't mean handwashing was ineffective. It just meant the profession hadn't caught up to the reality of the data yet.

As for your point about the 80s, the idea that hospital workers didn't get sick at "double the recorded rate" assumes the records were perfect. We have known for a century that hospitals are primary sites for contagion spread. We simply accepted those infection rates as an unavoidable cost of doing business.

The fact that we now have a better understanding of how respiratory particles move doesn't mean we are "fetishizing" new data. It means we now have a more clear explanation for the infections that have been happening in hospitals for decades. Using the absence of a mandate to prove the tool is unnecessary is like saying seatbelts were unnecessary in 1960 because the "professional community" hadn't made them mandatory yet.