Register a SA Forums Account here!
JOINING THE SA FORUMS WILL REMOVE THIS BIG AD, THE ANNOYING UNDERLINED ADS, AND STUPID INTERSTITIAL ADS!!!

You can: log in, read the tech support FAQ, or request your lost password. This dumb message (and those ads) will appear on every screen until you register! Get rid of this crap by registering your own SA Forums Account and joining roughly 150,000 Goons, for the one-time price of $9.95! We charge money because it costs us money per month for bills, and since we don't believe in showing ads to our users, we try to make the money back through forum registrations.
Which horse film is your favorite?
This poll is closed.
Black Beauty 2 1.06%
A Talking Pony!?! 4 2.13%
Mr. Hands 2x Apple Flavor 117 62.23%
War Horse 11 5.85%
Mr. Hands 54 28.72%
Total: 188 votes
[Edit Poll (moderators only)]

 
  • Post
  • Reply
Rosalind
Apr 30, 2013

When we hit our lowest point, we are open to the greatest change.

Thank you for the new thread and for getting rid of that link on the first page to horrifically outdated effort post I wrote in February 2020 with tons of (now known to be) ridiculously bad guidance.

I spoke with a friend at NYC DOHMH this morning. They're cautiously optimistic about the fall, despite schools reopening today. The new NYC mandates seem to be working, according to their metrics, but my friend wouldn't give me details on what that means.

edit: Oh also I know there are more than a few goons participating in the study I'm affiliated with. Thank you for your participation!

Adbot
ADBOT LOVES YOU

Rosalind
Apr 30, 2013

When we hit our lowest point, we are open to the greatest change.

Zarin posted:

The OP mentions "knock-off" N95/KN-95s.

I don't really know what to look for to know if something is genuine or not; how do I know if what I got is genuine or not?

The ones I purchased are brand-named, but I got them off of Amazon, so . . . have I already hosed up there?

For KN95s, there are several mask companies that market themselves as legitimate and reliable. I've had good experiences with https://bonafidemasks.com/ and NYTimes Wirecutter recommends them as well. As far as I can tell, everything they sell is legitimate as they are an American manufacturer with a relationship with a Chinese factory.

Rosalind
Apr 30, 2013

When we hit our lowest point, we are open to the greatest change.

How are u posted:

I suspect that, 5 or 10 years down the line, we will find that 'long covid' ended up being a pretty small and insignificant thing, all in all. This is heartening.

I still remain skeptical of the nebulous combinations of symptoms we're calling long COVID. There are clearly some long-term symptoms in some people with COVID, but when you look at long COVID studies they include every symptom under the sun as long COVID and I've only seen a few stratify by clusters of symptoms. It is likely in my mind that we are conflating a lot of possible things into "long COVID" because we have no agreed upon definition of what long COVID even is.

What I think is happening is that we're conflating several separate (but still important) conditions: 1) physical symptoms induced by COVID that have truly become chronic, 2) pre-existing conditions that were exacerbated by COVID such as diabetes, 3) mental health conditions that were exacerbated or caused by the trauma of having COVID, 4) mental health conditions that were exacerbated or caused by societal changes/stress of the pandemic.

Each of these conditions are valid and important to study and understand, but it is important to disentangle them. We can't conduct a good study of a cause-and-effect relationship if the effects are so poorly defined as the causal mechanisms for each of the possibilities listed above could be quite different. Right now I don't really trust many of the long COVID studies that have come across my desk (including our own study which has a long COVID component! I'm constantly arguing about it with the investigators.)

Rosalind
Apr 30, 2013

When we hit our lowest point, we are open to the greatest change.

bane mask golem posted:

Yeah, agreed. This whole last year's been pretty confusing, and the reactions of agencies like the FDA (ie. not even discussing boosters this week) have only added to the fear and confusion. To be honest, it's pretty worrying that the CDC still has mixed messaging about N95 masks on its website. I can't imagine how many deaths have already been caused by trusted medical agencies telling people to wear a cloth mask or surgical mask, or telling vaccinated people not to wear masks, or telling people they don't need a booster shot.

Hmmm, I don't know, that seems like a very high-risk low-reward bet.
If HIV was discovered just a few months ago, we might think the long-term effects were limited to just mild immune suppression.
If Creutzfeldt-Jakob Disease was discovered just a few months ago, we might think the long-term effects were limited to mild confusion and mild brain damage. (which is a particularly worrying comparison, since COVID also causes brain damage)
If chicken pox was discovered just a few months ago, there's no way we'd be able to predict shingles as a long-term side effect.

The scary answer is that we have no idea how COVID affects people even 5 years after infection, much less 50. The best way we can protect ourselves (and our kids) from long-term side effects is using P100 masks and booster shots to make sure we never give it a chance to infect us.

They are literally discussing boosters at the very moment you posted this. You can watch it live: https://www.youtube.com/watch?v=bQevYc2jX7Y

The CDC is a hollow shell of what it once was thanks in part to the Trump admin. I know a lot of people who graduated from my program who would have gone on to apply to the CDC saying "absolutely not" after seeing all the bullshit of the federal government in recent years. Many of them went to local public health, academia, or pharma instead. Who wants to be a scientist for the government when the president is manipulating your work with a sharpie for national television? Who wants to work for the CDC when the president is suggesting people drink bleach? Etc.

HIV maintains a persistent viral load after infection without treatment. COVID viral load is typically undetectable after 2 weeks of infection.
CJD is caused by prions not a virus so the mechanism is very different.
Varicella Zoster is more interesting in that it does indeed lay dormant and then possibly cause shingles. However, I don't think we've ever previously observed a coronavirus capable of being dormant in a way similar to Varicella Zoster. They are structurally very different.

I'm not a virologist or immunologist but I am skeptical about the possibility of some sort of long term surprise covid 2: covid with a vengeance years down the line.

Rosalind
Apr 30, 2013

When we hit our lowest point, we are open to the greatest change.

bane mask golem posted:

Oh neat, maybe we're not as gently caressed as I'd feared. That's a relief, I just hope boosters get rolled out soon since they really seem to help.

Yeah sorry, I didn't mean that COVID would use the exact same mechanism of action of those examples. I just meant that we should plan for the worst and hope for the best. We shouldn't assume COVID doesn't cause long-term damage, just because we don't have long-term data yet. Maybe I'm just a nervous nellie, but I'd lean in the opposite direction- that we should be cautious and not assume we fully understand it because we've got data for how it's acted in humans for 21ish months. I don't want to find out it lingers in brains and causes antivaxx lunatics to get even more crazy over time.

I don't know, I read an NPR article about that a couple of weeks back, and it talked about them finding COVID in peoples' bodies months after infection? That seems a little concerning.

There is evidence of persistence for many common viruses:

Influenza https://pubmed.ncbi.nlm.nih.gov/20587197/
Rhinovirus https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5289482/
Measles virus https://pubmed.ncbi.nlm.nih.gov/7737565/

There's quite a bit of difference between small amounts of a virus persisting in the body and them causing long-term negative health outcomes. A lot has to happen. Varicella Zoster, for instance, resembles viruses that cause chronic infections (such as HSV) which is evidence to how it can linger then cause shingles. Coronaviruses do not resemble these viruses.

I agree that caution is warranted, but there's a difference between caution and fear. I don't think there's enough (or any) evidence right now that people should be afraid of some sort of long-term surprising outcome down the line. While this coronavirus is novel, we have seen many coronaviruses in the past and as far as I'm aware there haven't been any surprise long-term outcomes documented.

Rosalind
Apr 30, 2013

When we hit our lowest point, we are open to the greatest change.

mod sassinator posted:

Yes, why should the FDA amplify antivaxxers under any circumstances?

Public comment could have been done at a different time and not impacted anything. Or they could have chosen to only take written comments.

Then they just say "Look the FDA censored us from presenting the truth!"

The solution here is kicking people who deliberately spread misinformation off these platforms, not attacking a government agency for their public comment policy. Could the FDA splash a "PUBLIC COMMENT DOES NOT REPRESENT FDA VIEWS" box on there in bright red letters? Probably, but anti-vaxxers are going to spread misinformation using their platforms regardless.

Rosalind
Apr 30, 2013

When we hit our lowest point, we are open to the greatest change.

mod sassinator posted:

It cannot be emphasized enough how much the FDA has failed the American people. Israel's warning is DIRE and that severe illness and death is coming for vaccinated people in a few months

Folks, use this knowledge however you please. Remember every single pharmacy in this country is currently handing out vaccine boosters to immoncompromised people. It might be time to discuss with your doctor concerns you have about being immunocompromised in the face of waning immunity and the delta variant.

This is ridiculous fearmongering as well as advocating for people to essentially try to manipulate doctors into giving them a booster and you should be ashamed of posting it.

Rosalind
Apr 30, 2013

When we hit our lowest point, we are open to the greatest change.

I have to say that this thread is a bit exhausting. It feels like any rational discourse is drowned out by people with extreme views. I totally get that this is an emotionally charged and scary topic, but it's tough to engage with this thread from a scientific background.

I'm going to step back again. If anyone has any specific and earnest epi questions, please feel free to PM me.

Rosalind
Apr 30, 2013

When we hit our lowest point, we are open to the greatest change.

My school is starting a podcast and the first interview is with one of my mentors Dr. Mary Schooling who 1) has an amazing posh British accent and 2) has VERY strong opinions about bad research. She's talking about assessing health research quality and mostly focused on clinical trials: why we do them, trial registration, and a few alternatives to RCTs. She avoids almost all jargon which is helpful.

It might be a little simplistic for folks in this thread, but I figured it could be good to send to friends/family who want to hear a basic primer on health research from an epidemiologist https://sphlearn.weebly.com/podcast

Rosalind
Apr 30, 2013

When we hit our lowest point, we are open to the greatest change.

Remember that Israeli study saying that the vaccines are less effective at preventing COVID infection compared to unvaccinated people with a previous infection? Well here's a CDC-funded study saying the exact opposite that just came out in this week's MMWR: https://www.cdc.gov/mmwr/volumes/70/wr/mm7044e1.htm

quote:

Among COVID-19–like illness hospitalizations in persons whose previous infection or vaccination occurred 90–179 days earlier, the odds of laboratory-confirmed COVID-19 were higher among previously infected, unvaccinated patients than among fully vaccinated patients (aOR = 5.49; 95% CI = 2.75–10.99)

Though this study included people from January 2021 onward, they did a secondary analysis examining just patients during Delta and had a similar finding. The sample size for that analysis was comparatively small, however.

I will note that this study is still subject to many of the same biases that affect observational studies: namely confounding and selection bias. In particular, I'd be worried about confounding by who chooses to receive the vaccine which may have a very different set of confounders in the US vs. Israel.

The authors do propose two possible explanations: (1) that the Israeli study was looking at positive tests in the general population, not lab-confirmed COVID in hospital settings and (2) that the Israeli study only included those 6+ months after vaccination. This could suggest that previous infection protects better against mild infection, but vaccination protects better against hospitalization.

Rosalind
Apr 30, 2013

When we hit our lowest point, we are open to the greatest change.

dwarf74 posted:

Yeah there's been a substantial debate about this in medical ethics for decades. Placebo groups are great to prove efficacy, but you may be able to prove it without actually giving people sugar pills just by looking at individuals outside the study. At least the control group got standard care....

No I'm sorry but that's bullshit. Causal inference is nearly impossible without RCTs. Hell it's even difficult with RCTs. Randomization is essential for preventing any possibility of unmeasured confounding. External control groups open you up to the same sorts of biases that can affect any observational study.

Doing observational research in place of RCTs is how you end up with drugs that don't work or even harm people.

Henrik Zetterberg posted:

I don't know the details of these studies and how they're conducted, but am I reading this correct that 7 people contracted COVID, Pfizer gave them a sugar pill vs the pill that could have possibly saved their life, and they died instead?

Like, I get you need a placebo group, but man that's brutal to read if I have the correct take on it.

The results of that are great though. How many right-wingers who get COVID are going to refuse to take this Pfizermectin because politics?

The grim truth is that we have to see if the medication works or not. The gold standard for doing so is an RCT. Patients in the control group are given the standard of care. Patients in the experimental group are given an experimental treatment that could very well harm them more than it helps them. Though generally at this stage of the research process we believe the treatment to be safe, there are many studies that have been ended early because it turned out to be worthless as a treatment or even worse harmful.

This is how the testing of new treatments is done. There are proposals and ideas on how to speed up the process slightly, but those are usually operating within regulatory frameworks. We do not have a better way scientifically to determine if a drug works or not.

Rosalind
Apr 30, 2013

When we hit our lowest point, we are open to the greatest change.

CeeJee posted:

And yet it's still not possible to do a test with exposing volunteers (who are from an age/health group least likely to get very ill) to infected people at different ranges and with types of masks in controlled settings to get some good information on actual infections. Every paper is still using models or data from the wildly uncontrolled infections in the wild.

Because a challenge trial is different from an RCT. No one in a drug RCT is deliberately given a disease; they are given an experimental treatment that the best available evidence (typically from animal and extremely small safety studies) says is safe and effective.

Deliberately exposing people to diseases is incredibly fraught ethically. Like one of the major fundamentals of modern bioethics that emerged after World War 2 is that we don't do that.

Rosalind
Apr 30, 2013

When we hit our lowest point, we are open to the greatest change.

If you believe it is ethical to do challenge trials of COVID because getting COVID is almost surely inevitable, do you believe it is ethical to do challenge trials of HIV because in certain risk groups in certain regions getting HIV is almost surely inevitable? Surely if we limit it to those groups, then by the "it's inevitable anyway" logic, it's ethical to do challenge trials on them.

Rosalind
Apr 30, 2013

When we hit our lowest point, we are open to the greatest change.

Platystemon posted:

What would you gain from challenging them if it is inevitable that they will encounter HIV anyway?

The point of the person who started this challenge trial debate was that they wanted to see more data on how COVID spreads so the same thing for HIV: there's still plenty to learn about how HIV spreads and why some people get it and others don't. Challenge trials would help with that.

But for some reason I'm guessing the people calling for COVID challenge trials are going to be a bit more squeamish when it comes to HIV challenge trials, despite HIV having like 10 times the death toll of COVID to date and no vaccine.

Rosalind
Apr 30, 2013

When we hit our lowest point, we are open to the greatest change.

VitalSigns posted:

Wait do straight people still think every single gay man has or will definitely get HIV in their lifetime

Nuh uh don't put awful loving words like that in my mouth. I'm a goddamn HIV researcher.

I was thinking specifically of certain groups of truck drivers in Sub-Saharan African that have incredibly and tragically high prevalences of HIV as well as certain groups of IV meth users in the US where many of them seroconvert due to sharing needles.

I was also being obviously and clearly sarcastic, let me spell that out for you I guess if you need it. No one in their right mind would say challenge trials of HIV are ethical. And that's the whole point. Despite HIV killing many more than COVID and being very infectious in its own right, there's absolutely no way that a challenge trial of HIV could be remotely conceived as ethical unless your views of bioethics are incredibly fringe.

Rosalind fucked around with this message at 03:46 on Nov 8, 2021

Rosalind
Apr 30, 2013

When we hit our lowest point, we are open to the greatest change.

Insanite posted:

I am dumb.

Is a 526-kid trial typical, or on the small side?

It's on the smaller side. Pfizer's under 11 phase 2/3 study is 2,268 participants (https://www.pfizer.com/news/press-release/press-release-detail/pfizer-and-biontech-announce-positive-topline-results), for instance. Moderna's is targeted at 13,275 but still recruiting it seems (https://clinicaltrials.gov/ct2/show/NCT04796896)

Rosalind
Apr 30, 2013

When we hit our lowest point, we are open to the greatest change.

poll plane variant posted:

What country are you in? I know Masklab ships internationally but they are quite expensive

Yeah if you're going to post in this thread, I think you should have to explain why you're an anti-vaxxer if you want anyone to take you seriously.

Rosalind
Apr 30, 2013

When we hit our lowest point, we are open to the greatest change.

GutBomb posted:

Saying “vaccines aren’t perfect and we still need NPIs to beat this” is not an anti-vax position.

Saying you wonder if they even are real and calling them "rushed" certainly is though.

Rosalind
Apr 30, 2013

When we hit our lowest point, we are open to the greatest change.

Platystemon posted:

It seems like a fair use of the English language to describe a feat accomplished in a quarter of the time of the last record holder (the mumps vaccine) as “rushed”.

It may have negative connotations, but it is also literally true.

Can I call the vaccine cheap? Twenty dollars a dose is the deal of the century.

I mean whatever you need to tell yourself to help you feel better about defending this person I guess. Personally, I know that a person wondering if a vaccine is real and then calling it rushed in the same sentence is expressing a position indistinguishable from many anti-vaxxers.

Like if your Aunt Karen was on Facebook saying the vaccine isn't real and they rushed it, would you be defending her? But it's ok now because it's on the Something Awful Forums instead?

Rosalind
Apr 30, 2013

When we hit our lowest point, we are open to the greatest change.

Platystemon posted:

Everyone in this thread has said dumb things at one time or another.

I recall that Rosalind had some exceedingly eyebrow‐raising takes about masks.

PPV has said a lot of stuff that I am honestly surprised he hasn’t been probed for, but saying that the vaccines were rushed isn’t one of them.

One reason for this might be that he hasn’t actually used that word in this thread. 🤔

If you're referring to posts I made in February and early March of 2020, I was echoing guidance from the CDC and many of the epidemiologists I work with. They were wrong about this. I was wrong to echo this. I have subsequently posted in this very thread about where to find good cheap masks, for instance.

I can admit when I was wrong about something, unlike you who seems unable to address the first part of the sentence where PPV said the vaccines aren't real so is instead now lashing out.

poll plane variant posted:

The vaccines' real-world performance and the effectiveness of piecemeal NPIs all seem pretty debatable in the face of Delta just cycling back and forth with waves of pretty much identical size everywhere, whether you're Florida or Singapore. It really seems like the only way to put a dent in this disease is the China/Taiwan/HK approach which obviously won't be repeated elsewhere. Obviously individuals should get vaccinated and wear properly fitting N95 or equivalent masks, but the vaccines really don't seem to be putting a dent in this either.

Maybe we're starting to be able to pick out lower ifr in high vax countries with big waves (Denmark), but even testing is ideologically aligned with vaccines so a high vaccine rate area seems like it will inevitably catch more asymptomatic cases by surveillance testing vs a "covid isn't real" jurisdiction.

The global spread of American ideological polarization is incredibly frustrating when trying to pick anything out of the numbers.

So when you posted that you wonder if the vaccines are real, what did you mean by that?

Rosalind
Apr 30, 2013

When we hit our lowest point, we are open to the greatest change.

I sure hope people who get the vaccine don't start spontaneously developing aquagenic urticaria since water is an ingredient.

Rosalind
Apr 30, 2013

When we hit our lowest point, we are open to the greatest change.

brugroffil posted:

Love 2 test positive 3 days after my booster

Now I don't know if I felt crummy on Wednesday because of the shot or because of an infection.

Sorry to hear that! I hope you feel better soon. Get lots of rest and fluids.

Rosalind
Apr 30, 2013

When we hit our lowest point, we are open to the greatest change.

If anyone wants a truly excellent explainer on COVID transmission to send to friends and family, a Spanish scientific magazine put out this great article: https://elpais.com/especiales/coronavirus-covid-19/a-room-a-bar-and-a-class-how-the-coronavirus-is-spread-through-the-air/

edit: Oh no pet tax--here is Justice doing what he does best (sleeping)

Rosalind
Apr 30, 2013

When we hit our lowest point, we are open to the greatest change.

Interesting open-to-the-public talk on an underdiscussed topic at my school this week:

COVID-19 and Political Economy, Part I: Structural Racism
Wednesday, November 17, 2021
11:30 AM – 12:45 PM EST

A discussion on the COVID-19 pandemic's social, political, and economic context, and what society can do to not repeat the history

Structural racism is embedded within the fabric of American culture, infrastructure investments, and public policy that fundamentally drives inequities. The same racism that has driven the systematic dismantling of the American social safety net has also created the policy recipe for American structural vulnerability to the impacts of this and other pandemics. The Bronx provides an important case study for investigating the historical roots of structural inequities showcased by this pandemic; current lived experiences of Bronx residents are rooted in the racialized dismantling of New York City’s public infrastructure and systematic disinvestment.

In this session, we will review global health crises in the human history must be understood within the broader social, political and economic context, apply such review to the case of the Bronx borough during the height of the COVID-19 pandemic, raise policy, historical, comparative, and normative issues about the impact of and challenges/responses to the current pandemic, and discuss what we as a society can do to not repeat the history.

https://www.eventbrite.com/e/covid-19-and-political-economy-part-i-structural-racism-tickets-190439849717

Rosalind
Apr 30, 2013

When we hit our lowest point, we are open to the greatest change.

no lube so what posted:

What does herd immunity threshold mean?

There is a theoretical threshold, when the population is simplified and treated as homogenous, where enough people have sufficient immunity to COVID through vaccination and previous infection that the disease can't spread and the pandemic ends, even if some people still aren't vaccinated.

Due to Delta, vaccine hesitancy, and waning protection over time, this threshold is probably quite high. It's also an oversimplification of a more complex problem since typically to model this threshold epidemiologists have to make a lot of assumptions and simplifications since we can't model real world conditions with perfect accuracy.

Rosalind
Apr 30, 2013

When we hit our lowest point, we are open to the greatest change.

no lube so what posted:

Has the theory even been observed in the real world with modern air travel?

Is that sort of theoretical model even possible with air travel?

Yes. Though again it's more complicated than what I've explained so far--I'm giving the epi 1 overview here--there are many diseases to which large populations of humans have herd immunity against: measles, mumps, rubella, pertusis, diptheria, and rotavirus come to my mind immediately in the developed world.

And since you appear to be asking this as some sort of bad faith gotcha, I will note that herd immunity does not mean there won't be isolated outbreaks (particularly in unvaccinated communities), but that isolated outbreaks probably won't spread to the wider general population.

Rosalind
Apr 30, 2013

When we hit our lowest point, we are open to the greatest change.

no lube so what posted:

Has that worked with covid? King county? Israel? Iceland?

I am all for eradicating the disease, but has that approach worked with covid?

Just because something hasn't worked yet doesn't mean it's never going to work. We were actually doing quite well until Delta hit--which emerged in the nearly completely unvaccinated population of India. Now we're in a very different situation where the majority of the world population is at least partially vaccinated.

I think there's a fair chance of achieving some degree of herd immunity and arguably some communities already probably have through high vaccination rates. That is absolutely not the same thing as disease eradication, however, which has only been achieved in exceptional circumstances.

Rosalind
Apr 30, 2013

When we hit our lowest point, we are open to the greatest change.

I'm skeptical that we've seen the end of variants--there are other variant lineages that public health agencies are monitoring and the virus seems to be capable of mutating fairly readily.

Also there's a bit of a delay between identification and the variant becoming predominant or even prevalent enough to warrant attention. Delta was first detected in India in October 2020 so that's more than a 6 month lag time between it emerging and it becoming a variant of concern. The Ligma variant that ravages us in Spring 2022 might be spreading right now under our noses!

Rosalind
Apr 30, 2013

When we hit our lowest point, we are open to the greatest change.

I personally find the talk of a COVID zero strategy via extremely strict lockdowns, enforced quarantines, and mandatory test-and-trace in the US exhausting for the reasons described--it just isn't ever going to happen with the current situation of the US politically. Endlessly posting in this thread about how these interventions would solve all our problems, while perhaps true, only serves to derail conversation from more grounded discussions.

At the same time, I think it's right to be critical of the US for lack of a coherent strategy, but blaming that on Biden or the CDC would be a mistake too, when many Republican governors are throwing as many resources as they can into undermining every proposed intervention via the courts and legislation.

The US public health system is also particularly fragmented due to a variation in state-level policies as well as a lack of centralized public health infrastructure. Cities, counties, states, and the federal government all have separate layers of public health agencies, rules, and oversight. The solution here is better cooperation and standardization across these layers, but processes for doing so have been slow even in the face of the pandemic and are even actively stymied by political disagreements. This is to say nothing of our fragmented health care system which makes data collection and reporting its own special nightmare.

All that being said, the questions I have that I am thinking about as an epidemiologist when I think about COVID are:

1. How do we increase vaccination rates?
2. How do we reduce disparities in health outcomes from COVID particularly among historically marginalized populations?
3. Given the political realities in the US, how do we minimize risk of COVID as much as possible?

To me these are interesting and difficult questions that there aren't clear answers for.

Rosalind
Apr 30, 2013

When we hit our lowest point, we are open to the greatest change.

I got my booster today. In contrast to my shots back in April where I had to wait in a line nearly an hour long (and that was with an appointment!), I was in and boosted within 5 minutes.

Rosalind
Apr 30, 2013

When we hit our lowest point, we are open to the greatest change.

Smeef posted:

There was a good RCT on mask use in Bangladesh that suggested something like 33% reduction in Covid if everyone masked up with surgical masks. However like most academic papers a lot of the "so what" of the findings require a close and informed reading. (I saw that 33% implication cited elsewhere, with significant caveats, so don't hold me to it.)

https://www.poverty-action.org/sites/default/files/publications/Mask_Second_Stage_Paper_20211108.pdf.pdf

I've written this up for some friends before but never posted it here, but this isn't really what the study says at all and I wish people would stop mentioning it.

Why the Bangladesh mask study is not saying what Twitter and the news says it is

This study is not a study of the effect of wearing a mask on COVID. This is a study of specific strategies to increase mask wearing in populations with low rates of masking. Their primary research question is focused on evaluating the particularly strategy to increase mask-wearing. As the authors state in the introduction: "We conducted a randomized controlled trial to identify the most effective mask promotion strategies for low-resource, rural settings and determine whether mask distribution and promotion is an effective tool to combat COVID-19."

But that sentence mentions masks multiple times doesn't it? How is that different from a study of masks? It's in fact very different. Let's say I invent a new type of toilet paper. I then launch a big ad campaign to promote my new toilet paper. I then commission a market research firm to study this ad campaign to see if it worked in getting people to buy my new toilet paper. Perhaps as a result of this work they may be able to incidentally conclude something about my toilet paper like that people think it's itchy or that it's too expensive, but that's not what was really being studied. The research question was specifically about the ad campaign.

That's what the Bangladesh mask study was concerned with--whether a specific health promotion strategy worked to increase mask usage. Incidentally, they were able to make some measurements of the effect of masks on preventing COVID, but that's not what they set out to do.

Why is this distinction important? Because you design a study to answer your research question. In this case, they designed a randomized control trial where they randomly assigned villages and households to receive various mask promotion strategies (mask distribution, text reminders, monetary incentives, verbal pledges, outdoor signage, etc.). They examined village-level mask compliance assessed using direct observation of public spaces. This design makes perfect sense for answering their research question. It allows them to test multiple household and village level promotion strategies in a single trial.

Their summary in the concluding paragraph emphasizes what they did and what it shows: "In summary, we found that mask distribution, role modeling, and promotion in a LMIC setting increased mask-wearing and physical distancing, leading to lower illness, particularly in older adults." They are focused on their prevention strategies, not on examining mask wearing itself.

But even if that is their focus, shouldn't their results for masks on prevention of COVID be useful? Yes and no. Since the study was not focused on answering the question of the protective effect of masks, it was not designed in a way that makes it uniquely valuable in answering that question. Even among the intervention arm, they had low mask-wearing (42.3% compared to 13.3% in the control arm). The units of study were villages and households making conclusions about the effect on an individual's risk of COVID based on mask-wearing impossible to assess. Most damningly, since the randomization assigned promotion strategies to increase mask wearing, there is still significant risk of confounding by many lifestyle, political, and socioeconomic variables when examining the relationship between mask wearing and disease outcomes.

It's not a bad study. In fact, it seems to be a really good study. It's just not the study people seem to think it is.

Rosalind
Apr 30, 2013

When we hit our lowest point, we are open to the greatest change.

Smeef posted:

I don't really have a strong position on this, and as noted in my post, my exposure to that finding/implication of the paper was secondhand. Your argument seems sound to me. However, I just did a quick search, and for what it's worth, even one of the authors of the study appears to be comfortable with making the assertion: (this pastes really messy)

I think the author is being deceptive in making representations that this study was a "real-world RCT evaluating masks." It is an RCT evaluating mask promotions strategies with an instrumental variable analysis conducted as part of it. There's nothing wrong with doing that and in many ways even a modestly well-conducted IV analysis is likely better than many of the observational studies in reducing possible sources of bias. However, representing an IV analysis as an RCT is misleading. It is a quasi-experimental method and comes with many assumptions that an RCT does not.

There's also an entire argument to be had about the transportability of the findings to other populations given that there may be many socioeconomic and cultural differences that affect mask wearing practices that vary from population to population.

Rosalind
Apr 30, 2013

When we hit our lowest point, we are open to the greatest change.

Buffer posted:

RE: non-authoritarian states - Africa has also done surprisingly well. Nigeria has been kicking rear end (only 3k deaths) and Lagos is dense as hell.

Lots of confounders here--Nigeria is an incredibly young country. Just look up the population pyramid for Nigeria and compare it to the US--like more than half their population is under the age of 25. Also public health data reporting systems just aren't very good in many lower-to-middle income countries meaning that it would be more informative to look at the excess deaths rather than confirmed deaths (which I was unable to find).

Rosalind
Apr 30, 2013

When we hit our lowest point, we are open to the greatest change.

Vasukhani posted:

States have coercive apparatuses for a reason. If a state disobeys the order of the Federal government it should be declared in rebellion and brought to heel by force of arms.

Historically speaking, countries with active civil wars do much worse at containing epidemics, not better.

Rosalind
Apr 30, 2013

When we hit our lowest point, we are open to the greatest change.

Rather than saying "the federal government hosed this up big time" for the zillionth time, it might be helpful to start identifying specific failures we made along the way and how they could be resolved in the future.

Off the top of my head, the biggest failures from my perspective as an epidemiologist have been:

- Failure to contain COVID prior to community transmission through enforced quarantine measures for international travelers
- Extremely bad initial models used to inform decision-making that made absolutely undefendable assumptions (IHME, namely)
- Failure to establish clearly what criteria would be used for lockdowns/reopenings, stick to those criteria when possible, or adjust and discuss those adjustments publicly
- Just generally there was a failure to rely on what was actually some surprisingly good early data instead of calendar dates for decisions (e.g. "We will open up by May 1st!")
- Failure to establish a single authoritative government resource for information on the pandemic (why the gently caress nearly 2 years later can I not go to like "covid.gov" and get a bunch of info from the CDC and FDA? Why do they have separate, confusing websites? Why does old guidance sometimes show up more easily than current guidance? It's infuriating.)
- Failure to aggressively regulate social media sites to prevent misinformation
- Poor messaging from federal health agencies in nearly every context whether it was with health care providers, the public, or state/local agencies, the federal government hosed it up

This is ignoring everything upstream like the US not having a rational health care system or trying to do something about the population being largely scientifically illiterate. The Trump administration also probably exacerbated many of these problems, but didn't create most of them by themselves.

Rosalind fucked around with this message at 22:11 on Nov 30, 2021

Rosalind
Apr 30, 2013

When we hit our lowest point, we are open to the greatest change.

mod sassinator posted:

Is this not the very violation of freedom which you have argued is why we cannot justify lockdowns? It's the first amendment... So we can trash it because people on twitter say things we might not agree with, but we absolutely under any circumstances cannot think about harming the fourth amendment or similar to keep people from traveling, etc. during a pandemic?

I have never argued against lockdowns writ large from any "violation of freedom" angle. I had some concerns back in February and March 2020 about how China implemented their lockdowns and in retrospect my feelings about those lockdowns are still pretty ambivalent. The goal of public health is always to implement the most effective, least invasive intervention possible and I stand by that.

As for the first amendment discussion, I am not a constitutional scholar but my understanding is that the government at the very least has some ability to regulate algorithms that drive viewers to certain content and that the government could punish social media companies that fail to combat COVID misinformation similarly to how they could punish companies that fail to protect against other issues such as human trafficking.

Rosalind
Apr 30, 2013

When we hit our lowest point, we are open to the greatest change.

Elea posted:

The CDC behaving like a politically focused organization rather than a science based one reverberates through the entire pandemic and should really cause more outrage. Why can't we expect our "science-based" disease control organization to actually deliver and study hypothetical plans for disease control for the public and experts to consider?

Every single one of my friends who worked for the CDC found new positions after 2016. This is anecdotal but I believe that Trump caused a significant amount of brain drain at the CDC and the people who were left were largely politically-oriented yes-people.

Rosalind
Apr 30, 2013

When we hit our lowest point, we are open to the greatest change.

Vasukhani posted:

I agree. The government can easily regulate the thoughts of its citizens via the media environment. This should be a priority going forward.

You're right. This power belongs to Zuck alone who is doing this right now with absolutely no oversight or accountability.

Rosalind
Apr 30, 2013

When we hit our lowest point, we are open to the greatest change.

mod sassinator posted:

Twitter owns the servers, they own the code on them, they pay for the bandwidth, they pay for the employees that write the code. The US government has no jurisdiction at all. Twitter's not a public place like a street corner.

Just because a company pays their own bills doesn't mean that that company is completely exempt from US laws and regulations. Just 3 years ago, FOSTA-SESTA became law which cracked down significantly on platforms that may have been hosting human trafficking (and hurt a lot of innocent sex workers in the process).

quote:

How do you define COVID misinformation? In March 2020 Fauci and the CDC were saying not to buy or even wear masks. I, and many other folks, were saying in this thread "make masks; wear masks" (and I have probations to prove it).

Was I giving misinformation? If so how is that rationalized with the fact that months later Fauci admitted it was a lie and the CDC guidance changed to require masks? Was it right that lives were lost because people didn't wear masks in those early days and got infected? Was I wrong for trying to help people stay safe and ultimately save lives, even if it wasn't the "correct" message?

How do you rationalize is it better that the message is "correct" vs. that actual lives are saved?

I don't know. I'm not a legal expert. I just know that misinformation has been one of the biggest issues of this pandemic and that regulatory frameworks have been proposed on how to fight it specifically around feed algorithms. How do you propose we fight misinformation?

Adbot
ADBOT LOVES YOU

Rosalind
Apr 30, 2013

When we hit our lowest point, we are open to the greatest change.

Vasukhani posted:

This obsession with jurisprudence is unhealthy. A republic should enforce the general will regardless of what laws were previously made.

Excuse me if I lose my temper for a moment. This is my problem with this thread. I try to move the discussion forward off the "Everything is terrible. We need full China lockdowns now even if it causes Civil War 2" spiral that we constantly get into only to get 3-4 people reading everything I'm saying in the most bad faith way possible and then doing these lovely stupid hyperbolic circlejerk takes about it endlessly until people who haven't followed the whole discussion think I called for like a complete government takeover of every human brain on earth using microchips or something.

It's loving exhausting and annoying as hell to be honest. It derails any sincere discussion in this thread to constantly feel like every single post I make has to be so carefully worded as to not open any possible line for bad faith interpretations from a handful of shitbags who are just here to troll and shitpost. I get that this is a dead comedy forum, but holy moly why can't we contain that sort of thing to the GBS thread or wherever?

Rosalind fucked around with this message at 23:10 on Nov 30, 2021

  • 1
  • 2
  • 3
  • 4
  • 5
  • Post
  • Reply