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nopie  1yr ago (vinayprasadmdmph.substack.com)   Edited 1yr ago   2933 thread views

Cochrane review is out and masks have weak evidence that they are not effective

vinayprasadmdmph.substack.com

This one is against rationalists because when Scott wrote his review that masks could be effective many of us trusted it.

I don't blame Scott for failing this one because doing review of hundreds of studies is hard and one person can hardly do it. But this clearly shows that rationalist way of thinking has no special formula, they can be easily mistaken and fall by accepting general consensus just like any other person.

I was impressed when Scott did his review about masks. I trusted it because there was no other clear evidence available. Cochrane hadn't done its review yet and NICE guidelines were silent on the issue. We vaguely knew from previous studies that masks are not effective, The WHO had said so. Suddenly everyone flipped and it was not because the evidence had changed. We simply wanted to believe that masks work and we mocked those who said “no evidence that masks help”.

Even with the belief that masks work, I never wanted mask mandates. I preferred recommendations only, so that no one was penalized or prohibited entry, travel etc if one doesn't want to wear mask. Scott unwillingly had been a catalyst for governments to introduce mask mandates and all this heavy handed approach has been for nothing.

Now we are back to square one, the evidence about masks is weak and it does not support their use even in hospital settings. We can all reflect now what happened in between during these 2 or 3 years. When I realized that Scott's review is clearly insufficient as evidence, I asked some doctors if they have any better evidence that masks work. Instead of getting answer I was told not to be silly, parachutes don't need RCTs and accused me of being covid denier for nor reason. Many so-called experts were making the same mistake as Scott by looking at the issue too emotionally. It is time to get back to reality and admit that it was a mistake and we should have judged the issue with more rational mind.

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It seems hard to believe that properly fitted N95s don't work considering that they are approved PPE for ebola which is somewhat higher stakes than Covid. Perhaps people do not wear them right, whatever that means?

considering that they are approved PPE for ebola

I thought ebola spreads through direct fluid contact. Which also includes respirated droplets assuming you stand very close to an infected person. But, based on my very non-epidemiologist understanding, that's not comparable to respiratory viruses.

People can't even wear condoms right, and if we counted sandwich bags held with a rubber band as condoms the statistics would look even worse.

(only allowable facial hair is mustache, as one factor)

Good to see that "toothbrush mustache" is still OK! Fans of, uh, Charlie Chaplin will be most relieved.

I feel the need to point out that that style of mustache was in fact adopted by German soldiers in WWI to fit under a gas mask.

That's the joke...

Missed opportunity to keep the image but label it "Hitler" and put a big red 'X' on it!

Ed: plus "Careful not to commit genocide" underneath, for a chef's kiss

It is possible that "people do not wear them right". I've seen many extremely smart people wear masks in very inconsistent and random manner. I attribute it to psychological mechanisms - if they feel unsafe (consciously or unconsciously) for some reason in the environment, they put on the mask, if they feel safe, they remove it. But whatever the deal is, saying "masks help when theoretical perfect human wear them in theoretical perfect manner, otherwise they don't" is just saying "masks don't help".

Ebola spreads primarily through bodily fluids like blood and faeces. Quite different from covid.

Okay, but they are also approved PPE for TB. https://www.cdc.gov/niosh/docs/96-102/pdfs/96-102.pdf?id=10.26616/NIOSHPUB96102

Then we should probably consider that, absent evidence that it works for TB, it probably doesn't work for TB and the guidelines are wrong.

Maybe masks filter things efficiently (just for the sake of argument) but it doesn't matter in practice because people cannot wear them 24 hours without stop and will get exposed to unfiltered air at some time. If the end result is that mask wearers get respiratory infections at almost the same rate as the rest, what is the point?

Also we are supposed to see the big picture, not just some technical point. Mask mandates would be wrong even if they were effective.

They presumably work on public transport, and airplanes.

Also we are supposed to see the big picture, not just some technical point. Mask mandates would be wrong even if they were effective.

Well then who cares what the cochrane review says?

The Cochrane report came out just now but the policy for mask mandates was made without it. The policy was wrong not because in hindsight we have the report but because it encroached on our freedoms without sufficient evidence that it was necessary.

So why did you post the report if it has nothing to do with the argument?

Because we can all learn from the mistakes made?

This is just to show what mistake rationalists made about masks. Some still are trying to claim that “masks work despite the evidence that they don't” whatever that is supposed to mean.

Some may use Bayesian method (my favourite). In my view, Cochrane report strongly decreases the odds. Whatever way you go, the threshold for mask mandates was never reached.

I think it's still important. It's wrong to say "we will force you to do this thing for your own good", but it's even more wrong - some would say evil - if the "good" actually isn't good at all.

Sometime if you get the chance, I highly recommend fit testing an N95, they're quite hard to get right without a good amount of training. The test is kind of goofy, after the mask is applied, they put a big hood over the head and shoulders and puff saccharine in if you taste sweet it's a fail.

Are respirators better? I wore a respirator for welding and when I held my hands over the filters I couldn't breathe at all so I think the fit was pretty good. Seems like that's what you would want if you're dealing with something that's actually dangerous like Ebola.

Wikipedia is pretty convinced that N95 masks are technically "respirators" as well, but, yes, one advantage of P100-style respirators is that they are easier to fit correctly.

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