Masks
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https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD006207.pub6/full
The pooled results of RCTs did not show a clear reduction in respiratory viral infection with the use of medical/surgical masks. There were no clear differences between the use of medical/surgical masks compared with N95/P2 respirators in healthcare workers when used in routine care to reduce respiratory viral infection. Hand hygiene is likely to modestly reduce the burden of respiratory illness, and although this effect was also present when ILI and laboratory‐confirmed influenza were analysed separately, it was not found to be a significant difference for the latter two outcomes. Harms associated with physical interventions were under‐investigated.
There is a need for large, well‐designed RCTs addressing the effectiveness of many of these interventions in multiple settings and populations, as well as the impact of adherence on effectiveness, especially in those most at risk of ARIs.
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Medical/surgical masks compared to no masks
We included 12 trials (10 cluster‐RCTs) comparing medical/surgical masks versus no masks to prevent the spread of viral respiratory illness (two trials with healthcare workers and 10 in the community). Wearing masks in the community probably makes little or no difference to the outcome of influenza‐like illness (ILI)/COVID‐19 like illness compared to not wearing masks (risk ratio (RR) 0.95, 95% confidence interval (CI) 0.84 to 1.09; 9 trials, 276,917 participants; moderate‐certainty evidence. Wearing masks in the community probably makes little or no difference to the outcome of laboratory‐confirmed influenza/SARS‐CoV‐2 compared to not wearing masks (RR 1.01, 95% CI 0.72 to 1.42; 6 trials, 13,919 participants; moderate‐certainty evidence). Harms were rarely measured and poorly reported (very low‐certainty evidence).
N95/P2 respirators compared to medical/surgical masks
We pooled trials comparing N95/P2 respirators with medical/surgical masks (four in healthcare settings and one in a household setting). We are very uncertain on the effects of N95/P2 respirators compared with medical/surgical masks on the outcome of clinical respiratory illness (RR 0.70, 95% CI 0.45 to 1.10; 3 trials, 7779 participants; very low‐certainty evidence). N95/P2 respirators compared with medical/surgical masks may be effective for ILI (RR 0.82, 95% CI 0.66 to 1.03; 5 trials, 8407 participants; low‐certainty evidence). Evidence is limited by imprecision and heterogeneity for these subjective outcomes. The use of a N95/P2 respirators compared to medical/surgical masks probably makes little or no difference for the objective and more precise outcome of laboratory‐confirmed influenza infection (RR 1.10, 95% CI 0.90 to 1.34; 5 trials, 8407 participants; moderate‐certainty evidence). Restricting pooling to healthcare workers made no difference to the overall findings. Harms were poorly measured and reported, but discomfort wearing medical/surgical masks or N95/P2 respirators was mentioned in several studies (very low‐certainty evidence).
One previously reported ongoing RCT has now been published and observed that medical/surgical masks were non‐inferior to N95 respirators in a large study of 1009 healthcare workers in four countries providing direct care to COVID‐19 patients.
So, Fauci was right - before he was wrong.
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I think a properly fitted N95 works to lower risk of infection, but it's only a piece of the protocol. Hand hygiene, contaminated surface awareness, fomites, etc.
Even with transmission awareness, healthcare workers screw up protocol. The general public doesn't even come close and given daily life, I don't think they can.
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Child mask mandates for COVID-19
Results: We screened 597 studies and included 22 in the final analysis. There were no randomised controlled trials in children assessing the benefits of mask wearing to reduce SARS-CoV-2 infection or transmission. The six observational studies reporting an association between child masking and lower infection rate or antibody seropositivity had critical (n=5) or serious (n=1) risk of bias; all six were potentially confounded by important differences between masked and unmasked groups and two were shown to have non-significant results when reanalysed. Sixteen other observational studies found no association between mask wearing and infection or transmission.
Conclusions: Real-world effectiveness of child mask mandates against SARS-CoV-2 transmission or infection has not been demonstrated with high-quality evidence. The current body of scientific data does not support masking children for protection against COVID-19.
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But it’s just common sense. I saw it on TV…
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I think Jolly was right in that an N95 can have some positive effect if used properly and in conjunction with other steps. Most everyone didn’t use properly and with all of the other steps. And kids? No chance.
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And...proving that I live life dangerously...My phlebe was having trouble sticking an 8-month old baby this weekend. Folks, when sticking a young'un of that size, I learned without gloves and the gloves come off. I have to feel.
Knew the child's grandmother...She's an MLT that used to work for me. So, no problem with taking my gloves off. Wash before and afterwards.
Anyway...Ran the swabs when I walked back in the lab. Flu A -, Flu B - COV -. RSV +.
Yep, that time of the year...
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And...proving that I live life dangerously...My phlebe was having trouble sticking an 8-month old baby this weekend. Folks, when sticking a young'un of that size, I learned without gloves and the gloves come off. I have to feel.
Knew the child's grandmother...She's an MLT that used to work for me. So, no problem with taking my gloves off. Wash before and afterwards.
Anyway...Ran the swabs when I walked back in the lab. Flu A -, Flu B - COV -. RSV +.
Yep, that time of the year...
And...proving that I live life dangerously..
I never wore gloves with starting an IV, drawing blood, or putting in an arterial line. When doing internal jugulars, I did.
Ditto intubating people.
I was trained in a different era, and we just didn't even consider it.
I put down NG tubes with my bare hands as well.
Of course, now things are different.
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They are, but I don't recall more transmission problems or accidental needlesticks back in the old days. The only time I remember gloving was with the HIV patients, back when we didn't know what the disease was.
BTW, I've had one needlestick in 43 years, and that was with a clean needle.
Second BTW...I'm also old enough to have used glass syringes... With resharpened and autoclaved needles.
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They are, but I don't recall more transmission problems or accidental needlesticks back in the old days. The only time I remember gloving was with the HIV patients, back when we didn't know what the disease was.
BTW, I've had one needlestick in 43 years, and that was with a clean needle.
Second BTW...I'm also old enough to have used glass syringes... With resharpened and autoclaved needles.
.I'm also old enough to have used glass syringes
Still used them for epidurals, up until the last day I did OB (2014?).
Glass bottles, too.
Of course, my cavalier attitude might have contributed to my contracting hepatitis C.
(which I cleared spontaneously and have no residual, for those of you who care)
"Now look here, you Baltic gas passer... " - Mik, 6/14/08
The saying, "Lite is just one damn thing after another," is a gross understatement. The damn things overlap.
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.I'm also old enough to have used glass syringes
Still used them for epidurals, up until the last day I did OB (2014?).
Glass bottles, too.
Of course, my cavalier attitude might have contributed to my contracting hepatitis C.
(which I cleared spontaneously and have no residual, for those of you who care)
.I'm also old enough to have used glass syringes
Still used them for epidurals, up until the last day I did OB (2014?).
Glass bottles, too.
Of course, my cavalier attitude might have contributed to my contracting hepatitis C.
(which I cleared spontaneously and have no residual, for those of you who care)
If you work in direct patient care, no matter how careful you are, you will be exposed to multiple transmissible diseases. I used to tell kids, if that bothers you, be an accountant.
