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08/14/2021

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I reviewed the mask randomized trial that you referenced in a link above. This study has some important weaknesses, as do many of these similar studies. First, only 80% of the patients followed-up, which is surprising given that the primary endpoint was measured at 1 month. Second, the primary endpoint was assessed at only 1 month; I would be very interested to see how the data looks at longer intervals. I would imagine it would be hard to see an effect with such short follow-up unless the effect were quite large. Third, the argument for surgical masks is that they help protect others, because they reduce the spread of infectious droplets, i.e. source control. (This study assessed infection in the person wearing the mask). Fourth, the participants practiced social distancing, where the baseline new infection rate would be expected to be very low. The argument for masks is in situations where social distancing is not possible.

This article reviews the challenges of studying these sorts of public health measures - https://pubmed.ncbi.nlm.nih.gov/33431650/

Thank you Andrew - this is very helpful, and your points well-taken. I was certainly not arguing that mask mandates are ineffective, but simply that evidence on their effectiveness is more equivocal than the evidence on vaccine effectiveness. Here are a couple more references illustrating that solid causal evidence that mask wearing works seems lacking (not necessarily about COVID, but respiratory diseases more generally), based on randomized controlled trials:
https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD006207.pub5/full
https://www.qeios.com/read/1SC5L4
These are meta-studies, aggregating results from a wide ranges of RCTs on mask effectiveness.
As you suggest, non-RCT studies cannot tell us much about the effectiveness of mask wearing.
In contrast the clinical trials that preceded emergency approval of the Pfizer, J&J and Moderna vaccines show their effectiveness in a reliable causal sense.

The part that strikes me is how polarized people are around vaccines and mask mandates, to the point where patients in hospitals, literally on their death beds, still say that they wouldn't get the vaccine if they survived. The intersection of the pandemic and the prevalence of technology to facilitate connecting with people like never before has certainly proved an interesting case study in the psychology of groups. I wonder if other black swans, like 9/11 for example, would have a similarly polarizing effect if it happened today. From the evidence you presented in your Cultural Divide paper, I have no doubt that it would, given the much sharper curve upward for both party and religious divide than what existed 20 years ago.

I appreciated your description of how an early pattern of events reinforces someone's reality. Having been extremely careful with masking during the pandemic (and having paid close attention to news coverage), I've been struck by the the different lenses applied to a choice: there are stories about privilege of three groups - the early vaccinated, those angry at the unvaccinated, and the holdouts themselves. Technical information has been all over the map, and peer reviewed articles suggest cases may be up to 9X the official numbers.

News nowadays appears to be branding and opinion, instead of actual journalism. As you state above, there isn't a "common set of news anymore". Long format stories, balance, and nuance are all but gone. The inability to listen to, or tell, two sides of a story increases the divide between people.

Reason would suggest that both vaccination and natural immunity could serve as a basis for safe interactions. Our public policy relies only on the former, largely eliminating tests for close contacts of new Covid cases when the contacts are doubly vaccinated. This can undercount breakthrough transmission. There is also fear of variants developing in the US from the unvaccinated, when these variants can develop anywhere in the world in almost any pool (human, birds, dogs, cats, minks, etc.).

Covid-19 is part of our ecosystem now. We need to recognize this, and use smarter techniques than coercion and willful blindness, to mitigate the role it plays in our lives.

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