Just the Facts, the Crown virus.

[Sedgehammer]

I've heard hundreds of different things from the CDC. They aren't complete imbeciles, but they are close.

[Ianab]

Size alone is not the only important distinction: Droplets fall to earth quickly, but aerosols can travel on air currents potentially for hours. Thus aerosolized viruses are likely to be much more infectious than viruses bound to respiratory droplets, and much more difficult to avoid.

True, but if you reduce the direct transfer of droplets from the scenario, then you must have reduced the risk of transmission? Yes you could still get infected by the aerosol particles, but they appear much less of a risk than close (droplet?) contact. A large droplet could have 1,000X the number of Viruses than an aerosol droplet, and if it gets coughed at your face, I'd expect a high chance of infection. 

Your reasoning explains a reason WHY simple masks are only partly effective. But it appears they ARE partly effective, which makes them a good idea. 

Seat belt analogy... People still die in car crashes even if they are wearing seat belts. Does that make seat belts useless? No because you are a lot less likely to die if you are wearing one. The fact that they are not 100% effective doesn't mean we shouldn't use them. 

I agree with the seasonal temperature have a large effect, but that does not say that mitigation strategies have zero effect. We know that other viruses like influenza and common cold spread more in the Winter, so it's no surprise this one acts the same. Just means you have to work HARDER to control the virus in the cold weather. 

[Don P]

I've heard hundreds of different things from the CDC. They aren't complete imbeciles, but they are close.

Hmm,
Center for Disease Control vs going to a retired truck driver for medical advice  :D
That's not a real hard call is it  ;)

[Sedgehammer]

Size alone is not the only important distinction: Droplets fall to earth quickly, but aerosols can travel on air currents potentially for hours. Thus aerosolized viruses are likely to be much more infectious than viruses bound to respiratory droplets, and much more difficult to avoid.

True, but if you reduce the direct transfer of droplets from the scenario, then you must have reduced the risk of transmission? Yes you could still get infected by the aerosol particles, but they appear much less of a risk than close (droplet?) contact. A large droplet could have 1,000X the number of Viruses than an aerosol droplet, and if it gets coughed at your face, I'd expect a high chance of infection.

Your reasoning explains a reason WHY simple masks are only partly effective. But it appears they ARE partly effective, which makes them a good idea.

Seat belt analogy... People still die in car crashes even if they are wearing seat belts. Does that make seat belts useless? No because you are a lot less likely to die if you are wearing one. The fact that they are not 100% effective doesn't mean we shouldn't use them.

I agree with the seasonal temperature have a large effect, but that does not say that mitigation strategies have zero effect. We know that other viruses like influenza and common cold spread more in the Winter, so it's no surprise this one acts the same. Just means you have to work HARDER to control the virus in the cold weather.

Not necessarily. It's much harder due to gravity to breath in large droplets and those large droplets drop almost immediately. The aerosols you can breath in for hours.

With that said, yes, if I am directly in front of you and you cough directly into my face, yes I'm going to have a higher chance of getting it. However, have you ever been directly coughed into the face? I never have been by anyone over 5 not sitting in my lap. People do use some sort of mitigation to stop the direct flow of large water droplets into my face. They either cough into their shirt, more like a loosely fitting mask or they cough into their elbow, more like a fitted mask or some will close their fist and place it over their mouth and the large droplets will land mostly onto their hand, but some will spray sideways (I see this one the least).  

I've never said they are totally worthless. Just mostly. I've stated the types of mask that do the most good and IF they are available to use them. The main masks I've pointed my criticism to are the loosely fitted ones on the face.

Seatbelt analogy is comparing oranges to gold nuggets.

Correct, but besides forcing people into their homes and destroying their financial future and economies, that mitigation is not doing much based on the numbers presented. The other main factoid is this is less deadlier than the common flu for those under 65 and healthy or at the very least no deadlier, so it makes no sense to lock down people and economies to stop it. Ask people to social distance, ask people to use the proper masks, wash hands more often, yes, them all will help to some degree and the cure isn't going to cause more harm than the disease.

[Sedgehammer]

I've heard hundreds of different things from the CDC. They aren't complete imbeciles, but they are close.

Hmm,
Center for Disease Control vs going to a retired truck driver for medical advice  :D
That's not a real hard call is it  ;)

Not much better. The CDC is, has been all over the place. I personally take little advice from hypocrites and political appointees no matter that flavor. I use common sense and intelligence to form my opines. I've presented studies and pictures to show that loose fitting masks don't do much. That lockdowns don't do much. If you want to wear a loose fitting mask, please do so. If you want to be locked down or are in agreement with such, please abide by such.  

[nativewolf]

I've heard hundreds of different things from the CDC. They aren't complete imbeciles, but they are close.

Hmm,
Center for Disease Control vs going to a retired truck driver for medical advice  :D
That's not a real hard call is it  ;)

apparently not as easy as you'd think

[Sedgehammer]

I've heard hundreds of different things from the CDC. They aren't complete imbeciles, but they are close.

Hmm,
Center for Disease Control vs going to a retired truck driver for medical advice  :D
That's not a real hard call is it  ;)

apparently not as easy as you'd think

Apparently not is right and from the CDC no less

Face Masks

In our systematic review, we identified 10 RCTs that reported estimates of the effectiveness of face masks in reducing laboratory-confirmed influenza virus infections in the community from literature published during 1946–July 27, 2018. In pooled analysis, we found no significant reduction in influenza transmission with the use of face masks (RR 0.78, 95% CI 0.51–1.20; I2 = 30%, p = 0.25) (Figure 2). One study evaluated the use of masks among pilgrims from Australia during the Hajj pilgrimage and reported no major difference in the risk for laboratory-confirmed influenza virus infection in the control or mask group (33). Two studies in university settings assessed the effectiveness of face masks for primary protection by monitoring the incidence of laboratory-confirmed influenza among student hall residents for 5 months (9,10). The overall reduction in ILI or laboratory-confirmed influenza cases in the face mask group was not significant in either studies (9,10). Study designs in the 7 household studies were slightly different: 1 study provided face masks and P2 respirators for household contacts only (34), another study evaluated face mask use as a source control for infected persons only (35), and the remaining studies provided masks for the infected persons as well as their close contacts (11–13,15,17). None of the household studies reported a significant reduction in secondary laboratory-confirmed influenza virus infections in the face mask group (11–13,15,17,34,35). Most studies were underpowered because of limited sample size, and some studies also reported suboptimal adherence in the face mask group.

Disposable medical masks (also known as surgical masks) are loose-fitting devices that were designed to be worn by medical personnel to protect accidental contamination of patient wounds, and to protect the wearer against splashes or sprays of bodily fluids (36). There is limited evidence for their effectiveness in preventing influenza virus transmission either when worn by the infected person for source control or when worn by uninfected persons to reduce exposure. Our systematic review found no significant effect of face masks on transmission of laboratory-confirmed influenza.

https://wwwnc.cdc.gov/eid/article/26/5/19-0994_article?fbclid=IwAR2V1hPqN0WKb2kXVExP_1UE9ARvru6mtPZvZN0w1jx0S3l3fXLhxMP_bXs

[Claybraker]

I've heard hundreds of different things from the CDC. They aren't complete imbeciles, but they are close.

Hmm,
Center for Disease Control vs going to a retired truck driver for medical advice  :D
That's not a real hard call is it  ;)

Not much better. The CDC is, has been all over the place. I personally take little advice from hypocrites and political appointees no matter that flavor. I use common sense and intelligence to form my opines. I've presented studies and pictures to show that loose fitting masks don't do much. That lockdowns don't do much. If you want to wear a loose fitting mask, please do so. If you want to be locked down or are in agreement with such, please abide by such.  

We've never had a real lockdown. Instead voluntary compliance has been the guidance.  The local mega church cancelled in person services but that was and still is voluntary. I'll see the Voltaire quote and raise with one from Joe Diffie. "Lord I wanna go to heaven, but I don't wanna go tonight."

[kantuckid]

NYT's today has an article on how to act at home when yer college kids & relatives come to visit for Thanksgiving.
 Watch what you wish for? is the name of that game. 
Are you gonna require testing for your guests? 6' chairs? plexi panels at the table? take temps all the time? One grocery chain on TV news has ordered smaller turkeys this year. 
My nearest regional university has a bit over 100 positives, the U of KY has over 2,000 positives. They monitor the sewer pipes at the U of KY dorms for positives.  
60% of those who die here in KY are nursing home related and it's ramping up fast. 
Health dept teams are supplanting nursing home staff who are off from covid in some areas. Not that many have enough staff to begin with pre-covid! 
Of our three adult sons, one AL bunch says they're coming home, another TN bunch will not and the oldest TX, probably not.  
The TN bunch has one grade school girl quarantined because she sat near a positive kid in school so back to virtual, plus Daddy stays home and falls even further behind from an extremely tough job.   

[doc henderson]

several of the spikes occur a few weeks (incubation period) after a holiday like July 4th or Halloween.  couple that with fatigue for mitigation.  then after a spike, most jump back on the bandwagon.  of course by the time the curve heads up, there are 2 more weeks at least of climbing numbers.  When I went in for 4 hours the other day, all patients had covid.  I wore a papr for 4 hours.  otherwise, an N95 or surgical mask.  we cannot ask patients to wear them and not us.  The alternative would be to keep everyone outside until a room is available, and no visitors.  

[Claybraker]

Let's hope for good weather on T-Day. I've been invited to my neighbor's. Eat outside around 3, then we'll crank up the skeet thrower for some socially distanced recreational activity. Watching football on tv inside probably not a good idea. 

[doc henderson]

Scientific Brief: Community Use of Cloth Masks to Control the Spread of SARS-CoV-2 | CDC

[Ianab]

That lockdowns don't do much.

The US hasn't done any effective lock down. That's NOT the same as "lockdowns don't work"

They have worked in Australia, they have worked in China, they have worked in NZ. Is there an economic effect? Of course, but it's demonstrably less that an ongoing and uncontrolled pandemic, because if you get the virus under control then business are able to open normally again. 

Yes I know there are reasons a lockdown is problematic in the US, but again, that's not the same as "they don't work"

[Sedgehammer]

That lockdowns don't do much.

The US hasn't done any effective lock down. That's NOT the same as "lockdowns don't work"

They have worked in Australia, they have worked in China, they have worked in NZ. Is there an economic effect? Of course, but it's demonstrably less that an ongoing and uncontrolled pandemic, because if you get the virus under control then business are able to open normally again.

Yes I know there are reasons a lockdown is problematic in the US, but again, that's not the same as "they don't work"

They don't work in terms of we possibly destroyed our economy and didn't get much if anything from it, so no, they don't work. 

[Sedgehammer]

Scientific Brief: Community Use of Cloth Masks to Control the Spread of SARS-CoV-2 | CDC

Thanks Doc for posting that, I was hoping someone wood.
My whole point with the CDC.
From 1946 to 2018 (72 years) in laboratory testing they saw no benefit in cloth masks
This spring they said don't wear them, they don't help
This summer they said wear them, they help
They released a study from July showing little benefit from them
They now say they work and have anecdotal 'testing' that shows they help
This spring and summer and even till now Doctors claim they have medications that work, but since those medications weren't 'tested' in the golden double blind studies, can't use that medicine
But we can say masks work with no double blind study......
If ya'll want to wear a loose fitting mask that clearly shows it expels 'smoke' around it like a freight train and think you're doing a lot of good, go ahead, but for me and mine, if we are going to wear a mask, it will not be one like that.

[donbj]

Scientific Brief: Community Use of Cloth Masks to Control the Spread of SARS-CoV-2 | CDC

Thanks Doc for posting that, I was hoping someone wood.
My whole point with the CDC.
From 1946 to 2018 (72 years) in laboratory testing they saw no benefit in cloth masks
This spring they said don't wear them, they don't help
This summer they said wear them, they help
They released a study from July showing little benefit from them
They now say they work and have anecdotal 'testing' that shows they help
This spring and summer and even till now Doctors claim they have medications that work, but since those medications weren't 'tested' in the golden double blind studies, can't use that medicine
But we can say masks work with no double blind study......
If ya'll want to wear a loose fitting mask that clearly shows it expels 'smoke' around it like a freight train and think you're doing a lot of good, go ahead, but for me and mine, if we are going to wear a mask, it will not be one like that.

Gotta love this internet thing where a guy can pull all kinds of goodies off the internet to support his own PERSONAL opinions. Just like interpreting biblical context and meaning of scripture at times. Give your head a shake sedgehammer and get on to logic and common sense!

[SwampDonkey]

Lock downs have worked here in New Brunswick, and we closed interprovincial travel to. It was opened only to Maritime provinces this summer. Masks have worked along with the other protocols, since we have very low numbers. I don't recall even 30 cases at any time being active. Those were most all travellers bringing it in.

But I do know some folks aren't following the protocols on travel the way they are meant to be. For instance, if I'm your father,  and you come here you have to self isolate 14 days. That does not mean you come to my home for them 14 days and potentially infect me if you have it. What will you think, if you bring it to my home and I die. Was the visit that important? Case in point, neighbors having their kids come and the words used are "oh we're all self isolating 14 days at the house". :

[Sedgehammer]

Scientific Brief: Community Use of Cloth Masks to Control the Spread of SARS-CoV-2 | CDC

Thanks Doc for posting that, I was hoping someone wood.
My whole point with the CDC.
From 1946 to 2018 (72 years) in laboratory testing they saw no benefit in cloth masks
This spring they said don't wear them, they don't help
This summer they said wear them, they help
They released a study from July showing little benefit from them
They now say they work and have anecdotal 'testing' that shows they help
This spring and summer and even till now Doctors claim they have medications that work, but since those medications weren't 'tested' in the golden double blind studies, can't use that medicine
But we can say masks work with no double blind study......
If ya'll want to wear a loose fitting mask that clearly shows it expels 'smoke' around it like a freight train and think you're doing a lot of good, go ahead, but for me and mine, if we are going to wear a mask, it will not be one like that.

Gotta love this internet thing where a guy can pull all kinds of goodies off the internet to support his own PERSONAL opinions. Just like interpreting biblical context and meaning of scripture at times. Give your head a shake sedgehammer and get on to logic and common sense!

No personal opines save the last comment. Them are all backed up by studies posted back through the pages.
I AM all about common sense. Common sense tells me something that leaks like a sieve ain't doing much. Maybe you have buckets that hold water when tipped upside down without lids, I don't. Mine dump all the water out.

[kantuckid]

Scientific Brief: Community Use of Cloth Masks to Control the Spread of SARS-CoV-2 | CDC

Regarding cloth masks- my latest November Smithsonian magazine has an article on bandanas, the history, etc.. Bandanas, especially black bandanas are at an all time high in sales based on mask use-I guess? I had another guess but left it out to keep things nice. 
 

[alan gage]

Thanks for your continued posts, Doc. Best of luck.

Alan

[Gary_C]

This ongoing discussion over the effectiveness of masks is getting old and tiresome. It reminds me of the ordinary set of pliers I always carry in the pocket of my work pants. I've had good mechanics cringe when I pull out my pliers to loosen or tighten something when my fingers don't work. They always say to always use a proper sized wrench but my response is I use the best tool available to get the job done and I can't carry a toolbox in my pocket at all times.

So guys, suck it up and quit quibbling about the masks. They are the best protection we now have available. Put them on your face when you are out and about and stop whining. 

[LeeB]

Indeed.

[ronwood]

One also has to consider how the mask is handle when putting it on and taking it off.   If the virus is present on the outside of the mask and you do not wash your hands and then touch your face what good did the mask do.

It's all in the way you handle the mask and keep your hands clean. Doc what procedure is used by the health care works when removing and putting on mask?

Remember the chain is only has strong has the weakest link.

[doc henderson]

we put on different ones for different levels of concern.  so many are + today, that we could wear the papr 24/7.  we foam in and out.  with sanitizing stuff.  we just started today with a monoclonal antibody infusion for people mild to mod. symptoms, but going home.  I do not wear gloves but keep my hands sanitized in and out or about every 1 to 2 minutes unless I am at my desk.

Bamlanivimab

 

Bamlanivimab is authorized for emergency use by FDA for use in outpatient settings to treat mild to moderate COVID-19 in adults and pediatric patients with positive results of direct SARS-CoV-2 viral testing who are 12 years of age and older weighing at least 40 kg, and who are at high risk for progressing to severe COVID-19 and/or hospitalization.
·      FDA recommends giving within 10 days of symptom onset
·      NOT authorized to be given to:
o  Hospitalized adult or pediatric patients due to COVID-19
§ Bamlanivimab arm of the ACTIV-3 trial was stopped early.
§ Trial data suggested that bamlanivimab is unlikely to help hospitalized COVID-19 patients
o  Adult or pediatric patients who require oxygen therapy due to COVID-19
o  Adults or pediatric patient who require an increase in baseline oxygen flow rate due to COVID-19 in those patients on chronic oxygen therapy due to underlying non-COVID-19-related comorbidity
·      High risk for progressing to severe COVID-19 and/or hospitalization is defined under EUA as patients who meet at least one of the following criteria:
o  BMI ≥ 35
o  Chronic kidney disease
o  Diabetes
o  Have immunosuppressive disease or receiving immunosuppressive treatment
o  ≥ 65 years of age
o  ≥ 55 years of age AND have:
§ Cardiovascular disease, or
§ Hypertension, or
§ Chronic obstructive pulmonary disease/other chronic respiratory disease
o  12-17 years of age AND have:
§ BMI ≥ 85^th percentile for their age and gender based on CDC growth charts, or
§ Sickle cell disease, or
§ Congenital or acquired heart disease, or
§ Neurodevelopmental disorders (ex. Cerebral palsy), or
§ A medical-related technological dependence, for example, tracheostomy, gastrostomy, or positive pressure ventilation (not related to COVID-19), or
§ Asthma, reactive airway or other chronic respiratory disease that requires daily medication for control.
 
 
 
 
 
 
Mechanism of Action: A neutralizing IgG1 monoclonal antibody that binds to the receptor binding domain of the spike protein of SARS-CoV-2 virus, which can reduce viral replication.
 
Dosing: 700 mg IV in 200 mL NS given over 60 minutes, one-time dose. Patients are to be observed for an hour following the infusion.
 
*May be given to children 12 years of age and older weighing at least 40 kg*
 
Dose Adjustments: None provided for hepatic or renal adjustments. Not renally excreted or metabolized by cytochrome P450 enzymes.
 
Adverse Reactions: possible infusion related reactions (fever chills, nausea, headache, bronchospasm, hypotension, angioedema, throat irritation, rash including urticaria, pruritus, myalgia, dizziness), possible anaphylactic and allergic reactions have been reported during the infusion of bamlanivimab.
 
Nausea, diarrhea, dizziness, headache, pruritis, and vomiting were most commonly reported.
 
All adverse reactions are to be reported to FDA Medwatch and Lilly
 
Preparation:
·      Remove the bamlanivimab from refrigerated storage and allow to come to room temperature for about 20 minutes before preparation. Do not expose to direct heat.
·      Inspect bamlanivimab visually for particulate matter and discoloration.
o  Bamlanivimab is a clear to slightly opalescent and colorless to slightly yellow to slightly brown solution
·      Gently invert vial by hand about 10 times. Do not shake.
·      Dilute bamlanivimab using a 250 mL 0.9% Sodium Chloride (NS) injection bag for intravenous infusion
o  Withdraw and discard 70 mL of NS from the infusion bag
o  Withdraw 20 mL of bamlanivimab from the vial
o  Transfer bamlanivimab to the NS infusion bag.
o  Discard any product remaining in the vial
·      Gently invert IV bag by hand about 10 times. Do not shake.
·      This product is preservative-free and therefore, the diluted infusion solution should be administered immediately.
o  If immediate administration is not possible, store the diluted infusion solution for up to 24 hours at refrigerated temperature (2^oC to 8^oC [36^oF to 46^oF]). Allow the infusion to come to room temperature prior to administration.
o  May store the diluted infusion solution up to 7 hours at room temperature (20°C to 25°C [68°F to 77°F]).
 
Administration: Give via an infusion set containing a 0.22 micron filter. Give over at least 60 minutes. Clinically monitor patients during administration and for at least 1 hour after infusion is complete.
 
Storage: Undiluted vials are to be stored under refrigeration and protected from light.
Once diluted, can be stored for up to 24 hours at refrigerated temperature or at 7 hours at room temperature prior to administration.

[Sedgehammer]

Hang in there Doc. I can only imagine the feeling of being a doc and not being able to do as much as you wish you could. My wife has that feeling at times.