Advice on mask-wearing to protect against Covid-19

I think this is a misconception of evidence based medicine. The idea of evidence based medicine was to stimulate doctors to get evidence to support their creative ideas. The restrictions from NICE have not always been justified but the aim of the policy was to reduce the amount of hack usage of old treatments that had never been shown to work and new fads set up without proper testing - nothing to do with inhibiting new ideas.

Doctors are always faced with two different sorts of situation - typical ones where guidelines are useful and atypical ones, as for rare diseases like dermatomyositis, where you have to make a judgment about what is likely to help, without formal trials.

The situation at the moment is that medical and scientific personnel are raring to try new things but blocked by an administration that cannot think outside the box. I agree that there is culture problem, but an administrative culture problem, nothing to do with evidence-based medicine.

 

That may be so, but in a situation like this, we don't really have the luxury of time, to conduct a study on the efficacy of surgical masks specifically for coronavirus.

It costs nothing to instruct the populace to cover their faces with cloth or improvised masks, as the US finally did yesterday. It requires no planning, no government organization, and takes up no national resources. You just have to announce it, and the public will follow it.

So it's a no brainer. Yet surprisingly nobody has had the brains to think of this in the West until now.

If you specifically ask people not to buy masks, but to improvise their own, it hopefully will not cause a mask shortage for frontline medics. This is a good study about which materials are best used to make an improvised mask (it concludes cotton T-shirt material or old pillowcases are best).

But in the longer term, I think we need our politicians to get industry to ramp up mask production so that everyone is well supplied with masks. Just as they did in Taiwan, where they had the foresight to see this pandemic coming.

 

I gave the bouncing bomb as an example of lateral thinking, creativity and the willingness to try out an idea when it looks like there's a reasonable chance it might work.

Whether it was ultimately a military success is not so important: many ideas tried out in WW2 were failures, and others were resounding successes. You don't know beforehand whether an idea on the drawing board will pan out, which is why many different ideas are tested out. In order to achieve some successes, you have to accept there are going to be failures.

 

Great article!

 

Possibly the topic for another thread, but how would change the administrative culture of the NHS to allow these guys raring to try new things some free rein?

 

My sister in law works in Walmart (very big box store in the US that sells everything for the home, perhaps a bit like ASDA but less focus on fresh food). She sent pictures yesterday of the sewing isle. No cloth material left and no elastic. Looks like a lot of people are trying to make masks.

 

Easy, you just provide adequate funding. Something closer to Germany.

The administrative culture arises from penny-pinching - to the extent that by far the largest waste of money in the NHS is paying people to penny-pinch. A large proportion of GP salaries go on using GPs to prevent people getting to see competent specialists - which they will need to see later when they are even more ill.

 

@Hip entirely reasonable response; I wasn't sure when I read your reply, I thought you might just be playing with us! No offence intended.

I think there are plenty of proven strategies; however, we don't have antigen/PCR testing to identify infected people --- possibly more worrying the Government doesn't have plans to deliver it either!

@Jonathan Edwards has suggested a community based strategy e.g. to try to figure out where to shop (where not to) and who has the virus --- who we could possibly help by dropping off groceries, medicines etc. Here's an extract from Anthony Costello's article, published in the Guardian, which seems to be on the same lines*. Any other advice on community based strategies welcome.

Hard to believe that we are accepting that we have to get by without central Government - seems almost post-apocalyptic!



*"But it isn’t too late. To prevent the spread of coronavirus, we need a change of direction. Local authorities must take control of their public-health outbreak management teams. We need a centralised app and database to allow citizens to report their symptoms, such as the NHSX app that researchers have been working on since January.

GP networks, working with teams of trained volunteers and retired health workers equipped with personal protective equipment, could visit everyone reporting suspicious symptoms at home every one to two days. If there is testing, all the better. But symptom-based reporting will do. With a proper community protection scheme in place, local authorities could shield their population from the threat of the virus, which has taken hold in hotspots like London and the cities of the Midlands and north west."

[https://www.theguardian.com/comment...herd-immunity-community-surveillance-covid-19]

 

They might be selling out of padded bras soon too. You can make 2 masks out of one.

 

Yea I wondered about doing that i.e. heating in an oven.

 

I think some of the medical scientists in labs are doing very well in their response to the pandemic. I was watching a news article about a company rushing to make a vaccine, and they are coming up with all sorts of innovative ideas to speed up the vaccine creation process. So no lack of creativity there.

Plus companies everywhere are rushing to create cheap coronavirus tests. I have not been following this in detail, but it seems that people are working hard on this all around the world. So that's good.


But on the basics of prevention of viral transmission, I don't see many good ideas emerging in that area. I think the WHO made a mistake with their doctrine that masks or face coverings do not help prevent transmission in the populace. That's definitely a bad start.

And then people talk about the shortcoming of face masks, such as if they are not used properly, then they may be less effective. But I don't see anyone trying to rapidly innovate new mask designs or face covering designs which might be more effective when used by the general public.

And there are other means that can help reduce transmission: one study published 2 April 2020 suggested that a nasal spray and mouth gargle with 0.5% povidone-iodine will provide 3 hours protection against the virus. Povidone-iodine absorbs into the mucous membranes and has an antiviral effect in that area (this is the area the virus often lands on and tries to set up an infection).

In fact a month ago on PR, we were already discussing the existing published evidence that povidone-iodine gargles reduce the chances of catching a respiratory viral infection.

And at least two supplements that I am aware of are demonstrated in studies to reduce the chances of catching a cold by a factor of 2, when a person is exposed to a cold virus. Remember that coronavirus is a cold virus, so it is likely these supplements would also work for SARS-CoV-2. Presumably taking both supplements together might reduce the risk of catching coronavirus by a factor of 4, which is a substantial number.

So there are a lot of creative ideas that could be tried out, and if used together, could dramatically lower the transmission of coronavirus to the point that the pandemic dies out.

 

@Hip thanks for the post

@Jonathan Edwards advice "I cannot see that it can be worse than no mask. I am using a scarf, bandit style."
"in towns I think everyone should be wearing a mask if within ten yards of others".
I'm with you on masks and so are many others --- South Korea ---

We might get surgical masks at some stage. At the moment I have a balaclava with a lump of vacuum cleaner filter for my rare visits to the supermarket --- every 5 days or so. Washing the packaging on perishables, with dilute bleach, before refrigerating; leaving non-perishable food for 3 days in the car -- then wash/blanch/---. Shower and wash clothes immediately you get back from the shops --

I went to the shops 3 days ago and now I've just developed a slight cough --- more importantly my wife has limited lung capacity. Regretting I sold the old caravan, I could have stayed in the drive!

There's a limit to what you can do to minimise risk --- 5 days between shopping trips and no trips to public parks/public areas. Try not to touch surfaces touched by others --- petrol pumps ---

Might try to get grocery shopping via volunteers - or volunteer to help/share with neighbours-- reduce visits to supermarkets!

Anthony Costello doesn't seem to be hopeful that we will see a vaccine soon*. From memory Ian Lipkin was talking 18 months (recent interview --- check for "Lipkin" here and you'll find the link).

Good luck in avoiding this!

*https://www.theguardian.com/comment...herd-immunity-community-surveillance-covid-19

 

There's no clinical trial evidence in that particular paper, but one of the studies we were discussing a while ago is about the efficacy of a povidone-iodine iodine gargling trial in a school, to see if it would reduce absenteeism due to colds. It did, but not to any amazing degree: the absence rate at schools due to illness changed from about 26% to 20% after gargling.

Though the 2 April paper goes further, and suggests povidone-iodine nasal sprays as well as gargling, which may then protect both the nasal and oral mucous membranes. So that should have increased efficacy compared to gargling alone.

If you look at other literature, it says the antimicrobial effects of povidone-iodine on the skin last for 4 to 8 hours. So I expect that's where they got their 3 hour figure; though mucous membranes are not the same as skin.

Povidone-iodine gargling is common in Japan to help prevent respiratory infections, so possibly there may be further studies from Japan.



Every effort to get the basic reproduction number (BRN) to below 1 is worth it, because when the BRN is less than 1, the pandemic dies out.

 

Yea there was talk that some antivirals may be more likely to be delivered in the short term. @Hip
Can't remember if Ian Lipkin covered antivirals in his recent talk but I guess he did.

Good luck with the other half of your post!

 

To try to provide some humour, in a kafkaesk/Myles na Gopaleen sense (not sure why). In Germany, in response to the threat of a influenza pandemic causing significant mortality, they set up a network of laboratories to provide sufficient diagnostic testing. This was around the time of the "bird flue (H5N1) pandemic"* i.e. a virus transmitted from chickens to people which killed a number of people in Asia. In the UK they took a different approach; one of the "measures" they introduced was special planning permission to build a bird shed**. Why? Well, the "logic" appears to have been that wild birds are a reservoir for H5N1 and your free range poultry could catch H5N1 (from the wild birds) and transmit it to humans. OK, so the mitigation was to build a bird house to house your free range chickens so that there was less risk that they would catch H5N1 and transmit it to people. Presumably it was cheaper than provide a laboratory network but, in hindsight, which would you rather have --- diagnostic testing --- or permission to build a bird shed?
Can you imagine the round table --- EU member states outlining the measures they propose to take to control H5N1 --- Germany: an expanded network of laboratory testing to identify cases and --- UK: planning permission to house outdoor poultry during the pandemic ---

*https://www.theguardian.com/world/2005/sep/30/birdflu.jamessturcke

**Google something like "Planning + Avian Influenza + order + 2008" and you'll find the legislation

 

Agree. Start producing more petite A-B cup sizes

 

The useful Worldometers website graphically demonstrates the dramatic power of universal wearing of surgical masks to slow down the pandemic:

Countries where the populace are not generally wearing masks:

• UK Coronavirus Worldometers — Deaths: 4,934
• France Coronavirus Worldometers — Deaths: 7,560
• Germany Coronavirus Worldometers — Deaths: 1,479
• Italy Coronavirus Worldometers — Deaths: 15,362

Countries where the populace nearly all wear masks:

• Taiwan Coronavirus Worldometers — Deaths: 5
• Hong Kong Coronavirus Worldometers — Deaths: 4
• Japan Coronavirus Worldometers — Deaths: 77
• South Korea Coronavirus Worldometers — Deaths: 183

On 15 Feb 2020, all the above countries had approximately the same number of people positive for coronavirus (in the order of 10 people test positive). So everyone started off the same.

But as it stands today, there is a dramatic difference of about 100-fold in the number of deaths in countries where the public are not generally wearing masks, and the countries where nearly everyone wears a mask.



In Taiwan, they have not even instituted any lockdown, which makes their low number of deaths even more remarkable.

This suggests masks can dramatically slow the pandemic.



These incompetent experts who advised the World Health Organisation that face masks are not necessary for the populace have probably caused the deaths of tens of thousands of people so far.

Advisors to the WHO include institutions from the UK, such as the London School of Hygiene & Tropical Medicine.

This Guardian article says: