- Location
- Europe
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Cluster randomisation would have been a perfectly reliable technique for testing and quantifying a whole host of things, from different mask wearing and track & trace strategies through to approaches to schooling (done successfully here, in fact). Nor is the lack of blinding a problem: it might be that mask-wearing merely helps remind people to do other things, as Tom suggests, but as he also says, that's fine. We don't really want to know the impact of masks so much as the impact of getting people to wear them, which is the actual intervention available.
.....We breach ethics far more often by failing to test hypotheses than we do by testing them. I spend most of my waking life wearing a mask and do so quite happily, but I would very much like to have better data quantifying what impact it has. Should we all wear masks forever in this way to reduce general transmission of respiratory diseases? Quite possibly we should, but I don't see how we can properly decide without reliably quantifying the impact of doing so. Would it save one life a year in the UK (most wouldn't think it worth the societal expense), a hundred (some would, some wouldn't) or a hundred thousand (most everyone would)? It seems too important a question to be decided without good evidence. In the absence of good evidence we can at least fret about not having such evidence, and refrain from too much certainty.
No idea, Gareth, that is what professionals are for.@Thom Blach @Alex Lake @Dom Shepherd @Jeremy Caan @Bryan Collins I’d be really interested in what for you constitutes the circumstances for-
1. a complete lifting of all restrictions
2. The reintroduction of limitations (starting with face masks & increased social distancing, then reduced hospitality, then lockdown to keep things simple).
Specifics would be helpful such as infection rates, hospitalisation rates and death rates.
Ill also have a think and post where I see things. I think they would counter my sense that restrictions just seem never ending and that the sort of invasion of basic freedoms will become a new normal regardless of how the present pandemic pans out.
It would also help us understand more clearly where people are coming from.
I don't think that's true; I think we need some idea of the degree to which it works. Your example about historically different behaviour in Britain and Taiwan is a good one. The difference in behaviour probably isn't because the two groups tolerate different risks of respiratory virus transmission, it's probably because one group estimates masks as being more effective than the other group. The former difference is a subjective one, the latter isn't. If it's the latter, one group is right and the other wrong. It matters to know which. Should we all wear masks forever as we did at the height of the pandemic? I think it's a reasonable question and the answer depends not on knowing whether masks work, but on how much they work, the numbers of lives saved.We actually only need to prove that facemask intervention works.
Absolutely. Just as in the trial I referenced had different schools pursuing different test & isolate strategies.Can we really, say, randomly get one school wearing facemask, one doesn't?
Not at all. Testing a hypothesis when you don't know which strategy is superior isn't a breach of ethics. In that circumstance, it's a breach of ethics not to test. Obviously one needs to pick a trial where there's genuine equipoise, hence my deliberately neutral suggestion of trialling one type of mask against another.Wouldn't it be breaching ethics a little bit too much?
Yes, I think that's the heart of it. I have no faith in lab-based data to predict most outcomes in medicine. There are exceptions, but they're exceptions.I think we have slightly different definition on 'good evidence'. There are some limitations on real-world study, while we have lab-based experiment data
I tend to call people how they call themselves before I was introduced otherwise, so let me know if I should call your another name
It’s just difficult to take objections to restrictions or suggesting that they need reimposing seriously if you don’t have any idea Tom. I mean unless you think that we should keep restrictions or reimpose them due to politeness or for the common good I’m at a loss as to why you want to do what you frequently suggest should be done.No idea, Gareth, that is what professionals are for.
We’re not deciding anything Tom. I’m just trying to understand where people are coming from abs what is driving, has driven, positions taken and comments made. Surely the basis of rational discussion involves at least that to help bridge our understanding?It is not for me to decide when they are no longer necessary any more than it is for you.
Much too complicated.In terms of when we should all stop wearing masks, it should be left to the individuals. I think that I would say that any restaurant or shop should be allowed to insist on its own rules at the moment without fear of being in trouble for discrimination.
@Thom Blach @Alex Lake @Dom Shepherd @Jeremy Caan @Bryan Collins I’d be really interested in what for you constitutes the circumstances for-
1. a complete lifting of all restrictions
2. The reintroduction of limitations (starting with face masks & increased social distancing, then reduced hospitality, then lockdown to keep things simple).
Specifics would be helpful such as infection rates, hospitalisation rates and death rates.
Ill also have a think and post where I see things. I think they would counter my sense that restrictions just seem never ending and that the sort of invasion of basic freedoms will become a new normal regardless of how the present pandemic pans out.
It would also help us understand more clearly where people are coming from.
But they are already under more pressure than ever before. The most clear expression of that is in ambulance wait times, which are not a problem with the ambulances per se so much as upstream congestion in the hospitals.I can’t see hospitals being overwhelmed (any more than they usually are)
Russ I am in total agreement that masks are effective. It would be madness if they were not. What I am more concerned about it the curtailment of personal freedoms and choices in the name of a much lower threshold of risk than for other things that are considered acceptable and publicly allowed. All sorts of things we could do would make us and others safer (not drinking very much, not smoking, not climbing mountains, not driving over 20 miles an hour et al) but they are an acceptable part of every day life and left up to individuals to partake or not.I posted and then linked the guardian article and BMJ study probably because I wanted like Gareth and others to understand how people here feel about the restrictions like mask wearing. So this discussion is very interesting.
To put my point of view, I can’t understand what the problem is with wearing a mask if it helps save lives.
Some people’s problem is that there is no firm evidence of the level of their effectiveness, nor will there be. It can only be a guesstimate of a percentage in an assumed reality. But if one takes the BMJ study at about 50% reduction add in a bit for social distance, then factor in the game changer of the vaccine around 70% effective (depending on jab timing booster etc). Then surely infection will fall. It seems such a small thing to do. Why all the fuss.
I think we can manage the risks to allow social and sporting life to return. Having a more flexible work life must be helpful in other ways too. So public transport is less crowded.
As to when restrictions get imposed or removed. I think if we’re all sensible we can tick along, but fear if everyone just thinks it’s all over we’ll have another hard time through the late winter.
Russ I am in total agreement that masks are effective. It would be madness if they were not. What I am more concerned about it the curtailment of personal freedoms and choices in the name of a much lower threshold of risk than for other things that are considered acceptable and publicly allowed. All sorts of things we could do would make us and others safer (not drinking very much, not smoking, not climbing mountains, not driving over 20 miles an hour et al) but they are an acceptable part of every day life and left up to individuals to partake or not.
My worry is that we are beginning to erode the freedoms we and other generations have enjoyed in the name of mitigating risk. I'm not saying this is a domino effect (i.e. mandating fask masks is something to be opposed at all costs) but it is rather corrosive and indicative of a change in direction. An analogy would be the use of surveillance and identification via video and other means. These of course could, maybe would, reduce the risk of many things but they also for me begin to cross the same sort of threshold around personal freedoms that I am uncomfortable with.
I think at the moment the balance between the freedoms of the individual and their effects upon society re mask wearing should not be dictated by the state and instead left up to the individual to do as they see fit. I do not see in the UK a clear case for the need of face masks nor any other restrictions (except in medical settings as outlined above). Though I can certainly see how that might change.
Total agreement. Crossed posts.I'm having difficulty understanding what's so difficult to understand about the concept of collective action. And as far as erosion of freedoms go, I am far more concerned about the looming Police, Crime, Sentencing and Courts Bill, the Elections Bill and the surge in cronyism than with any temporary measures to mitigate the pandemic.
My sentence was in the context of facemask intervention policy v.s. facemask itself as a tool, in response to your earlier comment.I don't think that's true; I think we need some idea of the degree to which it works.
Maybe something more.Your example about historically different behaviour in Britain and Taiwan is a good one. The difference in behaviour probably isn't because the two groups tolerate different risks of respiratory virus transmission, it's probably because one group estimates masks as being more effective than the other group.
But no research team have done it. Why not?Absolutely. Just as in the trial I referenced had different schools pursuing different test & isolate strategies.
Not at all. Testing a hypothesis when you don't know which strategy is superior isn't a breach of ethics. In that circumstance, it's a breach of ethics not to test. Obviously one needs to pick a trial where there's genuine equipoise, hence my deliberately neutral suggestion of trialling one type of mask against another.
So you have no faith in lab-based data, and you also have no faith in public-health real-world studies...Yes, I think that's the heart of it. I have no faith in lab-based data to predict most outcomes in medicine. There are exceptions, but they're exceptions.
Of course, that's why we need to have phase 3 trial for Covid vaccine and drug. A medicine works in tissue culture or in animal model, of course can generate side effect or not effective in human trail. That's not only possible but happen all the time.....The drugs all had lab-based data showing they were likely to work. Subsequently to that they'd passed phase 1 and 2 trials, showing they appeared to be safe and appeared, in real life, to do what the lab studies had predicted. ....
Hope you can finally make it in one WIMPS!I prefer Eric here, but hopefully we'll meet in person and share a glass of wine some day!
That seems to me to be an utterly hopeless approach, completely lacking in clarity. If one's going to do something one should do it properly.In any other situations it should be up to the individual to take personal responsibility and the government should give clear illustrations of what that might mean.
Well please enlighten us all with your alternative completely hope-filled crystal clear solution Tom instead on constantly dissenting from others views and then saying you don't have an opinion!That seems to me to be an utterly hopeless approach, completely lacking in clarity. If one's going to do something one should do it properly.
How is that different that what I said? It is compulsory in medical settings and optional everywhere else unless you want to. I see no point using the language of recommended for exactly the reason you state.It seems to me blindingly obvious that where mask wearing is recommended it should be compulsory. It's really not complicated.