- Location
- Europe
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NWR new zero tolerance covid thread
- Thread starter Tom Cannavan
- Start date
- Location
- London
@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.
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.
- Location
- London
First of all, thanks for your professional input, Eric (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).
The later part is actually what I tried to say. We actually only need to prove that facemask intervention works.
For the randomised study. Again I am not really in the field; yet I am not quite sure how this cluster randomised method which used in the schooling policy paper could apply to facemask study? (See below)
Can we really, say, randomly get one school wearing facemask, one doesn't? Wouldn't it be breaching ethics a little bit too much? School children would mostly survive, but they have older families.... I mean, if it's doable, has any research team done it? (Maybe I just missed it)
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 (for example: Face masks effectively limit the probability of SARS-CoV-2 transmission - PubMed). We also have some public health studies, as reviewed in the paper mentioned above. I guess it's like a jury panel; some would be well-convinced, some would still want to see more evidence. That's totally fine.
The question is, how certain we need to be, for us to start seeking balance between the benefit and hassle? What happen if we will never know precisely how many lives face mask could save per month, besides knowing there might be some? I have no answer for *you guys.
The reason I say *you guys.... during lockdown I was watching a Taiwanese film, in a scene half of people crossing the road wearing facemask, I was surprised: was this film shot in 2020? I checked, no, it's released in 2018. I forgot this is a normal scene in Taiwan before pandemic. Now it just that they don't need to take it off in a bank anymore! How many lives this Asian habit have saved per year? I don't know. I don't think most of Taiwanese know either. But I wouldn't just say that they are blindly following some misbelief.
- Location
- London
No idea, Gareth, that is what professionals are for.
- Location
- Oxfordshire
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.
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.
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.
One illustrative example. A seminal paper (I think Kumar et al 2005 BMJ, but that's from memory and is back when the BMJ published decent research, which it sadly doesn't anymore) looked at the result of phase 3 trials in oncology over a period of about fifty years. 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. The overall chance of the phase 3 trials being positive was fifty percent. The interventions, which had passed a vast number of hurdles, and which had been thoughtfully designed by world experts in order to do something good, were, when tested in the real world, as likely to harm as to help. Other studies followed showing similar success rates for phase 3 trials in other settings.
"World is crazier and more of it than we think," as the poet said. Expert predictions and lab-based tests are wonderful, useful things, but they're generally wonderful and useful only when used as starting points for figuring out the right things to then go on and subject to randomised tests. When they're used as replacements, they're perilous.
I prefer Eric here, but hopefully we'll meet in person and share a glass of wine some day!
- Location
- London
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.
- Location
- London
I am not suggesting reimposition, just the observation of currently recommended safeguards on the grounds that either one does something or one doesn't. It is not for me to decide when they are no longer necessary any more than it is for you.
I find it very hard to believe that people can make such a fuss about mask wearing. Of course it's tiresome, particularly for we four-eyed gits, but really, who cares about a bit of minor discomfort? it seems banal to me to care about oneself so much.
I find it very hard to believe that people can make such a fuss about mask wearing. Of course it's tiresome, particularly for we four-eyed gits, but really, who cares about a bit of minor discomfort? it seems banal to me to care about oneself so much.
- Location
- London
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?
- Location
- London
I am not taking a position. I'm just saying that while certain precautions are mandated or recommended(as long as one believes that those recommendations are for epidemiological rather than political reasons) they should be observed until they are repealed, particularly when the downsides are so tediously minimal.
- Location
- Deep South of Cambridgeshire
I don't think I have enough data to go on, but intuitively we're around the point now where stricter rules might be considered (I'd use hospitalisation rates, probably - understanding that many of the constraints are not actually covid related). Personally, I'd go more for the european model (essentially vaccine passports) to bully people into being vaccinated (or else face a great deal of inconvenience). I'm not convinced that NZ has it right. It's possible that they've just been kicking the can down the road (although impressively well, it must be said).
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.
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.
- Location
- London
Much too complicated.
- Location
- UK
Gareth I fear that if I answer that honestly I will be blocked by even more people than I already am! I do realise my views on Covid are not shared by the majority here.
I’m fine with that but what I would say is that it’s sometimes difficult for humans to accept there is something beyond our control. I also believe that wider society has become more & more hysterical, and with social media pressure governments have pandered to that in an effort to at least pretend to be in control.
Germany has mask mandates and vaccine passports yet they have just recorded their highest daily case count during the pandemic. I personally think that the only benefit of masks is as a comfort blanket for those who are scared.
The people I feel for the most are the children & teenagers who’ve had a large part of their youth stolen by adults who are consumed by their own fear.
Given the money & resources put into our response to Covid I’m convinced (and I said as much in spring 2020) that we’d have been better off doing our best to protect the vulnerable and let everybody else get on with life. The vaccines may well save or prolong some lives but locking down society until a vaccine arrives is a very dangerous precedent to set. We can’t all get booster jabs 3-4 times a year for the rest of our lives and we will all get Covid at some point (possibly multiple times) anyway now it’s endemic.
So to answer your question, I can’t see hospitals being overwhelmed (any more than they usually are) so I am not in favour of any restrictions either now or in the future.
- Location
- Manchester
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.
New Covid cases are a small but significant part of that problem, but if it is an element that can be reduced in the coming weeks by mask-wearing I am all for it.
In the longer term, as a society we could resource the NHS a great deal better, but that will not help this winter and it is another debate.
- Location
- Colchester
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.
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.
- Location
- London
To answer my own question.
I think at current levels the only restriction in place should be mask wearing in medical settings. 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.
In terms of further restrictions I would only wish to see them reintroduced when the hospital admissions and death rates (and I'd add in the flu death and admission rates onto these figures) are shown to be heading a little way above (maybe 20%?) what we have experienced from the worst winter flu of the last five years. The NHS has been able to manage this, however difficulty, without any public mandated restrictions and I could not under understand why we'd need to mandate restrictions if we were not heading higher than that.
Restrictions should start with the curtailment of social and cultural events and gatherings and only be extended to a full lockdown in the event that the trajectory continues up.
I think at current levels the only restriction in place should be mask wearing in medical settings. 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.
In terms of further restrictions I would only wish to see them reintroduced when the hospital admissions and death rates (and I'd add in the flu death and admission rates onto these figures) are shown to be heading a little way above (maybe 20%?) what we have experienced from the worst winter flu of the last five years. The NHS has been able to manage this, however difficulty, without any public mandated restrictions and I could not under understand why we'd need to mandate restrictions if we were not heading higher than that.
Restrictions should start with the curtailment of social and cultural events and gatherings and only be extended to a full lockdown in the event that the trajectory continues up.
- Location
- London
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.
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- London
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.
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- Colchester
I agree that we should be careful to guard against erosion of liberty. Freedoms we enjoy in the west have been hard won and can easily be taken from us. However I don’t think masks are a sign of that at all. I’m much more worried about Facebook etc taking data and using it and the complete disrespect of democracy check and balances than wearing a mask in a shop to protect the cashier who is on minimum wage and has mouths to feed.
- Location
- Colchester
Total agreement. Crossed posts.
Just need to watch politics.
- Location
- London
My sentence was in the context of facemask intervention policy v.s. facemask itself as a tool, in response to your earlier comment.
Of course "to know if it works" doesn't mean "don't care how much it works". Hence we have all the numbers in that review article.
Maybe something more.
Maybe people have different.... emotional feeling/resistance on facemask. In a country where masked Asian people were shouted at, made mean joke to (I myself, in London underground), or even beaten by random strangers in early 2020, I would say there are irrational something else under rational group estimation.
But no research team have done it. Why not?
Not so certain.
I don't think it's necessary to have that kind of trial. It will tell us more if done (well it has to be approved first), but lab-based data and multiple real-world public health analysis already indicated a rather huge possibility that facemask can reduce infection and hospitalisation, what more this trail can tell us has to be carefully considered. And that's a legit ethical question.
So you have no faith in lab-based data, and you also have no faith in public-health real-world studies...
Anyway I got your point, but I don't think what we discuss here (public health intervention policy) is similar to new drug or vaccine in clinical trail.
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.
While that is a very different thing that lab-based data (with real human) showing droplets and virus particles significantly reduced. It's a rather weird argument to suggest that a facemask which reduce droplets movement in the lab would not do the same in a bus. It's a much straight forward scientific concept, compared to something injected into human body as a "black box".
Hope you can finally make it in one WIMPS!
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- London
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.
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- London
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!
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- London
It seems to me blindingly obvious that where mask wearing is recommended it should be compulsory. It's really not complicated.
FWIW I think it's you promulgating dissenting views here though there's nothing at all wrong with that.
FWIW I think it's you promulgating dissenting views here though there's nothing at all wrong with that.
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- London
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.
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- London
It's the 'unless you want to' which is so hopeless when it comes to public transport, shops and where crowds of people assemble indoors.