Reason that past clinical studies, focusing on health-care worker outcomes, are not the best indicator is that masks for *source-control* is not an individual level variable. It's like asking if filters on car exhausts lower air pollution by measuring the air ... inside each car.
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Replying to @zeynep @boriquagato
Not sure why you're dismissing lab studies because measuring the filter on that exhaust is one good way to figure out what's going on. But okay, this virus is less well understood than pollution. Look at SARS is best we can do probably.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3322931/ …
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Replying to @zeynep @boriquagato
Strikingly from that study, there is a dose-response effect for the significant protection from masks. Dose-response is a pretty big signal. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3322931/ …pic.twitter.com/Zp9sfzzQ75
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Replying to @zeynep @boriquagato
We outline both the logic and previous existing studies for *source control* here. (Current as of few months ago).https://www.preprints.org/manuscript/202004.0203/v2 …
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Replying to @boriquagato
We didn't have many COVID specific studies at the population level at that paper (next update will include the natural experiment papers.) The reason I posted that is the source-control argument is important to acknowledge. Really changes what study is applicable to this.
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Replying to @zeynep @boriquagato
I mean you find a lot of this. …https://www-sciencedirect-com.libproxy.lib.unc.edu/science/article/pii/S0140673603131686 … Masks work to protect health-care workers. You find those across the board.
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Replying to @boriquagato
Right, and no doubt training+seal is very important for protecting oneself. But let me go here again, source control is different. I think this is my most plain-language analytic argument for why that's so.https://www.theatlantic.com/health/archive/2020/04/dont-wear-mask-yourself/610336/ …
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Replying to @zeynep @boriquagato
The issue here is potentially *infected* person infecting others. So incorrect wear is really not very relevant because the person is already infected. As for outside of mask getting infected? Well, obviously better to have whatever on the outside of mask than on your face!
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Healthcare worker studies were all about correct versus incorrect wear, and unsurprisingly, incorrect wear is less protective for oneself, especially around aerosolizing procedures etc. But here, we're discussing protecting *others* from the wearer. Very neglected area tbh.
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