I wonder what Karl Popper would say about the cloth mask debate.
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There are many valid methods to get at these questions. How do you do around my study when you can’t enroll the target beneficiaries in the trial? I don’t think people are fully thinking through the methodological issue at hand here.
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Replying to @zeynep @WesPegden and
You would need to do community level randomization with incidence as the outcome — like test and treat studies for HIV in Sun Saharan Africa, which gets at the treatment as prevention paradigm. They are difficult trials but can be done.
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Replying to @AaronRichterman @zeynep and
The intervention would not be mask / no mask but rather free masks on every corner, mask mandates indoors+/- outdoors, messaging campaigns
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Replying to @AaronRichterman @zeynep and
That said cat out of the bag at this point, and strongest observational evidence comes from hospitals, which went from one of the riskiest settings for transmission to one of the safest, with universal masking. Hard to see that another way.
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Replying to @AaronRichterman @WesPegden and
I had lengthy conversations with people (including who specialize on this kind of thing) on how to try to do a randomized study as early as March. Really couldn’t find a feasible way to do it because of external benefit/source-control issue.
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Replying to @zeynep @AaronRichterman and
Claim that I don’t think we can do a randomized study on because it’s my “pet intervention” is exactly wrong. People want to do randomization because it’s their pet method, but the nature of the question doesn’t allow it. For PPE, yes. Source-control? Show me a feasible design.
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Replying to @zeynep @AaronRichterman and
Hospital data? Yes but that’s confounded by PPE effects. The thing we really want to get at, for which we have much less clinical data, is source control. That said, as I wrote, when you have a well-established mechanism and lab studies, those are just as evidence.
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Replying to @zeynep @WesPegden and
Im not sure what you mean by PPE effects — PPE (aside from masks) used only for care of known COVID patients, who are usually minimally infectious by that point, 7+ days into illness. Hospital transmission was mostly occurring from pre/asymptomatically infected staff and patients
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Replying to @AaronRichterman @zeynep and
numerous substantial hospital outbreaks reported when masks and PPE were used for covid patients, but without universal masking
. Since universal masking, virtually none except in cases of breakdowns, shared eating spaces, etc
https://www.krisp.org.za/news.php?id=421 1 reply 0 retweets 1 like
Yeah. I'd love to see some data also controlling for the massive effort to PPE-up to see if there is a way to get sense of source-control versus PPE. There is some interesting new data from Kansas (post-mandate divergence) that gets at some of this confounding better than most.
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