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Brad Banko, MD, MS's avatar

This is so funny... the survey responses tell you everything you need to know about the population polled.... Do you wear a mask when flying? Will you go out shopping without a mask?

Should have asked "Do you wear a mask when you are driving around alone in your car?"

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Tony Glaves's avatar

Normalizing irrational behavior, of any sort/type, is a bad choice. For my friends/acquaintances who believe in the efficacy of masks/mask mandates (there is none), I might remind them that their embrace of an irrational behavior does, indeed, effective others. That relatively small minority of mask aficionados is one of the primary reasons young kids continued to be masked long after the rest of the country had been liberated.

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Tony Glaves's avatar

You wore goggles?

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Adam Cifu, MD's avatar

...and I looked good!

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KTonCapeCod's avatar

Would you in hindsight, say this was misguided advice/ hysteria?

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Adam Cifu, MD's avatar

Not really. It was a high risk time. I am on immunosuppressive meds (whose risk was not clear at the time) and the mortality for infection in my age group was about 1%. I was fine doing these things to reduce my risk. Now with immunity and basically no risk to me of infection, I woudn't even think of taking these precautions.

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Randy Bickle's avatar

The article was sadly serving the purpose of the STAT editors. The NEJM article on masking in schools in Boston was, to me, more egregious as I now see it quoted in some of the online medical sites. Sadly, the final paragraph of that study says it all about the motivation of the authors which is not really science but social correction. Adam, glad you needed to have one last say on the STAT article as now I feel like I can be like the old monk and let it go.

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Paul Fenyves's avatar

Agree -- frustrating that this article falsely suggests that there is a “zero Covid” consensus among experts. Great essay, old monk!

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Adam Cifu, MD's avatar

I'm taking "old monk" as a compliment.

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Vandan Panchal's avatar

That Volvo part made me chuckle!

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KTonCapeCod's avatar

I chuckled at the goggles :)

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Andrew Heard's avatar

This is just incredibly sad for the people who were interviewed in the article. I don't know how we help people like this.

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Elizabeth Fama's avatar

Adam, these are genuine questions: would you advise a young woman with Polycythemia Vera and Essential Thrombocytosis to wear or not wear a kN95 ("scrupulously," as one comment here noted) to teach college students in a class where she is required to give personal critiques of their work each session (they do not wear masks)? What if she is also eleven weeks pregnant? What about at the grocery store? I'm very interested in answers, but I also want people here to know that "to mask or not to mask" really is a difficult question for some people, and not because they're idiots!

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KTonCapeCod's avatar

And then there are.tgose people who have very low risk...and wear masks. I would be curious what the split is on that? Those people wearing masks are in what "camp" (like the immunocompromised vs the healthy older person). I have a patient who is older but healthy..she said she will never go in public again without a mask. I say, that's a tragedy/side effect of incorrect messaging. To live in constant fear by placing a mask in your otherwise healthy face and telling your subconscious "be afraid" isn't good. Now my friend who is actively in chemo, I get it. I think there are many people in the healthy fearful, I will wear a mask camp because someone told me it would keep me safe. How many people did you see wearing masks prior to this? There were plenty of immunocompromised people prior to this who didn't wear masks and lived with "the risk of life"...and did well....

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Adam Cifu, MD's avatar

You do a good job of pointing out that there are situations where masking is reasonable or, at the very least, situations in which the decision to mask or not is a really difficult one. It sounds like a cop-out but... ask your docs opinion AND as about his or her personal risk tolerance AND on what he or she is basing the recommendation. There are not right or wrong answers here.

Thanks for the really thoughtful response.

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Kayleen Hunsaker Smith's avatar

I agree (as the monk said) that we need to stop carrying things & leave them behind...

BUT many times we NEED to analyze stuff to make sure we are making rational decisions in the future & not just emotionally charged responses...

I just try to make sure that if I get into “looped” thinking that I stop & analyze the reason why, so I can live a life of happiness no matter what!

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George Cartwright's avatar

Hello Adam. I liked your article and agree with most of it. My problem is in parts of British Columbia there is a very high percentage of ethnic population, which remains quite connected to their original country as one would expect. Therefore large numbers continue wearing masks. On the surface, that’s just fine. However, this level of ongoing anxiety propagates anxiety in others and leads to more masking and more demands to mask others and even changed voting patterns. This led to masking while alone in cars, while riding alone on bicycles, etc. Completely anxiety driven stuff that just escalates and escalates. It definitely effected us. It entirely changed how we are forced to interact with neighbors and all regional services. Following vaccination, it has gotten much worse, not better. So, I am now trying to gently NOT accept people masking at this stage. It is time to stop accepting masking as a general attire choice. It has become a security blanket for every age rather than just those under 12.

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Gerard Waters's avatar

Wrong, the virus did not cause millions of people to die .Millions were certified dead related to Covid I know because I have spent 40 years as a GP certifying elderly deaths , very very few died of the coronavirus but of neglect and medical malpractice. We were directed to blame many deaths on C19 on fear of loosing out jobs ,as I did for my refusal to go along with the three card switch or give the mRNA of unknown purpose.

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Ron H's avatar

My wife and I (60, in excellent health) followed masking protocols until ~6 months ago and are fully vaccinated and boosted. We recently both came down with Covid and were absolutely laid out for nearly three weeks (though not hospitalized). I don’t know if our discontinuation of masking in (indoor) public locations led to our infections but we will once again be wearing N95 masks in public spaces through the flu season.

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KTonCapeCod's avatar

Or what if it is that your immune system being fully immunized is less healthy, leading you to a poor response...combined with not being exposed over time to "invaders" because you wore a mask so long? Maybe getting out in the world and getting your immune system back up to speed isn't a bad idea? I had the same response where the 3 times I did not mask in large crowds, got sick, and felt like my immune system went haywire to the exposure, trying to protect me. I no longer mask...I no longer get sick....I don't recall people wearing masks in flu seasons prior to covid? We think it's some magical covering to save us. The magic is in your body and your heart...be in love, connection, sunshine, fun....I wish your immune systems well!

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Larry Hubbard's avatar

Good advice. Let people do what is best for them without judgement. Wear a mask. Fine. Stand 10 ft apart. Fine. I'm going to live my life without irrational fear. Constant fear has a negative impact on your health, sorta like hearing sounds at night and each time believing someone is breaking into your house. Hard to get a good night's sleep.

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Johanna's avatar

Dr. Cifu, I’m grateful for this post – and while I sympathize with your longing to “let go” of the debate, I thank you for caring enough to be bothered. More doctors should be bothered!

A great deal of social harm is being done by the systematic exaggeration of Covid hazards and promotion of inappropriate and damaging “precautions.” Academic medicine at its upper levels should take a great deal of the blame. So should the self-styled “high-quality” and “progressive” media outlets like Stat, the Globe and the NY Times, which pride themselves on targeting the “educated” and “pro-science” reader. (Whew, that’s a lot of air quotes.)

Bottom line: That person out walking their dog in an N95 mask may be a statistical outlier. But they are also likely to be an Influencer with considerable social and political clout.

Deepening political polarization is probably the worst fruit of that influence. At least one academic declined to participate in Stat’s survey, and another asked Stat not to use their name, because they could not handle the vitriol attached to the debate “between the militant zero-Covid crowd and the It’s-Just-A-Cold crowd,” as one put it. The worst of this comes from experts who continue to insist that mask-wearing is a moral obligation to protect others by not transmitting the virus. Similar claims are made for fourth and fifth booster shots. In both cases the evidence is extremely meager and grows thinner by the day. Yet because these claims are felt to encourage “positive” behavior, both experts and sophisticated journalists close their eyes to the lack of evidence.

It's bad enough that the media constantly frame the maintenance of rigid Covid restrictions as science-based, while their relaxation is attributed to emotional frustration, boredom and wishful thinking by an ignorant population eager to be “over it.” What’s worse is that those who object to zero-Covid policies are denounced as selfish monsters who are willing to sacrifice society’s most vulnerable for the sake of mere convenience. This all-too-quickly becomes a political fight: Take off your mask and you’re not only reckless, you’re probably a racist “Trumper” who’s happy to throw the have-nots under the bus.

If increasing numbers of people shut out “public health messaging” of this sort, can anyone be surprised? We are breeding a level of suspicion and resentment of science, medicine and public health that will haunt us for years to come. The era of the Noble Lie – propagation of virtually evidence-free claims about Covid hazards in the interests of Positive Messaging – must end. Highly-placed, politically-connected “experts” have been a huge part of the problem. They need to call a halt and become part of the solution. Thanks again for doing your part.

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Adam Cifu, MD's avatar

Thanks so much for your thoughtful comment.

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Jeff Cunningham's avatar

"We are breeding a level of suspicion and resentment of science, medicine and public health that will haunt us for years to come."

I'd say it's going to take a generation to undo this. The memories are going to have to die out. It is ironic that a friend sent me a book titled, "The Death of Expertise" right at the beginning of the pandemic. In it the author argued that people were being stupid and foolish to not trust those experts who have spent their adult lives becoming such in their fields (his was Sovietology as I recall), and try to instead base policy decisions on their immediate fears and populist ideas. And he had some excellent examples and points. And then my objections were precisely born out by what has happened as the pandemic unfolded.

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Charles Mccarville's avatar

I appreciate your honesty in the footnote shown below, but wow. You wore goggles for a respiratory virus? And was your N-95 fit tested, and did you wear it appropriately? Do you still consider this a good idea?

"I traveled by air throughout 2020 but I wore an N-95 and goggles."

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Adam Cifu, MD's avatar

I now wear nothing outside the hospital (where I still have to mask). Back then, with no immunity and high rates of transmission, I was wearing what we wore in the hospital seeing COVID patients

Yes, my mask was fit tested - though the whole idea that fit testing is some magic process is kind of silly.

Yes, eye protection is part of PPE for respiratory viruses.

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Charles Mccarville's avatar

Thank you for your response.

I’m surprised you describe fit testing as ‘silly’. I’m not an expert in PPE and so defer to those who are, and it seems they find fit testing to be essential. A tiny leak destroys their usefulness.

The fact that you copied what you did in the hospital while traveling, and the fact that hospitals are still requiring masks despite no evidence they work and massive counter evidence they don’t indicates the medical profession is not rational on this subject.

If masks are necessary now then they were necessary previously. The fact that they weren’t is either proof of massive prior incompetence, since there have always been respiratory viruses and alway will be, or irrationality in the present.

Since over a dozen RCTs have been performed that show they don’t work, the medical profession as a whole is irrational regarding masks.

This is destroying trust in the competence of all healthcare workers. Frankly, you all look silly with your worthless masks, how can I trust them with important decisions about my health when they all look like fools?

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GBM's avatar

Let us get over this position that the RCTs show that masks do not work. I am a mask skeptic but the RCTs are very difficult to perform and they can only tell you that the hypothesis of the study -- in this context that masks protect - is supported or not. If not, the conclusion is NOT that it is proven that masks do not work at all! For masks to work, they must be fitted and used scrupulously which no study can fulfill. However, the continued insistence on masking in most clinics and hospital settings is irrational.

The other issue that Adam addresses is the nature of the irrationality of so many fellow citizens, including the experts. I believe that the uncertainty has brought out the presence of a profound inner vulnerability which is common in most human beings. Some of us give into this deep feeling and others put it in perspective. Risk taking is a part of life and we all draw the lines around us. In the past, it was rarely obvious to us how our fellow citizens were drawing the lines. Now it is clearer. We physicians need to remain committed to rational analysis, comparisons based on different models and listening to dissenting voices. The STAT article needs to be used in medical education for years to come.

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Charles Mccarville's avatar

Let us get over the position that RCTs don’t mean anything. Very few things in the world are tested in that way, and even fewer with multiple tests. And none of them show any evidence of effectiveness. None. The topic has been closed for a long time now, and should never have been opened. If the point is that N-95 or equivalent masks have to be fitted and used properly in order to work, that means in the real world they don’t work.

Adam shrugged that part off by saying fit testing is ‘magical’, but the real experts in PPE - who are not doctors - insist on it.

I don’t know why medical professionals keep pretending they know about masks, you don’t know anything but just make stuff up.

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GBM's avatar

Charles, you are right that the medical establishment has embraced the notion that masks are effective in certain situations. In specific hospital locations, there is fairly good evidence that they are. Specifically, standard paper surgical masks prevent infection from surgical wounds in the OR where the environment is under additional careful antiseptic conditions. Does that mean that the same masks worn in the elevators of the same hospitals play a meaningful role in preventing inter-individual contagion? Hardly! N-95 masks when properly fitted and used in defined clinical situations like active pulmonary tuberculosis are demonstrably effective. However, when extended in an uncontrolled manner to travel in an American airport, there is little reason to be so confident.

For narrow clinical questions or new therapies, RCTs are of enormous value. The mRNA vaccines were very effective and safe in the initial phase of COVID-19 when the alpha variant of SARS-CoV-2 was dominant.

Medical professionals can make the argument that although there are no definitive studies, the use of masks in certain clinical situations is reasonable like asking caregivers in the ED to wear masks while influenza, RSV and COViD are active in the community. However, to extend mandatory mask use in dermatology clinic, well child clinics and other venues cannot be justified.

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Charles Mccarville's avatar

Actually there are studies that say masks do more harm than good in medical settings, start here:

"A cluster randomised trial of cloth masks compared with medical masks in healthcare workers”

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4420971/

I really didn’t think it would be necessary to say that we are not discussing masks with respect to tuberculosis.

And let’s not do the ’safe and effective’ song and dance about the genetic covid vaccines. V-safe showed a 30% adverse effects and VAERS started recording deaths from the beginning.

I appreciate your response, and Adam’s, but frankly it seems that you both believe you know far more than you do.

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Jeff Cunningham's avatar

Actually, in fairness to the institutions there is another reason they are irrationally cautious: butt-covering. If a plaintiff's attorney could argue that someone's Mom caught COVID from a healthcare worker in their facility and, say, died, all they have to convince is a jury of their peers to win the megabucks lottery. It's more likely the malpractice insurers driving these decisions.

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Charles Mccarville's avatar

I think that is an important point. Corporations and institutions are responsible for more repression and covid hysteria than government by now. Nobody in the history of the world has been held liable for transmitting a respiratory virus but they still worry about getting sued so they go through the motions of ‘protecting’ us from each other. Maybe they really are that stupid, maybe they are cowards, either way they are wrong.

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Jeff Cunningham's avatar

True. But if the CDC and other "experts" are telling them they should wear masks and they don't, a plaintiff's lawyer is going to have an easy case, first though it may be. All they have to do is pick a jury whose moral foundations rests on the single care/harm pillar of Haidt.

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Charles Mccarville's avatar

I think you’re right, and my description of corporate leaders as either being stupid or cowards leaves out the possibility that they are in fact quite shrewd are taking legal advice that they could be vulnerable.

Btw, ‘The Righteous Mind’ by Haidt is one of those things I’ve read and has stuck with me for a long time.

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Reggie VanderVeen's avatar

This post reminds of what John Droz, Jr. said in September of this year:

"It’s fascinating to see how good people can have diametrically opposite views about the same situation, especially when the facts are largely indisputable. Why don’t the facts determine their response? Because the facts are irrelevant to people with certain world views."

Ain't that the truth!

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