Uptick in COVID-19 infections is seasonal, will drop in February

[reader]

From Thai PBS World

The current increase in COVID-19 infections is seasonal, like other respiratory diseases, and will continue until the end of January, returning to normal between February and May, according to Dr. Yong Poovorawan, head of the Centre of Excellence in Clinical Virology at the Faculty of Medicine of Chulalongkorn University.

He added that a new wave of infections will begin in June and last until September, dropping again by November.

Like many respiratory conditions, such as flu, COVID tends to peak during the rainy season.

COVID-19 infections are entering their fourth year and Dr. Yong said that the severity of the disease has declined substantially, even though the virus continues to mutate, such as the XBB sub-variants. The symptoms are less serious, except for those suffering from underlying diseases. These people should take special care, including the wearing of face masks and regular hand washing.

[unicorn]

On 12/16/2023 at 3:19 AM, reader said:

... for those suffering from underlying diseases. These people should take special care, including the wearing of face masks and regular hand washing.

The latest research from late 2022 and 2023 has shown that masks do not provide significant protection from infection. I posted a link to the latest research in another string:

It has also been known for a longer period of time that this virus is not transmitted from surfaces, so hand-washing also does not seem to provide protection from respiratory viruses either. The two interventions which appear to offer good protection and (1) good ventilation/air exchange (indoor locations), and, of course (2) vaccination. The effective air exchange in most modern airplanes explains why we weren't hearing about outbreaks from plane flights (although planes obviously hold many people in very close quarters). Hopefully, cruise ship companies are also getting the message regarding the importance of effective ventilation. It is extremely rare for vaccinated individuals to get seriously ill (unless severely immunocompromised). 

[floridarob]

42 minutes ago, unicorn said:

hand-washing also does not seem to provide protection from respiratory viruses either.

However, it does from so many other things, Norovirus for example, handwashing is a good habit to get into, anti-bacterial gel and other stuff like that, contributes to antibacterial resistance  .

Not touching your nose/mouth with your hands is a huge transmitter of germs....try to keep track how often you do that subconsciously in 30 minutes, then imagine a day.

And lets not forgot all of Olddaddy's health worries/problems with all the cocks he was sucking all over Asia 😲

 

[vinapu]

46 minutes ago, floridarob said:

And lets not forgot all of Olddaddy's health worries/problems with all the cocks he was sucking all over Asia 😲

 

But he overcome his problems and is getting ready for another round of debauchery in SE Asia

[Travelingguy]

Studies prior to the pandemic argued that flu and other respiratory viruses could not be prevented by masking.  So that was the default belief prior to Covid.

These studies now arguing that masks don’t prevent the spread of viruses don’t seem to address what happened during the first winter of the pandemic.  There was no flu. That was true all around the planet.  Previous studies had shown that masks did not help prevent getting the flu, but all those studies were probably confounded by people not religiously wearing masks.  The pandemic showed that we could stop flu, which would have been hard to imagine previously.

Also, once the pandemic really got going and hospital personnel got very good about N95 masks and avoiding exposures, very few doctors or nurses who worked with Covid patients every day were getting infected.  I am not talking about medical personnel who had already been infected and had immunity.  

So, based on what happened during the pandemic, I find these studies arguing the ineffectiveness of masking as not addressing the elephant in the room. Masks and social distancing literally gave us a flu free winter.  First one in my lifetime.

[unicorn]

2 hours ago, Travelingguy said:

...These studies now arguing that masks don’t prevent the spread of viruses don’t seem to address what happened during the first winter of the pandemic...

Studies don't "argue." They present factual data. We do not learn the truth by arguing. We learn the truth from scientific studies. We didn't know it at the time, but the effective intervention was the lockdowns. People worked from home. Restaurants, bars, theaters, subways, busses, and discos were closed. I worked at a primary care physician in 2020, and even the medical offices were mostly closed. Most of the visits were telehealth from the physicians' homes. We would come in for only a day or two per week, and only saw patients without coughs (patients were screened outdoors for their reason for visit, and if they had respiratory symptoms which weren't chronic, they were seen outside, usually by the younger physicians). When I first started seeing patients, and it was believed to be transmitted via surfaces, we wiped every surface, from phone, computer keyboard, door handles, etc., with disinfectant wipes, and wore gloves. As soon as the studies came out which showed the virus wasn't transmitted via surfaces, I stopped the disinfectant wipes, as did most of my colleagues. 

Yes, I also rigorously wore masks at the time (even with a face shield!), since the best knowledge of the time was that they'd be effective (they filtered droplets in lab studies). The recently-published studies had observers to verify masking compliance. In addition, some of the studies were done in medical settings, and the results have always come the same: no significant difference. In fact, the researchers doing the studies wanted to find a difference, so they were careful to ensure compliance. I certainly wish masks would help, but the issue has been carefully examined by multiple groups of scientists around the globe, and the results have been consistent. If any good came out of the pandemic, it was that methods of transmission prevention were rigorously studies, and we now know mostly what works and what doesn't. 

[unicorn]

4 hours ago, floridarob said:

However, it does from so many other things, Norovirus for example, handwashing is a good habit to get into, anti-bacterial gel and other stuff like that, contributes to antibacterial resistance...

Yes, of course, no one is suggesting that we shouldn't wash our hands. Many illnesses, such as norovirus and Hepatitis A, almost certainly seem to be spread at least in part by poor hand hygiene. Even then, norovirus is so contagious that it can be transmitted by inhalation as well (it's the most contagious agent known to man). 

https://www.cdc.gov/mmwr/volumes/68/wr/mm6828a2.htm

"...Transmission occurs through several different routes, and multiple transmission routes can coexist during norovirus outbreaks (6,7). In addition to foodborne and direct person-to-person spread, transmission can also occur through ingestion of aerosolized particles and through contact with contaminated environmental surfaces, which are believed to harbor the virus and play a role in sustaining outbreaks...".

[alvnv]

6 hours ago, unicorn said:

Restaurants, bars, theaters, subways, busses, and discos were closed. I worked at a primary care physician in 2020, and even the medical offices were mostly closed. Most of the visits were telehealth from the physicians' homes. We would come in for only a day or two per week, and only saw patients without coughs (patients were screened outdoors for their reason for visit, and if they had respiratory symptoms which weren't chronic, they were seen outside, usually by the younger physicians).

Meanwhile, hospitals were getting killed (pardon my poor choice of words): back-to-back shifts, no days off, lack of PPE, especially in the early days. I cannot fathom how anybody could justify the handling of Covid-19 by that orange asshole, starting from the Fall of 2019.

 

6 hours ago, unicorn said:

Yes, of course, no one is suggesting that we shouldn't wash our hands. Many illnesses, such as norovirus and Hepatitis A, almost certainly seem to be spread at least in part by poor hand hygiene.

Hand hygiene continues to be the best prevention to limit nosocomial infections

[Travelingguy]

I do not have much confidence in these studies, but you seem to have a great deal of confidence in them.  So, the next time a covid patient comes into the ED and is sick enough to need intubation (yes, that is still happening from time to time), you would be comfortable intubating them without an N95 mask?  I don’t know any ER doctors who would be willing to do that.

[vinapu]

8 hours ago, unicorn said:

and we now know mostly what works and what doesn't. 

until next pandemic when we will start it in panic all over again as  decision makers will be coving to prevailing public mood , not scientific findings. 

[unicorn]

2 hours ago, Travelingguy said:

I do not have much confidence in these studies...

Well, the confidence intervals in these studies were reported and combined:

"...Wearing masks in the community probably makes little or no difference to the outcome of influenza‐like illness (ILI)/COVID‐19 like illness compared to not wearing masks (risk ratio (RR) 0.95, 95% confidence interval (CI) 0.84 to 1.09; 9 trials, 276,917 participants; moderate‐certainty evidence. Wearing masks in the community probably makes little or no difference to the outcome of laboratory‐confirmed influenza/SARS‐CoV‐2 compared to not wearing masks (RR 1.01, 95% CI 0.72 to 1.42; 6 trials, 13,919 participants; moderate‐certainty evidence)...".

So it is possible that wearing masks is slightly beneficial--or slightly harmful. If so, however, any effect is almost certainly quite small. I'm sure that most ER physicians try to follow their hospitals' guidelines when intubating patients when practical (more likely done by paramedics prior to arrival). Covid patients don't require intubation these days, so hopefully any healthcare professional would assume something else is going on. Regardless, what an ER physician might or might not do in any given situation is obviously not evidence of anything, and certainly does not invalidate scientific investigation. To suggest otherwise is silly at best--perhaps rather childish. 

Of course, there will always be those who feel that their personal beliefs or intuition can invalidate scientific study. One of my cousins in Europe is a bit nutty and has been a lifelong anti-vaxxer. She was even able to convince an unscrupulous pediatrician to falsify her daughter's records to indicate that the daughter was vaccinated. That (wiser) daughter not only got all of her vaccines when she turned 18, but also became a physician. In the late Spring of 2021, the daughter got a call from her mother's hospital requesting permission to take her (unvaccinated) mother off of life support following a battle with the virus, believing further care was futile. The daughter requested they keep her on life support until she was able to come in and say her goodbyes. During that delay, the mother came to, and was eventually able to be weaned off the ventilator, although her lungs are permanently damaged, and she's hooked up to oxygen for the rest of her life.

It may come as little surprise to many that this cousin is still clinging to her anti-vax beliefs, despite overwhelming evidence of the stupidity of that belief staring at her in the face. Likewise, there will always be those who believe masks will protect them, irrespective of the number of studies done and the accumulation of evidence. Many people simply lack the ability to re-evaluate their beliefs in the face of new evidence. Quite a few people, in fact: it's amazing to witness all of the people who believe Trump is merely being persecuted despite almost countless indictments from various courtrooms around the US. 

[10tazione]

Authors' conclusions

[...]

There is uncertainty about the effects of face masks. The low to moderate certainty of evidence means our confidence in the effect estimate is limited, and that the true effect may be different from the observed estimate of the effect.

[...]

There is a need for large, well‐designed RCTs addressing the effectiveness of many of these interventions in multiple settings and populations, as well as the impact of adherence on effectiveness, especially in those most at risk of ARIs. 

[Travelingguy]

You present these studies as somehow definitive to the question, but the authors of the studies themselves do not support your confidence.  They report having low to moderate confidence in the results of their study based on the weaknesses that they identified in their study with regard to compliance with masking and handwashing.

 

[unicorn]

11 minutes ago, Travelingguy said:

You present these studies as somehow definitive to the question, but the authors of the studies themselves do not support your confidence.  They report having low to moderate confidence in the results of their study based on the weaknesses that they identified in their study with regard to compliance with masking and handwashing.

Each individual study may have low to moderate certainty, but the Cochrane report combines all of the (many) studies, to greatly increase the certainty. While it is true that even larger studies could show an effect (one way or the other), what seems fairly certain at this point is that if there is an effect, that effect is small. It would be foolish to have faith in masking for providing protection from either influenza or SARS-CoV2. At this point, efforts should be directed towards providing better ventilation in public facilities, and vaccination. 

[Travelingguy]

The authors said they had low to moderate confidence in their results from the Cochrane study, not the individual studies.

Like I had said, originally, the standard view prior to Covid was that masks were not effective in preventing viral infections.  Many of these studies in the Cochrane analysis are pre Covid and during non epidemic flu where the people being studied were unlikely to be worried about dying of flu.  

However, I worked in an ED with sick Covid patients throughout the pandemic. We weren’t turning people away or having them seen by younger staff outside. We were intubating patients as well as doing other procedures on them. People were dying around us.  My partners and I were extremely diligent about masking.  I wore an N95 from before I entered the hospital to the time I left without ever taking it off.  I did not eat or drink inside the hospital. Most of my partners did the same. We literally left the building if we needed to eat or drink.  We did not start getting sick until the end of the Covid pandemic despite taking care of people from day one. Many of us got sick after our kids got sick. My personal Covid infection did not occur from the hospital, since I had been off for a while when I got sick and that was more than 2 years into the pandemic.  

You can discount my experience as anecdotal, but my experience with Covid and the risk of contracting a deadly disease with people dying around you every day gave me an insight into what real compliance with masking looks like.  I would disregard any of these studies pre Covid because there was no real fear of dying.  I also doubt that there were many high quality studies of masking being done during the deadliest parts of the pandemic, since the focus was on patient care and keeping anyone that did not need to be around these patients out of the hospital.  

But for all of us who took care of these patients for years without getting sick with one of the most infectious agents that humans have been exposed to is not due to luck.  We took care of these patients for many months before the first vaccine. If masks were completely ineffective, we should all have gotten sick, yet only 1 or 2 of my partners got sick in the first year or so of the pandemic.  

When looking at a study, you have to look at the weaknesses and limits of the study.   Also, if you have insight into the question being studied, you can rightly apply skepticism to conclusions based on your experience and your knowledge of what masking diligently involves.

[unicorn]

21 minutes ago, Travelingguy said:

... My personal Covid infection did not occur from the hospital, since I had been off for a while when I got sick and that was more than 2 years into the pandemic.  

You can discount my experience as anecdotal...

Well, I applaud you for your service. Certainly things were diciest for those providing inpatient services (including ER and ICU), and knowledge at the time was lacking. I'm sure you're aware that anecdotes are the very weakest form of evidence, if they can be considered evidence at all. It has been well-documented that over time, as the virus mutated back towards its wild (original) form, it became more contagious and less virulent (deadly). This is because the virus again started latching onto the upper respiratory areas instead of the lungs, making it easier to spread but less deadly. Also, hospitals are designed to provide efficient air exchange, especially in ER's and ICU's. It's therefore little surprise that as schools and other facilities started opening up, and the virus became more contagious, that your kids were the ones to be the first to pass it along to you. 

https://www.cdc.gov/mmwr/volumes/71/wr/mm7104e4.htm

I hope that as a physician you base your treatment decisions based on the latest science, and not on your personal feelings based on your own experiences. Your personal experiences and feelings in this matter are a good example as to why, hopefully, medicine advances on the basis of scientific study rather than on individual anecdotes and "opinions." 

[Latbear4blk]

Are there any studies that, rather than suggesting uncertainty about the effectiveness of masks, definitively claim their ineffectiveness?

[Travelingguy]

Weak study with low to moderate confidence in the results that runs contrary to my experience in an ongoing life threatening situation.  You would argue to accept these studies whole heartedly and suggest that I am taking the less scientific approach.  I think that I have more trust in my N95 mask than your analysis of these studies which is way more bullish than the actual authors.

[unicorn]

1 hour ago, Latbear4blk said:

Are there any studies that, rather than suggesting uncertainty about the effectiveness of masks, definitively claim their ineffectiveness?

One can never prove that the difference is zero. With a large enough study, one could document a very small difference. What the studies can and do show is a 95% confidence interval, documenting that if there is a difference (might go either way), it is a small one (95% confidence interval (CI) 0.84 to 1.09; 9 trials, 276,917 participants; moderate‐certainty evidence). Since the studies, when combined, involve over 200,000 people, and the results are very close to zero difference, they do show that a truly significant difference is highly unlikely. What seems especially unlikely is that N95's are superior to surgical masks, as those studies were mostly done in medical, highly controlled settings. Obviously, preferred goal of researchers is to show that an intervention demonstrates an improvement. Fortunately, most researchers will publish results even when the results aren't what they'd hoped. 

(From the original post):

"Four studies were in healthcare workers, and one small study was in the community. Compared with wearing medical or surgical masks, wearing N95/P2 respirators probably makes little to no difference in how many people have confirmed flu (5 studies; 8407 people); and may make little to no difference in how many people catch a flu-like illness (5 studies; 8407 people), or respiratory illness (3 studies; 7799 people)...".

Of course, there will always be some people, including, unfortunately, physicians, who will be guided by their intuition and personal experiences rather than by careful study. 

[10tazione]

I will try one last time.

From https://www.cochrane.org/news/statement-physical-interventions-interrupt-or-reduce-spread-respiratory-viruses-review

The Cochrane Review 'Physical interventions to interrupt or reduce the spread of respiratory viruses' was published in January 2023 and has been widely misinterpreted.

Karla Soares-Weiser, Editor-in-Chief of the Cochrane Library, has responded on behalf of Cochrane:

Many commentators have claimed that a recently-updated Cochrane Review shows that 'masks don't work', which is an inaccurate and misleading interpretation.

It would be accurate to say that the review examined whether interventions to promote mask wearing help to slow the spread of respiratory viruses, and that the results were inconclusive. Given the limitations in the primary evidence, the review is not able to address the question of whether mask-wearing itself reduces people's risk of contracting or spreading respiratory viruses. 

[...]

 

[unicorn]

12 hours ago, 10tazione said:

I will try one last time...

Karla Soares-Weiser, Editor-in-Chief of the Cochrane Library, has responded on behalf of Cochrane:

Many commentators have claimed that a recently-updated Cochrane Review shows that 'masks don't work', which is an inaccurate and misleading interpretation...

 the review is not able to address the question of whether mask-wearing itself reduces people's risk of contracting or spreading respiratory viruses. 

Well, of course it would always be correct to say that it hasn't been proven that masks have NO effect. No researcher or health care professional would ever make a blanket statement such as "Masks don't work." Do you think any scientist would say "My study shows masks don't work!"?  One cannot prove a negative. There has been a fairly large number of studies done under controlled conditions, however, and they all come to a similar conclusion. What can be stated, with a high degree of confidence, is that if there is any effect, that effect is small (since the confidence intervals of the relative risks are generally near 1, the effect might be that masking increases risk of infection).

Most certainly, unless there are real-life randomized controlled trials of which I'm unaware, what can be unequivocally stated is that studies so far have shown no evidence of a protective effect of masking. It's interesting that for the last year, there don't seem to be more studies on this matter. I suspect it may be because most people in this field consider the matter settled (that any effect, if present, is too small to be considered helpful), or maybe because no one wants to fund such further research. To summarize:

(1) No real-life study has suggested masking has ANY efficacy at reducing spread of either influenza or SARS-CoV2.

(2) No study has or ever will prove that masking has no effect on transmission.

(3) When combining the multiple randomized controlled trials which have examined the effect of masking, either with surgical masks or N95's, one can say with 95% confidence that any effect either way is small (if present). This is the language of science. 

[Lucky]

If I am on a crowded flight and someone around me is coughing, I will put a mask on. I've seen some pretty sick people on planes. If it helps, fine. If not, I had the comfort of feeling like I was doing something to stay healthy. I just bought a new box of them...much cheaper these days!

I do notice an increase in mask wearing locally, especially in medical settings.

[10tazione]

How could they conclude that masks don't work, if that wasn't even the topic of the analisis???
The metaanalisis was about "mask wearing interventions".

For example one study from Bangladesh:
https://www.science.org/doi/10.1126/science.abi9069

"We cross-randomized mask promotion strategies at the village and household level, including cloth versus surgical masks. All intervention arms received free masks, information on the importance of masking, role modeling by community leaders, and in-person reminders for 8 weeks. The control group did not receive any interventions."

"Mask-wearing and distancing were assessed through direct observation at least weekly at mosques, markets, the main entrance roads to villages, and tea stalls."

From this to "masks dont work" (for an individual wearing the mask properly) there is a very long way.

[unicorn]

4 hours ago, Lucky said:

If I am on a crowded flight and someone around me is coughing, I will put a mask on. I've seen some pretty sick people on planes. If it helps, fine. If not, I had the comfort of feeling like I was doing something to stay healthy....

If it makes you feel better, that's wonderful. Some people get comfort from rosary beads or prayer. I'm sure you understand that this is not evidence of efficacy. 

[unicorn]

58 minutes ago, 10tazione said:

...For example one study from Bangladesh:
https://www.science.org/doi/10.1126/science.abi9069

....

If you're going to quote a study, it would be wise to read it. First of all, there were interventions other than mask-wearing between the two communities (i.e. distancing). However, even if we were to incorrectly assume that masking was the only intervention, the experimental group showed only a 9.5% drop in transmission, with a 95% confidence interval which approached unity. Even with that (again, incorrect) assumption, few people would say that an efficacy of less than 1 in 10 is significant. Randomized clinical trials, especially in healthcare settings, in which only one variable is changed are more instructive. And meta-analyses (joining together) of these RCT's even more instructive.