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COVID Gains After Mask Rules Dropped


Lucky

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14 minutes ago, Unicorn said:

The other obvious, and more accurate, explanation is that, given that the statistics measures any death from someone who tests positive rather than someone who dies due to the virus, those who died with the virus die mostly for other reasons. Despite very high "case" numbers, deaths have stayed very low in the US. Current 7-day average is 308:

Covid-Deaths042922

People who die BECAUSE OF the virus almost always spend some time in the ICU, because the cause of death is usually pulmonary, and this necessitates going on a ventilator. Yet the ICU rate of hospitalization has been close to zero (the ICU line is the dark blue line):

Covid-Hospns042922

 

We all know for a fact that immunizations offer substantial protection from the virus. The fact that the deaths are becoming unrelated to immunization status shows two things: (1) many unvaccinated have immunity from infection, and (2) deaths with the virus are not due TO the virus. 

 

Even at that "low" rate, that's double the number of people killed in car accidents in the US. And those are deaths that otherwise wouldn't have happened absent the Covid pandemic. Still tragic, just as each car fatality is.

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On 4/29/2022 at 2:32 PM, Unicorn said:

I really hope they're doing that or will be doing that. Some people don't seem to understand that over-reacting, or acting out of fear rather than science, carries not only economic and mental health adverse effects, but physical health adverse effects as well. 

Especially true of the polio scare  before a medical breakthrough.

Even worse scare in Summer.

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9 hours ago, Unicorn said:

The other obvious, and more accurate, explanation is that, given that the statistics measures any death from someone who tests positive rather than someone who dies due to the virus, those who died with the virus die mostly for other reasons. Despite very high "case" numbers, deaths have stayed very low in the US. Current 7-day average is 308:

Covid-Deaths042922

People who die BECAUSE OF the virus almost always spend some time in the ICU, because the cause of death is usually pulmonary, and this necessitates going on a ventilator. Yet the ICU rate of hospitalization has been close to zero (the ICU line is the dark blue line):

Covid-Hospns042922

 

We all know for a fact that immunizations offer substantial protection from the virus. The fact that the deaths are becoming unrelated to immunization status shows two things: (1) many unvaccinated have immunity from infection, and (2) deaths with the virus are not due TO the virus. 

 

I get annoyed when they lump all the "with Covid" deaths in with the "because of Covid" deaths.  If hospitals need to track "with Covid" for whatever reason, so be it, but why make that data public?  I wish they published only "because of Covid" deaths because as a matter of public health that's the number that concerns us laypeople.

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2 hours ago, BSR said:

I get annoyed when they lump all the "with Covid" deaths in with the "because of Covid" deaths.

@Unicorn would be better able to comment than I, but I suspect it's not as simple as that, and that there is a grey zone between the two. Some would likely be clear, say a serious injury or a major cardiac event or stroke. Any interaction between those and Covid is less likely.

In other cases there could be an interaction. For patients with one of the oft-cited underlying conditions that they had been living with successfully for some time, if Covid is an added factor, which of them is the cause? They may not have died of Covid absent the other condition, but the other condition may not have been fatal if Covid had not come along. What to put on the death certificate?

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Here’s another go at a post I just deleted:

I believe there are models that can assess how much “from” and “with” get baked into each other, accounting for the degree to which they may otherwise be conflated due to clinically more proximal conditions and other factors. I believe it involves estimates of happenstance of active infection across expected all-cause mortality and across similar but infection-free illness, with constancy in historical mortality denominators enabling calculations of the changing ratio of “from” : “with” as estimates of rolling new infection incidence and case fatality change.

Edited by SirBillybob
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19 hours ago, mike carey said:

@Unicorn would be better able to comment than I, but I suspect it's not as simple as that, and that there is a grey zone between the two. Some would likely be clear, say a serious injury or a major cardiac event or stroke. Any interaction between those and Covid is less likely.

In other cases there could be an interaction. For patients with one of the oft-cited underlying conditions that they had been living with successfully for some time, if Covid is an added factor, which of them is the cause? They may not have died of Covid absent the other condition, but the other condition may not have been fatal if Covid had not come along. What to put on the death certificate?

The statistics are currently measuring everyone who tests positive, even if the cause of death is clearly unrelated, such as a heart attack, stroke, or hip fracture. I don't know of any way to know for sure now, but a proxy is the percentage of hospitalized patients who are in the ICU. The graph I pulled up, a few posts up, shows that only a very small percentage of hospitalized patients with Covid-19 are in the ICU. When the virus kills, it's usually accompanied by serious destruction of lung tissue, and those people are usually on a ventilator (breathing machine), which would put the person in the ICU. 

The virus is currently extremely prevalent. As posted previously, it's been determined by serological (blood) studies that over 60% of the US population had contracted the virus by February 2022, so by now the overwhelming majority of the US population has probably contracted the virus at least once. Rarely do fully vaccinated people even have any symptoms, even when they're extremely old, such as Nancy Pelosi. With the virus being so prevalent, it's not surprising that there will be a number of people entering the hospital who test positive. Probably, at this time, most of the positive tests are incidental. The death certificate will probably list another cause of death (with the virus more likely listed as a "contributing factor"), but the statistics are not going by the death certificates, just the positive test. 

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Masking up again in San Francisco:

UCSF’s Wachter masking up again: Dr. Bob Wachter, UCSF chair of medicine and a prominent voice on pandemic issues, said Monday he is resuming rigorous masking as coronavirus cases spike in San Francisco. He said the city’s asymptomatic test positive rate, a reliable proxy for community prevalence given the downturn in citywide testing, shows cases are surging. About 1 in 30 San Franciscans may have COVID-19 without knowing it, he said. “If you’ve decided you’re OK getting COVID ... then fine to keep mask off in crowded indoor spaces,” he tweeted. “If you’d prefer to avoid COVID & have become less cautious, it’s time to re-think.” Wachter cited his concerns about long COVID and other virus-related risks (”heart/neuro/diabetes”). For masking: “I’ll now do 100% N95 in crowded indoor spaces.” People should keep their “eyes open” because “there’s a lot of COVID out there,” he warned. (sfchronicle.com)

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16 hours ago, Lucky said:

Masking up again in San Francisco:

UCSF’s Wachter masking up again: Dr. Bob Wachter, UCSF chair of medicine and a prominent voice on pandemic issues, said Monday he is resuming rigorous masking as coronavirus cases spike in San Francisco. He said the city’s asymptomatic test positive rate, a reliable proxy for community prevalence given the downturn in citywide testing, shows cases are surging. About 1 in 30 San Franciscans may have COVID-19 without knowing it, he said. “If you’ve decided you’re OK getting COVID ... then fine to keep mask off in crowded indoor spaces,” he tweeted. “If you’d prefer to avoid COVID & have become less cautious, it’s time to re-think.” Wachter cited his concerns about long COVID and other virus-related risks (”heart/neuro/diabetes”). For masking: “I’ll now do 100% N95 in crowded indoor spaces.” People should keep their “eyes open” because “there’s a lot of COVID out there,” he warned. (sfchronicle.com)

I'm not sure why some people feel some sort of sense of pride because they can find one person in the US who agrees with them. Dr. Wachter is not a public health specialist or official. Just the fact that he's wearing an N95 clearly shows that he's not keeping up with the science. All 6 randomized clinical trial that have looked at this issue, as well as the meta-analysis of these RCT's  (the highest standard of evidence which exists) have shown that N95's work no better than surgical masks. This is not a matter of "opinion." It's established fact at this point. 

The CDC announced last month that as of February 2022, 60% of the US populace had contracted the virus. There's little doubt that as of now, the vast majority of Americans have as well--most probably without symptoms, especially if it's true (don't doubt that it is), that 3.33% of the populace has it at any one time. Even if everyone is masked, the best data show that masking reduces transmission by around 61% (less if only one person is masked, obviously). Unless one is staying at home, getting one's groceries delivered, and being reclusive, one would have to be foolish to believe one is able to "avoid" the virus. 

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"I'm not sure why some people feel some sort of sense of pride because they can find one person in the US who agrees with them. "

I'm not sure why a retired doctor repeats his position on the topic with every post that seems, even in some small way, to disagree with him. He even posts these pieces while he is on vacation! Nobody is right except him!

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The CDC continues to recommend masks on public transportation:

https://www.latimes.com/world-nation/story/2022-05-03/cdc-restates-recommendation-for-masks-on-planes-trains-despite-court-ruling

"U.S. health officials on Tuesday restated their recommendation that Americans wear masks on planes, trains and buses, despite a court ruling last month that struck down a national mask mandate on public transportation.

Americans age 2 and older should wear a well-fitting mask while on public transportation, including in airports and train stations, the Centers for Disease Control and Prevention recommended, citing the current spread of coronavirus and projections of future COVID-19 trends."

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There is more than one systematic review of mask typology in the context of SARS-CoV-2, as well as meta-analytical research in relation to comparative effectiveness for influenza and related respiratory illness, research stated as partially intended to cross over into the CoV realm.

Respirators/N95s are consistently non-inferior to surgical/medical masks; that is incontrovertible. Data sensitivity analysis by researchers suggests superiority of respirators in some ways; not the reverse. Those findings have tended to be downplayed by the researchers themselves (a report bias) due to HCW supply issues earlier in the pandemic, and by assumed real-world behavioural compliance problems in proper use owing to greater physical discomfort posed by respirators that may offset any protective advantage.

Therefore, like Wachtel (?) I use N95s in indoor settings and usually nothing outdoors. However, what is common between the two of us is access, affordability, and I imagine the willingness to trade off comfort for what is likely a marginal advantage considering the moderate degree of protection conferred by either format in the first place. As such, I see no point in broadly recommending one over the other for the masses. Science and practicality go hand in hand. 

Admittedly, this year so far I wore N95s in crowded sauna brothel common areas with extremely high background infection prevalence on approximately 30 occasions, and where 95% of fellow occupants wore no face coverings. I should probably have acquired infection even though dodging karaoke crooners belting out songs off-key. Repeated RATs and RT-PCRs supported the reality of not having caught SARS-CoV-2. I don’t know that mask use or type made the difference. The clinical heuristic suggests it did.

I caught a bad but non-hemorrhagic case of dengue fever in urban Brazil a few years ago, a holiday ruined. The morbidity risks are elevated with catching any subsequent subtype. It was statistically rare but I probably undertake anti-skeeter protection no less inconvenient over the years there than is the hassle of a mask. Same goes for on-demand PrEP with condom use when there. 

Edited by SirBillybob
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2 hours ago, Lucky said:

...Nobody is right except him!

Thanks for finally recognizing this! 😃 Those who are observant will also notice that when I make a point, I make reference to actual scientific studies and hard data. Those who disagree with me almost always counter with "Well, there's this dude in SF or Philadelphia who agrees with me!". 

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51 minutes ago, SirBillybob said:

... Data sensitivity analysis by researchers suggests superiority of respirators in some ways; not the reverse...

The only studies which suggest "superiority" of N95's over surgical masks are  non-real life studies which simply look at the size of particles filtered. Every single study which looks at actual reality (healthcare workers who were randomized to wear either properly fitted N95s vs surgical masks, and positivity rates are measured) shows no difference. What is important is not the size of particles filtered, but actual transmission. This is true because the infectious agent is not an individual virus, but rather whatever particle causes infection--respiratory droplets in the case of SARS-CoV2. You cannot cite a single study in which N95's perform even marginally better than surgical masks in preventing the spread of this virus, because such a study doesn't exist. The studies have been done repeatedly and are conclusive. Once again, this is not a matter of conjecture or opinion. The answer to this question is known, with a high degree of certainty. 

Incidentally, those of us who've worked in the healthcare field know that in order to obtain the enhanced filtering of N95's, the masks have to be professionally fitted. Those KN-95's you buy in the store are not the same.

Mask Fit Testing Course - Pacific First Aid

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3 hours ago, Lucky said:

"I'm not sure why some people feel some sort of sense of pride because they can find one person in the US who agrees with them. "

I'm not sure why a retired doctor repeats his position on the topic with every post that seems, even in some small way, to disagree with him. He even posts these pieces while he is on vacation! Nobody is right except him!

A retired doctor who, even when practicing, had no special qualification in infectious disease or epidemiology.  But some people think they know everything about everything.

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10 minutes ago, Rudynate said:

A retired doctor who, even when practicing, had no special qualification in infectious disease or epidemiology.  But some people think they know everything about everything.

He should probably go back to work - he seems to miss it.  My sister is a CRNA.  She lasted less than a year in retirement and went back to work because she missed the intellectual challenge.

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On 5/3/2022 at 6:37 AM, Lucky said:

(Dr. Wachter) said the city’s asymptomatic test positive rate... shows cases are surging... “If you’ve decided you’re OK getting COVID ... then fine to keep mask off in crowded indoor spaces,” he tweeted.

This is great news and advice!  I'm glad asymptomatic cases are on the rise, as opposed to life threatening cases. I am definitely Okay catching a virus that has little to no affect on the human.  If only we can change the common cold to become asymptomatic as well!

I will be following this leader's recommendation of keeping mask off in crowded indoor spaces.

Thanks!

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10 minutes ago, Vegas_nw1982 said:

This is great news and advice!  I'm glad asymptomatic cases are on the rise, as opposed to life threatening cases. I am definitely Okay catching a virus that has little to no affect on the human.  If only we can change the common cold to become asymptomatic as well!

I will be following this leader's recommendation of keeping mask off in crowded indoor spaces.

Thanks!

But not being masked in indoor spaces puts others at risk.  The "my body, my choice" people keep forgetting that, or they just don't care.

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1 hour ago, Rudynate said:

But not being masked in indoor spaces puts others at risk.  The "my body, my choice" people keep forgetting that, or they just don't care.

That's not what Dr Wachter said in his chirp.  He said it is fine to not wear a mask in a crowded indoor space if you are okay with catching the virus.

And, no, I and most others shouldn't care if someone catches the mostly assymptomatic virus at this point.  We stayed home to flatten the curve and spare our hospital beds from reaching capacity, and we developed a vaccine for the world to use.  It's done, move on.

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I guess we each get out of it what we want to -Since what you wanted to hear is that it's OK to go without a mask in crowded indoor spaces, that's what you conveniently heard.  I heard the same words that you did but my listening  was "if your only concern is whether you get the virus or not, go ahead and go unmasked in crowded indoor spaces." 

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2 hours ago, Unicorn said:

The only studies which suggest "superiority" of N95's over surgical masks are  non-real life studies which simply look at the size of particles filtered. Every single study which looks at actual reality (healthcare workers who were randomized to wear either properly fitted N95s vs surgical masks, and positivity rates are measured) shows no difference. What is important is not the size of particles filtered, but actual transmission. This is true because the infectious agent is not an individual virus, but rather whatever particle causes infection--respiratory droplets in the case of SARS-CoV2. You cannot cite a single study in which N95's perform even marginally better than surgical masks in preventing the spread of this virus, because such a study doesn't exist. The studies have been done repeatedly and are conclusive. Once again, this is not a matter of conjecture or opinion. The answer to this question is known, with a high degree of certainty. 

Incidentally, those of us who've worked in the healthcare field know that in order to obtain the enhanced filtering of N95's, the masks have to be professionally fitted. Those KN-95's you buy in the store are not the same.

 

I spotted one human (non-medical-engineering particle-focused example) I append here, simply from a quick Google search on my tiny screen. It seems more pronounced and happens to collapse two SARSes, as well as limited to a meta-analytic blend of but two studies that itself prohibits sensitivity analysis, but I am not trying to cherry-pick because these reports as a whole generally concede low certainty evidence irrespective of findings. That low certainty applies to either side of an arbitrary binary of any hypothesis or corresponding null. 

I don’t use a computer or tablet any more  so I try to limit eye strain. I have read a few systematic mask comparator reviews but I don’t keep formal track because I am long retired and my ID Grand Rounds presentation days are considerably behind me, as is reference hoarding previously necessitated by manuscript &c critical appraisal role. You may relate because I believe you have repeatedly cited one particular 6-study meta-analysis on the board. 

These studies I have tripped upon include COVID proxy examples, some where applicable extrapolation is reasonably warranted, others that subsume CoV-specific components in the methodology. In fact, I believe that the meta-analysis you cited  (China-specific? Wuhan ancestral?) may be dated enough to be no more representative than other respiratory proxies, considering marked contagion and lethality changes since then.

The net takeaway from my sporadic reading is that, notwithstanding research limitations posed by both individual and meta-analytical approaches, a properly worn respirator confers an edge. As but one component within an aggregate of mitigation measures it falls short of absolute irrelevance. I agree that  respirator quality lives on a gradient. I already pointed out that the knowledge translation does not suggest a strong argument for public recommendation. However, preferential use of a respirator reflects neither a characterological contrarian trait nor an overriding of the limited extant research.

——

I meant the two screenshots to be reversed in order. 

F8EBD453-19A7-48EF-9442-D0B25A9F1303.jpeg

BD22449F-DC96-4D1A-8D23-434D529AE18D.jpeg

Edited by SirBillybob
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4 hours ago, SirBillybob said:

... a properly worn respirator confers an edge....

 

Well, you didn't give a link to the studies, but the snapshot clearly stated case-control studies. Case-control studies are vastly inferior to randomized clinical trials (and meta-analyses of RCT's). The only way to refuse an RCT is with another RCT. 

I did look up that study manually, so here's the link. In that study, which YOU brought up, they clearly state that if we only look at the RCT's, there's no difference in transmission for influenza, and the other studies were of poor quality. Read the discussion section:

https://onlinelibrary.wiley.com/doi/10.1002/emp2.12582

"... This meta-analysis of the included RCTs displayed no statistically significant differences in N95 respirator versus surgical mask effectiveness in reducing laboratory-confirmed influenza. However, pooled results were statistically significant for decreased risk of influenza-like-illness, non-influenza respiratory viral infection, respiratory viral infection, SARS-CoV 1 and 2 viruses, and laboratory-confirmed respiratory viral infections. Of these significant results, only 1 was a laboratory-confirmed method, whereas the others relied (at least partially) on clinical diagnoses, placing the included studies at risk for reporting bias and misdiagnosis. The laboratory-confirmed methods were not uniform among the studies, as they tested for various different respiratory viral infections...The recent study by Fischer et al. established varying relative droplet count during speech using different mask types in a reproducible optic measurement.38 Their findings demonstrated that fitted N95 respirators and surgical masks both have a similar effectiveness in reducing droplet expulsion. In contrast, the popular mask types among the public, such as bandanas and neck gaiters, showed no statistically significant reduction in droplet count when compared to an unmasked speaker..."

 

Edited by Unicorn
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6 hours ago, Rudynate said:

But not being masked in indoor spaces puts others at risk...

But, with the current strain, less risk to others (regardless of their age or immune status) than the risk of the common cold (to those immunized). Neither Covid-19 viruses, nor other cold viruses, nor influenza will ever be eradicated. If you are saying we should mask when indoors now, what you are saying is that we should always mask when indoors forever--in the movie theater, airplane, etc. That doesn't make sense to me, nor, I doubt, for most people. 

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2 hours ago, Unicorn said:

Well, you didn't give a link to the studies, but the snapshot clearly stated case-control studies. Case-control studies are vastly inferior to randomized clinical trials (and meta-analyses of RCT's). The only way to refuse an RCT is with another RCT. 

I did look up that study manually, so here's the link. In that study, which YOU brought up, they clearly state that if we only look at the RCT's, there's no difference in transmission for influenza, and the other studies were of poor quality. Read the discussion section:

https://onlinelibrary.wiley.com/doi/10.1002/emp2.12582

"... This meta-analysis of the included RCTs displayed no statistically significant differences in N95 respirator versus surgical mask effectiveness in reducing laboratory-confirmed influenza. However, pooled results were statistically significant for decreased risk of influenza-like-illness, non-influenza respiratory viral infection, respiratory viral infection, SARS-CoV 1 and 2 viruses, and laboratory-confirmed respiratory viral infections. Of these significant results, only 1 was a laboratory-confirmed method, whereas the others relied (at least partially) on clinical diagnoses, placing the included studies at risk for reporting bias and misdiagnosis. The laboratory-confirmed methods were not uniform among the studies, as they tested for various different respiratory viral infections...The recent study by Fischer et al. established varying relative droplet count during speech using different mask types in a reproducible optic measurement.38 Their findings demonstrated that fitted N95 respirators and surgical masks both have a similar effectiveness in reducing droplet expulsion. In contrast, the popular mask types among the public, such as bandanas and neck gaiters, showed no statistically significant reduction in droplet count when compared to an unmasked speaker..."

 

Thanks for posting the link.

As such, anybody here can read the full article Discussion and pick up that that the researchers are not dismissive of case-control methodolology that  nevertheless downgrades it, relative to RCT, within the level of evidence hierarchy. In fact, many of the limitations are posed by the complexities of bias that affect that RTC gold standard for studies of this nature. Breadth of relative risk metric for the CoV component, albeit case-control methods, fleshes out the story. In spite of the elaborate cogent outline of limitations, a portion of which you selectively quoted, a large part of the Discussion strongly underscores the differential value of respirators in terms of infection risk receptivity. If you remove the CoV component, you are left with findings more reflective of the RCT grouping that were imported into the recommendation of respirators, in spite of no apparent effects for confirmed flu. Similarly, if you exclude confirmed flu, the remaining findings buttress the idea of respirator advantage, notwithstanding the research list’s minority proportion of non-RCT. This way of looking at the findings is analogous to meta-analytical data sensitivity analysis. A strongly persuasive totality of findings discounting respirator superiority did not emerge in this meta-analysis. 

One of the references is a meta-analysis exclusively RCT-inclusive and has a different angle, more summarily dismissive of a difference between surgical and respirator, yet presents limitations that undermine the evidence certainty. (See below)

In sum, it would be easier to switch to surgical. I take all the input with a grain of salt, but a combination of behavioural habituation, and the limited extent of research findings in the direction polarized from where I think the balance rests, leaves me ‘team N95’. I am not suggesting absence of evidence is not evidence of absence. I did not intuit a preference. Rather, the evidentiary tilt at this point influences my choice.

[Anyway, this is me OUT, off-grid this topic for now, heading to Spain with my travel declaration etc all completed, and better things ahead than a basically high-output low-impact board discussion such as this.]

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7228345/

A8CD3A19-980C-4237-95AF-84B0BB88D5E1.jpeg

Edited by SirBillybob
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4 hours ago, Unicorn said:

But, with the current strain, less risk to others (regardless of their age or immune status) than the risk of the common cold (to those immunized). Neither Covid-19 viruses, nor other cold viruses, nor influenza will ever be eradicated. If you are saying we should mask when indoors now, what you are saying is that we should always mask when indoors forever--in the movie theater, airplane, etc. That doesn't make sense to me, nor, I doubt, for most people. 

 

 I agree with Dr. Wachter, who is going back to masking indoors.   

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