Covid 5 years later: Learning from a pandemic many are forgetting

There is no good evidence showing that masking slows the spread of SARS-COV-2 because wealthy nations like the USA failed to use the opportunity of the pandemic to conduct large scale randomized controlled trials testing their efficacy.

The positive studies that everyone is referencing are all observational studies subject to confounders. For instance, the people that comply with mask mandates probably do other things that slow the spread of the virus, like washing their hands. It's impossible to control for all confounders without a priori randomization. That is why RCTs were invented, why they are the "gold standard" of evidence, and why they are the only type of study included in the systematic reviews done by Cochrane.

When the RCTs are systematically reviewed the effect of masks disappears. This is the infamous "Cochrane study" you'll read about. This review is conducted periodically, it has been done six or seven times in the last 20 years, and has failed to find evidence of masks/respirators slowing the spread of any respiratory viruses. However, this same review shows that hand washing slows the spread of the COVID virus. [0]

Maybe masking works but there just isn't the evidence available to say that it does. All medical interventions have a cost and it shouldn't be paid by the public without good evidence that it will be worth it.

This video is an excellent discussion of the controversy with the lead author of the Cochrane review of physical interventions to interrupt or reduce the spread of respiratory viruses and another epidemiologist from the "Evidence Based Medicine" movement which discounts observational studies. They discuss the evidence including the "Bangladesh RCT," the precautionary principle, equipoise, the reaction to the latest review as compared to previous ones and the actions of Cochrane's director. [1]

[0] https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD... [1] https://www.youtube.com/watch?v=P_JTBftjQuA

5 actually, 3 of those replying to followups to earlier posts. I'm not obligated to display patience with misinformation. Did you have anything factual you wanted to contribute here?

The weirdest part to me is that we were well aware being outside was relatively safe early in the pandemic.

There is another world where the pandemic became about telling people to focus on good ventilation and being outside as much as possible. Imagine classes and meetings conducted outside, and everyone just hanging out at the beach and parks.

It almost sounds like we could have ended the pandemic feeling like it improved our mental health.

The reality is that effectiveness of masking is dependent on relatively strict protocols for masking. While masking does work in clinical environments, early research on covid spread has shown that there was very little if any public health effect attributable to masking mandates in particular.

Think of it as running publicly facing web service based on an extremely popular software. The sheer amount of skiddy traffic ensures that unless you are diligent and methodic at applying protective measures something will eventually slip through. If your cumulative probability of "catching" something over certain period approaches 1 with a "security" measure on, that measure is effectively ineffective even if you can show efficacy.

Imagine you are an admin on some computer network and notice that a particular node is infected with some worm. Intuitively (or following best practices) you isolate that node first and foremost instead of deploying some protective measures on the rest of the nodes. This approach is more effective due to 1:n relationship in infection spread, where your spread block probability is multiplied by the number of healthy nodes if deploy protective measures on healthy nodes instead of the infected one.

This is masking. Masking is much more effective when deployed on the sick, however for many diseases detection lags behind spread due to symptoms lagging behind infection. So you have this weird tautology. Masking is only effective if the majority of the population, including asymptomatic, uses masks correctly. Otherwise the sheer amount of viral particles one is bombarded with still ensures infection ratio larger than one.

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> On the one side we have people that say 'our bodies need to learn again to fight against viruses'

Sorry, but this is scientifically dumb take. Yes, immunity against repeat exposure does build up, but you are playing russian roulette. There are no benefits to contracting a "full" disease while there are risks associated with that. Prevention carries much lower risks at similar or better reward.

> died to COVID

*Died with COVID