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The CDC asked for public comments on needs in PPE research. Click below for why we need a regulated high-filtration general population mask standard and a robust US supply chain. regulations.gov/comment/CDC-20…

@masknerd So sorry to hear that. Lots of us are so thankful for your work, your dedication, and just demonstrating that there are still good people out there who are trying to help others.

Been a little quiet lately as Twitter has turned into a bit of a dumpster fire for me, with my feed full of anti-vaxxers and other anti-masker craziness. Just bums me out every time I am on here. 🫤

On the anniversary of the covid shutdowns, we should remember what could avoid shutdowns "next time" - i.e. having good masks available and IAQ. That will be how we minimize spread while developing new testing/vax/meds. We should work on hi-filtration community respirators now.

A basic problem with Cochrane - We didn't test the right "masks" because they didn't/don't exist, ie high-filtration comfortable community respirators that people can wear "always" in public in a pandemic. High-filtration "masks" with high adherence would likely show a benefit.

Darn. The Cochrane review has everyone who said to follow the science explaining why the science is wrong.

@JenniferNuzzo We need to develop better "masks" - i.e. comfortable community (adjustable earloop) respirators that people can wear "always" in public - and have them available for the next pandemic so we can buy time to develop/distribute new testing/vaccines/meds.

At the beginning of a pandemic, we can’t wait until we have all the data to act. Decisions have to be made with imperfect evidence. But we should get to work collecting the data we need to evaluate our decisions. 20/

Thinking about the RCT that found no evidence that parachutes work. Serious point that just because an RCT cannot demonstrate benefit, it doesn't mean that benefit doesn't exist. How you do the trial to see if something "works" matters. bmj.com/content/363/bm…

@masknerd @Globalbiosec The most important study in the meta-analysis (MacIntyre 2013 by @Globalbiosec) showed that continuous N95s DO work to decrease clinical respiratory illness, in spite of only 57% adherence. atsjournals.org/doi/10.1164/rc…

I have now crafted about 4 different tweet threads about the now infamous Cochrane review that "masks don't work". I will keep chewing on it, good Sci Comm takes time In the mean time I think this is a good take. Also @Globalbiosec, who's papers are in the review, has good tweets

@trishgreenhalgh Agreed, masks are not forever. They're a temporary measure to buy time to develop better solutions - testing/vax/meds. Having good masks available could help flatten the curve without shutdowns "next time."

@trishgreenhalgh A better systematic review/meta-analysis. It included observational studies as well as RCTs (vs only RCTs in Cochrane.) Literature review through May 3, 2020. Yes, masks "work," and better masks work better. thelancet.com/article/S0140-…

Think about March 2020 when we were trying to "flatten the curve." Why? To buy time to get to better solutions - testing/vax/meds. "Next time" good masks and IAQ could buy time without shutting down. We should be ready.

Re do masks "work?" South Korea had a low covid death rate, due to masks and other NPIs. When restrictions eased, covid came back in Mar 2022. But the cumulative death rate never approached that of other countries, b/c masks and NPIs gave them time to dev. testing/vax/meds.

A better systematic review/meta-analysis. It included observational studies as well as RCTs (vs only RCTs in Cochrane.) Literature review through May 3, 2020. Yes, masks "work," and better masks work better. thelancet.com/article/S0140-…

@trishgreenhalgh So many issues lumped under whether masks "work." N95s decrease exposure well, surgical masks not as well. To eval results of any study, need to know type of mask, how it was distributed, instructions on when to wear (continuous vs targeted) & compliance (incl. how measured.)

@trishgreenhalgh Maybe the most important study in the meta-analysis (MacIntyre 2013) showed that continuous N95s DO work to decrease clinical respiratory illness, in spite of only 57% adherence. atsjournals.org/doi/10.1164/rc…

@trishgreenhalgh Of course good masks "work." But we never made comfortable general population high-filtration respirators for wide distribution that people could wear often/"always." Even in a monitored clinical trial, only 81% of the group assigned to N95s wore them "always." (Loeb 2022.)

@jonlevyBU Of course good masks "work." But we never made comfortable general population high-filtration respirators for wide distribution that people could wear often/"always." Even in a monitored clinical trial, only 81% of the group assigned to N95s wore them "always." (Loeb 2022.)

I know there are subtleties here, but at a basic level, if we agree that high-quality masks worn properly can reduce individual risk, we have to agree that they can reduce population risk too. And we should support measures that make that happen.

Seems like the Reasonable Middle Ground™️ position on masks right now is to say they work for individuals but not for populations. But all this really means is that masks work. Period. And that we need to increase access and education so they work for more people.

@sri_srikrishna Can't get people to wear N95s "always," as shown in monitored trials. In Loeb 2022 only 81% of the N95 grp wore them "always," and in Macintyre 2013, only 57% adherence to N95s. It's why we need comfortable community respirators that ppl can wear 100% of the time in public.

"In theory, then, if every person in the world had worn a high-quality mask 24/7 for a few weeks the COVID-19 pandemic would have been, if not over, then at least substantially slowed." (4/4)

"But in practice, the intervention that we implemented was not some perfect ideal of mask-wearing, in which everyone consistently wore a well-fitting N95 in every situation." (1/4)

N95 adherence is terrible even in monitored studies, 81% "always" in Loeb 2022, 65% in Radonovich 2019. It's why we need comfortable high-filtration community respirators (for public and HCWs NOT caring for covid pts) that people can wear 100% of the time.

@brosseau_lisa Just looking at a study (Macintyre 2013) that showed that continuous N95s DO work to decrease clinical respiratory illness, in spite of only 57% adherence. atsjournals.org/doi/10.1164/rc…

@crosscutanne @aaronsibarium @joshgerstein Key point - N95 adherence was terrible, 81% "always" in Loeb 2022 (not in Cochrane), 65% in Radonovich & 57% in Macintyre 2013. It's why we need comfortable high-filtration community respirators (for public and HCWs NOT caring for covid pts) that ppl can wear 100% of the time.

@MaubeTim @andyharry819 @ftw_caden @aaronsibarium @joshgerstein Meta analyses are usually fraught w problems because the study designs vary widely. It renders them less valuable. I don’t think there is much to be taken from this Cochrane review given the flaws in the individual studies.

NEW: One of the largest and most comprehensive studies on masks to date found they do almost nothing to reduce the spread of respiratory viruses. The study was done by the Cochrane Review—a database long considered the Bible for evidence-based medicine.🧵 freebeacon.com/coronavirus/th…