The COVID-19 pandemic has led to a surge of information being presented to clinicians regarding this novel and deadly disease. There is a clear urgency to collate, review, appraise and act on this information if we are to do the best for clinicians and patients. However, the speed of the pandemic is a threat to traditional models of knowledge translation and practice change. In this concepts paper, we argue that clinicians need to be agile in their thinking and practice in order to find the right time to change. Adoption of new methods should be based on clinical judgement, the weight of evidence and the balance of probabilities that any new technique, test or treatment might work. The pandemic requires all of us to reach a new level of evidence-based medicine characterised by scepticism, thoughtfulness, responsiveness and clinically agility in practice.
The mRNA-1273 vaccine is being developed to prevent COVID-19, the disease resulting from Severe Acute Respiratory Syndrome coronavirus (SARS-CoV-2) infection. The study is designed to primarily evaluate the efficacy, safety, and immunogenicity of mRNA-1273 to prevent COVID-19 for up to 2 years after the second dose of mRNA-1273.
…Wales’ chief medical officer said “very little had changed” in the science, which pointed to them having little benefit.
Also speaking to Claire Summers on Tuesday, Wales’ chief medical officer Dr Frank Atherton said the evidence for making face coverings mandatory was “quite weak”, although there might be a “small benefit”.
Nevertheless, the BBC went with the headline, “Coronavirus: Face masks ‘should be compulsory in shops.'”
A fifth of vulnerable people in Britain thought about self-harming or killing themselves during lockdown, according to research shared with the Guardian, as a series of inquests underline the mental health toll of the Covid-19 pandemic.
Findings from University College London reveal that 8,000 out of 44,000 people surveyed (18%) reported thoughts of self-harm or suicide, and 42% had accessed support services. A further 5% said they had harmed themselves at least once since the start of the UK’s lockdown.
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Personal data is usually kept super-safe under onerous government restrictions – for the obvious risk of it falling into the wrong hands. But the pub landlord is less likely to have a data security policy, so it is easy to see how the list of drinkers can fall into the hands of a barman. Or even a customer. It gives an ominous new meaning to track-and-trace and undermines the basic privacy issues that this system raises.
The new Oxford study released by Royal Society and British Academy does not prove face coverings work. It is a policy document masquerading as an investigation into face coverings.
The Mayor Of London claims new evidence supports the use of face coverings as effective in reducing the spread of COVID-19. He cites a University of Oxford study that claims: “face masks and coverings work – act now.“
The study, from Oxford’s Leverhulme Centre for Demographic Science, is freely available for download from The Royal Society website. Nevertheless, we doubted that many people would take time to verify the claims so we took a look. What did we find?
The bulk of study is in fact an investigation into policies and behavioural factors behind face mask usage. Only a small section is dedicated to analysing the effectiveness of cloth face coverings and even this provides nothing new. Further, rather than performing randomised controlled trials (RCTs), which form the highest level of evidence in medical science, this report simply looked at existing research.
From this existing research, the authors forced a conclusion that ‘face masks and coverings work’ but with some very important caveats:
The tests were carried out in medical and lab settings, not within the community.
There were other factors that contributed to the masks’ effectiveness.
The conclusions were based on small studies.
The study limitations can be found in the document appendix, table A5.1.
The Royal Society published, on 26 June, a ‘rapid review of the science of the effectiveness of different face-mask types’ – a dense, 37-page tract which made the case for face masks. It was neither peer-reviewed nor opened to wide expert and public debate before being used to argue for policy.
…the hasty assembling of research articles in support of a policy position is not science, and demanding that the government introduce new ‘taboos’ is naive and clumsy social engineering, not careful examination of the facts.
A positive test result shows you may have antibodies from an infection with the virus that causes COVID-19. However, there is a chance a positive result means that you have antibodies from an infection with a virus from the same family of viruses (called coronaviruses), such as the one that causes the common cold.
Regardless of whether you test positive or negative, the results do not confirm whether or not you are able to spread the virus that causes COVID-19.
A review of the peer-reviewed medical literature examines impacts on human health, both immunological, as well as physiological. The purpose of this paper is to examine data regarding the effectiveness of facemasks, as well as safety data. The reason that both are examined in one paper is that for the general public as a whole, as well as for every individual, a risk-benefit analysis is necessary to guide decisions on if and when to wear a mask.
According to the current evidence, COVID-19 virus is primarily transmitted between people via respiratory droplets and contact routes. Droplet transmission occurs when a person is in close contact (within 1 metre) with an infected person and exposure to potentially infective respiratory droplets occurs.
N95 vs medical masks:
Meta-analyses in systematic literature reviews have reported that the use of N95 respirators compared with the use of medical masks is not associated with any statistically significant lower risk of the clinical respiratory illness outcomes or laboratory-confirmed influenza or viral infections.
Wearing masks by the general public:
There is limited evidence that wearing a medical mask by healthy individuals in households, in particular those who share a house with a sick person, or among attendees of mass gatherings may be beneficial as a measure preventing transmission.
At present, there is no direct evidence (from studies on COVID-19 and in healthy people in the community) on the effectiveness of universal masking of healthy people in the community to prevent infection with respiratory viruses, including COVID-19.
At the present time, the widespread use of masks by healthy people in the community setting is not yet supported by high quality or direct scientific evidence and there are potential benefits and harms to consider.
“Intensive care units are getting empty, the wards are getting empty, we are really seeing a decrease — and that despite that people are really loosening up. The beaches are crowded, social distancing is not kept very well … but still the numbers are really decreasing. That means that something else is happening – we are actually getting closer to herd immunity. I can’t really see another reason.”
“I can’t say if the Swedish approach was right or wrong – I think we can say that in one or two years when we are looking back. You have to look at the mortality over the whole period.”
“I don’t think that we have more new cases, I think we are just detecting more cases”
“We found that if you have a mild case you can be negative for antibodies afterwards … in those almost all of them had strong T-cell activity. This study says that there are cases that you can have a strong T-cell response even though you have not had antibodies, meaning that you have encountered the virus and built up immunity.”
Persons who are diagnosed with influenza…should remain at home until the fever is resolved for 24 hours…and the cough is resolving to avoid exposing other members of the public. If such symptomatic persons cannot stay home during the acute phase of their illness, consideration should be given to having them wear a mask in public places when they may have close contact with other persons.
No recommendation can be made at this time for mask use in the community by asymptomatic persons, including those at high risk for complications, to prevent exposure to influenza viruses.
The study, published in JAMA, found that surgical masks were as effective as N95 respirators at preventing the flu, which is to say, not all that effective because, of the 446 nurses who took part in this study, nearly one in four (24%) in the surgical mask group still got the flu as did 23% of those who wore the N95 respirator. And, because both groups wore masks, it’s impossible to say how they would have fared compared with not wearing a mask at all.
Basically, there is no strong evidence to support well people wearing surgical masks in public. Or as the US Centers for Disease Control and Prevention put it: “No recommendation can be made at this time for mask use in the community by asymptomatic persons, including those at high risk for complications, to prevent exposure to influenza viruses.”
The best thing you can do to stop getting the flu is to regularly wash your hands, and try to avoid touching your face.
The authors of the commentary, titled “COVID-19 Transmission and Children: The Child Is Not to Blame,” base their conclusions on a new study published in the current issue of Pediatrics, “COVID-19 in Children and the Dynamics of Infection in Families,” and four other recent studies that examine Covid-19 transmission by and among children.
Such is the quality of decision-making in the process generating our lockdown narrative. An early maintained but exaggerated belief in the lethality of the virus reinforced by modelling that was almost data-free, then amplified by further modelling with no proven predictive value. All summed up by recommendations from a committee based on qualitative data that hasn’t even been peer-reviewed.
According to Office for National Statistics, this year comes only eighth in terms of deaths in past 27 years.
The spread of viruses like Covid-19 is not new. What’s new is our response.
The whole Covid drama has really been a crisis of awareness of what viruses normally do, rather than a crisis caused by an abnormally lethal new bug.
Modelling is not science, for the simple reason that a prediction made by a scientist (using a model or not) is just opinion.
To be classified as science, a prediction or theory needs to be able to be tested, and potentially falsified.
A problem with the current approach: a wilful determination to ignore the quality of the information being used to set Covid policy.
Most Covid research was not peer- reviewed.
In medical science there is a well-known classification of data quality known as ‘the hierarchy of evidence’: a seven-level system gives an idea of how much weight can be placed on any given study or recommendation.
Randomised controlled trials (RCTs) form the highest, most reliable form of medical evidence: Level 1 and 2.
Virtually all evidence pertaining to Covid-19 policy is found in the lowest levels (much less compelling Levels 5 and 6): descriptive-only studies looking for a pattern, without using controls.
Level 7 is at the bottom of the hierarchy (the opinion of authorities or reports of expert committees) because ‘authorities’ often fail to change their minds in the face of new evidence.
Committees often issue compromise recommendations that are scientifically non-valid.
The advice of Sage (or any committee of scientists) is the least reliable form of evidence there is.
Britain could have been hit harder by Covid-19 than other European nations because the past two winter flu outbreaks have only been mild, according to a study.
Researchers say influenza kills the same groups of people as the coronavirus, with both illnesses posing the greatest danger to the elderly and those with underlying conditions.
Public Health England statistics show around 20,000 excess deaths – those of any cause that happen above average – occur from influenza each year.
But only 1,700 extra fatalities were recorded during the 2018/19 outbreak, said lead author Dr Chris Hope who claimed data showed the 2019/20 season was also ‘very mild’.
It means more than 30,000 people in England alone were alive at the start of the Covid-19 pandemic who would have been expected to die in the previous two flu seasons.
Prof. Yoram Lass, the former director general of the Ministry of Health, continues to press for calming panic over coronavirus.
“There was no first wave – a lie. In March, April and May, 115 less people died in the State of Israel compared to the same period last year. There was no first wave, it is in the hysterical mind of you know who. In Europe and America there was a very respectable first wave, and no second wave,” Lass said in an interview on 103fm.
“No government in the world can stop the virus. This is shown by the fact that the only place in the world where there is no virus is Antarctica. The entire world is full of the virus.
As you do more tests, you find more people – who are healthy – testing positive. And the government insists on calling them sick.”
Novelist Hector Drummond decided to look at the annual death figures for England and Wales from the Office for National Statistics. This is what he found after graphing the numbers all the way back to the turn of the twentieth century.
The 2020 death figures on the right cannot even be considered a spike over the course of the century.
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