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Respiratory consequences of N95-type Mask usage in pregnant healthcare workers—a controlled clinical study – Antimicrobial Resistance and Infection Control (2015)

Results
Exercising at 3 MET while breathing through N95-mask materials reduced mean tidal volume (TV) by 23.0 % (95 % CI −33.5 % to −10.5 %, p < 0.001) and lowered minute ventilation (VE) by 25.8 % (95 % CI −34.2 % to −15.8 %, p < 0.001), with no significant change in breathing frequency compared to breathing ambient air. Volumes of oxygen consumption (VO2) and carbon dioxide expired (VCO2) were also significantly reduced; VO2 by 13.8 % (95 % CI −24.2 % to −3 %, p = 0.013) and VCO2 by 17.7 %, (95 % CI −28.1 % to −8.6 %, p = 0.001). Although no changes in the inspired oxygen and carbon dioxide concentrations were demonstrated, breathing through N95-mask materials during low intensity work (3 MET) reduced expired oxygen concentration by 3.2 % (95 % CI: −4.1 % to −2.2 %, p < 0.001), and increased expired carbon dioxide by 8.9 % (95 % CI: 6.9 % to 13.1 %; p <0.001) suggesting an increase in metabolism. There were however no changes in the maternal and fetal heart rates, finger-tip capillary lactate levels and oxygen saturation and rating of perceived exertion at the work intensity investigated.

Conclusions
Breathing through N95 mask materials have been shown to impede gaseous exchange and impose an additional workload on the metabolic system of pregnant healthcare workers, and this needs to be taken into consideration in guidelines for respirator use. The benefits of using N95 mask to prevent serious emerging infectious diseases should be weighed against potential respiratory consequences associated with extended N95 respirator usage.

https://aricjournal.biomedcentral.com/articles/10.1186/s13756-015-0086-z

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Effect of a surgical mask on six minute walking distance – PubMed (2017)

Results: Distance was not modified by the mask (P=0.99). Dyspnea variation was significantly higher with surgical mask (+5.6 vs. +4.6; P<0.001) and the difference was clinically relevant. No difference was found for the variation of other parameters.

Conclusion: Wearing a surgical mask modifies significantly and clinically dyspnea without influencing walked distance.

https://pubmed.ncbi.nlm.nih.gov/29395560/

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The physiological impact of wearing an N95 mask during hemodialysis as a precaution against SARS in patients with end-stage renal disease – PubMed (2004)

Results: Thirty nine patients (23 men; mean age, 57.2 years) were recruited for participation in the study. Seventy percent of the patients showed a reduction in partial pressure of oxygen (PaO2), and 19% developed various degrees of hypoxemia. Wearing an N95 mask significantly reduced the PaO2 level (101.7 +/- 12.6 to 92.7 +/- 15.8 mm Hg, p = 0.006), increased the respiratory rate (16.8 +/- 2.8 to 18.8 +/- 2.7/min, p < 0.001), and increased the occurrence of chest discomfort (3 to 11 patients, p = 0.014) and respiratory distress (1 to 17 patients, p < 0.001). Baseline PaO2 level was the only significant predictor of the magnitude of PaO2 reduction (p < 0.001).

Conclusion: Wearing an N95 mask for 4 hours during HD significantly reduced PaO2 and increased respiratory adverse effects in ESRD patients.

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Amending Koch’s postulates for viral disease: When “growth in pure culture” leads to a loss of virulence – NCBI (2016)

It is a common laboratory practice to propagate viruses in cell culture. While convenient, these methodologies often result in unintentional genetic alterations, which have led to adaptation and even attenuation in animal models of disease. An example is the attenuation of hantaviruses (family: Bunyaviridae, genus: Hantavirus) when cultured in vitro. In this case, viruses propagated in the natural reservoir species cause disease in nonhuman primates that closely mimics the human disease, but passaging in cell culture attenuates these viruses to the extent that do not cause any measurable disease in nonhuman primates. As efforts to develop animal models progress, it will be important to take into account the influences that culture in vitro may have on the virulence of viruses. In this review we discuss this phenomenon in the context of past and recent examples in the published literature.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5182102/

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Disposable surgical face masks for preventing surgical wound infection in clean surgery – Cochrane Library (2016)

We included three trials, involving a total of 2106 participants. There was no statistically significant difference in infection rates between the masked and unmasked group in any of the trials. We identified no new trials for this latest update.

From the limited results it is unclear whether the wearing of surgical face masks by members of the surgical team has any impact on surgical wound infection rates for patients undergoing clean surgery.

https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD002929.pub3/full

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Bill and Melinda Gates Pledge US$ 10 Billion in Call for “Decade of Vaccines” – World Economic Forum (2010)

Bill and Melinda Gates announced that their foundation will commit US$ 10 billion over the next 10 years to help research, develop and deliver vaccines for the world’s poorest countries.

https://web.archive.org/web/20190328193748/https://www.weforum.org/agenda/2010/01/bill-and-melinda-gates-pledge-us-10-billion-in-call-for-decade-of-vaccines/

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Social Relationships and Mortality Risk: A Meta-analytic Review – NIH (2010)

The quality and quantity of individuals’ social relationships has been linked not only to mental health but also to both morbidity and mortality.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2910600/

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It’s not exponential: An economist’s view of the epidemiological curve

The spread of COVID-19 is not going to follow an exponential curve – and grave errors will follow if analysts believe it will. The number of new cases rises rapidly, peaks, and then declines. It’s called the epidemiological curve. It’s not a theory or hypothesis; it plays out that way every flu season. It is how it has played out in China and Korea for COVID-19. Flattening the peak to avoid overloading the healthcare system is the main medical goal of the seemingly extreme containment policies we have seen to date.

https://voxeu.org/article/it-s-not-exponential-economist-s-view-epidemiological-curve

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Coronavirus disease (COVID-19) advice for the public: When and how to use masks

  • If you are healthy, you only need to wear a mask if you are taking care of a person with COVID-19.
  • Wear a mask if you are coughing or sneezing.
  • Masks are effective only when used in combination with frequent hand-cleaning with alcohol-based hand rub or soap and water.
  • If you wear a mask, then you must know how to use it and dispose of it properly.

https://www.who.int/emergencies/diseases/novel-coronavirus-2019/advice-for-public/when-and-how-to-use-masks

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Time variations in the transmissibility of pandemic influenza in Prussia, Germany, from 1918–19 – BMC (2017)

The COVID-19 epidemic curves are consistent and follow the Gompertz curve. Similar distributions have been reported for Influenza, such as the 1918/19 epidemic in Prussia.

Epidemic curve of pandemic influenza in Prussia, Germany, from 1918–19. Reported daily number of influenza deaths (solid line) and the back-calculated temporal distribution of onset cases (dashed line). Daily counts of onset cases were obtained using the time delay distribution from onset to death (see Table 1). Data source: ref [18] (see [Additional file 1]).

https://tbiomed.biomedcentral.com/articles/10.1186/1742-4682-4-20

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Why Most Clinical Research Is Not Useful – Prof. John Ioannidis

Many clinical research studies, even in the major general medical journals, do not satisfy the identifiable features that make them useful. These features include:

  • problem base;
  • context placement;
  • information gain;
  • pragmatism;
  • patient centeredness;
  • value for money;
  • feasibility;
  • transparency.

Most clinical research findings false. Further, most of the true findings do not result in huge human benefit. Reform and improvement in the clinical research are overdue.

See also: Peer review: a flawed process at the heart of science and journals by Richard Smith at the Journal of the Royal Society of Medicine

Quoted summary points

Blue-sky research cannot be easily judged on the basis of practical impact, but clinical research is different and should be useful. It should make a difference for health and disease outcomes or should be undertaken with that as a realistic prospect.

Many of the features that make clinical research useful can be identified, including those relating to problem base, context placement, information gain, pragmatism, patient centeredness, value for money, feasibility, and transparency.

Many studies, even in the major general medical journals, do not satisfy these features, and very few studies satisfy most or all of them. Most clinical research therefore fails to be useful not because of its findings but because of its design.

The forces driving the production and dissemination of nonuseful clinical research are largely identifiable and modifiable.

Reform is needed. Altering our approach could easily produce more clinical research that is useful, at the same or even at a massively reduced cost.

https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1002049

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SPARS Pandemic Scenario – Center for Health Security

Project completed: October 2017

The Center’s SPARS Pandemic exercise narrative comprises a futuristic scenario that illustrates communication dilemmas concerning medical countermeasures (MCMs) that could plausibly emerge in the not-so-distant future. Its purpose is to prompt users, both individually and in discussion with others, to imagine the dynamic and oftentimes conflicted circumstances in which communication around emergency MCM development, distribution, and uptake takes place. While engaged with a rigorous simulated health emergency, scenario readers have the opportunity to mentally “rehearse” responses while also weighing the implications of their actions. At the same time, readers have a chance to consider what potential measures implemented in today’s environment might avert comparable communication dilemmas or classes of dilemmas in the future.

Link to PDF: https://archive.today/2022.12.31-040215/https://www.centerforhealthsecurity.org/our-work/pubs_archive/pubs-pdfs/2017/spars-pandemic-scenario.pdf

https://web.archive.org/web/20200423182829/https://www.centerforhealthsecurity.org/our-work/Center-projects/completed-projects/spars-pandemic-scenario.html

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Vaccine-attributable severe dengue in the Philippines – The Lancet

In 2016, WHO1 recommended that the dengue vaccine CYD-TDV (Dengvaxia; Pasteur, Lyon, France), the first dengue vaccine, licensed for use in adults and children aged 9 years or older, be considered for use in highly endemic regions where at least 70% of 9-year-old children had previously been infected with dengue. The Philippines was the first country to introduce Dengvaxia on a large scale in selected highly endemic regions, targeting about 1 million children aged 9–10 years. In November, 2017, an excess risk of hospitalisation for dengue and severe dengue in vaccinees who had not had a previous dengue infection at the time of vaccination was reported,2 on the basis of retrospective analyses3 of data from the Dengvaxia phase 3 trials, using a novel non-structural protein 1 (NS1) based antibody assay. Following a reanalysis of these data,3 the Philippine Dengvaxia programme was suspended. However, by the time the programme had been suspended, more than 830 000 children had received at least one of the three recommended Dengvaxia doses. The news about the safety concerns in dengue-naive vaccinees led to major public outcry, with loss in vaccine confidence that extended to routine childhood vaccines.4

https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(19)32525-5/fulltext

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Might hydrogen peroxide reduce the hospitalization rate and complications of SARS-CoV-2 infection? – NCBI

To the Editor—The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is the virus responsible for COVID-19, which emerged in Wuhan, China, in December 2019. The current pandemic appears to be characterized by human-to-human transmission; it occurs through cough, sneeze, droplet inhalation, and direct contact of hands with mouth, nose, and eyes. The virus resides in the mucous membranes and it is transmitted through the saliva and the respiratory droplets. Although prevention of person-to-person transmission is the key to limiting the pandemic, so far, little attention has been given to the events taking place immediately after the onset of the first symptoms.

http://archive.today/2020.07.31-022930/https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7308628/

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National Covid-19 Testing Action Plan – The Rockefeller Foundation

The industry of mass-testing the population at least twice per month was laid out in the National Covid-19 Testing Action Plan by The Rockefeller Foundation, published in April 2020.

Note: See embedded video below for commentary from Fiona Marie Flanagan and Dave Cullen.

https://web.archive.org/web/20200421120351/https://www.rockefellerfoundation.org/national-covid-19-testing-action-plan/

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Rapid response to: Face masks for the public during the covid-19 crisis – BMJ

In conclusion, as opposed to Greenhalgh et al., we believe that the context of the current covid-19 pandemic is very different from that of the “parachutes for jumping out of aeroplanes”,[7] in which the dynamics of harm and prevention are easy to define and even to quantify without the need of research studies. It is necessary to quantify the complex interactions that may well be operating between positive and negative effects of wearing surgical masks at population level. It is not time to act without evidence.

https://www.bmj.com/content/369/bmj.m1435/rr-40

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Vets would not manage Covid-19 this way – BMJ

There needs to be a more effective and sustainable strategy to manage Covid-19 than the current economically ruinous policy, argue vets Dick Sibley and Joe Brownlie.

https://veterinaryrecord.bmj.com/content/186/14/462.full

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ROADMAP FOR THE IMPLEMENTATION OF ACTIONS BY THE EUROPEAN COMMISSION BASED ON THE COMMISSION COMMUNICATION AND THE COUNCIL RECOMMENDATION ON STRENGTHENING COOPERATION AGAINST VACCINE PREVENTABLE DISEASES – European Commission

ROADMAP ON VACCINATION
Last update: Q3 2019

Commission proposal for a common vaccination card/passport for EU citizens.

http://archive.today/2021.08.17-123441/https://ec.europa.eu/health/sites/default/files/vaccination/docs/2019-2022_roadmap_en.pdf

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Global Covid-19 Case Fatality Rates between 0.1% and 0.36% – CEBM

Global Covid-19 Case Fatality Rates
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COVID-19 lethality in 0.12% to 0.2% which is in the range of severe influenza – medRxiv

Stanford University study founds antibodies in 50 to 85 times more people than previously thought in Santa Clara County, California. Covid-19 lethality of 0.12% to 0.2% which is in the range of severe influenza.