Masks are Back in Fashion and How Doctors Really Treat Coronavirus Patients

Masks are Back in Fashion

From ninjacat14@deviantart

Do I ever get tired of being right? I do not.

Today the mayors of Los Angeles and New York City recommended that everyone wear “face coverings” in public if they’re likely to pass within six feet of anyone. Bandannas, scarves, or even—gasp!—masks. (Though they’re still holding the word “mask” at arm’s length, as if it were a dead rat. Sissies.)

European countries, too, are starting to figure out that China, South Korea, Hong Kong, Japan, and so on were right all along to wear masks during epidemics. The Czech Republic went first, mandating some kind of face covering in mid-March. They were followed by Slovakia and Bosnia-Herzegovina. Austria now requires that you wear something in grocery stores.

This is a good idea. Going into a grocery store where people are wandering around unmasked gives me the willies. And the poor checkout clerks, breathing in everyone else’s germs all day! And maybe returning the favor for a few days after they’ve caught the disease but before they feel sick. That’s called being a “pre-symptomatic carrier.”

 

Survey of How Front-Line Doctors Actually Treat COVID-19

Wouldn’t it be nice if we heard from a whole bunch of actual doctors who were treating actual coronavirus patients? Not the talking heads we see on TV? Now we can. An anonymous survey of 6,227 physicians in 30 countries was asked questions about:

  1. State of the Pandemic in their regions.
  2. Resource needs.
  3. Experiences treating COVID-19 patients.
  4. Impacts: effect of triaging and shortages.

This represents the experiences of practicing physicians as they grapple with COVID-19 any way they can.

Here are some highlights in no particular order. You might want to read the whole presentation, too:

Hydrochloroquine (an Anti-Viral Drug)

  • Hydroxychloroquine is already widely prescribed. It has been prescribed  by 72% of respondents in Spain, 49% in Italy, 41% in Brazil, 39% in Mexico, 28% in France, 23% in US, 17% in Germany, 16% in Canada, 13% in UK and 7% in Japan.
  • Effective. Overall, it was chosen as the most effective COVID-19 therapy. Azithromycin and similar antibiotics were #2.
  • Prescribed on spec. 17% of doctors have prescribed it or seen it prescribed for patients with severe symptoms but no test results yet. 16% have prescribed it for patients with mild symptoms but no test results yet.
  • It’s for prevention, too. 19% of the respondants had prescribed it , or seen others prescribe it, to prevent COVID-19 infections for high-risk patients and 8% for low-risk patients.

Testing for Coronavirus

  • Tests in the US average 4-5 days before results come back, with 10% taking more than a week.
  • In Europe and Japan, 50% of the results come back within 24 hours. In China, 73% come back within 24 hours and 8% come back within an hour.

Effectiveness of Official Response

What do doctors think of their national, regional, and local governmental actions? If we add “not at all effective” and “slightly effective” responses, the thumbs-down level is as follows (smaller is better):

  • New York: 38%
  • US as a whole: 34%
  • Italy and Spain: 29%
  • Europe as a whole: 25%
  • China: 2%
  • Rest of World: 38%

So of the named areas, the US self-reports as having the worst official response to the crisis. I suspect this means that we’re not living up to our doctor’s expectations more than it means that we’re literally doing worse than Spain and Italy right now.

Critical Needs

  1. Personal protective equipment (masks, gloves gowns, eye shields).
  2. Testing kits.
  3. Ventilators.

You probably guessed this as well. This is why I’m so adamant that we need to produce our way out of this disaster. We can’t treat people properly if this stuff isn’t plentiful.

Final Thoughts

In my opinion, our goal should be maximum overproduction.  We don’t really know how much we need, so we need to make as much as we possibly can, and then some.

“But what if we make too much?” Fat chance. We should be so lucky! But if we do, it can become our new stockpile. against next time.

And you noticed that doctors are prescribing hydrochloroquine on spec and as a preventative. After all, it’s a drug that was introduced in 1955 and is taken by millions of people, sometimes for decades on end. Not only for malaria prevention, but to treat lupus and rheumatoid arthritis.

Have you noticed that our stuffed shirts in Washington, D.C. can’t even grasp the concept of plentiful masks and improved prevention and treatment?  To them, the future is just like today, but with a taller stack of bodies. I think we should replace them. Doesn’t matter who. We can draw names out of a hat or something. It’s sure to be a big improvement.

 

What’s the Coronavirus Endgame?

Well, since nobody else is talking about how this COVID-19 epidemic is going to pan out, I’ll take a stab at it. I present this without proof, as a prediction. It’s obvious, anyway:

  1. We’re in a holding pattern as we wait for adequate supplies to arrive: test kits, ventilators, antivirals, masks, antibody-rich blood plasma, infrared thermometers, etc.
  2. “Masks4All” will become a Thing. It’s already a grass-roots movement. Soon the technicians will reprogram the animatronic talking heads in charge of the CDC and the FDA, and they’ll jerk and spasm into line and tell us to use the best masks we can. Improvised masks, until medical-grade masks start being delivered to Home Depot and Amazon again. It’s not like these people are real or anything, so they can change their tune with no memory of their past statements.
  3. When? Within days.
  4. Shortly after that, we’ll be required to  wear masks (or bandannas, or scarves, or whatever we can).
  5. Soon people in high-risk groups will be offered all the N95 masks they want. First health-care workers, then the elderly and people with medical conditions, then grocery-store employees, then everyone.
  6. We’ll finally start testing not only people with symptoms, but everyone people with symptoms have come into contact with. Everyone testing positive is isolated and treated. Their contacts are isolated, too.
  7. Infrared temperature guns will be deployed at places of high danger for infection. No getting in unless your temperature is normal. Hospitals, doctors’ offices, buses, train stations, grocery stores, schools, churches, etc. This was one of the key ways that China and South Korea got the epidemic under control. It’s a zillion times faster the virus test, and …  maybe half as effective? It’s one of the keys to opening up crowded places like schools again. (This is already being done in some health-care settings in the US.)
  8. Antivirals will become universal in treatment. All confirmed cases, presumed cases, and suspected cases will be given the best antivirals in the store. Soon the shootout between Old Faithful generics like hydroxychloroquine and New Kids like remdesivir will make the prescription flowchart more interesting, but it’ll start with “prescribe what you’ve got.”
  9. Antivirals will become universal preventatives among people in risk groups: health-care workers, the elderly, grocery checkout staff, etc.
  10. Blood plasma (from people who have recovered) is chock-full of antibodies and will cure most of the severe cases.
  11. The other test, the one that tests for antibodies instead of for the virus, will be deployed on a massive scale to separate the sheep from the lambs. If you have your full complement of antibodies, you’re immune, so you get to work in any job you like.
  12. Everyone will be allowed to be out and about if they’re taking preventative antivirals and using a good mask, both of which will soon be superabundant.
  13. At this point, most things can go back to normal-ish while we wait for the vaccine.
  14. How long? Depends on how good we are at intimidating bureaucrats. The production capacity getting is there if we don’t let the people in Washington tie themselves to the railroad tracks. Or if we have the sense to keep going if they do.

Don’t Go Out Without Wearing a Mask (or a Bandanna, or Something)

 

Look, it’s really simple: coughing into the air infects people. You’re supposed to put a barrier between your cough and everybody else, like a handkerchief. If you were the clever inventor type, you’d come up with the idea that tying a handkerchief around your face would intercept your coughs even if both hands were full or if the cough was very sudden. You’d have invented the face mask.

All this is obviously true and needs no verification. If using a Kleenex or a handkerchief is a good idea, a mask is an even better idea. But here’s a summary that shows that it’s true.

Hence, lots of people who can’t get commercial masks or have been shamed into not wearing them are using improvised masks: everything from bandannas to custom-sewn masks like the ones shown above.

In fact, our local hospital, Good Samaritan, is accepting donations of homemade masks. They like the commercial ones better, of course, but it’s a case of “any port in a storm.” They’re solidly behind the idea of not dying, you see. We can learn from their example.

So wear your masks when you go out.

Masks Protect You and Others

As it turns out, a mask—even an improvised mask— is more than just a pre-positioned handkerchief to protect others: it helps keep you safe as well. That’s good news for all you sociopaths out there: even if you won’t lift a finger (or a Kleenex) to protect others, the mask protects you.

So why are the CDC, etc., saying “masks don’t work but our health-care workers really need them or they’ll die?” My guess is that they’re stupid, they think we’re stupid, or both. Doesn’t matter; it’s not our job to fix their brains for them. Anyway, you should look for original sources and see what the hands-on people have to say, not the talking heads.

More About Stupidity

Our so-called leaders and experts, especially the suit-wearing and microphone-talking kinds (not the real experts, who we don’t see very often: “those that can, do”) are constantly make all the fundamental errors of reasoning that are available to them. Here are just four:

  1. Black-and-white thinking. “Every little bit doesn’t help: it’s all or nothing.” They apply this reasoning to masks but not to Kleenex. Oddly, no one claims that coughing into a Kleenex traps all the viruses, but they know it helps a lot. But they can’t apply this reasoning to masks.
  2. Appeal to authority. “If the FDA hasn’t approved it, I’m really scared.”
  3. The best is the enemy of the good. We’d rather use the best masks. If we can’t get them, we use the second-best masks. If we can’t get those, either, we use the third-best masks, and so on. Strangely, this is too complicated for some people.
  4. Projecting their own panic. People who are overwhelmed and panicky sometimes latch onto the panic itself as the larger problem, since their brain has shut down when thinking about the real problem. Panic, like hoarding, is more of a nuisance-level symptom than a real problem. But some people find it easier to blather on about panic than face the real issue.

Wear Your Damned Mask (or Something)

Soon we’ll be awash in classy commercial masks. Wouldn’t it be nice if we and our loved ones are all still alive when this happens? So wear a mask, or a bandanna, or something whenever you’re in public. Starting today. And spread the word.

Turning the Corner on Coronavirus

A lot of our so-called leaders, putative experts, and alleged Brainiacs of all kinds have a real talent for obsessing over trifles.

Take masks. All we need are a few hundred million n95 masks and a few billion surgical masks. We’re not there yet, but it won’t take long.

Especially because everyone’s focused on ramping up production, right? No, of course not! People with teeny-tiny minds (most people in the suit-wearing and sounding-smart biz) are freaked out because Home Depot is sold out. I hate to tell you this, but hospitals don’t buy their masks at Home Depot. They buy them from medical-supply wholesalers.

Overcoming a shortage isn’t about allocating scarce resources—that’s just hoarding by the numbers. No, it’s all about production: making these resources abundant, even super-abundant. It’s time for our so-called leaders to stop thinking like misers.

Adults vs. Children

In fact, we’re already ramping up production like crazy, using both the methods we want to use and the ones we have to use. Few people who are (or pretend to be) authorities seem to be talking about this, though, because they’d rather go the Peeping Tom route and obsess over other people’s toilet paper. At best, this is occupational therapy for morons.

Fortunately, the actual adults are working like crazy to produce—at incredible speed—all the masks, gowns, test kits, pills, ventilators, and whatever else we need.

While this is happening, the non-adults are squabbling about consumption. Let ’em. They’d only get in the way if they tried to do something real.

The shortages have encouraged various “experts” to make nonsensical statements like, “Masks don’t work: save them for our health-care personnel, who rely on them because they work” and “tests are in short supply, so  we claim you don’t need one” and “maybe antivirals are in short supply (and maybe not), but we’ll say you don’t need those, either.”

Time for a Prediction

So here’s my prediction:

  1. We’ll be buried in masks sooner than you think. Suddenly we’ll be told. “What are you, nuts? Masks are essential! Wear one whenever you’re in public!”
  2. Tests will become plentiful very soon. We’ll be told, “Don’t be a sociopath: get yourself tested if you feel the least bit ill, or even on a whim.”
  3. Antivirals will be more common that Tic-Tacs, and we’ll be told, “Don’t be a schnook! These pills are magical! You’re a mass-murderer if you don’t see your doctor for a smallish dose as a preventative and a larger dose if you have symptoms.”

Vast numbers of people are making this happen all over the world and in all sorts of ways, because they know it’s the right thing to do. Nobody had to tell them to do it.

The Epidemic Endgame

When everyone around you has been tested, when you have all the masks you want, and you’re taking preventative doses of antivirals if you’re in a risk group (or if you just feel like it); when every new case is contact-traced so everyone they’ve come into contact with is tested again and quarantined, then the number of new cases will fall like a rock.

We’ve pretty stopped the epidemic at that point, haven’t we? Yes, we have. Obviously. Piece of cake. Things will go back to normal before we know it.

We can probably even do it without the antivirals, but that’s not even worth thinking about because, in reality, using them is already standard practice, both in the US and worldwide. It’s just that the Powers That Be are poor listeners and slow learners. But they’re largely being ignored, so that’s okay. People are ramping up production and shipping stuff to where it’s needed on spec.

Coronavirus: Positive Developments

Reuse of FFP2 masks. Paper from the Dutch National Institute for Public Health.  FFP2 is the European equivalent of an n95 mask. They found hydrogen peroxide effective in sterilizing the mask, allowing it to be used three times. Read the paper for details: it involves more than spritzing it.

UW Medicine Interim Treatment Guidelines for SARS-CoV-2 Infection/COVID-19. These are the current treatment guidelines (updated March 19) by the most experienced coronavirus team in the US. Interestingly, they already use antivirals on every COVID-19 patient, preferably Remdesivir, which is in clinical trial, but otherwise Hydroxychloroquine.

Advisory on the use of hydroxy-chloroquine as prophyaxis for SARS-CoV-2 infection. From India: Recommends that this drug be taken by healthcare workers helping suspected or confirmed cases of COVID-19 and asymptomatic household contacts of confirmed cases. From the (Indian Ministry of Health & Family Welfare) National Task Force for COVID-19.