Thread by @MonicaGandhi9

I & my co-authors suggested a hypothesis, acknowledged limitations, and we & others are trying to study it further (inoculum & severity of disease). Science has never been a fixed thing – people got KILLED for thinking of scientific ideas that didn’t fit the predominant paradigm.

A hypothesis is based on an idea; a theory gathers more (but indirect) evidence for the hypothesis; a fact has been proven by usually experimental means (and even that can be disputed based on bias)

There are two things that masks may do- decrease transmission and decrease severity of disease by decreasing viral load. Even decreasing transmission has been questioned because physical sciences can show that a virus can leak around a mask.

Disease severity even more so in that it implies understanding that inoculum is related to disease severity and that is true of some viruses, but not others and hard to prove experimentally (unethical with dangerous viruses in humans)

I think physical scientists/engineers getting into the mask debate is understandable but may be very confusing. Epidemiologic evidence to me as a medical scientist is more convincing but people can always question epidemiology (have you controlled for “everything”?)

Experimental evidence will be lacking for masks in humans- you can’t take 4 groups- one with N95s, one with surgical masks, one with cloth masks, and one with none and spray them with SARS-CoV-2. Not ethical.

You cannot even randomize half of the population to masks and half to not and see who gets sicker or more COVID-19 – that study was done in Denmark but could have been confounded from the control group (who wear masks when they see the evidence and WHO guidelines)

So, it can’t be proven that masks work- you just need more and more evidence and people will choose to believe or not.

Take on top of this the bias around immunity. Those who want lockdown will look at 5 re-infection cases reported to date and say – “see, no immunity”. People who believe immunity combats viruses will will say “see, rare”.

Take on top of this that this is still a new virus and we are in the most politicized climate in the U.S. we can ever think of - and finally, public health messaging- when unkind and not taking into account people’s needs to be around each other or see their family, etc –

will lead to distrust without harm reduction. That distrust will then turn against the science and the studies that look at public health measures. And, similarly, public heath officials or epidemiologists without taking into account people’s needs are perceived as

out of the loop, ivory tower and privileged. Therefore, as scientists, all we can do is watch this, try to message with the best evidence at hand, try to acknowledge limitations and message kindly

Finally, enough said about this debate on masks/social distancing, viral inoculum, and reduced disease severity. We posed it as a hypothesis, groups (including ours) are working on it. Has limitations. Please turn to something else until people can work on it more!

Sorry for tweet verbosity; can you tell I am stressed about the election? Good luck, U.S.

ooh, and now I really do have to get off twitter for a bit since everyone else is getting mad at me that I am not doing my work (yes, A, I'm doing that talk now!). I am keeping the faith for this election, for COVID-19 being combatted, for fewer polemics, and for kindness.