The answer is that it doesn't matter. Masks, social distancing and lockdowns are NPIs not drugs. It's enough signal that everyone gets masked and the burden of proof is on those who want to demask to provide level 1 evidence it won't cause excess mortality/morbidity.
The burden of proof to come up with evidence to substantiate their position falls on those who propose the potentially unsafe course of action. With novel drugs, that falls on the prescriber/manufacturer of the drug. With NPIs it is the de-prescriber of precautionary measures
There is no level 1a+++ evidence for the efficacy of lockdowns, handwashing, or social distancing for COVID. That is not grounds for de-prescription of these precautionary NPIs. The burden of proof falls on those who wish to de-prescribe them to prove it won't increase mortality
Masking for COVID to filter the air is like boiling drinking water in cholera. There is no level 1a evidence proving that boiling contaminated drinking water reduces mortality in cholera. Yet it would be madness to not recommend it while people die, because of a lack of an RCT Image
An RCT of boiling drinking water for cholera would involve getting those in the control group to drink unsterilised drinking water to see if they died more. The big question is, whether here or with masking in COVID, is whether that is even ethical to do now. I doubt it is
The burden of proof here falls on those who propose encouraging people to drink unboiled water during a cholera pandemic. Show us your level 1a+++ evidence that this won't result in senseless mass deaths. Until then the water gets boiled

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More from @ToshiAkima

20 Nov
Unsolicited Review: Castle Grade N98 respirator. This gets a recommendation from me. TGA approved making it suitable for HCWs. It is comfortable and reusable. Ideal for Australian HCWs who suffer PPE burns from N95 masks, while upgrading aerosol protection castlegrade.com.au
Initial concerns included that I am not fit-tested by work, but as soon as you put it on you can tell there is reduced air leakage around the mask edges vs. a fit-tested N95. That means ZERO fogging of glasses. The tight seal pushes the air through the front of the respiratory
The acid test is whether I'd wear it working on COVID duties despite not being fit-tested. The answer is YES. There is obvious reduction in air leakage around the mask edges. It would be difficult for work to object to me wearing a TGA approved N98 respiratory instead of an N95
Read 14 tweets
20 Nov
Another cycling day today. 50km done wearing a KF94 mask all throughout the ride (only removed to drink water). The trick to avoiding having it fog up your glasses is to push it as high on the bridge of your nose as possible.
During my work N95 fit testing, I was instructed to push the N95 mask as high up as possible. A KF94 is smaller so it causes it to sit above your chin, but this encourages exhaled air to be expelled from the bottom—not the top, fogging up the glasses
I was also instructed to carefully mould the nose bridge wire so that it fits the contour of your face. It's best to do this in front of a mirror. This further improves the fit, reducing leaks of air upwards, fogging up your glasses.
Read 6 tweets
19 Nov
If Australians wish to avoid further disruptive lockdowns, we must find alternative NPIs to take their place. The evidence is clear: universal mask mandates are the best solution. They probably work even better than lockdowns or social distancing while keeping the economy running
The only reason to reject masks is that we love lockdowns. That's what's going to happen if we don't find a better alternative. Now we know #COVIDisAirborne we can use this insight to find more mode-of-transmission specific NPIs other than crude lockdowns
Anyone who rejects masks is an agent of chaos who secretly wishes more lockdowns upon us for the purpose of stirring social unrest, then harnessing it for their crazed populist cause. Gallows and all Image
Read 6 tweets
18 Nov
Masks are 2x more effective than social distancing according to a new BMJ systematic review. This isn't the first systematic review to come to such conclusions. That it is mechanistically plausible based on COVID's airborne mode of spread makes it highly credible #COVIDisAirborne
From a Cochrane review dated 6th Jul 2011: "Surgical masks or N95 respirators were the most consistent and comprehensive supportive measures. There was limited evidence that social distancing was effective" cochranelibrary.com/cdsr/doi/10.10…
The information found in that 2011 Cochrane review formed a springboard for the South Koreans to develop aerosol-mitigation based systematic biosecurity defence protocols that are the envy of the world
Read 5 tweets
17 Nov
COVID mRNA vaccines aren't dose-equivalent: "A homologous booster with 30μg [Pfizer] increased neutralizing antibody titers to more than 5 times as high as after dose 2. 50µg of [Moderna] increased neutralizing antibody titers 3.8-fold and 2.1-fold" medrxiv.org/content/10.110…
Here's another source saying that 30µg of Pfizer boosts Ab levels more than 50µg of Moderna. Yet we know that 2 x 100µg Moderna is more effective than 2 x 50µg Pfizer ImageImage
The 50µg Moderna 3rd shot appears less effective than a 30µg Pfizer. But that's because they aren't equipotent µg to µg. It's likely the Moderna 3rd shot would have been as effective if you had kept it at 100µg. In Australia, the 3rd Moderna dose will be 100µg, in the US, 50µg
Read 5 tweets
24 Oct
People get curiously upset about the idea that viral infections might drive neurodegenerative disease. But this is an old concept that has been well explored in the literature. For example the link between Herpes simplex and Alzheimer's nature.com/articles/s4146…
There are people who get upset over the fact that I am tweeting on an area I'm not published in. It doesn't change the fact that there are peer-reviewed publications on the subject statnews.com/2020/05/06/res…
I believe in anthropogenic climate change, yet I am not a climatologist. Likewise, it is reasonable for me to post material viruses causing neurodegenerative disease where I am able to support my statements with quality citations pubmed.ncbi.nlm.nih.gov/34205498/
Read 8 tweets

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