re: Facts about Ivermectin from an ICU Nurse

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I will say I’m one of the very few ID docs who publicaly questions large scale societal masking. Masks can help prevent a sick person from spreading the disease on an individual basis if worn consistently and correctly, and in controlled environments such as hospitals can help limit hospital acquisition of certain respiratory infections, and N95s are very effective, but is large scale cloth masking effective across whole populations? I just haven’t seen the evidence to support that.

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I dug pretty deep into mask data at the onset of this. One meta-analysis had about 14 “real world” trials in it + one “lab” study- There was one study that looked at culturing influenza after coughing through masks at a controlled distance (the lab study)
One was actually a cloth-mask field-hospital study from the Spanish Flu. It showed a positive benefit to masking (in outdoor/open air field hospitals with cloth masks for healthcare workers among many other con founders).
The only other study to show a benefit to masking and flu transmission was a study where a subset of people who were household contacts of an initial case both masked and hand washed within 24h of the sentinel case. The overall study failed to show benefit in the “mask vs no mask” overall question.

I’ve never been accused of being great at interpreting and explaining research to others, but the one thing most of the studies in this particular meta-analysis seemed to show was that they were given instructions to mask but never measured on compliance, fit, and fidgeting (wiping nose, scratching mouth, etc). The other thing I’ve noticed is that once we sort of figured out that it was here and airborn, we didn’t see a ton of patient to provider/nursing transmission.

So when someone asks me what I think, I usually tell them that I think masking, if done properly, is probably an effective way to reduce your own risk of contracting it if you wear it appropriately, but that it’s generally too hard for most people to do. On a “mandate” scale, it’s wholly ineffective for this reason. I, of course, don’t have hard data to rest that on, and I’ll admit that. From the public health side, I can at least appreciate the recommendation to mask in public could have this same thought process and may prevent some who do wear masks appropriately from infections, but I think mandates are far outside the scope of medicine and public health given the abundance of data to support the futility of it, leaving the politics of using healthcare to enforce the law on people aside (ok, not totally. So it’s unethical for a doctor to force treatment on a person with bipolar disorder who’s already spent 15 stays in a mental hospital for various manic activities including previous suicide because someone with sound mind and body (At that moment) has a right to refuse healthcare/treatment (which in the case of mania definitely can hold some “affects others” consequences, potentially) but we are going to impose fines or jail times or sanctions on people for not sticking to mandates that have proven futility? Give me a break)