In a recent article published in City Journal, Vinay Prasad promotes himself as the scientist-physician who shines a light on government incompetence and corruption as he leads us to a post-COVID promised land. I discovered after writing this post that the City Journal is a conservative publication that holds itself to the highest intellectual, journalistic, and literary standards, and I urge them to keep it.
If you search forVinay Prasad masks orVinay Prasad vaccine, you will find an article that is representative of his other articles. He starts several paragraphs with a false statement made by the CDC or FDA. Let's review his assertions and see if they hold up.
Last week, CDC director Rochelle Walensky asserted that any mask is better than no masks at all. This statement was factually incorrect when she said it. The only published cluster randomized trial of community cloth masking during Covid-19—performed in rural Bangladesh—found that surgical masks reduced the spread of Covid-19 among villages assigned to wear them, while cloth masks were no better than no masks at all regarding the primary endpoint of blood-test-confirmed Covid-19. In an umbrella review of masking that I coauthored, we found no good evidence to support cloth masking. Two days after Walensky’s statement, the CDC conceded that cloth masking was inferior to other masks. Notably, however, this is still misleading because cloth masking is not just less effective—it is entirely ineffective.
The CDC flip-flops on its position oncloth masking, and it seems that the idea that any mask is better than no mask is logically inconsistent. The two conditions can coexist.
The Bangladesh trial's results were not better than no masks at all. The adjusted prevalence ratio is used to interpret the results. From the original article.
Although the point estimates for cloth masks suggests that they reduce risk, the confidence limits include both an effect size similar to surgical masks and no effect at all. (aPR = 0.94 [0.78,1.10]; control: 0.67%; treatment: 0.61%).
The shorthand way of interpreting the confidence interval is, we are 98% sure that the true adjusted prevalence ratio is within the range of 0.78 to 1.10. The CI allows for the possibility that cloth masks are better than no masks at all. It would be more accurate to say that the trial was not informed about cloth masks or no masks. The trial shows that cloth masks are not better than not wearing a mask.
Consider that randomized trials ask specific questions. The investigators asked if there was a difference between masking and not masking, according to the results of the study. The default position is the null hypothesis and the statistical methods are specific for it. By stating that cloth masks were no better than no masks at all, Prasad is stating a one-sided question similar to that of non-inferiority. The null hypothesis or default position is that there is at least a small difference between cloth masks and no masks. You don't get to change the hypothesis after the statistical analysis is done.
The beneficial effect of surgical masks was larger than that of cloth masks. In the Bangladesh trial surgical masks had a statistically significant effect while cloth masks did not. The control (non-mask) positive seroprevalence rate for COVID-19 was higher in the surgical mask villages than in the cloth mask villages. It is easier to show a statistically significant improvement when the baseline situation is more common or more severe than when it is rare or less severe. There were fewer villages that received cloth masks than received surgical masks, and a smaller sample size makes it more difficult to demonstrate statistical significance if there is a real but small effect. The cloth masking comparison was somewhat handicapped compared to the surgical mask comparison.
In the Bangladesh trial, mask wearing was 42% in intervention villages. The issue may be that the villages didn't reach a threshold needed for cloth masks to be effective. Is it possible to get people to wear masks consistently and properly? We abandon the idea if they don't work. If they do, we will try to facilitate proper mask wearing.
The type of cloth masks provided for the trial is important.
We used high-quality surgical masks that had had a filtration efficiency of 95% (standard deviation [SD] = 1%); this is substantially higher than the filtration efficiency of the cloth masks we designed, which had a filtration efficiency of 37% (SD = 6%). These cloth masks had substantially higher filtration than common commercial 3-ply cotton masks, but lower than hybrid masks that use materials not commonly available for community members in low-resource settings.
An article found that masks using cotton cloths of hybrid fabrics have a higher filtration efficiency. There is a reasonable reason for testing the type of cloth mask that can be used in low resource settings. The problem is that Prasad lumped all cloth masks together with his remark, which is clearly an oversimplification. I will defer a discussion as to whether we can apply results from rural villages in Bangladesh to cities and towns in high resource countries.
The quality of most studies was poor, according to the review of masking studies. Why didn't he design, fund and conduct a high-quality randomized trial of mask wearing? He seems to have plenty of time for grant writing, but only if the results of his trial are in his favor.
Now the CDC has endorsed the use of N95 or equivalent masks in community settings, which it presents as the superior choice. Here, too, the evidence is misleading. First, a masking policy involves more than just the filtration properties of the material; it should consider both filtration and human behavior. Will people wear the mask appropriately?
Since he can argue that N95 masks are useless, he changes tactics to say that no one is going to wear them properly anyway. If the real problem is that we can't get people to wear masks properly, why did he talk about how surgical masks work and cloth masks don't?
There is no reference for where CDC made this statement. The statement is in context. It was important to reserve the supply of N95 masks for health care personnel, according to the CDC. The concern about the supply of N95 masks has decreased to the point where the CDC feels they can be used outside of healthcare. This is not an arbitrary change in position.
The CDC says that you should wear an N95 mask. CDC continues to recommend that you wear the most protective mask you can, that fits well, and that you will wear consistently.
The virus changes, but our policies remain the same. Masking—even if it works—is not a permanent solution. It cannot work when you stop doing it. Recently, in a striking admission, Anthony Fauci confirmed not only that the virus will not be eliminated, but also that it will eventually infect us all. Even vaccination is not enough to entirely halt omicron breakthroughs. Thus, even if N95 masking delays the time to infection, we will eventually be infected. The question becomes: Is it worth it? We aren’t getting any younger, and at some point we will have to trust our immune systems (helped by vaccination) to fight off the virus. Is it worth it for a young person to delay exposure with an inconvenient and intrusive mask?
This appears to be a plan by Prasad to impress people with gibberish.
Is it worth it for a young person to delay exposure by wearing a mask? He shows his lack of understanding that viruses can be penned like cattle. Some young people will become very ill with COVID-19. They may have sequelae that last a long time even if they don't die. I find it odd that he provided a link to an article about the suffering of children with severe COVID-19 illness, despite his assertion that young people don't suffer bad consequences from COVID-19.
On August 12, 2021, after more than a year in which daycare providers routinely wore masks while caring for infants, the American Academy of Pediatrics tweeted: “Babies and young children study faces, so you may worry that having masked caregivers would harm children’s language development. There are no studies to support this concern”…The truth is, we don’t know. We are running an unprecedented experiment on our youth. We have never concealed faces from children in daycare for so many hours a day for so many years. Thus, we cannot be certain of the full effects.
I appreciate how far humankind has come when I hear about the things we wring our hands over. Generations ago, we were afraid the enemy would kill our baby. There is a possibility of a delay in language development.
We should consider whether there are drawbacks to children not seeing faces and how severe these effects might be. The problems of allowing COVID-19 to run through the community must be compared to them. If we don't reduce transmission there will be a shortage of daycare workers. Since children spend time at home every day, it's highly unlikely that they don't see other people's faces. Many parents have had to take their children out of daycare due to the Pandemic, where kids are most likely seeing their parents faces.
If we want to stop wearing masks so that young children can see faces, this should motivate us to take actions that end the Pandemic rather than offer up young people as a sort ofviral farm.
First, consider boosters. The case for population-wide boosters, including for young, healthy adults, is tenuous and was contentious even among senior scientists. Marion Gruber and Phil Krause—the director and deputy director of the FDA—reportedly resigned over White House pressure to approve boosters for all…But substantial uncertainty persists that boosting a 20-year-old man will redound to his net health benefit. After two doses of mRNA vaccination, he will have a markedly reduced chance of hospitalization or death. He will also face a nonzero risk of myocarditis from a dose three. While a third dose may provide short-term protection against symptomatic disease, his disease would likely be mild anyway. We do not know with confidence that such a person should receive a booster. Recently, in light of these concerns, Paul Offit, director of the Vaccine Communication Center of Children’s Hospital of Philadelphia, advised his own son not to receive a booster.
The case for population-wide boosters is tenuous and was contentious among senior scientists.
Public health policies are meant to maximize the health of the population, not necessarily bringing the most benefit. Medicine is the role of the latter.
I like the ominous meaning of "nonzero risk of myocarditis" The risk of vaccine-related myocarditis is not justified because it is less severe than myocarditis caused by the disease.
Recently, the government made an unusual regulatory change. It had initially recommended boosters six months after the initial vaccination series for Moderna, but it has accelerated this timetable to five months. The FDA admitted that this decision was based on data submitted for the Pfizer vaccine after the initial Pfizer series. Thus the FDA used data from a different manufacturer, at a different dose, to make vaccine policy.
I'm not sure how worrisome this example is, but I can object to Prasad's concern here. The FDA might not want to make a habit of it. This isn't a falsehood or an uncomfortable truth.
The idea that public health organizations should hold off on recommendations until multiple rigorous randomized trials are done or we have accumulated a lot of solid evidence behind them is a theme that resonances throughout the commentary. They don't have that luxury during an epidemic. I can't comment on the job that the CDC and FDA have done because I didn't get the message. I wouldn't be surprised if they made mistakes or didn't communicate clearly. That isn't the same as spreading false information andomitting important facts. Public health organizations, whether national, state, or local, operate under the direction of politicians. It isn't uncommon for a public health organization to recommend a product, but it isn't politically expedient.
Recently, the CDC published an alarming study suggesting that children who get Covid-19 may develop diabetes at higher rates than normal. Yet the study was grievously flawed. It did not adjust for risk factors—being poor or overweight—that predispose to both diabetes and Covid-19. It also failed to note that the absolute risks were astonishingly low. One can’t help but wonder if the CDC promulgated a highly imperfect study to push vaccination in this age group.
It is interesting to compare the provocative language of Prasad with that of the other person. He pushes people's emotional hot buttons.
There is an article in the CDC's Morbidity and Mortality Weekly Report about both type I and type II diabetes. CDC didn't control for the important confounders because they couldn't get the data they had. The evidence presented is interesting, but the results do not support the idea that COVID-19 causes diabetes in some children. The study's authors acknowledge this. The MMWR article provides references for the fact that other investigators in different populations are making the same observation of new cases of diabetes.
Monitoring for long-term consequences, including signs of new diabetes, is important in this age group.
To recap.
Federal agencies and respected organizations push recommendations that are deeply uncertain, rely on fearmongering or provide hollow reassurances. It is followed by a different form of fearmongering. The commentary gives the impression of a powerful entity that is either implementing a hidden agenda or bungling every decision. I'm afraid of something. I was in the hospital for a long time and didn't get a chance to say goodbye to my family. Did that fear come from the government or big pharma? It came from working in a hospital and talking with physicians who care for patients with COVID-19.
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