Cochrane: Physical interventions to interrupt or reduce the spread of respiratory viruses, 2023, Jefferson et al

[AliceLily]

There's no freaking way N95's are ineffective. It's basic physics and engineering; I'm not letting a meta-analysis with potential confounders confuse me. Anecdotally, many people in my social circle have had Covid 2-3 times already, I haven't had it once, and not for lack of going out.

I'm one of those rare people still wearing a mask when I go out. I haven't had Covid. I go out nearly every day catching a bus or a train. I wear a surgical mask and a cotton mask over top of it. It has worked very well for me. I do constantly sanitize my hands also.

I live on my own now and don't have visitors inside the house except for when family visit which is not often due to their living further away. Tradespeople, I provide a mask for them to wear if they have to come into the house.

I haven't even had a cold for the last 2 years.

 

[Andy]

Preprint: Quantitative errors in the Cochrane review on "Physical interventions to interrupt or reduce the spread of respiratory viruses"

The COVID-19 pandemic has brought a heightened sense of urgency in the scientific community regarding the need to advance understanding and prevention of pathogen transmission, particularly concerning infectious airborne particles and the utility of various preventive strategies in reducing the risk of infection. There are extensive studies validating scientific understanding about the behavior of larger (droplets) and smaller (aerosols) particles in disease transmission and the dosimetry of particles in the respiratory track. Similarly, modalities for respiratory protection against particles in the size range spanned by infectious particles, such as N95 respirators, are available and known to be efficacious with tested standards for harm reduction across environments including physical, chemical and biological hazards. Even though multiple studies also confirm their protective effect when adopted in healthcare and public settings for infection prevention, overall, studies of protocols of their adoption over the last several decades in both clinical trials and observational studies have not provided as clear an understanding.

Here we demonstrate that these studies are strongly biased towards the null by infections resulting from transmission outside of the investigated environments and study participants. Such study limitations are frequently mis-stated as not influencing the conclusions of research on respiratory protection. The reason for the failure to properly analyze the studies is that the standard analytical equations used do not correctly represent the random variables that play a role in the study results.

By correcting the mathematical representation and the equations that result from them, we demonstrate that conclusions drawn from these studies are strongly biased and much more uncertain than is acknowledged, providing almost no useful information. Even with all these limitations, we show that existing results, when outcome measures are properly analyzed, consistently point to the benefit of precautionary measures such as N95 respirators over medical masks, and masking over its absence. We also show that correcting manifest errors of widely reported meta-analyses also leads to statistically significant estimates. Our results have implications for the design of studies and analyses on the effectiveness of respiratory protection and on using existing evidence for policy guidelines for infection control.

https://www.researchsquare.com/article/rs-3486610/v1

https://twitter.com/user/status/1717966494665941401

 

[ahimsa]

Merged
What Went Wrong with a Highly Publicized COVID Mask Analysis?

The Cochrane Library, a trusted source of health information, misled the public by prioritizing rigor over reality

https://www.scientificamerican.com/...with-a-highly-publicized-covid-mask-analysis/

The COVID-19 pandemic is ongoing, but in May officials ended its designation as a public health emergency. So it's now fair to ask if all our efforts to slow the spread of the disease—from masking, to hand washing, to working from home—were worth it. One group of scientists has seriously muddied the waters with a report that gave the false impression that masking didn't help.

The group's report was published by Cochrane, an organization that collects databases and periodically issues “systematic” reviews of scientific evidence relevant to health care. This year it published a paper addressing the efficacy of physical interventions to slow the spread of respiratory illness such as COVID. The authors determined that wearing surgical masks “probably makes little or no difference” and that the value of N95 masks is “very uncertain.”

The media reduced these statements to the claim that masks did not work. Under a headline proclaiming “The Mask Mandates Did Nothing,” New York Times columnist Bret Stephens wrote that “the mainstream experts and pundits ... were wrong” and demanded that they apologize for the unnecessary bother they had caused. Other headlines and comments declared that “Masks Still Don't Work,” that the evidence for masks was “Approximately Zero,” that “Face Masks Made ‘Little to No Difference,’” and even that “12 Research Studies Prove Masks Didn't Work.”

Karla Soares-Weiser, the Cochrane Library's editor in chief, objected to such characterizations of the review. The report had not concluded that “masks don't work,” she insisted. Rather the review of studies of masking concluded that the “results were inconclusive.”

 

[SNT Gatchaman]

A few more quotes relevant to our experience (failure to recognise harms with exercise therapy) are worth capturing.

This was not just a failure to communicate. Problems with Cochrane's approach to these reviews run much deeper.

Recently Jefferson has claimed that COVID policies were “evidence-free,” which highlights a second problem: the classic error of conflating absence of evidence with evidence of absence. [...] Jefferson erased that distinction, in effect arguing that because the authors couldn't prove that masks did work, one could say that they didn't work. That's just wrong.

Cochrane has made this mistake before.

 

[rvallee]

There is so much worse than absence of evidence, false assertions were made with high confidence. Just the same, the WHO communicated in March 2020 that COVID is not airborne. They even published it as a fact-check, not just asserting that there enough evidence. Even though it made no sense at all, could not explain how easily it spread otherwise, an explanation that defied physics. You never win by going against physics. Never. "Masks don't work" is going against physics.

The whole clusterfuck over "masks don't work" was a disguised forced herd immunity strategy that could not be voiced out loud, which made it wrong twice over, and exactly why such strategies are not worth it. It's often repeated that one of the reasons why this was said was because there weren't enough masks and authorities chose to say this so that healthcare workers could have enough.

And that's complete BS. The way to have enough masks and other equipment is to admit the plain truth and structure mass production around this emergency need, because once you lie about stuff like this it can be forever be assumed that medical and public health authorities will lie with impunity. Which is where we are. Most countries have the industrial capacity to ramp this stuff up if they choose to, even as stop-gap measures while ventilation is improved, which hasn't even happened because of all the minimization and denial.

The way medicine handled this is actually quite similar to militaries in war time, but with the odd reality of denying there is any threat while lying under guise of "national security". The worse parts of both situations, leading to the worst possible outcomes.

The textbooks of pandemics and epidemics all say that you have to tell the truth since no one can fully enforce those measures, there needs to be a high level of truth from the population, and now that trust has been forever destroyed, will never be regained. All the institutions of medicine played some role in it, either complicitly or tacitly. They can and should forever be assumed to be willing to either lie or go along with it.

Those assertions were ideological, and they exposed the sham of so-called evidence-based medicine. But not a single lesson was actually learned, which is even more disturbing. It's hard to put into perspective in just how deep a level of shit we are if there is soon, as in the next decade, a major pandemic with high mortality.

This is the worst-case nightmare scenario, the kind that could cripple our entire civilization. We are far worse prepared than we were before COVID, and it turns out that we were not prepared at all. All they had to do is tell the truth, but medicine has made worrying about illness a worse thing than illness itself. What an incredible mess, and no one is responsible, no one is accountable, and failed organizations like Cochrane will keep on doing the same stuff regardless of the outcomes they create.

 

[rvallee]

Karla Soares-Weiser, the Cochrane Library's editor in chief, objected to such characterizations of the review. The report had not concluded that “masks don't work,” she insisted. Rather the review of studies of masking concluded that the “results were inconclusive.”

Well, this is exactly how it was understood and heavily promoted. Cochrane is basically pretending that how people understand their reviews doesn't matter. And having made no correction to the review itself, it now had a baby and the BMJ is the father this time.

Even though this "systematic review" only concluded that the evidence was not conclusive, on the basis that it's simply not good, this is being heavily promoted in the pandemic minimizer and denier crowd as evidence that they don't work. Even though the review is over mandates, which were poorly followed at best, and is basically so full of holes you couldn't even use it as a sieve.

Child mask mandates for COVID-19: a systematic review
https://adc.bmj.com/content/early/2023/12/02/archdischild-2023-326215

Background
Mask mandates for children during the COVID-19 pandemic varied in different locations. A risk-benefit analysis of this intervention has not yet been performed. In this study, we performed a systematic review to assess research on the effectiveness of mask wearing in children.

Methods
We performed database searches up to February 2023. The studies were screened by title and abstract, and included studies were further screened as full-text references. A risk-of-bias analysis was performed by two independent reviewers and adjudicated by a third reviewer.

Results
We screened 597 studies and included 22 in the final analysis. There were no randomised controlled trials in children assessing the benefits of mask wearing to reduce SARS-CoV-2 infection or transmission. The six observational studies reporting an association between child masking and lower infection rate or antibody seropositivity had critical (n=5) or serious (n=1) risk of bias; all six were potentially confounded by important differences between masked and unmasked groups and two were shown to have non-significant results when reanalysed. Sixteen other observational studies found no association between mask wearing and infection or transmission.

Conclusions
Real-world effectiveness of child mask mandates against SARS-CoV-2 transmission or infection has not been demonstrated with high-quality evidence. The current body of scientific data does not support masking children for protection against COVID-19.​

Shamez Ladhani, a collaborator of Esther Crawley on the NIHR-funded pediatric Long Covid studies, is a contributor. He and other collaborators have been very dismissive of the possibility that COVID was possibly harmful to children.

 

[rvallee]

I have read the review and although it's shocking in its brazenness, it's not surprising. This is really the natural consequence of evidence-based medicine, and why it is simply not a valid paradigm. It isn't just invalid to assess the safety and efficacy of treatments, it's simply invalid. The process is only truly as good as the scientific studies that go into it, and when there are none, the process is worse than useless, it's actively harmful. It's actually worse than what a legislative committee would produce, since it's a secretive process with selective, well, everything. You change the people involved, you change everything, evidence is entirely irrelevant.

To begin with, the choice of question is very important. The review is over mask mandates for children, which were very sparse and never actually adhered to. It's not over masks, it's over mandates, and yet this is exactly how it's interpreted and communicated, same as with the Cochrane review: "masks don't work". It's also trying to review in isolation a factor that was never isolated, so it's even worse than the Cochrane review that is cited not once, but twice, somehow referred to as "two studies" even though they cited the most recent update and an earlier version of it.

As the review notes, there are no controlled studies, because it's not possible to do so. Science doesn't rely on naturalistic controlled studies, and naturalistic studies don't make sense when people's behavior is influenced by the messages they receive. All of the studies are biased and poorly done. So the conclusion is that the evidence, which can only rely on mechanistic knowledge, in this case physics, can only be assumed to be harmful in the absence of evidence for the absence of harm.

Because this review actually has the shamelessness to argue that interventions should only be recommended when not only has efficacy been proven, but harm has been positively demonstrated to be absent, or at best to outweigh the harms. A feature that we are explicitly denied when it comes to basically the entire "evidence base" for chronic illness, where the mere distant possibility of some form of generic benefit is argued to be enough, and harm is simply disbelieved to be possible at all.

There is actually quite a bit, and it's famous, about how the intervention was never adhered to. So this is basically an uninterpretable review of poorly done studies that makes an explicit recommendation against. We see the exact opposite e.g. in the Cochrane study on exercise, this is why evidence-based medicine is essentially an entirely useless paradigm: it is fully biased and the evidence is always selected and interpreted to justify pre-determined conclusions.

I very well remember that even at the height of mask mandates, it was always well-understood that when it came to children, mask-wearing was never really happening. Because they're children. There is also an odd mention of "perpetual mask-wearing", a silly construct as all recommendations were always based around relative risk, and in many countries schools were actively used as explicit vectors to maximize transmission in the pursuit of herd immunity.

So many health care professionals have bizarrely been pushing the lie of "immunity debt", when all that they achieved is creating a giant credibility debt for medical expertise. This review adds a lot to that debt, the loss of credibility, of legitimacy, in medical expertise is unprecedented in history, and will have ramifications for decades to come, depending on how AI unfolds. The human factor is the flaw, this is simply not science, it's garbage-out using garbage-in and being proud of it.

The authors behind this study know that masks work because they are based on physics and engineering. They would absolutely use high-quality respirators to protect themselves from most viruses. But they don't believe that COVID should be controlled, in fact have promoted the idea that people need to be infected with COVID for their own good, and this is what influences everything they did here. This is death of expertise.

 

[rvallee]

From the Cochrane review:

In addition, although the use of medical/surgical masks versus N95 respirators demonstrates no differences in clinical effectiveness to date, their use needs to be further studied within the context of a well‐designed RCT in the setting of COVID‐19, and with concomitant measurement of harms, which to date have been poorly studied. The recently published Loeb RCT conducted over a prolonged course in the current pandemic has provided the only evidence to date in this area (Loeb 2022).

This "RCT" has 28 references throughout the review.

The trial has been re-analyzed, and it's full of the same flaws and biases we are used to from so-called evidence-based medicine. Well-designed this R"C"T is not.

Failure to protect: COVID infection control policy privileges poor-quality evidence
Pre-print: https://osf.io/preprints/metaarxiv/ey7bj

The failure to immediately recognize the urgent need to control airborne spread of COVID-19, including use of adequate personal protective equipment for an airborne pathogen, represents a major medical error that cost “an enormous number of lives”. Made in the face of significant scientific evidence and a clear requirement to adhere to a precautionary approach, it has still not been fully remedied. To understand the substantial, ongoing gap between science and policy, we carried out an in-depth investigation of an illustrative publication authored by prominent authorities in the fields of Public Health and Infection Prevention and Control, describing a trial of medical masks and N95 respirators for the prevention of COVID-19. Although it was portrayed as among the highest quality evidence available within the Evidence-Based Medicine decision-making paradigm, we found this work to be deeply flawed to the extent that it does not meet basic standards of scientific rigour. Extensive prior work in the respiratory protection field –sufficiently well-established to be incorporated into both national standards and specific recommendations made to address infection control failures in SARS –was ignored. Randomization was compromised, with a statistically significant correlation between female sex and allocation to the higher-risk arm of the trial. Significant conflicts of interest in favour of the reported finding that medical masks are noninferior to N95 respirators in preventing COVID-19 transmission were not disclosed. Prespecified analyses were omitted, and the finding of noninferiority is entirely a product of inappropriate alterations to the trial that were not prospectively registered. Despite numerous flaws biasing the outcome towards a finding of noninferiority, re-analysis using the prespecified approach and noninferiority criterion unambiguously reverses the reported outcome of the trial.​

Thread from one of the authors highlighting some of the issues with it. Doesn't appear to have been accepted by a journal. For all the claims of science being self-correcting, corrections are often treated as hostile.

https://nitter.net/Mark_Ungrin/status/1731799615618294099

 

[Trish]

From Cochrane's minutes of their Governing Board meeting in August/September 2023, an item which I assume refers to the review on this thread:

https://community.cochrane.org/orga...e/governing-board/meetings/agenda-and-minutes

https://community.cochrane.org/site...23_09_01_restricted access_final draft OA.pdf

GB-2023-65 Cochrane communications

Following the publication of a Cochrane review on a controversial topic which generated adverse publicity, a short-term panel was convened to consider what actions could be taken to help mitigate the risk of adverse publicity in the future.

Gill Leng presented a report from the panel which made the following recommendations:
• expectations with authors should be set at the start of the review process
• Cochrane’s role in assessing the evidence should be reinforced
• potentially controversial reviews will be identified proactively
• producing only one review summary will be considered to avoid confusion

The Editorial Board had seen the report and would take forward the recommendations included in it.

The Governing Board noted the report and asked Karla Soares-Weiser to develop an implementation plan and timetable for taking the recommendations forward.

The spokesperson policy will be reviewed too. ACTION: To be included on the agenda for the Governing Board meeting to be held in December 2023 Catherine Marshall said that she and Karla Soares-Weiser had both been subjected to personal criticism and the fact that the panel did not find that anything had been done incorrectly should bring comfort. The Board confirmed that the Editor in Chief had their full support.

ACTION:A statement setting out the process, findings and next steps will be drafted with input from the Head of Communications. (KSW)

 

[Kitty]

Cochrane’s role in assessing the evidence should be reinforced

And this has only just occurred to them?

expectations with authors should be set at the start of the review process

"Anybody can stick a label on a bottle saying Chanel No. 5. Have a sniff before you buy it."

 

[rvallee]

Catherine Marshall said that she and Karla Soares-Weiser had both been subjected to personal criticism and the fact that the panel did not find that anything had been done incorrectly should bring comfort

So Cochrane fully stands behind the "masks don't work". Of course. Nothing was done incorrectly. Everything was perfect. The Leader is good, the Leader is great. We surrender our will as of this date.

 

[Trish]

Cochrane seem to be drowning in procedures and processes and have long ago lost sight of the need for their reviews to actually make scientific, rational or any other sort of sense.

It sort of reminds me of a novel I read some time ago where the main character was working in a department of a largish organisation that occupied many floors of an office building. Each floor had its teams and roles in holding meetings, shuffling around paperwork and all the trappings of a large beaurocracy. What nobody seemed to know was what the organisation actually did beyond endlessly ensuring all its internal processes happened according to regulations. The denoument was the central character discovering that there was no external function. All the workers were doing nothing but keeping a completely pointless multilayered organisation functioning.

 

[Sid]

I am getting very close to being the only person I know of (in my real life) who hasn't had it.

With rare exceptions I still mask up when out and around people. Almost the only one left doing it now around here. Rarely more than 1-2 others masking at the supermarket. Always older people, and almost always just standard surgical masks, not N95/P2 grade, and rarely worn properly.

I wore N95 every time I got on public transport and at work. Never caught covid or any real cold/flu for years despite working in a hospital. Then 3 years into the pandemic the person who lives with me went to a social event unmasked, caught covid and infected me at home. Before that, I was essentially the last person I knew in real life who hadn't caught it and I believe I would have continued to avoid it if I was living alone.

 

[rvallee]

Cochrane seem to be drowning in procedures and processes and have long ago lost sight of the need for their reviews to actually make scientific, rational or any other sort of sense.

It sort of reminds me of a novel I read some time ago where the main character was working in a department of a largish organisation that occupied many floors of an office building. Each floor had its teams and roles in holding meetings, shuffling around paperwork and all the trappings of a large beaurocracy. What nobody seemed to know was what the organisation actually did beyond endlessly ensuring all its internal processes happened according to regulations. The denoument was the central character discovering that there was no external function. All the workers were doing nothing but keeping a completely pointless multilayered organisation functioning.

Ultimately, Cochrane has fallen to the Iron law of institutions. Without external oversight or accountability for results, every institution inevitably becomes about its own continuing existence, and the leaders of those organizations make the organization serve their interests, ignoring any goals it may initially have had.

The people who control institutions care first and foremost about their power within the institution rather than the power of the institution itself. Thus, they would rather the institution "fail" while they remain in power within the institution than for the institution to "succeed" if that requires them to lose power within the institution.

https://rationalwiki.org/wiki/Iron_law_of_institutions

 

[Caroline Struthers]

Ultimately, Cochrane has fallen to the Iron law of institutions. Without external oversight or accountability for results, every institution inevitably becomes about its own continuing existence, and the leaders of those organizations make the organization serve their interests, ignoring any goals it may initially have had.

https://rationalwiki.org/wiki/Iron_law_of_institutions

So true.

 

[Sean]

Always said that the first business of those who get power is to arrange things so they are never held accountable for any adverse outcomes of wielding that power.

 

[SNT Gatchaman]

Professor Brendan Crabb, interviewed by Australia's ABC —

Masks, he adds, should be worn in crowded places or spaces with poor ventilation. Of course, the topic sometimes sparks heated debate. A Cochrane review which last year suggested masks do not work was later found to be inaccurate and misleading and subject to an apology. But the damage it did was significant. Since then a vicious culture war has raged, much to the dismay of respected scientists who continue to make the point: numerous studies show high-quality, well-fitted N95 and P2 respirators prevent infection when they're worn correctly and consistently.

 

[rvallee]

Subject to an apology? It's still published, and the apology seemed more in line with "sorry you misinterpreted it, but we stand by it". That's not really an apology. Argh.

 

[Hutan]

CNN news item that makes clear the harm done by the Cochrane study
www.cnn.com/videos/health/2023/09/09/smr-author-of-mask-study-on-effectiveness.cnn
The lead author of the review features, making it clear that the review was not misunderstood

"Masks have become political" says an author of the Cochrane Library study on mask effectiveness. "I can only tell you what the science is....I can't tell you whether they work or don't work. But it's more likely than not that they don't work."

And an article from Scientific American from November 2023
https://www.scientificamerican.com/...with-a-highly-publicized-covid-mask-analysis/

 

[rvallee]

So, Cochrane has been spending years saying that it doesn't mean that, even though the lead author went out and made it clear that, yes, this is exactly what they mean and, no, it's not misinterpreted. And in ambiguous non-committal useless EBM language that leaves you scratching your head regardless.

But Cochrane still go on pretending that it's been misinterpreted. Damn. This EBM industry really is just a giant mess.