lystn

Characteristics and Strength of Evidence
of COVID-19 Studies Registered
on ClinicalTrials.gov

Looked at ClinicalTrials.gov

identified 1551 studies registered fromMarch 1, 2011, to May 19, 2020,
Lets look at the gold standard RCT
Of the 664 RCT (76.1%) were single center. PROBLEM! Weather analysis!
Only half of the rct looked at clinical course with only 8% of the rct looking at mortality and this is a problem because blinding was only reported for half of the trials so half of the time your outcome is clinical course and half the time you are not blinding them to the treatment do you think the people you knowingly got the treatment drug will ‘get better’ faster. And maybe they got better because they knew they were getting the good stuff or maybe they got better because eh provider knew they were getting the active. Both can be bias when they know if the patient is getting placebo or active arm.
The authors state it best “evidence, the large proportion of studies with
an expected low level of evidence is concerning. Rapid dis-
semination of studies with low-quality evidence studies can
influence public opinion, government actions, and clinical prac-
tice in potentially harmful ways,3



And I couldnt agree more so lets talk about something else that has no evidence-- MASK



Lets be clear about mask—we have no evidence that they work for what we think they work for—we have evidence they says they help decrease the spread of droplets when you speak but we don’t have evidence that then says that this decrease in droplets leads to a decrease in coronavirus cases and rememeber we don’t care about cases we care about deaths and does that lead to a decreaes in deaths. We don’t have evidence on this so ANYONE that has an opinon on mask is purely giving you their opinion—zero fact!

Well my hospital sent out an email saying hey look at this study https://jamanetwork.com/journals/jama/fullarticle/2768533
In the journal of the american medical association PROOVES that mask actually work!!!!


A research letter- https://jamanetwork.com/journals/jama/fullarticle/2768533
Association Between Universal Masking in a Health Care System and SARS-CoV-2 Positivity Among Health Care Workers

The study assessed the association of hospital masking policies with the SARS-CoV-2 infection rate among HCWs.

12 hospitals and more than 75 000 employees in Mass General

They looked at HCWs who tested + for SARS-CoV-2 between March 1 and April 30, 2020

This was broken down into 3 time periods
before implementation of universal masking of HCWs (March 1-24, 2020)
intervention period with universal mask (April 11-30, 2020).
out of the 75000 employees – only 10k got test and only 1271 had a positive result-

During the preintervention period, March 1-24, 2020, the SARS-CoV-2 positivity rate increased exponentially from 0% to 21.32%!!

During the intervention period requiring mask from April 11-30, 2020 the positivity rate decreased linearly from 14.65% to 11.46%
THUS
Universal masking at mass general was associated with a significantly lower rate of SARS-CoV-2 positivity among HCWs.
This association may be related to a decrease in transmission between patients and HCWs and among HCWs.
MAY BE or may not!! Always be careful!
The decrease in HCW infections could be confounded by other interventions inside and outside of the health care system (Figure), such as restrictions on elective procedures, social distancing measures, and increased masking in public spaces, which are limitations of this study.

this study doesnt say that mask prevent infection because what we were doing during the rest of the time was drastically different!!
how we handled covid on march 1 was drastically different than april1! they are not even close to the same, we shut down bards and restauranted by april 1 and we didnt do that by march 1 so if you want to say look at the huge benefit mask made then you have to say look at t a huge benefit mask, and social distance and limits to group gatherings and economic shut down had on the cases of covid19 for of health care workers--- this is just another article that spins the numbers come up with a covid conclusion that is not accurate or tell the whole story.
As far as the answer on mask, the answers will vary wide and far – they are kind of like butts, everyone got one and none of them are evidence based

or something like that

But the next article has also hit the press and a popular title saying ‘kids don’t spread covid’
Which comes from this article


Posfay-Barbe KM et al. COVID-19 in children and the dynamics of infection in families. Pediatrics 2020 May 26; 146:e20201576. (https://doi.org/10.1542/peds.2020-1576)

What is a child’s role in transmission of COVID-19? This study looked at 39 patients RESULTS:
Of the 39 children, 18% required hospitalization, and none required intensive care unit admission.
Cough was the most common symptom (82%), followed by fever (67%) and nasal discharge (64%)
HERE IS THE KICK IN THE PANTS
In 79% of cases, at least one adult in the household had COVID-19 symptoms before the child.
They use this to say look 4 out of 5 times the adults in the house has symptosm before the kids so this “confirms that children are infected mainly inside familial clusters” – no it does not it just confirms child don’t have symptoms or don’t report their symptoms prior to the adults.
“Interestingly, 85% (75/88) of adult household contacts developed symptoms at some point, compared with 43% (10/23) of pediatric”
The article uses this to say – look the kids are not developing symptoms or they are developing them at a rate half that of adults so obviously this means kids don’t get covid right???? wellThe mean age was around 11. How many 11 yr old are going to mention to their parents ‘hey I have a runny nose today’ OF COURSE NOT, wipe it on your sleeve and keep playing ball with your friends or video games or whatever kids do these days. Or please name me the number of 11yr olds that are going ot say ‘um I cant smell’ or ‘my taste isnt the same’ – OF COURSE NOT in my house if you said this “taste kind of funny” or “this taste terrible” or this doesn’t taste right you would get sent to bed with an extra bowl of broccoli! Kids are not going to speak up about these odd and weird symptoms! So maybe it is not that kids don’t develop symptoms half the rate of adults they just don’t complain about them at the same rate as adults
And
The the weirdest part of all which we have seen over and over is this line “Surprisingly, in 33% of households, symptomatic HHCs tested negative despite belonging to a familial cluster with confirmed SARS-CoV-2 cases”

Why is this happening? You could say it was a bad sample- but it is a single center so really it should be the same swabbers for everyone. Why are we seeing so many people test positive then 1/3 to half the time the household contacts even spouses are not testing positive??

Which takes me to my next article
https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2768377?guestAccessKey=ff853102-6da2-4db9-bf72-1ce8904ecd57&utm_source=silverchair&utm_medium=email&utm_campaign=article_alert-jamainternalmedicine&utm_content=olf&utm_term=071420
Outcomes of Universal COVID-19 Testing Following Detection of Incident Cases in 11 Long-term Care Facilities
We know or we think we know that Residents in long-term care facilities are at particularly high risk of infection and poor outcomes associated with coronavirus disease 2019 (COVID-19).
Some of this may be because residents in long term care facilities are at particularly high risk of infection and poor outcomes associated with EVERYTHING! A bad fart can derail some of these ships.
We performed universal testing of untested residents across 11 Maryland long-term care facilities that ) had known positive cases and had recently undergone targeted testing based on individual residents’ symptoms and (2) had known positive cases.
Of the almost 1200 residents of the 11 long term care facilities just doing target testing resulted in 153 cases
Among the remaining 893 residents who were universally tested, 354 (39.6%) tested positive for SARS-CoV-2 RNA.
so many questions- why no symptoms in almost 40% of the individuals. that tested positive. In total there were 56% of the individuals testing positive? why not the other 44%, what is special about them?
If this had not been a study with universal testing we would have missed 40% of the people that tested positive for covid19, we are likely drastically underestimating how many people have had this illness already and by these numbers we are underestimating it by 40%.


I wonder if this would also work for people that have no symptoms--- like football player.
Self-collected swabs research in JAMA Network Open (Free)
Self-collected Midnasal vs Clinician-Collected Nasopharyngeal Swabs to Detect SARS-CoV-2 Infection
Self-collected midnasal swabs: Midnasal swab specimens self-collected at home may be comparable to clinician-collected nasopharyngeal swab specimens for detecting SARS-CoV-2 in symptomatic patients,
Nearly 200 symptomatic patients — 85% of whom were health care workers — contributed both types of specimens for analysis.
with the clinician-collected swabs as the reference, home swabs had a sensitivity of 80% and specificity of 98%.
The authors acknowledge study limitations but write, "This approach is safe and scalable in the pandemic setting, permitting widespread testing of symptomatic participants early in illness and the potential for prompt self-isolation and [contact] tracing."