Different countries have different strategies, different people have different ideas too.

The problem with US is due to President D. Trump himself who is still refusing to comply with anti-covid 19 emergency rules (including mandatory mask wearing) issued by US officials as Dr Fauci for instance.

Dear Gary, Is the press in the USA free? Or is it paid and bought?

What do you think is more important for a free democratic nation?

A smart president? A free press system? Sigh... In november 2020 there will be the next US presidential elections...

Sigh again. There is a high chance that this president (this is just like the flu)

(It will go away all by itself) will be elected again... Sigh again...

Free press system in Europe, really? What would you have preferred in 2016...war in Europe with Russia about the Ukrian or president Trump. Check out the middle east Obama wars. As a European I go for Trump and not the neolibs with their war machine running high voltage.

Sorry, but I don't mind a mask or respirator. As a physician I have worn one for hours every day for many years, so you get used to it. I don't even notice it now. You have to get used to it as a physician, doing surgery, contagious patients, immune suppressed patients; hours a day. Right after AIDS came out what was called "Universal Protection" was instituted in the hospitals, clinics and offices. A gown, gloves, mask, and eye protection. Similar state should be in effect now. SARS-CoV-2 is more contagious, and through respiratory, than HIV. Thank you again.

In places where personal pride prevents the use of Personal Protective Equipment, I would say that in a time of a deadly Pandemic, pride maybe should be secondary to good health. I f a person catches the virus, and ends up in the hospital, usually personal pride unfortunately disappears, modesty and privacy disappear as tubes are inserted into places you didn't know existed.

I have to agree with you, President Trump upset me about refusing to touch a mask. He is the leader and I think he prides himself too much on his appearance and public presentation. Unfortunately, at least half of the country appears to be following his lead on abstaining from masks and respirators. The numbers unfortunately are proving this point.

Thank you, stay safe.

Another way of looking at the mask issue. This point of view has been espoused by various health departments around the world. That is, that the mask or respirator mainly protects others from catching what the wearer of the mask has. Not necessarily does the mask or respirator protect the wearer from other people's contagious diseases. So, the wearer of the mask is altruistic, protecting the public from anything that he/she may have to spread. The person who is not wearing a mask, doesn't care about spreading things to the public and his/her fellow human, and I would venture may not be an altruistic person. (I would say the same thing goes for other articles of PPD, and even actions such as distancing. There may be some cofounding variables such as ignorance, lack of supplies, etc. But this could be an interesting sociological study.

Thank you again. June 19, 2020.

June 20, 2020: Here is the latest from the CDC:

"Should I wear a mask?

The C.D.C. has recommended that all Americans wear cloth masks if they go out in public. This is a shift in federal guidance reflecting new concerns that the coronavirus is being spread by infected people who have no symptoms. Until now, the C.D.C., like the W.H.O., has advised that ordinary people don’t need to wear masks unless they are sick and coughing. Part of the reason was to preserve medical-grade masks for health care workers who desperately need them at a time when they are in continuously short supply. Masks don’t replace hand washing and social distancing."

This is confirming my comments as above. yes, please wear a mask when in public or around other non-live-in family members. The other PPE are also extremely important. This explains that the initial rules were protection for the healthcare workers, due to inadequate preparation with equipment for this Pandemic. Thank you for your support. Gary Ordog, MD

An interesting point told to me yesterday. When you walk into a place where people aren't wearing masks and also are avoiding distancing suggestions, the people immediately part and give you distancing (As if you are contagious). In theory, you are preventing the spread of infection to them, those not wearing masks are not concerned about giving it to you. Those same people are probably the ones you have to worry about. Looking in a store, deciding whether to go in or not, if the clerks are wearing masks and shields and gloves, etc., it is probably a safe bet to go in. Especially for food preparation and serving establishments, if the employees are using PPE, it is probably safer than an establishment not using PPE. This is just common sense, but like the saying goes, "Common sense is not so common." On the bright side, it is getting closer to probably having a good vaccine. Thank you and stay safe.

It is partially true in too few cases in India - Majourity of the News Channels are busy to deliver /point out News regarding the utilisation of PPEs .

June 30, 2020(JAMA today)

Evidence For the Efficacy of Medical Masks and Respirators.

Gary Ordog, MD, DABMT, DABEM | County of Los Angeles, Department of Health Services, Physician Specialist (retired)

Thank you for your excellent and timely article. I wish to respond to a controversial comment by Dr. Thomas Pliura. He implied that there are no research studies published on the preventive efficacy of facial masks and shielding (I will include respirators to be more complete): "I ask for a single citation to a validated study to support the premise that face masks would do anything at all to contain the spread of COVID-19." Five simple Med-Line searches with those words, virus, and efficacy, yield around well over 100 peer-reviewed articles, including several from the COVID era. Additional searches on studies of safety yielded over a thousand research articles, including recently in this very journal, JAMA. Would there even be a century of wearing surgical masks if they weren't useful in the prevention of transmission of infectious agents? I daresay that most or all of our healthcare workers would currently be SARS-CoV-2 positive if not for PPE. Please review and reconsider your comments. Thank you and stay safe.

CONFLICT OF INTEREST: None Reported COMMENT for:

April 29, 2020

Moving Personal Protective Equipment Into the Community

Face Shields and Containment of COVID-19

Eli N. Perencevich, MD, MS1,2; Daniel J. Diekema, MD, MS2; Michael B. Edmond, MD, MPH, MPA2

Author Affiliations Article Information

JAMA. 2020;323(22):2252-2253. doi:10.1001/jama.2020.7477

On March 19, 2020, California became the first state to issue a stay-at-home order in response to the evolving coronavirus disease 2019 (COVID-19) pandemic. It was quickly recognized that widespread diagnostic testing with contact tracing, used successfully in countries such as South Korea and Singapore, would not be available in time to significantly contain the spread of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2).1,2 Over the following month, additional nonpharmaceutical mitigation strategies, including school closures, bans on large in-person gatherings, and partial closures of restaurants and retail stores, were applied to “flatten the epidemic curve” and limit the peak effects of a surge of patients on health care systems. Yet, even as the benefits of mitigation bundles have not fully been realized, there are widespread calls to reopen businesses, given the immense economic and social consequences of extreme physical distancing strategies.

Recently, public health, infectious disease, and policy experts have outlined recommendations for gradually reopening society using combinations of containment and mitigation strategies.3,4 Proposed containment strategies have followed the South Korean model and include rapidly expanding public health infrastructure for widespread testing and data-driven contact tracing, while ensuring that safe medical care is delivered by health care workers wearing adequate personal protective equipment (PPE), such as N95 respirators, medical masks, eye protection, gowns, and gloves. However, there is growing recognition that containment strategies that rely on testing will be inadequate because the necessary testing capacity may not be available for weeks to months, and in the US the ability to track, trace, and quarantine is unclear. In addition, countries where testing was not limited and containment was achieved, eg, Singapore, have seen substantial second waves of infection and mandated extreme distancing interventions that the US and other countries are trying to scale back.

The Infectious Diseases Society of America (IDSA) has included societal use of PPE, such as masks and face shields, in its recommendations for easing restrictions.4 Experience and evidence, even during this pandemic, suggest that health care workers rarely acquire infections during patient care when proper PPE is used and that most of their infections are acquired in the community where PPE is typically not worn.5 Thus, it becomes important to know if practice from occupational safety can be used in the community as a bridge to longer-lasting measures, such as vaccines. Could a simple and affordable face shield, if universally adopted, provide enough added protection when added to testing, contact tracing, and hand hygiene to reduce transmissibility below a critical threshold?

COVID-19 Transmission in the Community

The mode of transmission of respiratory viruses has long been a subject of debate. Evidence to date suggests that SARS-CoV-2 is spread like other respiratory viruses: by infectious droplets emitted in close proximity (ie, within 6 feet) to the eyes, nose, or mouth of a susceptible person, or by direct contact with those droplets (eg, touching a contaminated surface and then touching the eyes, nose, or mouth).6 Although droplet vs airborne transmission is likely to be a continuum, with smaller droplets able to be propelled further than 3 to 6 feet and remaining airborne longer after certain respiratory emissions,7 the implications of limited aerosol spread are most important in health care settings after aerosol-generating procedures, such as open suctioning of airways and endotracheal intubation or extubation.

Contact investigations for SARS-CoV-2 have confirmed community transmission rates that are consistent with droplet and contact spread (household attack rates of 10%, health care and community attack rates of 600 asymptomatic cases were identified and >2500 close contacts were traced. Employees in the essential sectors, such as hospitals and clinics, education facilities, and service sectors were required to get nucleic acid tests or antibody results. The tests are now included in the medical insurance scheme and the out-of-pocket payment was about 10%-30%. However, it should be noted that testing per se is insufficient to contain the outbreak, and the ability to track, trace and quarantine after testing is also crucial, as shown in China and South Korea.

Meanwhile, community actions are needed. In February in Wuhan, the government initiated two waves of community symptom screening to identify potential cases, isolate the source of infection and block the transmission route. Although it was argued whether the screening was necessary to drive the reproduction number below 1.0, the strategy helped quickly crush the epidemic curve and dramatically reduced the number of incident cases. Since February, people were required via online platforms to report fever and respiratory symptoms. Temperature screening has been widely enforced in public places. Those with symptoms should get immediate medical attention and be tested as soon as possible.

In addition, transmission from asymptomatic infected cases has been documented (3) and over 40% of secondary cases were infected during the index cases’ presymptomatic stage (4). Therefore, facial covering is necessary to block the transmission and prevent these apparently healthy infectious sources. Accumulating evidence now demonstrates that mask-wearing is efficient to protect people from infection (5). As governments plan how to exit societal lockdowns, face masking in crowded public areas or unknown-risk areas, particularly in closed rooms, could be a key component of public health interventions for containing the pandemic and preventing a major second wave (5). Face masks have been widely encouraged and compulsorily required in public places in Asian countries. There are increasing voices for the shift of culture stigma for healthy people wearing face masks in the community and that mask/shield-wearing could be considered in the Western countries. Broad support and clear guidance are needed from the governments and various health organizations. The viewpoint paper by Dr Perencevich and his colleagues is an important piece in this context.

With Prof Tangchun Wu from HUST.

1. JAMA. doi:10.1001/jama.2020.7477.

2. JAMA. doi: 10.1001/jama.2020.6130.

3. JAMA 2020;323(14):1406-7.

4. Nat Med. DOI: 10.1038/s41591-020-0869-5.

5. https://arxiv.org/pdf/2004.13553.pdfCONFLICT OF INTEREST: None ReportedREAD MORE

June 18, 2020

Transparent Face Masks Cannot Prevent Microbial Inhalation

Tang Lee, Building Scientist | University of Calgary, Canada.

Transparent face masks have many advantages as discussed in this article and remarks. However, they cannot protect from airborne infectious diseases. Breathing in will draw airborne microorganism into the space behind the face mask which then can enter the lungs. The only way to prevent drawing in airborne microbes into the transparent face mask is with a positive air pressure. This will require a fan that blows air between the transparent face mask and the face. However, the air must have germicidal properties and also remove any volatile organic compounds, and airborne particulates.

CONFLICT OF INTEREST: None Reported

June 30, 2020

Evidence For the Efficacy of Medical Masks and Respirators.

Gary Ordog, MD, DABMT, DABEM | County of Los Angeles, Department of Health Services, Physician Specialist (retired)

Thank you for your excellent and timely article. I wish to respond to a controversial comment by Dr. Thomas Pliura. He implied that there are no research studies published on the preventive efficacy of facial masks and shielding (I will include respirators to be more complete): "I ask for a single citation to a validated study to support the premise that face masks would do anything at all to contain the spread of COVID-19." Five simple Med-Line searches with those words, virus, and efficacy, yield around well over 100 peer-reviewed articles, including several from the COVID era. Additional searches on studies of safety yielded over a thousand research articles, including recently in this very journal, JAMA. Would there even be a century of wearing surgical masks if they weren't useful in the prevention of transmission of infectious agents? I daresay that most or all of our healthcare workers would currently be SARS-CoV-2 positive if not for PPE. Please review and reconsider your comments. Thank you and stay safe.

CONFLICT OF INTEREST: None Reported

Here is a famous archival photograph from 1918 showing nurses wearing and folding reusable cotton facemasks.

Here is a news article today in support of mask; but showing that many people do not want to wear them, out of incorrect information, mask myths, propaganda, etc.: (CTV source modified, truncated)

Public health and government officials say that mask-wearing is an important part of helping to curb the spread of the novel coronavirus — but not everyone is listening.

Across the U.S., fights have erupted over stores' mask policies, and some have even turned deadly. A security guard at a Flint, Mich., dollar store was fatally shot after telling a customer they needed to wear a mask inside the store.

In Toronto, a video of a woman refusing to wear a mask at St. Joseph's Health Centre, per hospital policy, went viral after she posted footage of her arguing with health-care workers on social media. Video footage taken at a Mississauga, Ont., T&T Supermarket and uploaded on Tuesday shows an angry shopper refusing to wear a mask, per the store's policy, and telling a store clerk that the benefit of masks is "a communist, socialist lie."

READ MORE: These are the most likely — and least likely — ways to spread COVID-19

The man is also heard yelling at a store employee, saying the virus is from China, and continues on a racist, anti-Asian rant telling the worker to "go back to where he came from." The employee responds by telling the customer that he’s Canadian.

But why are masks, which help catch infectious respiratory droplets expelled by the wearer, so controversial during the pandemic? According to experts, there are several common reasons why.

Emotions are high

The pandemic has greatly affected people's well-being and has upended many folks' lives. People have lost jobs and loved ones, and stress levels and mental distress are up.

When people are in a heightened emotional state, their ability to think rationally can be affected.

"While some people view wearing of masks as altruistic and a joint effort to combat the virus, others view it as yet another way that their lives are being controlled by the government, and by the virus," said Taslim Alani-Verjee, a Toronto-based clinical psychologist and founder of the Silm Centre for Mental Health.

"When anxiety is heightened, we tend to take more rigid stances and lose our flexibility, and, unfortunately, sometimes our ability to see things rationally."

Cultural differences

Many Canadians are not accustomed to wearing face masks in their daily lives, and doing so feels uncomfortable, "culturally strange" and even like an inconvenience, said Steven Taylor, a professor of psychiatry at the University of British Columbia.

Taylor, who is also the author of The Psychology of Pandemics, said these factors can contribute to a general disinterest in mask-wearing, as can the issues they pose when trying to communicate with others.

READ MORE: Mask myths, debunked — No, wearing a mask won’t ‘shut down’ your immune system

Jay Van Bavel, an associate professor of psychology at New York University, said North American societies often value individualism over collectivism, which means Canadians and Americans greatly value their individual freedoms. When it comes to masks, this means people may think of themselves and their own comfort over the collective good that comes from virus prevention measures.

"That's a cultural characteristic of often western European and North American countries that differ, say, from Asian countries, especially East Asia, which are more collectivistic," Van Bavel, who co-authored a recent paper on behaviour response to the COVID-19 pandemic, said.

"In individualistic cultures, you pride things like individual freedom of expression more. In collectivistic cultures, you tend to prioritize the benefit of the group. And so that might be one cultural factor that puts people at risk in Canada."

Underestimating threat

Another reason that people don't wear masks is because they underestimate the seriousness of the COVID-19 pandemic, experts said. Taylor said COVID-19 is like a "hidden pandemic" because many people have not witnessed first-hand the death or harm it can cause.

This plays into "optimism bias," which is the idea that bad things are more likely to happen to other people than oneself. This mentality can play a role in how people assess risk, causing them to think they don't need to take health precautions as seriously.

"Even if they might realize there's a big risk for the population, they somehow think they're exempt from it, that it doesn't apply to them," Van Bavel explained.

"They might think they're smarter, more clever or healthier."

Masks symbolize change

Our lives have changed since the outbreak of the novel coronavirus, and the pandemic has affected nearly every aspect of "normal" life. Masks are a physical symbol that things are different and we have to adapt from the way we previously lived.

Some people are better at adapting to change, Alani-Verjee said, while others have less cognitive flexibility. For those who struggle to adapt their perspectives to new information, refusing to accept masks can offer a slice of the "pre-COVID" days.

READ MORE: Does wearing a face mask pose any health risks? Not for most people

"If we stand firmly in our stance that we do not need to wear masks, it may help us hang on to that sense of normalcy for a little bit longer," Alani-Verjee said.

"That, in a way, can help people cope with all of the change. Unfortunately, this stance does not allow us to see the situation for what it is. What we need is an acceptance of the reality of the situation."

Messaging and misinformation

Consistent and clear public health messaging about health risks and prevention measures during the pandemic is key. When people get mixed messaging or don't understand the rules, it can lead to confusion around what measures are necessary.

Early in the pandemic, government officials said the public did not need to wear face masks as health-care workers were a priority during fears over mask shortages. Now, as the pandemic has evolved and the public health messaging on masks has changed, it has led to some confusion, Taylor said.

Experts say masks can be helpful reducing the spread of COVID-19 alongside other health measures like handwashing, physical distancing, testing and contact tracing.

"Ideally, what we would have done back in January is be proactive and said, 'OK, there could well be a point when infection becomes widespread in the community where it's going to be wise for everyone to wear masks,'" he said.

"We know from history that non-adherence is going to be a problem, and we should anticipate that."

Coronavirus misinformation is also spreading on social media, which can fuel the anti-mask fire. Graphics with inaccurate information on mask safety are popping up on Instagram, causing some people to believe that masks do more harm than good — despite evidence showing the contrary.

"Social networks can amplify the spread of behaviours that are both harmful and beneficial during an epidemic, and these effects may spread through the network to friends, friends’ friends and even friends’ friends’ friends," Van Bavel and his co-author wrote in their paper on pandemic behaviours.

'Violation' of freedoms

Drastic — and sudden — change can take a toll on people's emotional well-being and lead to a sense of loss of control. The idea that we are no longer able to move as freely or do activities as we like, as we could pre-pandemic, is upsetting to many.

READ MORE: Should masks be mandatory? It depends

Mask policies or bylaws are another way some people feel like they've lost control over their lives.

"For those who are resistant to wearing masks, it is likely that they highly value their personal freedom, and their anxiety around the virus and the loss of freedom are playing a significant role," Alani-Verjee said.

What's more, when people are told or legally required to do something, they can rebel, Van Bavel said.

This was seen in Toronto when an anti-mask protest on public transit took place on Tuesday morning in response to the TTC mandating that riders wear masks while taking transit. A group of about 40 protesters boarded a subway car sans masks and talked through megaphones about “informed decision-making” and “freedom of choice.”

The City of Toronto also recently passed a bylaw that makes masks mandatory inside all businesses and indoor public spaces.

"When some people are forced to do something that they feel is against their will, they react against it," Van Bavel said.

"As things are required, for example, wearing a mask in the subway, some people react against that; they react against authority. It's just a way of asserting themselves and their autonomy."

Normalize mask wear

In order for all (or most) people to wear masks, social norms have to adapt, experts said.

It's not enough to have political leaders say, "wear a mask," but lateral acceptance has to happen among society, Taylor said.

Van Bavel said local community leaders need to model behaviours to help normalize them. People who are greatly respected within spaces, like religious groups or community organizations, can help shape people's acceptance of new health measures.

Workplace managers and business leaders play a role, too, he said.

READ MORE: Woman says she was asked to leave East Vancouver yoga studio for wearing mask

"It's really important that we model these (behaviours) throughout the organizations that we're in and in sustainable ways so they take hold," Van Bavel said. "Because once they become social norms, they become self-perpetuating, and people start automatically doing it. Almost like a new habit or a reflex."

When people refuse to wear masks, shaming them for their behaviour is rarely effective, Alani-Verjee added. People do not react well to shame and often become even more defensive.

"Instead, by recognizing that so much of people's decision-making around the issue of wearing masks is driven by anxiety and emotions, we can perhaps make an opportunity to understand people's thinking and help them understand why wearing masks is the better option," Alani-Verjee said.

Questions about COVID-19? Here are some things you need to know:

Symptoms can include fever, cough and difficulty breathing — very similar to a cold or flu. Some people can develop a more severe illness. People most at risk of this include older adults and people with severe chronic medical conditions like heart, lung or kidney disease. If you develop symptoms, contact public health authorities.

To prevent the virus from spreading, experts recommend frequent handwashing and coughing into your sleeve. They also recommend minimizing contact with others, staying home as much as possible and maintaining a distance of two metres from other people if you go out. In situations where you can't keep a safe distance from others, public health officials recommend the use of a non-medical face mask or covering to prevent spreading the respiratory droplets that can carry the virus.

Dear Gary Joseph Ordog as you can see from the article sited below, wearing masks in the USA is a battle of cultures. In Germany, where I live, people have gotten used to wearing masks in buses, trains, and when shopping, especially in supermarkets.

https://www.washingtonpost.com/business/2020/07/08/retail-workers-masks-coronavirus/

The evidence underlying these public health interventions has not changed since the 1918 flu pandemic. Mathematical modeling studies and empirical evidence support that public health interventions, including home quarantine after infection, restricting mass gatherings, travel restrictions, and social distancing, are associated with reduced rates of transmission. Risk of resurgence follows when these interventions are lifted.

This was quoted from today's JAMA.

Pathophysiology, Transmission, Diagnosis, and Treatment of Coronavirus Disease 2019 (COVID-19) A Review July 10, 2020

and supports the information I have been espousing. Thank you, stay safe, Gary Ordog, MD.

Dear Gary Joseph Ordog

I fully agree with Professor Frank T. Edelmann . The first defense line versus COVID-19 is the gag. Therefore, the gag wearing should be widespread as a global culture.

Regards

What Frank Edelmann did not mention is that Germany had no mask use culture before 2020 (like China or Japan)...

It emerged due to changed expert and government advice - and fear and mask obligations in public Transport and shops from mid march 2020 on dramatically...

Now about 98 % wear masks in public transport or when shopping...

Last week two federal states (Saxony, MV) thought openly about taking that mask obligation back (due to low new infection numbers) and a public outcry by experts (and a large part of the public) followed. Now 17 health ministers and secretaries have agreed not to touch the mask oblication in public transport and shops for the time being... Smart decision, thank you...

One of the best SARS-CoV-2 prevention of spread papers I know is by Prather et. al. and they use that helpful diagram/figure...

Article Reducing transmission of SARS-CoV-2

Background info and political analysis of the US fight over to wear or not to wear the mask by Germany's weekly (like time magazine) Der Spiegel, see

https://www.spiegel.de/politik/ausland/corona-krise-in-den-usa-maske-oder-freiheit-a-2462f0ec-6c4b-41d6-89b6-d427bd2ec599

July 13, 202

Masks prevent transmission from people who don't know they're sick

It takes an average of five days (but sometimes as long as 14 days) for people infected with COVID-19 to show symptoms. In addition, up to 18 percent of people who have the virus never develop symptoms at all but can still pass it on to others, according to an article from the BBC. In fact, nearly half of all people who develop COVID-19 are infected by people who do not show any symptoms. If those asymptomatic people had worn masks—even though they felt fine—they could have prevented this transmission, Pekosz says. "That's part of our critical defense against this virus," he explains. "It's people spreading this virus before they show symptoms who are really driving this infection." Researchers still don't understand why some people remain asymptomatic while others develop full-blown symptoms. That's just one of the coronavirus mysteries that still can't be explained: Today on MSMBC:

Good advice! finally they are getting their act together.

More good advice from MSNBC today July 13, 2020:

Masks protect people with underlying conditions

The teenager bagging your groceries might have Type 1 diabetes. The toddler on the bus might have a heart defect. The man in line in front of you might be caring for his wife who has MS. The truth is, more than half the people you encounter on a daily basis probably have an invisible underlying condition, such as high blood pressure or diabetes. A Canadian study found that 54 percent of workers do. And the evidence is clear that people with underlying conditions are at the highest risk for severe complications from the coronavirus. Managing a chronic illness is difficult enough in the best of times. We can extend kindness by not making it harder. Donning a mask in public keeps everyone safe.

July 26, 2020: After due consideration, to your question:

1. Face masks are not perfect.

2. The possibility of leakage and contamination increase with time (e.g. a 12 hour shift too long for one mask)

3. There are breeches in protocol

4. There are other modes of transmission than just airborne-respiratory

5. Some of the cases may be contracted outside of work, e.g. home and play.

Stay safe and thank you for allowing these thoughts. Gary Ordog, MD

Is it because of presentation such as this?:

Doctor subject of complaints after COVID-19 tweets

Ontario doctor K K G has been criticized by fellow physicians and others after a series of tweets that they say spread misinformation about COVID-19.

CBC has reviewed two email complaints about G's tweets, including one by a family doctor to the College of Physicians and Surgeons of Ontario, which sets regulatory standards for doctors in the province.

One of her tweets, from Aug. 6, stated: "#Humanity's existing effective defenses against #COVID19 to safely return to normal life now includes: -Truth, -T-cell Immunity, -Hydroxychloroquine."

That tweet has since been taken down for violating Twitter's rules. Twitter doesn't confirm what rules a specific tweet may have violated when it has been taken down. Many doctors also replied critically to G's tweet.

Hydroxychloroquine is a drug used to treat malaria and some autoimmune diseases, such as lupus and rheumatoid arthritis. It has been touted by U.S. President D T as a potential fix for COVID-19. However, the drug has been shown to be ineffective in combating the virus, according to a major study published in the New England Journal of Medicine.

Medical bodies such as the Canadian Pediatric Society say hydroxychloroquine has no significant benefit in fighting COVID-19. Health Canada has not authorized hydroxychloroquine to treat or cure COVID-19 and has warned Canadians about products making false and misleading claims. It says hydroxychloroquine can have serious side effects. Only recently did Health Canada authorize, with conditions, remdesivir to treat severe cases of COVID-19.

On Aug. 4, G tweeted "If you have not yet figured out that we don't need a vaccine, you are not paying attention," adding the hashtag #FactsNotFear. G identifies herself as K K on her Twitter profile.

Another of G's tweets on the same day states, "There is absolutely no medical or scientific reason for this prolonged, harmful, and illogical lockdown."

G operates a clinic in Brampton, Ont., and she has over 22,000 followers on Twitter. She is also the president and co-founder of Concerned Ontario Doctors, a self-described grassroots group that has been critical of the Ontario Medical Association, the organization that represents 34,000 of the province's doctors.

All practicing physicians in the province are legally mandated to pay dues to the OMA, though they do not have to be members of the group. The Concerned Doctors of Ontario did not respond to multiple requests for comment.

G and others have said the OMA attempts to muzzle doctors, and it refuses to be financially transparent and accountable to its members.

According to the CPSO, G's specialty is pediatrics. 

G did not respond to CBC News's multiple requests for comment. On Twitter, she said, "There are always opposing views in medicine — historically many have led to some of the most significant medical advances.

"In a democratic society: there must always be open, constructive, public debate. Voices of Physicians & Scientists must never be attacked, censored or silenced."

G has also retweeted another doctor, S G, who claimed there was a financial incentive to discredit hydroxychloroquine as a treatment. S G's tweet was taken down for violating Twitter rules, but not G's retweet. 

S G was one of the doctors in a 40-minute long video that went viral at the end of July, which promoted hydroxychloroquine as a treatment for COVID-19. At least 17 million people saw one version of the video, though both Facebook and Twitter removed copies from their platforms.

Twitter temporarily suspended the account of D T Jr. for posting the video until he deleted the tweet. 

Any comments on this topic? Thank you. Stay safe...

Thank you Dr. Durrani. I read your attached article, but found it very negative. The writer does not seem to possess the knowledge of a medical worker, as many of the comments about masks were negative and not relevant to a medical discussion. For example, the discussion of hypercapnia in "mines" is not relevant here, and is a study area of mine, is due to external sources of CO2, commonly fatal, and requires SCUBA and not any kind of a mask. I would not follow this, consider it another source of misinformation, perhaps even politically motivated. I reiterate, masks have worked for over a hundred years, and over a thousand medical research studies have proven their effectiveness. The closest other choice is to "stay home." Thank you, stay safe.

Self explanatory. August 13, 2020.

September 1, 2020 Fascinating Study! Gary Ordog, MD, DABEM, DABMT | County of Los Angeles, Department of Health Services, (retired) First to answer the previous question, I believe it is stated in the article that no one was wearing masks, as a COVID-19 outbreak had not been identified at that time. My point here is that you have a fascinating article, that was extremely well done. Thank you and congratulations. I would like to see the next phase of a similar study using PPE. We already know that health care workers have a higher risk of infection despite using PPE. But it obviously helps. You study confirms the proverbial "sardine can" analogy, avoid buses, trains, planes and indoor restaurants in this time of COVID-19. Again, excellent study! Original Investigation September 1, 2020 Community Outbreak Investigation of SARS-CoV-2 Transmission Among Bus Riders in Eastern China Ye Shen, PhD1; Changwei Li, PhD1,2; Hongjun Dong, MD3; et alZhen Wang, MD4; Leonardo Martinez, PhD5; Zhou Sun, MD6; Andreas Handel, PhD1,7,8; Zhiping Chen, MD4; Enfu Chen, MD4; Mark H. Ebell, MD, MS1; Fan Wang, MA9,10; Bo Yi, MD3; Haibin Wang, MD11; Xiaoxiao Wang, MD4; Aihong Wang, MD3; Bingbing Chen, MD11; Yanling Qi, PhD12; Lirong Liang, MD, PhD13; Yang Li, PhD9,10,14; Feng Ling, MD4; Junfang Chen, MD6; Guozhang Xu, MD3 Author Affiliations Article Information JAMA Intern Med. Published online September 1, 2020. doi:10.1001/jamainternmed.2020.5225 Key Points Question Is airborne transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) a potential mean of spreading coronavirus disease 2019 (COVID-19)? Findings In this cohort study of 128 individuals who rode 1 of 2 buses and attended a worship event in Eastern China, those who rode a bus with air recirculation and with a patient with COVID-19 had an increased risk of SARS-CoV-2 infection compared with those who rode a different bus. Airborne transmission may partially explain the increased risk of SARS-CoV-2 infection among these bus riders. Meaning These results suggest that future efforts at prevention and control must consider the potential for airborne spread of SARS-CoV-2, which is a highly transmissible pathogen in closed environments with air recirculation. Abstract Importance Evidence of whether severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the virus that causes coronavirus disease 2019 (COVID-19), can be transmitted as an aerosol (ie, airborne) has substantial public health implications...

Thank you so much, Dr. Durrani. This brings up a good point that I should be talking about more. That is those masks with the one way valves. All the health department information says that the primary purpose of COVID masks is to protect others from your virus. Secondarily, is the purpose to protect the wearer from others. But the masks with the one way valves in the front, causes the unfiltered breath air to shoot right out the front. This would make it more comfortable to breath, but does nothing to protect those people around you. To the bystanders, you would basically be standing there with no mask on at all. Just as it appears that people interacting with others, not wearing any mask, is a danger to others; so too, those wearing the masks with the one way valves are also a potential danger. From a moral point of view, both of these groups would be considered selfish, caring only about themselves and not others. So, in conclusion, the altruistic, moral, healthy thing to do is get rid of those masks with one way valves and also to stop producing them for COVID-19 protection. (Please note that they were designed for airborne noxious materials for the wearer, and were not for viruses; so they do still have a purpose, but no purpose and should not be used for COVID-19) Thank you and stay safe. Gary Ordog, MD September 02, 2020.

Dr. Durrani; I would like to take one of the points made here and start a new discussion with it, with your permission, as it is relevant at this present time, and a forgotten subject that most people are probably not aware. Thank you. (If you object, I will remove it and you can run with it. I credit you in the statement.)

November 22, 2020: Today in JAMA, the latest on masks in COVID-19:

Wearing a Mask Can Protect Against Coronavirus Disease 2019 for the Wearer as Well as Others, The CDC Says

"Joan Stephenson, PhD People who wear multilayer cloth masks protect not only the people they encounter from severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) but also themselves, according to an updated scientific brief from the US Centers for Disease Control and Prevention (CDC). Previous recommendations from the CDC advising people to wear cloth masks stressed evidence that the practice helps with source control—that is, preventing people infected with SARS-CoV-2, including those without symptoms, from spreading the virus to others. Individuals with infections who are pre-symptomatic or asymptomatic are estimated to be the source of more than half of SARS-CoV-2 transmissions, the agency has noted.However, last week, as cases of coronavirus disease 2019 (COVID-19) were surging across the US and threatening to overwhelm hospitals in some states, the CDC cited emerging evidence that the person who wears a mask also garners some protection against infection. “The prevention benefit of masking is derived from the combination of source control and personal protection for the mask wearer,” the brief says.With respect to protecting other people, wearing a multilayer cloth mask can block up to 70% of fine droplets and aerosol particles and limit the spread of those that do penetrate the mask. In human experiments, masks have blocked the passage of “upwards of 80%” of all respiratory droplets, the brief notes, and some studies found that cloth masks performed as well as surgical masks as barriers to protect others.As the updated brief highlights, wearing a mask thus offers potential benefits to persons who wear masks. “Studies demonstrate that cloth mask materials can also reduce wearers’ exposure to infectious droplets through filtration, including filtration of fine droplets and particles less than 10 microns,” the agency wrote.The agency cites a number of real-world observational and epidemiologic human studies that have found a link between wearing of masks and reduced spread of SARS-CoV-2. In 1 case, reported in May, 139 clients at a Springfield, Missouri, salon were exposed to 2 hair stylists with symptoms and confirmed COVID-19 while both the stylists and the clients wore face masks; none of the 67 clients tested for SARS-CoV-2 developed the infection. Similarly, a report on 124 households in China with at least 1 person with COVID-19 each found that when everyone in the household wore masks as a preventive measure before the family member with the infection developed symptoms, further household spread was reduced by 79%.A report in April also showed that masking likely protected individuals in the close quarters of the aircraft carrier USS Theodore Roosevelt during an outbreak and was associated with a 70% reduced risk of infection. Furthermore, the CDC noted, investigations of airline flights longer than 10 hours that turned out to have passengers with infections aboard “strongly suggest” that masking prevented transmissions during the flights, given that other passengers and crew did not develop infections in the 14 days following exposure. In addition, the report notes, 7 studies found that at the community level, new infections declined significantly after issuance of “directives from organizational and political leadership for universal masking.” Two of the studies, along with other analyses, showed a decline in deaths as well. There is also evidence that mask use makes sense economically. An analysis of US data by Goldman Sachs found that “increasing universal masking by 15% could prevent the need for lockdowns and reduce associated losses of up to $1 trillion or about 5% of gross domestic product,” per the CDC report.The brief notes that “relative filtration effectiveness of various masks has varied widely across studies, in large part due to variation in experimental design and particle sizes analyzed.” Masks that include multiple layers of cloth with higher thread counts perform better—with some filtering nearly half of fine particles of less than 1 micron—than ones with single layers of cloth with lower thread counts. Some materials, such as polypropylene, may boost filtering effectiveness by generating a form of static electricity called triboelectric charge, which improves capture of charged particles. “The relationship between source control and personal protection is likely complementary and possibly synergistic, so that individual benefit increases with increasing community mask use,” the CDC said, adding that adopting universal masking policies “can help avert future lockdowns, especially if combined with other non-pharmaceutical interventions such as social distancing, hand hygiene, and adequate ventilation.”" (So, as we all knew, at least subconsciously, for the past 50 years, that masks do work for both the wearer and the contacts. Thank you and stay safe)

January 20, 2021 by Gary Joseph Ordog, MD:

Finally, after a year of COVID-19, we get some common sense Public health direction:

Dr. Fauci Issues Urgent Warning Over COVID Deaths

Dr. Fauci Issues Urgent Warning Over COVID Deaths

As of Tuesday, 400,000 people in the United States and over 2,000,000 globally have lost their lives as a result of COVID-19. While the death toll of the virus is incredibly sad, it also represents something else far more important. During an interview with the Harvard Business Review, Dr. Anthony Fauci, the nation's top infectious disease expert and the director of the National Institute of Allergy and Infectious Diseases, issued a warning in regards to the COVID-19 death toll, urging people to use it as proof of a fundamental fact. Read on to find out what it is—and to ensure your health and the health of others, don't miss these Sure Signs You've Already Had Coronavirus. 

The Virus Is Real, Warns Dr. Fauci: "Look at Your Own Hospitals"

Dr. Fauci explains that the COVID death toll is proof that the virus is 100 percent real. However, due to "mixed messages that have come to Washington" there are people who still believe it is a hoax—despite the fact that hospitals are at capacity and people are dying. 

"I think when we go back and look at this in history, we'll be scratching our heads and saying, how did that happen?" he said. "You know, how was it that you add a region, a state or a city where the hospitals are being overrun, where you have 20 intensive care unit beds, and you have 50 people who need intensive care that in that same town, city, state, there was still people that think it's a hoax that think it's false news. How can you think that close to 400,000 deaths, which is historic in the proportion, like nothing we've ever seen in 102 years is a hoax? I mean, look at your own hospitals, look at the people who are dying and yet astoundingly, there are people that don't believe that's real. I mean, I'd never seen anything like that."

RELATED: 7 Tips You Must Follow to Avoid COVID, Say Doctors

COVID Is a Health Issue—Not a Political Issue—He Says

Fauci explains that due to the fact that the virus was somehow turned into a political issue, the fundamental ways of preventing the spread were rejected by a good portion of the population. 

"Public health officials have had a very difficult time because if everything we're dealing with was in the context of public health, I don't think you would be seeing this disparity and discrepancy among various sectors in this country about things that seem to be reasonably straightforward—wearing masks, keeping distance, avoiding congregate settings in crowds, particularly indoor," he pointed out. 

"We have gotten caught, and this is so unfortunate, in being in an extremely divisive society in our own country," he continued, using the Capitol riots as an example. "The issues of public health have been consumed in a divisive context so that there are people who feel that when we say to avoid congregate settings or wear a mask that somehow or other we're encroaching upon something that really has nothing to do with, with public health, it's like their freedom."

RELATED: If You Feel This, You May Have Already Had COVID, Says Dr. Fauci

How to Survive This Pandemic

So follow Fauci's fundamentals and help end this surge, no matter where you live—wear a face mask, social distance, avoid large crowds, don't go indoors with people you're not sheltering with (especially in bars), practice good hand hygiene, get vaccinated when it becomes available to you, and to protect your life and the lives of others, don't visit any of these 35 Places You're Most Likely to Catch COVID.

Looks Like Just a "Stern" Warning:

Ontario doctor cautioned by regulators for spreading COVID-19 misinformation

Stewart Bell and Andrew Russell, Global News: March 04, 2021.

An Ontario doctor has been cautioned by the College of Physicians and Surgeons for spreading misinformation about COVID-19 vaccines and lockdowns that could put the public at risk. Provided by Global News Dr. Kulvinder Gill, a Brampton, Ont. physician, has been cautioned for spreading COVID-19 misinformation.

Dr. Kulvinder Gill was issued three cautions for “inappropriate” and “unprofessional” statements she posted on social media claiming that neither lockdowns nor vaccines were necessary.

On Twitter, the Brampton doctor had claimed there was “absolutely no medical or scientific reason for this prolonged, harmful and illogical lockdown,” the college wrote in its decision.

She had also written “we don’t need a vaccine” and shared a Tweet claiming that contact tracing, testing and isolation were “ineffective, naive & counter-productive against COVID-19.”

The college’s complaints committee ruled that the comments, posted last year, were factually incorrect and likely to be taken seriously by non-medical members of the public because she is a physician.

Gill was cautioned for “lack of professionalism and failure to exercise caution in her posts on social media, which is irresponsible behaviour for a member of the profession and presents a possible risk to public health.”

No Hoax: Fighting COVID-19 has meant tackling conspiracy theories, even within families

The first of its type, the decision comes as Canada’s doctors are growing increasingly concerned about misinformation and conspiracy theories about COVID-19 that have become pervasive online.

A Global News investigation found that an assortment of far-right, anti-government and anti-vaccine groups, as well as China, Russia and Iran, have been spreading COVID-19 misinformation.

In its decisions, the college said that while it was valid to point out that lockdowns had drawbacks and to question if they were working or whether the costs outweighed the benefits, Gill had gone beyond that.

“She stated unequivocally and without providing any evidence that there is no medical or scientific reason for the lockdown," the college wrote.

"Her statement does not align with the information coming from public health, and moreover, it is not accurate,” according to the ruling.

Misinformation is spreading as fast as coronavirus. It will ‘take a village’ to fight it

Lockdowns in China and South Korea were evidence they reduced the spread of COVID-19, the college wrote.

“For the respondent to state otherwise is misinformed and misleading and furthermore an irresponsible statement to make on social medial during a pandemic,” the decision read.

Video: Concerns about third wave and getting back to normal

Gill is the co-founder of the advocacy group Concerned Ontario Doctors. Her Twitter account has more than 56,000 followers. She could not be reached for comment.

Her claim that vaccinations were not needed was also deemed inappropriate by the college, which said vaccines had been tested and approved in Canada and were the best way to end the pandemic.

“While it is possible for a return to ‘normal life’ without vaccinating the public, this is a high-risk strategy and one that could potentially take years to achieve,” the college wrote.

According to the decision, Gill provided no evidence to support the statement that vaccines were not necessary.

“It would be expected and understandable if a certain proportion of the general public who read this statement decided to decline the vaccine with the assurance that they were acting on the guidance of a physician.”

“For this reason, the Committee considered it irresponsible, and a potential risk to public health, for the respondent to have made this statement in the middle of a pandemic.”

The college complaints committee additionally took Gill to task for retweeting that contact tracing, testing and isolation were counter-productive, a view it called “indefensible.”

“The committee would expect a certain proportion of the non-medically trained public who read this post to subsequently decide not to follow government and public health rules and recommendations regarding contact tracing, testing and isolation," the ruling read.

“This could have significant negative consequences for public health. The Respondent’s comments in this regard are irresponsible and careless in the current context and climate."

While Gill had argued her tweets were taken out of context, the college said that tweets by nature had “limited context.” Nor did the college accept that her tweets were made on a personal account.

“The respondent’s Twitter biography makes it very clear that she is a physician and also identifies her as the leader of a group of physicians, Concerned Ontario Doctors," it said.

“The respondent’s tweets are accessible by the public. Moreover, members of the public who are not healthcare professionals are likely to attribute significant weight and authority to the respondent’s tweets, given her profession.”

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