Some Quotes and Links about Colonoscopy Co-Pays

Last March, I had a routine screening colonoscopy at a major medical center, Cedars-Sinai (Los Angeles).  After six months of silence, I suddenly got a bill from Cedars for $4000 because my insurer (California Blue Shield) had denied the claim.   This is ridiculous - it was a completely routine, legally covered, no-copay (no-deductible) service.   I have no idea what happened to my transaction that was different than the thousands of bills that Cedars must submit to a range of insurers (and often California Blue Shield) for screening colonoscopy.    But I'm not tied up in a mess of 30 minute calls to the provider, 30 minute calls on hold to the insurer, each asking me to call the other, and so on.

I pulled a range of government links that screening services are covered under the Affordable Care Act with neither deductible nor copay.  

###

GOVT LINK:

https://www.healthcare.gov/preventive-care-adults/

All Marketplace health plans and many other plans must cover the following list of preventive services without charging you a copayment or coinsurance. This is true even if you haven’t met your yearly deductible.

ASSOCIATION LINK:

https://www.cancer.org/cancer/colon-rectal-cancer/detection-diagnosis-staging/screening-coverage-laws.html

The law stipulates that there should be no out-of-pocket costs for patients, such as co-pays or deductibles, for these screening tests. But the definition of a "screening" test can sometimes be confusing, as discussed below.

Kaiser Article

https://www.kff.org/report-section/coverage-of-colonoscopies-under-the-affordable-care-acts-prevention-benefit-report/

From 2012, early on under the ACA, but describes: Confusion/

Long 2012 report.

Examples of patients harassing their insurer to get the correct adjucation.

Govt Link:  Official ACA guidance and regulations

https://www.cms.gov/CCIIO/Resources/Fact-Sheets-and-FAQs/aca_implementation_faqs12#Coverage_of_Preventive_Services

PHS Act section 2713 and the interim final regulations[5] require non-grandfathered group health plans and health insurance coverage offered in the individual or group market to provide benefits for and prohibit the imposition of cost-sharing requirements with respect to, the following:  (...)

Q5: If a colonoscopy is scheduled and performed as a screening procedure pursuant to the USPSTF recommendation, is it permissible for a plan or issuer to impose cost-sharing for the cost of a polyp removal during the colonoscopy?

No. Based on clinical practice and comments received from the American College of Gastroenterology, American Gastroenterological Association, American Society of Gastrointestinal Endoscopy, and the Society for Gastroenterology Nurses and Associates, polyp removal is an integral part of a colonoscopy. Accordingly, the plan or issuer may not impose cost-sharing with respect to a polyp removal during a colonoscopy performed as a screening procedure. On the other hand, a plan or issuer may impose cost-sharing for a treatment that is not a recommended preventive service, even if the treatment results from a recommended preventive service.   

###

For Medicare patients, there has been a slower pathway to avoiding copays when the colonoscopy includes a biopsy.  However, that is moving to no-copay, no-deductible status based on ongoing updates to law and regulations.  (See discussion near the bottom of my 7/13/2021 blog here.)

Very Brief BLog: CMS Blogs on "First 100 Days" and "CMMI"

CMS has had several publications about innovation and new directions in the past few weeks.

MCIT #1

There's yesterday's announcement CMS plans to cancel the MCIT, Medicare Coverage for New Technologies, which was developed under the Trump administration last fall.  Here.

MCIT #2

On September 13, CMS revisited the MCIT topic in a long blog that parallels the release of the rulemaking.  Here.  Penned by Dr. Lee Fleischer, Chief Medical Officer.  

CMMI in Review

In August, CMS published a long blog at Health Affairs on CMMI, The First Ten Years.  Here.

CMS Administrator: Looking Ahead

September 9: Administrator Chiquita Brooks-LaSure pens an essay on her first several months and her outlook.  Here.

Research Facilitation Websites

PUBMED, PUBMEDCENTRAL

PubMed is the world's medical literature.  Usually with abstracts.  With flags if there is a free version.  (You can also search PubMed with a check box on left, Free Full Text).  

PubMedCentral is a parallel entry point which offers you ONLY free article results.

https://pubmed.ncbi.nlm.nih.gov/

https://www.ncbi.nlm.nih.gov/pmc/   (Pub Med Central, known as PMC)

 RESEARCH RABBIT

     Elaborate hub for research paper tracking.  Free for academics.   Can petition for special permission to get an account for example, leveraging a ResearchGate account to ask for a Research Rabbitt account.

https://www.researchrabbit.ai/

    Cool video by Danny Hatcher demonstrates how powerful Research Rabbitt is. (Check out his channel too).

    https://www.youtube.com/watch?v=wHBql2JncyU

SCI HUB

    This is known as a quasi illicit resource or in Wikipedia's term, "shadow library," that may have posted PDFs of articles that are otherwise behind a paywall.   Requires search by a tag like the IOL universal link.

https://sci-hub.se/

RESEARCH GATE

    This has a level for free accounts but requires review and authorization if you aren't at a recognized business or university.  I've applied for a free account (it found some 20 papers I was a coauthor on), which they gave me after some correspondence and proof I've authored true academic articles.   

Research Gate been described both as a library resource AND a sort of Facebook for science (wikipedia, https://en.wikipedia.org/wiki/ResearchGate  )   Among other things it appears to search keywords in BioRxiv (which could be searched directly).   You can search a concept and get a three-column result listing (papers) and (common authors, locations) and (questions answered by forum).  They send perpetual emails once you get signed up, so I have my email filter those to a back folder away from my main inbox.

https://www.researchgate.net/

Somewhat similar to Research Gate is Academia.edu, although I haven't spent much time with it.

    https://www.academia.edu/

   BIORXIV

   Preprints.  Zillions.  https://www.biorxiv.org/

GOOGLE SCHOLAR

   Handy Google based search of world literature

https://scholar.google.com/

GOOGLE BIOMED EXPLORER

   BioMed Explorer mostly produced PubMed results, BUT, produces somewhat different results with broader/smarter/more-AI-type  recognition of keyword ideas than you get with a PubMed direct search.  Worth trying.

https://sites.research.google/biomedexplorer/

UNPAYWALL (Plug In)

   This is a free background Google Chrome Plug-in that shows a green flag if an article is available for free somewhere.  I think much of the time it's just doing what PubMedCentral (the free paper version of PubMed) does but it's still helpful when the green flag pops up. 

ENDNOTE CLICK (Plug In)

   I use Endnote XX (Endnote 20) software for reference citation management and bibliography formatting.   (Other choices include Mendeley, etc).  I installed an Endnote Click Chrome plug-in which gives me a purple View PDF banner when a free PDF is available.  Again, I'm not sure what UnPaywall and Endnote Click offer beyond PubMed's own notification of when a free PDF is on PubMedCentral, but maybe there are in fact sometimes papers at only one of these.  See graphic below.  The native PubMed free article tags are in blue, the Endnote Click tag in purple, and the UnPayWall tag in green.   

Here, I'm being told in triplicate (blue, purple, green) there's free PDF.

___

Google NGRAMS vs PubMed Hits by Year

This is the website where you can do word frequency searches over centuries.  It's books, so use this when you're looking at word use over decades.

https://books.google.com/ngrams

Note that PUBMED now gives you a hit frequency bar chart for searches (e.g. your topic hit10 papers in 2010, 15 in 2011, 25 in 2012 etc).

For whatever reason, "physician extender" (e.g. nurse practitioner) had a boom, in books, only around 1980 (Ngram left), but remains popular in PubMed today (PubMed bar chart by year, right).

click to enlarge

BioRender.Com

On a different note, BioRender.com is a graphics & illlustration website that has an initial free level, which lets you make very complex cell biology charts as used in journals like Nature.   

Reader Aggregators

I get numerous newsletters, blog posts, articles, aggregated into a collected eReader called FEEDLY.  (I used the free version; extra tools with the paid one.)  

FEEDLY automatically aggregates.  In contrast to that, there are also places to "send" articles from anywhere, for reading later, such as Instapaper, Pocket, Raindrop.io.  I have tried these briefly and found they often failed with my frequently subscription-based reading (NYT for example).  However, I send articles often to a reading folder in EVERNOTE (or ONENOTE) which seem to handle the subscription articles almost always perfectly.   Another "send to" reader is Readwise.io, which I understand is designed to hold "highlights" and can aggregate in highlights from Kindle.   In a paid version, it can sync Kindle clippings into organizational software called NOTION.

Video

Also on a different note, I sometimes make short videos on "hot topics" to help people understand Medicare policy innovations.   I have a fairly elaborate setup with a Sony ZV-1 camera, and Elgato studio light, Key Light Air, $110, and a fast gaming laptop to support video.  I film via OBS Studio, which is fairly elaborate freeware.   This lets me use e.g. a green screen while filming, while using another channel to put a PowerPoint slide over my shoulder.  I initially used a simple $15 green screen cloth from Amazon, and later upgraded to a $140 Elgato green screen system.  (And a very simple trick I like: make your PowerPoints for videos on a bright green background, then use OBS to greenscreen or chromakey-out the background.)  

Windows 10 has very simple video editor - at the tic-tac-toe level -  so you can e.g. film a 30 second intro and a 2 minute PowerPoint talk and then bind them together before uploading to YouTube, or clip off the last 5 seconds when you're reaching to turn off the camera.  After some research and dithering, I graduated to a $70 amateur editing program called Filmora X.  Another choice would be what I'm told is a slightly friendlier editor, MovAvi, $60.  There are also 3 popular free editors, OpenShot, ShotCut, KdenLive, any one of which would probably be a good entry point.  YouTube and Google offer tons of reviews and instructions about all fo these.

Prevent Cancer Dot Org - Multi Cancer Early Detection (MCED) (Access 8/23/2021)

 https://www.preventcancer.org/multi-cancer-early-detection/coverage-and-legislation/

• Are these tests covered by insurance?
• What is the Medicare Multi-Cancer Early Detection Screening Coverage Act of 2021?
• The Prevent Cancer Foundation leads more than 300 organizations in support of the Medicare Multi-Cancer Early Detection Screening Coverage Act of 2021.
• How does the MCED legislation work in practice if passed by Congress?
• Why is FDA approval required?
• What are the benefits of introducing legislation before FDA approval of MCED tests?
• Why not create coverage authority for all new cancer screenings?
• Is coverage or cost-sharing for existing screenings impacted by MCED legislation or these tests? 
• How much does this policy score?

Are these tests covered by insurance?

Currently, MCED tests are not covered by insurance. The Prevent Cancer Foundation and more than 300 advocacy organizations and cancer centers support the Medicare Multi-Cancer Early Detection Screening Coverage Act of 2021. This legislation would authorize the Centers for Medicare & Medicaid Services (CMS) to evaluate and cover blood-based multi-cancer early detection tests and future test methods (e.g., urine or hair tests), once approved by the Food and Drug Administration (FDA).

Under current law, Medicare coverage of preventive services is limited to tests for which Congress has explicitly authorized coverage.  Private insurers cover screening tests that receive an “A” or “B” recommendation from the U.S. Preventive Services Task Force (USPSTF). 

In the absence of congressional action, it could take several years after FDA approval before Medicare beneficiaries can receive coverage for MCED tests. This bill would greatly reduce such access delays for seniors while allowing CMS to use its evidence-based process to determine coverage.

What is the Medicare Multi-Cancer Early Detection Screening Coverage Act of 2021?

The Medicare Multi-Cancer Early Detection Screening Coverage Act is a bill that would authorize the Centers for Medicare & Medicaid Services (CMS) to evaluate and cover blood-based multi-cancer early detection tests and future test methods (e.g., urine or hair tests), once approved by the Food and Drug Administration (FDA).

The House bill (H.R. 1946) was introduced with bipartisan support on March 16, 2021, and its companion bill in the Senate (S. 1873) was introduced on May 27, 2021.

Read the full text of the House bill.

Read the full text of the Senate bill.

The Prevent Cancer Foundation leads more than 300 organizations in support of the Medicare Multi-Cancer Early Detection Screening Coverage Act of 2021.

The Prevent Cancer Foundation and more than 300 organizations from all 50 states joined together in a sign-on letter in support of the Medicare Multi-Cancer Early Detection Screening Coverage Act of 2021.

National advocacy organizations who support the legislation include the American Cancer Society – Cancer Action Network, the National Minority Quality Forum, Cancer Support Community, the Association of Community Cancer Centers, the Community Oncology Alliance and the Oncology Nursing Society. A diverse array of additional medical, community and public health focused organizations across the country joins with the Prevent Cancer Foundation in applauding the legislation and calling for action on this issue. These organizations provide essential services to cancer patients, offer resources to families, and raise awareness of the need to improve prevention and care for a range of different cancers.

Read the full letter.

How does the MCED legislation work in practice if passed by Congress?

The Medicare Multi-Cancer Early Detection Screening Coverage Act modernizes the Medicare program and creates a benefit category for MCED tests, which allows the Centers for Medicare and Medicaid Services (CMS) to initiate an evidenced-based coverage process for multi-cancer tests upon FDA approval. 

The legislation was drafted based on the colorectal and prostate cancer screening legislation from the Balanced Budget Act of 1997 that established a covered benefit for colorectal and prostate cancer screening tests and granted the Secretary of the Department of Health and Human Services (HHS) the authority to cover new screening technologies for these cancers.

The Medicare Multi-Cancer Early Detection Screening Coverage Act does not establish coverage policy for MCED tests, but rather gives CMS the authority to create coverage parameters through the National Coverage Determination (NCD) process. During this process, CMS evaluates the evidence for available tests to establish patient criteria.  The NCD process includes multiple opportunities for stakeholder input through a comment period before finalizing coverage.

Why is FDA approval required?

The Medicare Multi-Cancer Early Detection Screening Coverage Act is for screening tests, not diagnostics. Diagnostic tests are routinely covered by Medicare and do not require congressional action, but for screening tests to obtain Medicare coverage through a National Coverage Determination, it must fit within a “benefit” category. (Under the Affordable Care Act, Medicare is also required to cover cancer screening tests that are given an “A” or “B” grade by the U.S. Preventive Services Task Force.)

The Medicare Multi-Cancer Early Detection Screening Coverage Act is based on the precedent of Congress’ authorization of Medicare coverage of mammography for breast cancer, Pap test for cervical cancer and screening tests for colorectal and prostate cancers (all requiring FDA approval). Congressional action is necessary to pursue a National Coverage Determination after FDA approval.

CMS’ National Coverage Determinations for cancer screenings have only provided coverage to FDA approved tests, including Cologuard (colorectal cancer screening), HPV tests approved by the FDA, and a recent blood-based biomarker test for colorectal cancer screening.

What are the benefits of introducing legislation before FDA approval of MCED tests?

Passing legislation can be a lengthy process. By starting now, it is possible to have legislation enacted by the time these new tests are approved by the FDA and prevent significant patient access delays. If Congress decides not to introduce legislation until tests are approved by the FDA, patients could face several years of access delays as the legislative process moved forward. 

Why not create coverage authority for all new cancer screenings?

The Medicare Multi-Cancer Early Detection Screening Coverage Act does not prevent any other efforts to create coverage for new single-cancer screening tests.  The policy is focused on multi-cancer tests because it is where coverage barriers are most acute. New multi-cancer early detection tests can help maximize cancer detection by adding an additional tool to our existing arsenal of cancer screenings. By creating coverage authority for MCED tests, Congress can fuel additional development of multi-cancer screenings.

Is coverage or cost-sharing for existing screenings impacted by MCED legislation or these tests?

No. Existing screenings save lives, and it is important that patients maintain adherence to existing screenings and continue to benefit from zero cost-sharing.  For this reason, the legislation states that coverage of existing screenings should not be impacted.

How much does this policy score?

This policy has not been scored by the Congressional Budget Office (CBO). Historically, CBO has scored preventive services and cancer screening as impacting the federal budget, in part because CBO will attribute costs associated with lives saved from the benefits of early detection.

According to CBO, the agency is required by federal law to undertake a formal cost estimate for most legislative proposals (except appropriations measures) that are passed out of a House or Senate full committee. CBO cost estimates employ certain economic assumptions and require the agency to make projections over a period of time, usually 10 years. CBO scores use current federal law as a baseline for its assumptions and the agency does not presume any future modifications that might be made to federal laws, programs or spending.1  

---

1. The District Policy Group, “CBO Score,” Washington, D.C. Accessed April 2021. http://www.districtpolicygroup.com/dewonkify-detail/dewonkify-cbo-score#:~:text=Definition%3A%20%22Score%22%20or%20%22,Congressional%20Budget%20Office%20(CBO)

Medlearn Matters re IDTF and Preventive Services

 https://drive.google.com/file/d/1PyHjynk5BEjbjFzHD9zLDPeylt88scb4/view?usp=sharing   

Above, you have links to my own cloud copy of MM9246.  

But I downloaded it within the last couple years, almost certainly in 2020.

DEAD LINK:

https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/Downloads/MM9246.pdf  

Screen shot of document:

Also, if you go direct to the CMS website, you can't find this by CMS key word searches.

MM9246 was a 2015 document with instructions for Low Dose CT Lung Cancer / and it reflected a 2017 revision adding the IDTF text.

There are remaining contemporary documents that cite the once-live CMS link from 2017 or so.

At ACR for example

https://www.acr.org/Advocacy-and-Economics/Advocacy-News/Advocacy-News-Issues/In-the-June-16-2017-Issue/Medicare-Announces-Lung-Cancer-Screening-Coverage-in-the-IDTF-Setting#:~:text=On%20June%2012%2C%202017%2C%20the,national%20coverage%20criteria%20are%20met.  

At Novitas for example

https://www.novitas-solutions.com/webcenter/portal/MedicareJL/pagebyid?contentId=00155104

Covid Links for Unusual Facts

NYT 7/29/91

If we must wear masks again, we need a smart approach.  Nuzzo & Blauer.

https://www.nytimes.com/2021/07/29/opinion/mask-mandate-cdc-covid.html?action=click&module=Opinion&pgtype=Homepage

WSJ August 3, Masks are a Distraction

https://www.wsj.com/articles/masks-covid-cdc-vaccination-mandate-provincetown-biden-11627940971

NY 

Do Masks Matter in Schools?

https://nymag.com/intelligencer/2021/08/the-science-of-masking-kids-at-school-remains-uncertain.html

NYT 7/28/91

A confusing message [from CDC.]  Leonhardt.

https://www.nytimes.com/2021/07/28/briefing/mask-guidance-cdc-vaccinated.html

NYT 7/30/2021

More COVID mysteries.  (Peak, fall.)  Osterholm/U MN.  Leonhardt.

https://www.nytimes.com/2021/07/30/briefing/coronavirus-delta-mysteries.html

NYT 7/29/2021

Vaccine mandates bigger than "mask mandates."  Leonhardt.

https://www.nytimes.com/2021/07/29/briefing/mask-mandates-coronavirus.html

Alternate:
School masks save lives, Duke, NYT

https://www.nytimes.com/2021/08/10/opinion/covid-schools-masks.html

At same time as WSJ, Masks don't save lives or matter

https://www.wsj.com/articles/masks-children-parenting-schools-mandates-covid-19-coronavirus-pandemic-biden-administration-cdc-11628432716?mod=searchresults_pos1&page=1

TWITTER

JHowardBrainMD - Pediatrics and Covid (Has email)

CNN
White House Protests Adverse Press (Lots of Sick Vaccinated People)

https://www.cnn.com/2021/07/30/media/variant-media-coverage-white-house/

Good Housekeeping - How good are masks. N95 better.  Links to Mayo.

https://www.goodhousekeeping.com/health/a37135570/best-face-masks-delta-variant/

https://www.mayoclinic.org/diseases-conditions/coronavirus/in-depth/coronavirus-mask/art-20485449#:~:text=An%20N95%20mask%20is%20a,when%20the%20wearer%20inhales.

MASK ADHERENCE AND COVID RATES - FISCHER (2 10 2021)

https://www.medrxiv.org/content/10.1101/2021.01.18.21250029v2

PLOS ONE also

Looked at mask adherence not mask policy

   Not clear corrected for lockdown, closures, etc.

What the evidence for masking

Vinay Prasads MD

https://www.medpagetoday.com/opinion/vinay-prasad/93803

Mask Free Sweden = Zero Deaths

https://www.msn.com/en-gb/health/medical/mask-free-sweden-is-close-to-zero-daily-covid-deaths/ar-AAMSKMZ?li=AAJt1k3&srcref=rss

WHO Different Countries and Mask rules

https://www.weforum.org/agenda/2021/07/drones-and-harry-potter-memes-how-to-persuade-people-to-wear-masks/

HIV not good for COVID

https://www.hivplusmag.com/world-news/2021/7/15/people-living-hiv-have-higher-risk-death-covid-19

https://apps.who.int/iris/bitstream/handle/10665/342697/WHO-2019-nCoV-Clinical-HIV-2021.1-eng.pdf

SARS Super Antibiodies

https://www-news--medical-net.cdn.ampproject.org/c/s/www.news-medical.net/amp/news/20210705/Scientists-identify-natural-SARS-CoV-2-super-immunity-against-23-variants.aspx

Wang et al science

https://science.sciencemag.org/content/early/2021/06/30/science.abh1766

COVID and Children.  Jonathan Howard.

https://sciencebasedmedicine.org/cognitive-illusions-and-how-not-to-write-about-covid-19-and-children/

Versus Med Page Today makary

https://trialsitenews.com/theres-no-need-to-vaccinate-healthy-kids-according-to-medpage-today-editor/

Vinay Prasad and Children

https://www.medpagetoday.com/opinion/vinay-prasad/93453

Vinay: 
WHo are the real Experts

https://www.medpagetoday.com/opinion/vinay-prasad/92652

Gottlieb says; COvid gone soon (Maps to other surges which led to dramatic fall-offs, as Leonhardt at NYT discussed and earlier BQ Linked IN article)

https://www.dailysignal.com/2021/07/31/delta-variant-of-covid-19-soon-will-be-gone-former-fda-chief-predicts/

USA big red map of COVID high rates per CDC (consider 7X change of scale)

https://www.usatoday.com/in-depth/graphics/2021/07/29/cdc-mask-guidelines-map-high-covid-transmission-county/5400268001/

It's a live map for every county in US. Polk County is High at 66 (10 per 100K per day), while places in FL have 500 (70 per 100k per day).  I suspect, but don't know, this might be a current map (?).

CNN, What Subst. and High mean.

https://www.cnn.com/2021/07/28/health/substantial-or-high-covid-19-transmission-wellness/index.html

CDC has a live map by County (but the actual numbers don't auto pop like in the USA map.)

https://covid.cdc.gov/covid-data-tracker/#county-view

Specifically, a "Low" transmission is considered no more than 10 cases per 100,000 people, or a test positivity rate of less than 5%. "Moderate" transmission is 10 to 50 cases per 100,000 people, or a positivity rate between 5% and 8%. "Substantial" transmission is 50 to 100 cases per 100,000, or a positivity rate between 8% and 10%, and "high" transmission is 100 or more cases per 100,000 people or a positivity rate of 10% or higher.

Separate:
Future belongs to Digital Pathology

http://geekdoctor.blogspot.com/2021/07/the-future-belongs-to-digital-pathology.html

Kaiser Tool to Predict Surges

https://medcitynews.com/2021/07/kaiser-permanente-creates-tool-to-predict-upcoming-covid-19-surges/?rf=1

Bullsh## Book

Carl Bergstrom

https://www.amazon.com/dp/B08191DV5T/ref=redir_mobile_desktop?_encoding=UTF8&qid=1627790651&ref_=tmm_kin_swatch_0&sr=8-3

Join me in the fight against COVID misinformation

https://www.medpagetoday.com/opinion/kevinmd/93832

Kevin MD   Tomi Mitchell MD

####

BRUCE QUINN:
PEAKS AND PLUMMETS ARE COMMON, YET WE'RE MYSTIFIED!

https://www.linkedin.com/pulse/wapo-mystified-falling-uk-cases-yet-peakplummet-pattern-bruce-quinn/

THE CDC's 7X SWITCH - BAIT AND SWITCH?

https://www.linkedin.com/pulse/vinay-prasads-op-ed-cdc-mask-evidence-bruce-quinn/

LA TIMES PUBLISHES HIGHLY MISLEADING COVID STATS

https://www.linkedin.com/pulse/los-angeles-times-publishes-highly-misleading-covid-numbers-quinn/

VERY UNUSAL COVID SURGE IN UPPER CLASS LA (MID JULY POST)

https://www.linkedin.com/posts/bruce-quinn-2831674_los-angeles-county-coronavirus-cases-tracking-activity-6821560353177112577-4UNM

See Later July 29:

https://deadline.com/2021/07/los-angeles-covid-surge-driven-by-white-affluent-neighborhoods-1234802675/

and Santa Monica in NYT

https://www.nytimes.com/2021/08/01/us/covid-santa-monica-icu.html

and August 5 at Crosstown LA (XtownLA / USC)

https://xtown.la/2021/08/05/delta-covid-surge-los-angeles/

I AM PRO MASKING BUT C'MON (LA WINTER)

https://twitter.com/brucequinnmd/status/1423766385243484162

BRUCE
All you need to know about infectiousness and evolution of Delta - UK

https://www.linkedin.com/posts/bruce-quinn-2831674_covid-activity-6817884184653254657-zFwm

####

Masks Objective Data

Howard J,  evidence review of face masks, PNAS Jan 2021

https://www.pnas.org/content/118/4/e2014564118

(Not, review of face mask policies.)
(Face mask policies affect eg. people in Target.  Covid affects everyone 24/7.)

AIM, Bae, Surgical v cotton masks in COVID in 4 patients, July 2020

https://www.acpjournals.org/doi/10.7326/m20-1342

Nature, 9/2020, Asadi, Efficacy of masks and face coverings

https://www.nature.com/articles/s41598-020-72798-7

PNAS, 5/2021, under review 9-2020 to 3-2021, Bazant and Bush

https://www.pnas.org/content/pnas/118/17/e2018995118.full.pdf

20210812

https://www.latimes.com/california/story/2021-08-11/despite-surge-california-doing-much-better-with-delta-variant-than-florida-texas-heres-why

https://theconversation.com/compare-the-flu-pandemic-of-1918-and-covid-19-with-caution-the-past-is-not-a-prediction-138895

Everyone should just wear a mask; swiftly effective.

https://www.nytimes.com/2021/08/12/health/covid-masks-cdc.html

Dakotas; Plummet Both

https://www.postbulletin.com/newsmd/coronavirus/6824462-North-Dakota-got-a-mask-mandate-South-Dakota-didnt.-COVID-19-cases-have-plummeted-in-both

Numerous WaPo national county maps (low med high COVID, low med high VAX)

https://www.washingtonpost.com/health/interactive/2021/vaccinated-counties-delta-hotspots/?itid=hp-top-table-main

CDC JAMA EARLY 2021

Brooks and Butler: Effectivenses of mask wearing

No argument for SOME reduction but much anecodotal or uncontrolled data like "temporal association"

Real data as high as 70% but sometimes lower in table

Self report confounds for other behaviors (avoiding crowded bars and indoor poker parties)

https://jamanetwork.com/journals/jama/fullarticle/2776536

Puzzlingly, there is an op ed but apepared in July 2020 of 8 months earlier

https://jamanetwork.com/journals/jama/fullarticle/2768532

Brooks, Butler, Redfield, Masking - time is Now.

Based on Wang et al, universal masking in a Mass. health system.

Wang et al here

https://jamanetwork.com/journals/jama/fullarticle/2768533

Not community masking - bad extrapolation

ALSO the HEALTHCARE impact was MODEST

the SARS-CoV-2 positivity rate among health care workers declined from 14.65% to 11.46%

October 2020

Lerner et al, Lerner Folkers Fauci

Low Tech interventions

https://jamanetwork.com/journals/jama/fullarticle/2772459

Focuses on "filtering efficacy" rather than "wearing effectiveness"

Surgical masks can reduce respiratory virus shedding in exhaled breath,⁵ and the filtering efficacy of some materials used in cloth masks may approach that of surgical masks.⁶

LEUNG et al

any LAB STUDy biasd to best performance

Any RWE study biasd for "choice of person" eg avoid bar

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8238571/

Substack - Emily Oster - We Don't Have Needed Data

https://emilyoster.substack.com/p/we-still-do-not-have-the-covid-data

Delta variant means anxiety in California

https://www.latimes.com/california/story/2021-08-20/why-delta-variant-makes-mask-and-vaccine-mandates-essential

Bloomberg - too much caution is bad for kids

https://www.bloomberg.com/opinion/articles/2021-08-20/covid-in-the-schools-too-much-caution-will-hurt-children

Fast Comapny - Can schools open safely  By brandon guthrie

https://www.fastcompany.com/90668041/how-can-schools-reopen-safely-heres-what-an-epidemiologist-suggests?partner=rss&utm_source=rss&utm_medium=feed&utm_campaign=rss+fastcompany&utm_content=rss

SAME  Schools can open safely- An epidem. describes.

https://theconversation.com/schools-can-reopen-safely-an-epidemiologist-describes-what-works-and-whats-not-worth-the-effort-165594

###

WAPO. Europes growing mask ask: Medical grade

https://www.washingtonpost.com/world/europe/europe-coronavirus-masks-regulations/2021/01/20/23463c08-5a74-11eb-a849-6f9423a75ffd_story.html

Delt and hybrid immunity - Jenkins

https://www.wsj.com/articles/covid-19-coronavirus-delta-hybrid-natural-immunity-vaccine-breakthrough-cases-11629492042

CANADIAN PAPER on 10% BLUE MASKS - - - - -

PAPER

https://aip.scitation.org/doi/10.1063/5.0057100

PRESS RELEASE

https://uwaterloo.ca/news/media/study-supports-widespread-use-better-masks-curb-covid-19

DAILY MAIL

https://www.dailymail.co.uk/news/article-9914969/Popular-blue-surgical-face-masks-NOT-stop-people-infected-COVID-19.html

NYT - US gets crash course in pandemic SCIENCE uncertainy

https://www.nytimes.com/2021/08/22/health/coronavirus-covid-usa.html

Klompas rec N95 masks May 2021

https://academic.oup.com/cid/advance-article/doi/10.1093/cid/ciab539/6296401?login=true

https://twitter.com/brucequinnmd/status/1430052553576771584

https://twitter.com/Oshoaum1/status/1430219093987184643/photo/1

Bruce Table of Masks

https://www.linkedin.com/posts/bruce-quinn-2831674_im-not-sure-the-exact-origin-of-this-table-activity-6836698201479872512-O9pm

Yet NYT says "virus can't cut through paper"

https://www.nytimes.com/2021/08/26/health/covid-breakthrough-infection.html

As many Americans begin the familiar exercise of questioning and calling off plans, scientists are stressing the continued importance of mask-wearing to reduce transmission and infection.

“If you get infected and breathe virus out, it will get trapped by your mask,” said Dr. John Moore, a professor of microbiology and immunology at Weill Cornell. “These viruses don’t have pairs of scissors that can cut through masks.”

Bruce Pew Polarized

https://www.linkedin.com/posts/bruce-quinn-2831674_covid-activity-6836698958950223872-lgTB

Masks may not have "caused" Surge dip in SF area

https://www.sfgate.com/coronavirus/article/Bay-Area-COVID-delta-mask-mandate-work-when-county-16413589.php

NYT has 3 articles on Mask Policy, none of which discuss efficacy except one which is hand waving and mistitled.

Aug 30 Hard questions we're not asking

https://www.nytimes.com/2021/08/30/opinion/us-covid-policy.html

July 29

If we must wear masks we need a smarter approach

https://www.nytimes.com/2021/07/29/opinion/mask-mandate-cdc-covid.html

August 10

We studied 1M students...

https://www.nytimes.com/2021/08/10/opinion/covid-schools-masks.html

##

Shay - Navigating Spaghetti Junction - Medicare's Dx Test Rules

 https://www.gosfield.com/images/DFS.NavSpaghettiJunc.PrePubDraft.011420.pdf

46pp