Keeping the coronavirus from infecting healthcare workers
newyorker.com
newyorker.com
Even a scarf made of a t-shirt over the nose and mouth will likely reduce RO when used at scale on the population. The best way to protect healthcare workers is to reduce the R0 below 1. Nothing else will help. Widespread use of homemade masks, though not tested in a double blind trial, is low risk enough and seemingly effective enough to encourage.
Countries enforcing widespread mask use have lower ROs.
They all still have an R0 above 1.
I didn't but I also didn't make the claim that they would help so I suggest we start by getting claimants to back up their claims before we get anyone checking claims to prove negatives.
https://www.channelnewsasia.com/news/singapore/covid19-coron...
https://www.wsj.com/articles/asian-countries-wield-fines-jai...
And you can't just claim social distancing. Unless they have shut down their trains, where people are literally packed in, that just doesn't fly. (So, have they?)
The virus has been in Italy for a lot longer than they think, and they get close to each other/have actual contact a lot (I don't know if that's actually true, I've never been to Italy)
Maybe they mostly have a particular mutation that is more deadly/infectious
In short, I trust the figures here about one step more than ones coming out of China.
[0] https://slate.com/news-and-politics/2015/06/kodokushi-in-agi...
So, possible, but seems not as likely to be the explanation.
Edit for reference: https://m.youtube.com/watch?v=E7kor5nHtZQ
The New Yorker article we are supposedly discussing literally says the coronavirus is not very efficient even in hospital settings.
I am familiar with crowded trains in East Asia. Your video does not have time marker so I assume it is not taken recently.
I posted that as evidence masks have not always been worn by everyone.
I'm confused on your 80% compliance number. Are you saying Japanese get 80% compliance on things, and by extension don't have flu outbreaks?
How would an entire country obtain N95 masks and training and proper fitting (it's done by trained fitters) and dispose of them properly, and do that daily? (if not more often)
Every time I go out I see the cheapo ones left in the street because there's a vague notion they should be disposed of "properly" so I don't see this idea working at all.
I can't do it.
> read the article
Okay, maybe they can square it:
> Luckily, methods were found that protected all the new health-care workers: none—zero—were infected.
> But those methods were Draconian. As the city was locked down and cut off from outside visitors, health-care workers seeing at-risk patients were housed away from their families. They wore full-body protective gear, including goggles, complete head coverings, N95 particle-filtering masks, and hazmat-style suits.
They failed, it was probably the use of "Draconian" that let them down.
I also read the paper you provided, not just the abstract, and it spends a lot of its time talking about N95 masks. Here is from a part it spends on facemasks:
> whereas for the facemasks the efficiency can vary from 10% to 90% (Guha et al., 2017)
Have you read Guha's paper? I've got it here. I have so many problems with someone relying on that paper beyond its narrow applicable scope. I wonder if they've ever worn a mask. I digress.
Additionally (we're back to the paper you shared), you should count how many times "except the low-filtration adult surgical mask" or some combination of those words following except comes up in that paper.
It's also a model and not a study. Let me know when there's a study that shows masks work (the Guha paper mentioned is a study, in a lab, not using people or even a model of a face), in use by the general public, in the kind of settings they wear them, and it's the kind of masks they usually wear.
Second explanation that comes to mind is that they tend to be just healthier than other countries. They have low obesity, exercise correctly and routinely, walk and ride bikes to get where they go, and do all of this even when elderly. The counterpoint to this is that they have a really high smoking population.
Source: I lived there for two years.
Second is also tougher to square. The risk pool is supposedly older people, per reports from Italy. But, that doesn't seem to square with age profiles of Japanese. So??
Still, there's a long way to go for this thing.
Social distancing isn't happening much at all, and unless the population is magically becoming immune then there's no way R0 is less than 1. The real questions are whether that will translate into symptomatic and serious cases, and when.
"Homemade masks appear to be reasonably effective" is hardly a compelling case.
If we were to weigh the priors, the existing evidence would be leaving towards mask use having a protective effect. The question that we should ask ourselves is, what if the reality turns out to be different? There are 2 scenarios. First, mask use is harmful and the second, mask use has no effect on transmission. The first is very unlikely given what we know and the second will mean that if mask use is encouraged, it will be wasted resources for no gain. If these resources that were wasted were easily obtainable i.e. masks made of old clothing etc, then the downsides aren't serious at all but could have very good upsides if the priors were right.
So I agree, that we should encourage widespread home-made masks use and leave the disposable ones to the healthcare workers.
I guess if you believe that's actually true, you should be advocating for doctors to stop wearing masks...
But that's not something we do, because we have enough priors that masks help that we will continue to use them.
I realize that you are just enjoying being contrary here, but please try to think through your argument and ensure it isn't incorrect in itself before posting.
Absence of evidence does not prevent you from making decisions or otherwise coming to conclusions. The fact is, you can make decisions with no evidence at all. Your outcome may be no better than chance but also likely no worse.
Not making a decision can be worse than chance, especially in time critical or low information environments and if you always “wait for the evidence” you will end up being worse than a magic 8-ball at the most crucial moments.
(1) https://www.forbes.com/sites/tjmccue/2020/03/20/calling-all-... (2) https://www.uza.be/mondmaskers. (in Dutch)
"R0 is not a biological constant for a pathogen as it is also affected by other factors such as environmental conditions and the behaviour of the infected population."
"R0 is not a biological constant for a pathogen as it is also affected by other factors such as environmental conditions and the behaviour of the infected population."
It is defined as "expected number of cases directly generated by one case in a population where all individuals are susceptible to infection". And that is possible to influence by behavior. If no one even meets anybody, no sick person can generate next case. If people live in over-crowded houses, one person will infect many more.
"Promoting simple do-it-yourself masks: an urgent intervention for COVID-19 mitigation" (Svara et al. 2020)
Pre-print available at https://link.medium.com/LY7RRNr2X4
Summary: "We demonstrate that widespread use of masks by the general population could be an effective strategy for slowing down the spread of COVID-19. Since surgical masks might not become available in sufficient numbers quickly enough for general use and sufficient compliance with wearing surgical masks might not be possible everywhere, we argue that simple do-it-yourself designs or commercially available cloth masks could reduce the spread of infection at minimal costs to society."
https://www.forbes.com/sites/tjmccue/2020/03/20/calling-all-...
> In settings where facemasks are not available, HCP might use homemade masks (e.g., bandana, scarf) for care of patients with COVID-19 as a last resort. However, homemade masks are not considered PPE, since their capability to protect HCP is unknown. Caution should be exercised when considering this option.
https://www.cdc.gov/coronavirus/2019-ncov/hcp/ppe-strategy/f...
This is because the medical industry needs proven methods, and they still suggest homemade masks as a last resort. Maybe we should all be wearing homemade masks in public.
During world war 2 it was normal to use reusable cotton masks. They just need to be put into boiling water for a few minutes to kill sars-cov-2 at 100%.
You should try to get into touch with C. Drosten from Charité hospital Berlin. He recently stated in an interview that self-made masks could have a certain value, so he is not totally averse to this concept and Spahn [1] will listen to him.
China has been promoting it, now czech republic is doing it. If Germany also starts promoting it, that will help immensely.
The same goes for the hand sanitizer, any +70% alcohol/ethanol will do. No need to be from a factory with medical certifications.
I am in France, there is a total lock down here but police still wears no masks and so does nobody else. Super markets have no hand sanitizer at the entrance so the virus will continue to spread.
Masks cost nothing compared to the economic damage of the shut down.
[1] German minister of health
Edit: For those downvoting me, I'd sincerely be interested to hear your arguments.
I was looking for information on (high) heat killing viruses such as sars-cov-2. Are you able to point to a reliable source on this?
They're not really alive, so they can't be killed. But you can destroy vital parts of them and make them unable to reproduce.
https://en.wikipedia.org/wiki/Denaturation_%28biochemistry%2...
Most educated people know that viruses aren't alive in the traditional sense. People who aren't as educated simply don't care, and I don't blame them. Using the more scientifically precise term helps nobody, except scientists, in this situation.
Should software engineers stop using the word "kill" in POSIX-land because CPU processes aren't really "alive"? Give me a break.
I answered his question while also correcting a minor mistake. Also I'm not sure what you're quoting there.
> Most educated people know that viruses aren't alive in the traditional sense. People who aren't as educated simply don't care, and I don't blame them.
Are you trying to insult your grandparent? Most people on HN aren't willfully ignorant and are quite open to new knowledge.
Hence I'd assume that boiling will be reasonably effective.
Source: WHO https://www.who.int/csr/sars/survival_2003_05_04/en/
> All [known] strains of virus can be inactivated at 70 °C.
For reference, an autoclave used for sterilization is around 121 °C.
> A minimum temperature range to inactivate most virus is 48°C to 60°C. Some virus still able to survive at temperature below 60°C e.g. adenoviruses(dsDNA naked virus) relatively thermostable, it able to withstand temperature at 56°C for 10min.
¹ https://www.quora.com/At-what-temperature-do-viruses-die-1
I've sent pleas to several local and national government agencies and health directors, but it's unlikely that such e-mails will be read, so information needs to be disseminated another way. The fact that the western world hasn't called for widespread use of even cloth masks is unconscionable. Presume you're already infected to protect others.
IMHO this is a really good idea, especially because people who are infected and dont know that yet are less likley to infect others. How good the mas is at protecting you is pretty much secondary concern at this point in time.
That is an amazingly forward-thinking position that we should applaud. The mask thing will be one of those “obvious” things that we’ll look back on in a couple of years and shake our heads at.
BTW, its quite an interesting cognitive change - basically in a span of about two days everyone in public has a mask, even anchors and politicians in news coverage! Even the sign language interpetters!
Also I found out I feel rather uneasy now watching footage from affected areas, some of them in worse situation than us, with people not wearing any masks.
Such a simple way to protect otjers once you thing about it a bit, yet not universally adopted so far...
The Taiwanese response has been exemplary.
The argument against masks is based on 1) that people want them to protect themselves 2) that there aren’t nearly enough masks to do so.
So as I understand it, the authorities that say “don’t wear a mask” isn’t answering the question “would transmission be reduced if everyone wore a mask?”, but rather the question “Should I get a mask to protect myself”. Those are two very different questions.
If we had successfully promoted "wear a mask when you're sick" as general US policy in advance we probably wouldn't have these supply chain issues and it would be safe to advise people just wear a mask at all times during the crisis. We didn't, so most people don't have any masks, which means they're going to look at this crisis + advisory and panic buy a big pile of them when supplies are already limited.
It completely covers my nose and mouth and chin and wraps around over my ears. I tie it in the back with 4 ties one on the top edge and one on the bottom edge.
I have friends tell me "that's dangerous! It may trap particles behind it and make you sicker!"
I'm willing to take my chances. I believe
- combined with my eyeglasses, it will keep me from touching my face and eyes when I'm out
- if someone a few feet away coughs, the large droplet that the virus is riding on will surely get trapped. The pores don't need to be virus-sized to do that.
I have a proper "Gas Mask" but I want to save that for a gas attack. That's why we all have one.
The NY Times ran an op-ed about this:
https://www.nytimes.com/2020/03/17/opinion/coronavirus-face-...
I've also seen people mis-wearing N-95 masks. I was behind a couple in the supermarket yesterday who were wearing them and every few minutes they were reaching up to readjust their noseclips. I got this on video, it was so perversely amusing to me. I hope they don't get sick.
Health care providers, scientists and health officials are rapidly changing and adapting to the situation. It probably is a good idea for all people to wear homemade / improvised masks to reduce R0
But I'd still hope that civilians with large stores of N95 masks or other PPE would consider donating them to healthcare workers. The optimal scenario seems to be that non-HCPs stay home as much as possible, wash hands, sanitize and wear improvised masks when leaving home, and donate PPE to healthcare workers
9% of COVID-19 cases in italy are HCPs
[0] https://www.cdc.gov/coronavirus/2019-ncov/hcp/ppe-strategy/f...
I was at Home Depot today and was surprised to see N95 masks available, though limited in number per customer.
As the article states, China had that ability.
If that statement is true, It’s amazing to me that this is something China can do and not the U.S.A. The country that put man on the moon not even a century ago! Incredible.
I feel like there are a lot of acquisitions lately that go on about how “draconian” China’s behaviour is etc, but they protected their medical staff by making sure they were adequately equipped. It read a bit like jealousy.
Aren't those two massively different tasks/skills? And both in massively different situations?
Even in a crisis, all that economic wealth and military dominance that the US claims to have can’t put masks and gowns on people that need them, so is there really much steam left in the tank ? I hope there is and I’m sure there is, it just needs to find the right channels. God Bless America!
it's a similar story with the PPE. the US has moved a lot of manufacturing capacity overseas because it's economically efficient. the US is certainly wealthy enough to manufacture as much of this stuff as needed, but it isn't a switch that can be flipped overnight and the unit cost would be much higher due to regulatory burdens like worker protection.
Quote from a Minneapolis/St. Paul Business Journal article related to the mask manufacturing ramp up at 3M for COVID19: “‘We're seeing increased demand for our respiratory protection products, and we're ramping up our production worldwide, in China, around the world to meet that demand.’ (Mike Roman, 3M CEO)” [0]
Nothing about that statement gives me any confidence that a single 3M N95 mask is produced in the U.S. In fact, it sounds downright evasive to me.
[0] https://www.bizjournals.com/twincities/news/2020/01/29/3ms-c...
3M's general offices, corporate research laboratories, and some division laboratories in the US are in St. Paul, Minnesota. In the United States, 3M operates 80 manufacturing facilities in 29 states, and 125 manufacturing and converting facilities in 37 countries outside the US (in 2017).[66]
I don’t believe 3M would buy white-label products, they employ several hundred research scientists and have invented countless original products / innovations.
“‘We're seeing increased demand for our respiratory protection products, and we're ramping up our production worldwide, in China, around the world to meet that demand.’ (Mike Roman, 3M CEO)” [0]
Nothing about that statement gives me any confidence that a single 3M N95 mask is produced in the U.S. In fact, it sounds downright evasive to me.
[0] https://www.bizjournals.com/twincities/news/2020/01/29/3ms-c...
I agree, you’d think if they were producing masks in the US they would make that clear.
My wife is an R.N. and is the clinical care coordinator on a cardiac critical care unit in northern NJ that has been converted to a negative pressure covid-19 unit. They currently have two positives and several suspected under treatment. They do not have enough PPE gear to see every suspected patient using full protection, i.e. gown, goggles, N95 mask, gloves, etc. This is a fact that bothered me much more than her. It's possible to prevent transmission to health care workers without full PPE on every case. See for reference this article currently linked on HN front page: https://www.newyorker.com/news/news-desk/keeping-the-coronav.... Naturally I still wish she was wrapped head to toe in antiviral something every time she goes near the place, but my fears are those of a layperson and I have to trust her professional judgement.
China has a lot of experience with SARs and other respiratory viruses. They are basically ground zero right.. so I would expect people to listen to China when they say you need masks.
I understand the “golden arches” theory, and the intent if globalism, but I feel that COVID19 has revealed what a short sighted, deeply flawed view the globalists have.
As an extreme example, the US continues to manufacture it's own military aircraft instead of buying from China. Even though China might be willing to sell them cheaper than we can make them.
And note that "mostly okay" here doesn't mean we have anywhere close to enough masks. Just that, with extreme rationing, we can ensure most but not all doctors have the absolute bare minimum of protective gear.
Like, in China, factories that made bedding products are re engineered to make masks, suits, etc.
These are exceptional conditions, so if you had the protocols in place (blue prints, machine configurations, assembly line structure, briefings for management, briefing and courses for factory workers), maybe it was doable.
And maybe it would be of low maintenance, just when new machines were introduced, you'd release a new document to configure that machine.
The main problem would be raw material, but again, maybe with planning and study new materials and combinations could be used (even if not perfect).
This would be only a problem for countries with little to no industry, but that's where organizations like the EU should come into play.
The US policy of 14 day quarantine for healthcare workers who had even limited exposure to a COVID patient was never sustainable and threatened to shut entire ERs before the restrictions were loosened.
A broad array of moderate measures (stringent hand washing, surgical masks all the time, 6 foot rule except during exams, etc.) combined with isolation of only identified “close” contacts has worked in a few different places now.
The question of asymptomatic spread is still confounding experts. It seems they can’t fully explain the spread in some places without it, but they can’t explain lack of spread in some places with it.
When left in a situation where data is conflicting and unreliable, I think the path forward has to always balance the conflicting interests. Just like you can’t send the entire ER department home in the middle of an epidemic, you also can’t exhaust your entire years supply of hazmat gear in a week, and you similarly can’t crater your entire economy to put on a show of strong action.
Measured responses ultimately are what will save the most lives, because they can be sustained for the reasonable expected duration of the outbreak rather than shock and cripple the whole system in a matter of weeks.
They surely can. They just have to assume there are way more asymptomatic cases than they have been assuming, and a relatively small susceptible population.
I’m not sure why people keep talking like this is all in the past for these countries ?
I think Singapore and Hong Kong (and South Korea) were able to aggressively test (e.g. temperature readings at airports), contact trace (e.g. grab location data off phones), force mobile apps for tracking and checking in, etc. All of that gave them the option of a measured approach.
China had to go full in because they realized they had a uncontrolled pandemic brewing for a month before they took any significant action.
He’s a practicing surgeon, public health researcher, educator, and he was one of the early champions of wide use of checklists in hospitals to reduce infection rates and complications.
He is not prone to blowing sunshine and rainbows, either.
https://www.nytimes.com/2020/03/17/opinion/coronavirus-face-...
people are sewing masks to make up the difference between what is needed and what we can supply. the federal government can't seem to supply the states with much of anything. and purchasing domestically-produced masks is becoming rapaciously expensive, with some manufacturers charging $7 per mask. allegedly our domestic manufacturers are ramping up production. but let's face it, that takes time. and we don't have time, because once one of our healthcare workers gets sick, they're out of commission for weeks.
i will not abide by this disaster for our heathcare workers. i am working with an established charity to raise money to purchase thousands of n95 respirator masks from chinese manufacturers so that those masks can be shipped and donated directly to hospitals in epicenters like new york.
i'm calling it the million mask campaign because i hope that we can eventually donate at least a million masks to hospitals in need. in reality, we will need many millions of masks if we want to protect our healthcare workers, but everything we can bring to bear on their behalf will be beneficial.
please consider contributing to our campaign: https://www.gofundme.com/f/the-million-mask-campaign?utm_sou...
Might be effective in some way but there's a heavy dose of wackadoo there. US patent 88,819,662 doesn't seem to exist either.