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Comment by SiVal | Hacker News Reader

I agree with every point you're making, so I wonder if it isn't just one big factor: lots of people routinely put on masks at the first suspicion that they might be sick, even before they're sure. They just go ahead and do it just in case. And they do this all the time, so there's no delay due to self-consciousness or unfamiliarity or having to go buy a mask. It's just ordinary life.

Like taking shoes off in the house and making high school a college-admissions death march, maybe this widespread East Asian custom will spread in the West as well.

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It is too early to know whether what Japan has done is enough and whether it will be effective long term.

That said, It isn't just people wearing mask, or something innately Japanese. At the beginning of last year they had a serious flu outbeak[1]. This years flu cases saw a major reduction when measures to combat COVID-19 came into effect[2].

I have noticed a lot of little things that have come into effect as a response to covid-19.

* Medical clinics put signs up saying don't come in if you have flu like symptoms, phone and keep yourself isolated. That allows them to keep the vast majority of people with mild colds and flu separated from those with possible COVID-9.

* Stopping schools reduced the numbers of people on public transport.

* Putting pressure on companies to allow people to work from home.

* The supermarket bakery started wrapping all bread and pastries before putting them out, previously you would place what you wanted in a tray and they would wrap it.

1. https://www.nippon.com/en/japan-data/h00386/japan-gripped-by... 2. https://twitter.com/adtimmering/status/1240900101687480320?s...

But we are being told that masks don't hep with prevention. Do you mean that sick ones do that not to spread?

Masks absolutely help. You are told otherwise for a whole other reason: to stop hoarding masks.

This has been asserted by so many different people, but there doesn't seem to be much scientific evidence backing it up. Why are you so sure?

There is evidence indicating it helps to prevent infection and to help prevent spreading infection.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5153448/ “The overall effectiveness of vaccination and mask wearing was 9.9% and 8.6%, respectively.”

There aren’t nearly enough masks to go around for the general population so it would be reckless to recommend people in the USA wear (commercial quality) them right now due to the need for all available supplies to go to healthcare workers.

That paper also has:

> Hand washing (1.447, 1.274–1.644) and gargling (1.319, 1.183–1.471), however, were not associated with protection. In the natural setting, hand washing and gargling showed a negative association, which may have been due to inappropriate infection control measures or aggregating infected and non-infected children to conduct those measures.

So hand washing isn't effective and masks are? That's the opposite of what we're being told for a different disease. Are you going to say we shouldn't wash our hands?

I think there are plenty of other studies showing that hand washing can make a big difference.

But I don't think that negates the whole paper. It could be that the methodology used for the hand washing data is more flawed than the mask portion.

The recommendation is not to use masks unless you are sick.

Japanese people use masks all the time though, and it seems to help?

Even in Japan they traditionally only wear masks when sick.

not sure why you are being downvoted, as this was very much what we were told by outlets like cnn, etc. "dont where masks, they dont work and health care workers need them to not get the virus"

I was basically treated like a country bumpkin in a work channel (Amazon) for suggesting if you are going outside (Seattle) you should wear a mask.

> they dont work and health care workers need them to not get the virus

Isn't that an obvious oxymoron?

I don't think so, but its definitely a contradiction in logic...

That would depend on the assumptions, those being:

- context i.e. clinical setting vs on the street

- type of mask

- skill set of those using the equipment

For example, knives are very effective in surgery when they are:

- in a surgical theatre

- a scapel

- used by a surgeon

I don't suggest doing surgery in the street with a knife from your kitchen draw used by a teenager.

Surgical masks are designed to prevent you spreading viruses. That is the type most people wear in Japan. N95 masks are designed to protect you.

> Surgical masks are designed to prevent you spreading viruses

That maybe true but that doesn't change the fact they help you from catching it as well.

It simply doesn't make any sense going one way is 100% and the other is 0%

And what we want is to chip away at the R0 in as many ways as possible.

And that's skipping the fact people thinking they are protecting themselves are also protecting others.

If there were an unlimited supply of surgical masks that would make sense. If you wearing a mask deprives actually sick people of wearing one then you are still worse off then not wearing one.

Imagine if everyone didn't just accept this lie and we retooled factories 2 months ago

https://www.news-journalonline.com/business/20200320/coronav...

When you sell to the public to protect themselves they can fund a lot more than a hospital and maintain it for long periods of use.

Other than just letting people all die off and getting herd immunity any possible solution will involve everyone wearing masks.

We have a year more of this, there is still time to change direction.

Good advice 1 year too late.

> It simply doesn't make any sense going one way is 100% and the other is 0%

It's not 100% vs 0%. It's probably something like 70% vs 5% (Disclaimer: I'm pulling numbers out of my ass).

When someone who is sick wears a mask, they dramatically cut down on how much virus is PROPELLED OUT OF THEIR MOUTH. That's the big win. It still likely comes out their nose or is on their hands. But at least it isn't propelled with a cough or sneeze so if you wipe surfaces and avoid contact, you're probably okay. That mask protects dozens of people.

When a healthy person wears a mask, he protects only himself and the only thing he is "protecting" against is airborne droplets into his mouth. Most masks don't cover the nose and eyes which are the primary transmission routes for droplets. Most people don't breathe with their mouth open. You're probably safer simply wearing glasses, especially safety glasses. A lot of famous singers wear glasses/sunglasses all the time for exactly this reason.

A mask shortage will exacerbate these scenarios. One healthy person taking a mask away from one sick person is a TERRIBLE tradeoff.

Conceptually, I agree completely. Your conclusions are right.

Factually, perhaps you never have seen a mask such as we are discussing here. They do cover the nose. Perhaps not perfectly, but to a very large extent.

They don’t do very much unless you follow a protocol that you aren’t.

When they get wet and uncomfortable, you adjust the mask, and now you are transmitting the virus to the surfaces you touch.

Washing your hands and avoiding contact with crowds are the main ways to avoid getting sick. Everything else may help, like using your ring finger knuckle to press elevator buttons or wearing gloves that you change frequently or a mask. But they will only help marginally.

They don't do much to protect you from getting infected.

They do a lot to prevent you from infecting other people.

If masks don't prevent you from getting infected then why do medical professionals want masks? Everything I've read suggests that masks reduce your risk of infection, and that pairs with the common sense idea that filters in front of your respiratory tract entrance would reduce the risk of foreign particles entering and infecting you.

Simply putting on a mask does a great deal to limit the spread of a virus you already have - you’re not spewing particles all over your environment due to respiration.

Simply putting on a mask does very little to keep you from getting sick, because you’re very unlikely to be following proper PPE donning/doffing procedures. Unless you your house set up as a “clean zone” with two rooms between it and the outside world - one for removing PPE, and one for putting PPE on - then it’s really not helping much for reducing your exposure.

It makes sense to me.

I don't think that's how things work. Infection is a probabilistic thing. Maybe you'll get infected and maybe you won't. A high quality mask properly fit and worn according to an exacting protocol will reduce your risk of infection by X. Compromising on any of those factors may mean your risk is only reduced by Y and Y is less than X, but that doesn't mean it's a complete waste to wear a mask without a clean room or without fitting.

In one of the articles linked in this thread there is a study showing mask usage in children is nearly as effective as intervention against flu as vaccines are. I only read the summary of that paper but I don't think the children are working with clean zones or following doffing procedures carefully.

The article does mention that the effectiveness of masks was greater along older children. To me, that connects with what I wrote earlier. The better you are about using your mask, and here I expect mask diligence comes with age, the better a result you will have, but something is still better than nothing.

Oh, so that's why every hospital room has an air sealed clean zone that medical professionals have to enter to put on ppe?

For those that don't know, this is sarcasm. Most ICUs don't have any sort of sealed off clean zone.

> Most ICUs don't have any sort of sealed off clean zone.

Right - most ICUs aren’t set up to handle infectious diseases.

Here’s the CDC recommendation on doffing procedure. Note the repeated mention of the “doffing area”: https://www.cdc.gov/vhf/ebola/hcp/ppe-training/n95Respirator...

They simply need masks to protect their patients. They can never be sure that they themselves are not infected, and they treat a lot of severly ill (non COVID-19) patients in hospitals. If they spread the virus, those patients are at very high risk.

If that were true, all the medical professionals in America would already be infected.

Proper use of PPE very much decreases your chances of infection.

Pretty much all masks protect you to some extend, but the extend and the way in which they offer protection is different.

Surgical masks protect you from inhaling larger particles to some extend, but there’s large holes in it’s coverage, so you still basically get a bunch of contaminated air in, especially when spending time in a saturated room. What they do do however is prevent you from spraying droplets all over everyone near when you sneeze/cough/exhale, and that’s their main benefit. Protecting others from the bacteria and viruses in those droplets.

I think a study was done that indicated they make you about 30% less likely to get sick.

More highly rated masks (generally called respirators), will completely seal your mouth and nose (at least to a much greater extend than a surgical mask) and prevent bad stuff from coming in much better. Generally this is indicated in the form of a rating N95, N99, N100 (actually 99.97). And indicates what percentage of bad stuff the mask is likely to keep out. They’re less useful for protecting others, since there’s still some exhalation valve to get rid of excess air (still mostly same usefulness as surgical mask though).

Medical professionals generally want the N95 masks, but they’ll happily settle for just a surgical mask if that’s the only thing available.

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