How South Korea Reined In The Outbreak Without Shutting Everything Down
npr.org
npr.org
The cost of the epidemic now goes into the trillions, self-made cotton masks are cheap compared to the economic damage. They can be disinfected in boiling water and if everybody uses them they will help to stop the spreading of the virus.
In all the countries mentioned in the article people wear masks when in public, often just against pollution (i.e. Thailand).
The moment we open our mouth we spread germs, even more so when we speak. And when we touch our nose or mouth, we have them on our hands.
Thus entering a supermarket without a mask and without first disinfecting the hands should be forbidden.
Social distancing is one thing, stopping the virus at the source is another and seemingly very effective measure.
https://news.expats.cz/health-medical/breaking-face-covering...
If so, is there something the "outsiders" are missing (e.g. some political bs between the two countries) ? Or is it just plain old theft ?
[1]: https://www.reuters.com/article/us-health-coronavirus-czech-...
Czech authorities during a customs raid last Tuesday mistakenly seized 101,600 facemasks gifted by a branch of the Red Cross in eastern China to a Chinese community in Italy. Although Czech officials apologized for the mix-up, the Italian newspaper La Repubblica on Sunday published a bogus article claiming the Czech state had “stolen” that shipment – and much more.
Czechs would send 110,000 facemasks to Italy on Monday (March 23), dispatched along with an evacuation bus of 43 Italian nationals heading home, as agreed with the Italian Embassy in Prague.
--- My comment is that our goverment officials or those policemans are probably stupid...
Or they thought "better safe than sorry", given that smugglers aren't stupid and you can't just believe it was sent by Red Cross just because the courier says so.
If anything, I'd ask why La Repubblica published a bogus article.
Seasons come and go, but click bait is eternal
Agree it sounded confrontational, but it probably wasn't.
The masks were sent to Italy within a few days.
By using even a very rudimentary mask, the infected droplets have it much harder to get out to other people and to contaminate surfaces. Also you are less likely to touch your face, so less hand contamination & thus less surface contamination.
Of course this only works if everyone has a mask, but given how easy it is to make simple cloth masks I think this is a fully reasonable requirement.
The government even made an exception so the sewing supplies shops could open.
I'd be surprised if that worked at all. At least one Chinese ecommerce website is preventing foreign IPs from even viewing item listings for masks. When you try to view the item from the search results, it gives you an error saying something like export is prohibited.
Also China has pretty much shut down air travel to the country to prevent "imported cases," so air freight capacity from is greatly reduced: https://www.nytimes.com/2020/03/26/world/asia/china-virus-tr...:
> The halt to almost all international passenger flights in and out of China will make it even harder for other countries to import N95 respirators, disposable surgical masks and other personal protection gear from China for their own doctors and nurses. About half the world’s airfreight typically moves in the bellies of passenger aircraft, while the rest travels aboard air freighters.
> Previous, large-scale cancellations of passenger air services to China have already created an acute shortage of air cargo capacity over the past two weeks.
Turns out we can just keep those passenger aircraft flying.
https://www.wired.com/story/airlines-use-empty-passenger-jet...
> But Monday afternoon, Delta said it’s putting an unspecified number of passenger jets back in the air, flying out of 13 American airports and to 70 destinations overseas. Delta’s not selling any tickets for those planes, however. Rather, they’ll be operated by Delta’s cargo arm, running charter flights to cater to anyone who needs to move a package or pallet.
Sometimes, quite stylishly: https://www.huffpost.com/entry/president-slovakia-coronaviru...
But of course, you may not know that you're sick... so wear a mask.
Your mileage may vary, of course.
Do you have any evidence to back up you talk of masks?
(And if YOU are infected you should not be out anyway)
Edit: I was thinking of non-medical situations. @j7ake below, clearly pointed out they work in medical situations, something I was not contesting at all but did not make clear. The original post talked of "wearing masks in public" which was clearly not in medical situations and I was following through that.
You dont know for first ~5-6 days whether you are infected or not.
https://www.businessinsider.com/people-are-making-diy-face-m...
Don't worry too much about effectiveness of DIY face masks - in few months Respilon and other Czech companies will put on market face masks made from nanomaterials which filters virus much more effectively ;)
OK, I think that the mask over your own face is to prevent viral spread in largish water particles caused by coughs and sneezes, not general breathing (I'm not sure general breathing spreads much virus anyway, but I don't know).
So if you are infected and not showing symptoms ie. not coughing/sneezing then arguably the mask is not doing anything.
Arguably not, but we need more data - can anyone comment with sources?
People cough and sneeze all the time even if they're not sick.....
It prevents you from touching your mouth and your nose and thus getting it on your hands.
There is an excellent video visualising the spreading of germs:
https://www.youtube.com/watch?v=I5-dI74zxPg
How To See Germs Spread (Coronavirus) by Marc Tober
Maybe that convinces you.
How do I know I'm not infected? There are a lot of asymptomatic carriers, that's the main problem.
A lot of people still think that no symptomps = not infected = no mask needed but that's totally wrong
If someone sneezes at you, even most simple mask will stop at least 50% of viruses. If someone was far away and only a small load reached you, that may be enough to keep you safe.
> (And if YOU are infected you should not be out anyway)
The big problem is to know when you're infected. Mask keeps others safe if you're not aware that you're infected.
Some reports say that you start distributing viruses pretty much immediately after getting it yourself. Even if all contacts (which is far from guaranteed) get traced and you get checked and/or isolated in a day or two, you'd be already spreading viruses for that timeframe.
Good point!
> If someone sneezes at you, even most simple mask will stop at least 50% of viruses
sounds plausible, but any reference for that figure?
FFP2 / N95 respirators - 90-something percent, medical "blue" masks - 80 percent, home-made piece-of-cloth style ~ 50%.
Wearing sunglasses is encouraged too. Both to stop the load if someone sneezes at you and discourage from touching your eyes.
Medical mask - 96,4%.
Home made mask - 60-96% (depends on cloth and sewing).
https://www.researchgate.net/publication/258525804_Testing_t...
https://cdn.shopify.com/s/files/1/0080/6830/0851/products/6_...
https://www.123rf.com/photo_138981777_stock-vector-person-we...
https://phonetub.com/products/100-disposable-face-surgical-m...
The main problem with blue masks and home made is that they tend to get wet from breath and their effectiveness go down the drain.
Here's evidence and list of 34 science papers backing up the utility of masks in slowing down a viral epidemic:
Thread with charts, articles, link to paper summaries: https://twitter.com/jeremyphoward/status/1242894378441506816
ADDED: Just the list of papers & their brief summaries: https://docs.google.com/document/d/1HLrm0pqBN_5bdyysOeoOBX4p...
Does this link work for you?
https://mobile.twitter.com/jeremyphoward/status/124289437844...
Happens I proxy through squid - it might have something to do with that. If I go direct (no proxy) it works. Interesting.
At least I can get to it, and will read your link this evening. Thank you.
Unless that situation changes, masks are a good alternative. And yes, only if everybody wears them.
And where did OP mention anything about masks protecting the carrier from infection?
The point you're missing there is that some people are asymptomatic. They don't know they're infected.
Right. No one has ever studied contagions among the community at large and the effect of masks. When you hear people say there is no evidence, this is what they are referring.
"is not thought to be any more protective than not wearing one"
This is taking that claim too far, and is seldom what they're saying. Or rather never what they are saying.
Early on there were PDAs that discouraged masks because a) there is a weird social effect in much of the West where people get panicky, and somehow view someone else wearing a mask as increasing the odds, or at least the reality, that they instead will get sick, b) to discourage personal buyers competing with medical buyers, c) because the odds of coming into contact with a SARS-CoV-2 carrier was very low, whereas it's high to very high for medical professionals.
We need to discard with that bullshit. We know with overwhelming evidence that masks work -- that's why medical professionals wear them -- and even the lowly surgical mask has the same effectiveness blocking pathogens in as they do out, especially aerosol pathogens like this one.
And of course we know that people can be spreading this without symptoms, so it would be a massive win just for that.
As supplies normalize and manufacturers ramp up, we're quickly going to be at a place where most in the West will be wearing a mask of some fashion, and it will be officially encouraged. This whole weird anti-mask paranoia will have cost lives.
Masks aren't a panacea, of course, They should be properly worn and rotated. Add that they increase the effort the lungs have to exert, especially N95 masks, so in a unfortunate irony people with compromised lungs -- the most vulnerable to COVID-19 -- have the most difficulty using masks.
Definitely experienced the stigma of wearing one in public. Have had reactions ranging from stares to hurriedly moving away from me.
> We need to discard with that bullshit. We know with overwhelming evidence that masks work
To add, why else would NY ask older folks to wear masks when going outside?
Also, this NIH study adds to support that masks are effective.
> why else would NY ask older folks to wear masks when going outside?
I don't know. Is there any evidence that significant proportion of experts are recommending this practice, and why BECAUSE THAT'S WHAT I'M ASKING FOR.
People can be deeply illogical when it comes to personal protection. I did a summer stint during college with a factory, assembling some part of an air conditioner system for cars. This was done with huge, incredibly loud machines. Fiberglass. Etc.
The company offered ear plugs, eye protection and masks. No one used them. There was a 0% utilization rate. It was bizarre. I did, however, and earned snarky comments, critical suggestions, and lots of sideways glances. People really seemed to feel that my concern for myself made the threats more real.
I'd like to say that when I left everyone had followed the path I blazed, but it was the same as it always was. People still sabotaged their own health and hearing to avoid looking "paranoid".
I used to work as an intern at a shipbuilding company making aircraft carriers. People wore stuff when they were required to, so hard hats were always worn, and the attached earmuffs seemed to be generally worn when someone was working with something very loud.
However, at one point I was helping an inspection in a tank and there was a noxious odor, and I couldn't breathe in it. The shipyard worker with me went ahead and went in and did the test, but after this I tried to procure a respirator and they refused to get me one, saying it wasn't necessary for the work I was doing.
Music concerts are another place where you don't see people using personal protection much, though I will say that's changed in the last 10 years from what I've seen. I do see a minority (but a growing one) of people wearing earplugs, and we now have a lot of choices for "musician's earplugs" being sold which are designed to have a neutral frequency attenuation.
Of course we know it works for them, because in your own words "coming into contact with a SARS-CoV-2 carrier was low, whereas it's high for medical professionals"
> We know with overwhelming evidence that masks work
Yes they do, for medical professionals. I'm referring to non-medical situations, and I guess I didn't make that clear. I'm trying to understand why... well, I explained in my first post. I'm not looking for opinions but for actual solid evidence. Which someone (not you) actually provided.
"Of course we know it works for them"
How does this anti-logic make any sense? Do you think the masks have a sensor that turns off the "works" bit if it's on the face of a medical professional or not?
This is bit like demanding to see research that gravity has an impact on alpacas. We know fundamentally how gravity has an effect on mass, so it follows. Just as we know the fundamental filtering ability, and contagion spread limiting, of masks, including even surgical masks. We know that the CDC is telling health workers that don't have masks to even use a bandana wrap, as not only does it stop face contact it has some limited utility in stopping the tiny droplets of liquid that are one of SARS-CoV-2's vectors.
Actually, they have[1,2]. According to one study, surgical masks helped cut down the community spread of SARS in Beijing by 70%[3]:
> Always wearing a mask when going out was associated with a 70% reduction in risk compared with never wearing a mask.
But if you're specifically referring to randomised trials on mask efficacy during an on-going pandemic, you're right that there are no such studies -- because it would be unethical. So effectively all of the relevant studies are retrospective (which does introduce recall bias), but these are basically the best studies we can do ethically.
[1]: https://medium.com/better-humans/whats-the-evidence-on-face-... [2]: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6993921/ [3]: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3322931/
It's been studied. There has not been a randomized controlled trial because performing one would be extremely unethical.
There is plenty of study evidence to support their use, just nothing meeting the gold standard of a RCT and there never will be one against a true live fire contagious disease.
The irony with all this is that the US administration really want to get people back to work as soon as possible. Massive deployment and mandatory usage would be the safest way to do that the soonest.
Too bad they already foreclosed that option by materially misleading the public.
Given we know there are people with COVID-19 who are asymptomatic, any "Healthy people have no use for a mask" can simultaneously be true, and be practically irrelevant, as any definition of "healthy people" is necessarily impossible to prove. You simply can not know you are free of Corona Virus, short of having recovered from the virus.
If the standard was EVERYONE wears a mask, asymptomatic people would be a non-issue. Any advice contrary to the 100% mask usage argument has to explain how we deal with asymptomatic people. Short of testing everyone all the time, what would that even be?
TL;DR In a world with asymptomatic COVID-19 people, a 100% mask policy seems the sane default position.
What you say (and others too) makes sense to me and I could well believe it true, but I'm NOT claiming that masks are useless unless you are infected, I'M ASKING IF ANYBODY KNOWS WHY EXPERTS ARE SAYING OTHERWISE (or whether I just heard an unluckily skewed sample)
Plus, I also asked for a citation to back up the poster's position, not common-sense arguments (which are a good starting point but not evidence in themselves).
Oh, and you want citations, sorry, my bad:
https://docs.google.com/document/d/1HLrm0pqBN_5bdyysOeoOBX4p... - 30 some citations on masks.
See my reply https://news.ycombinator.com/item?id=22701821 Mind, I just don't know if what I'm saying there holds water.
Citations are good, following up!
The official position for many countries that are containing the virus suggests wearing a mask when out in public. One notable exception is Singapore.
Here is the Korean society of infection FAQ that says wearing a mask can reduce transmission:
https://translate.google.com/translate?sl=ko&tl=en&u=http%3A...
The evidence very much shows that wearing masks can reduce community transmission rates of SARS-like viruses -- up to 70% even with just plain surgical masks[2]. And even if you don't buy that, everyone wearing a mask means that asymptomatic carriers (who have no idea they're sick) cannot spread it as effectively.
[1]: https://www.nytimes.com/2020/03/17/opinion/coronavirus-face-... [2]: https://medium.com/@adrien.burch/whats-the-evidence-on-face-...
There's nothing noble about it. This is extremely short-sighted. What is easier to solve, shortage of masks, or shortage of ICU beds and medical personnel?
I would imagine that a face mask is a relatively low-tech good that can be mass-produced at scale. You cannot ramp up production of ICU beds and nurses and doctors. If this is true, then the consequences of this "noble" decision will make Chernobyl blush.
I am not. My point is that solving the problem of mask shortage by allowing the infection to spread at full speed is like setting your home on fire to deal with a clogged pipe.
The road to hell is paved with good intentions.
The problem is that you can have COVID19 and be contagious without showing symptoms. Mandating everybody to wear some sort of mask should reduce transmissions because it should reduce the viral load in the air. By how much? It is not clear, but it's not worth waiting for results from a randomized double blind clinical trial during a global pandemic. I would put money that the effect of putting on a mask will be at least as effective as washing hands.
The danger to be careful of is if wearing mask can make you more sick, but the current actions from healthcare workers around the world suggests it is not the case.
Another point some people argue is that wearing a mask in public means one less mask for health care workers. This is false on two fronts, one because mask supplies will soon flood the market and there are DIY solutions to masks that can reduce transmissibility; two because what's best for health care workers is not to get sick at all.
However, if healthy people aren't wearing the masks, and only the unhealthy are, then the unhealthy don't want to signal they are unhealthy so they don't either. A huge part of getting the infected to wear masks is to get the healthy to wear masks so the infected don't put a huge label on themselves that indicates: "diseased", "corrupted", "infectious", "frail", "unclean" etc.
Logic says one thing, but people are not logical like machines.
First there was the cult in Daegu, where believers are not allowed to cover their faces because apparently their god can't see through fabric. Mass infections also occurred in churches where people took off their masks to eat or sing together, or tried to "sanitize" one another's mouths with a folk remedy. A gym in Cheonan was responsible for the majority of cases in that province, and recently there was a small burst of cases in an insurance company call center in Seoul.
Meanwhile, the subway in Seoul is just as packed with people as always, but I haven't heard of a single case that was conclusively traced to the subway. Why? Everyone wears a mask when riding the subway and sanitize their hands afterward.
Masks have been so effective that the Korean government has even stopped publishing locations that were visited by infected people if they are known to have worn a mask while visiting them. Yes, they still track down each and every case outside of the Daegu area.
The closest thing to a comprehensive source about the distribution of infections in South Korea that I can find is [1], which still contains too much Korean-in-a-canvas that can't be automatically translated:
54.6% of cases are related to the Shincheonji cult
0.5+0.7+0.5% various other churches and religious groups
1.3% Daenam Hospital (almost all cases occurred in the psychiatric ward, as well as the attached funeral home where the Shincheonji cult leader held his brother's funeral)
1.2% related to gyms
1.2% related to the call center in Guro-gu
3.6% nursing homes
6.3% related to other mass infections (this includes other call centers, nursing homes, etc.)
11.3% contact with people infected from one of the other sources
3.3+0.6% infected overseas
14.9% other/unknown
Of course this doesn't say anything about masks. But you can clearly see that unlike in many other countries, ~70% of cases in Korea are concentrated in a handful of clearly delineated groups, with relatively little spillover into the general public. It takes a bit of familiarity with the religious landscape of Korea and the workplace culture to recognize that most of these groups are where people don't wear a mask. (As for nursing homes, the elderly often have difficulty breathing through a mask, not to mention they're together 24/7.)
Some people still got infected while wearing a mask, though, so it's not bulletproof. But it seems that the effect becomes visible as a kind of herd immunity when aggregated over a large population.
As for the government not publishing locations visited with a mask on, here's an example from my city's official Instagram account [2]. It says that the infected person's movements on some days are redacted because she wore a mask on those days (among other precautions) and therefore didn't make any epidemiologically significant contact with other people. You can compare this with other press releases by the same account that contain a lot more location data for other people.
But then you have Vietnam, also pervasive mask usage. Shares landborder with China which is leaky at best. They were also very proactive like the other countries but have a fraction of the resources. I don't think it's an answer for containment, many that cracked down early are seeing record case levels now, but I wonder if it's enough to reduce spread and severity.
But the rationale that made sense to me is that covid19 spread via respiratory particles, and mask reduce the viral load over time, which reduces risk of infection and severity since your body will have more time to recognize the infection and ramp up antibody production much earlier in the virus’s exponential growth cycle. Reduces R0 when ubiquitous. Maybe it spreads the curve and crushes it at the same time by reducing severe cases.
Seems like a cheap experiment short experiment to run honestly. Give one group of essential workers masks vs control. Test in 7 days and collage symptom severeness etc. Giving everyone surgical or home made masks is cheaper and less damaging than what's happening now. The HK SARS tsar who was also part of the Wuhan investigation team endorse public mask usage.
“The masks don’t do anything” story was just something floated around to prevent runs on hospital supplies. A better strategy would’ve have been to say “everyone make and wear your own masks and it will afford us some additional amount of protection.”
"A T-shirt is 79% as effective as a surgical mask. So if someone is coughing next to you and you can't escape, breathe through your shirt sleeve. Any filtration is better than none."
[1] https://twitter.com/michaelzlin/status/1241052444798279680
So while masks may have some effect, it hasn't been enough to give different graphs to Asian nations in general.
[1] https://www.arcgis.com/apps/opsdashboard/index.html#/bda7594...
They do a good job collecting all the data but a seriously bad job visualising them.
Thailand looks straightforwardly exponential so far and has fairly heavy mask use, agreed. But Singapore, Taiwan, and arguably Malaysia seem too early to call: they're still plausibly on either of a European curve or South Korea's ramp-then-flatline.
Vietnam, Cambodia, Laos, Mongolia, and Burma all seem to be below the line for meaningful data. And Hong Kong isn't broken out. So I guess my questions are: do Indonesia and the Philipines have "mask cultures" to a level comparable to South Korea and Japan, and are their testing regimes wide enough to rely on those curves?
I don't know the answer to that. And I agree that the "masks work" graph/meme circulating is questionable. But unless I'm missing something/somewhere, this data just looks like "too soon to call"?
The rejection of masks looks to me like a similar prioritization of law enforcement's preferences over public health.
Singapore resident here. Not enough people are wearing masks in Singapore, and the government has only distributed a token 4 masks per household (family members living at the same address), with no further measures to allow a family to replenish their mask supply.
A lot of us can't buy new ones at reasonable prices even if we want to.
The population is completely confused and feel righteous anger now telling people off when they wear professional (medical disposable, or ffp3/n95) masks to go shopping or elsewhere. It's insane.
And then in many Asian cultures it's considered a moral failure to not wear a mask in these times, yet hospitals function. This problem clearly isn't universal, or inherent in capitalist functioning.
It's propaganda. It is reasonable propaganda as having to have actual PSAs on how to sew your own masks or make them out of materials at home would really start ramping up the general anxiety.
They should've instead:
* Banned sales of masks to the public until healthcare and other essential workers had enough stock.
* Honestly conveyed the reasons for the above ban, in WWII-style "do your part" advertisements etc.
* Encouraged homemade cloth masks, bandannas, etc. to reduce the spread of droplets.
* Ramped up surgical mask production to get supply to the general public as soon as possible.
(another 1/3 don't care because the system doesn't affect them, until it does)
And I guess the opposing 1/3 just don't understand the difference between positive and negative rights?
Healthcare, as a matter of fact, does represent a collection of products and services, and access to those products and services represent a positive right because it requires somebody else to provide something for you.
It is only negative rights, those which define what other people can not do to you, that should be considered inalienable. The right to free spreech doesn't require somebody else to go to school for 20 years so that you can express yourself, they just aren't allowed to prevent you from doing so.
Intentionally or not, people like you confuse the issue by treating both positive and negative rights as the same, and actually do not seem to understand, or are avoiding acknowledgment of the fact, that treating a positive right as some kind of natural right carries the high potential that you will be demanding access to another human being's labor or resources against their will, and in America, 1/3 of use are against the enslavement of others.
But trust is hard to gain and easily lost. A real compounding factor in this crisis is also that our leaders have lost all credibility. In many, if not most, countries, the citizens just know that actions that were and are being taking are neither competent nor in their best interest. The specific implementations of democracy we implemented never selected for reason, precaution nor long term benefits or well-being for all.
So most of us have a political 'leadership' (and I do not mean a specific country or party, it's mostly across the board, with few exceptions) that has lost all credibility, trust and moral authority long before this happened, leaving the population already at best confused, but mostly mistrusting and (justifiably) cynical.
For scientists to go 'on message', telling obvious non-truths, just further undermines the already shaky ground they were on after decades of anti-science propaganda.
I really, really hoped they would refrain from this, but, judging by what is happening in my own country and what the science community is publicly communicating (privately it is a completely opposite discourse), I sadly must say that the opposite is true.
From where I stand, the countries that have a culture of wearing masks are doing better with regards to coronavirus. At the very least, it seems like a good hypothesis.
People misrepresenting this study are doing tremendous harm, it has to stop.
Wondering what the reasoning is for this?
Family member works in a similar dept at large hospital and they have stopped seeing patients.
> Other potential considerations being explored include:
> Limiting use of N95 masks to only procedures where respiratory secretions can be aerosolized, including intubation for PUI or COVID+ individuals. Use loop surgical masks for all other encounters. Read the latest guidelines on keeping the coronavirus from infecting health care workers.
> Limiting use of loop masks to only encounters with patients on droplet precautions such as PUI or COVID+ or other flu like illness investigations.
It sounds like their department has implemented this second recommendation. I feel like that's sub-optimal.
For this reason our media seems to be under strict orders to de-emphasize masks and just talk about distancing and hand washing.
It is very regrettable that we have a completely incompetent federal government that did not stock up on masks even though they had plenty of warning but these are the facts. If we ever make enough masks so that all the health care workers are covered, then yes all civilians should wear masks. I am sure then the media will start talking about masks.
Why would you buy safety critical equipment from China? There are good reasons those hospitals have such strict requirements.
http://www.xinhuanet.com/english/2020-03/12/c_138870714.htm
> A joint law enforcement operation by government agencies including the State Administration for Market Regulation (SAMR) was launched in early February, with over 80 million defective face masks and 370,000 other faulty PPE items seized, SAMR official Yang Hongcan told a press conference Thursday.
https://elpais.com/sociedad/2020-03-25/los-test-rapidos-de-c...
(350,000 tests supposed to have 80% specificity but actually have something like 30%).
Hospitals have done this for decades.
1) Because that's where it's made
2) Because they're obviously a lot more competent at public health than we are. We don't know WTF we are doing.
https://www.npr.org/sections/goatsandsoda/2020/03/16/8149292...
All in all, there is in my opinion no excuse to not to have everyone wear government provided masks, even though they don't offer complete protection. That would make it culturally the norm and hence many of the people who start coughing, but aren't sure do they have the virus, would at least have the mask covering their mouths to catch most of the escaping droplets. And also it would make it a little more difficult for everyone to rub their facial areas with their hands.
And N95 is a respirator, which is different from mask as it protects the wearer better from airborne particles?
Surgical masks mainly prevent droplets from entering your nose and mouth, and your breath/sneezes/coughs from affecting others.
https://multimedia.3m.com/mws/media/1794572O/surgical-n95-vs...
Surgical masks: 1. keep the wearer from infecting the patient 2. keep fluid spray (e.g. bleeding) from getting in the face
N95 respirators are meant to protect the wearer from airborne particles, which surgical masks don't really do at all, since they don't form a seal and air and particles still go around the mask into the mouth. Many N95 masks have an ubobstructed one-way output valve for easier breathing that will not protect the patient from the wearer.
And as it mentions, surgical N95 masks (the blue respirators many medical professionals wear in news photos lately) do both.
* Edit: Another 3M brochure shows that many of their non-N95 masks are also tested for filtration efficiency, even though not certified by NIOSH.
http://multimedia.3m.com/mws/media/312703O/masks-and-respira...
There is no reason why Mask's supply problem could not be solved when you are looking at a comparatively speaking trillion of dollars package not to save the economy, but barely holding it up so it doesn't fall.
I am still baffled at the insistence that mask are useless, surgical or not. When there are ample of evidence to suggest it is the best tool to help and stop virus from spreading.
WHO currently says that healthcare professionals in non-AGP areas who aren't doing AGP should wear surgical mask, gloves, apron, and do a risk assessment for eye protection. All of that PPE is single use. This is the current practice in English NHS settings. See here: https://twitter.com/OutbreakJake/status/1242020875328684038
If aerosol generating procedures are happening the healthcare professional needs a fit-tested FFP3, gown, gloves, and eye protection. https://twitter.com/OutbreakJake/status/1242233685392396289?...
Surgical masks are fluid resistant, and this is an important part of their protective property. Home made cotton masks tend not to be fluid resistant.
So it's sorta like "herd immunity": if everyone is wearing a mask to keep everyone else from catching whatever they might have, it makes it much harder for diseases to spread around and everyone benefits.
No, for the most part they won't stop coming to work, for better or worse. My wife is an RN in charge of a critical unit caring for confirmed covid-19 patients. They were asked to reuse masks and gowns a week ago due to lack of supply. As far as I know none of them has refused to go to work, and she in particular will be on 4 12-hour shifts this week.
People misrepresenting this study are doing tremendous harm, it has to stop.
> medical masks, cloth masks or a control group (usual practice, which included mask wearing).
Yes, the cloth mask group had more infections than the medical mask group and the control group. But the control group included wearing masks as usual. It does NOT say cloth masks are less effective than nothing. "No mask" was not studied. Cloth masks might be less effective than wearing no mask (I personally doubt that), but this study didn't say anything about that hypothesis.
Yesterday I was in a shop and saw 2 different people with a scarf over their mouth. You would think this is no problem, but they both had to keep this scarf up with their hands... . Seems like the most effective way to spread and receive germs.
Govermnent needs to be clear what the protocol is.
Advising people to not wear mask is the biggest disservice the American government (and the CDC) did to its people. Just asking people to cover their mouths with bandanas and scarfs would've helped a lot.
I shudder when I see reporters in a breakout zone reporting without masks on. Man.
https://jamanetwork.com/journals/jama/fullarticle/2762689
Taiwan has huge flows of Chinese people, yet no outbreak. Maybe it’s a good thing they are not recognised by the WHO?
And before that they had plenty of people coming in from China with active Covid infections - returning from New Year including people from Hubei.
The US enacted their travel ban to China on 31st Jan, yet that hasn’t helped the US...
Now Taiwan is getting cases from other countries (returning citizens and foreign migrant workers) e.g. yesterday: “Meanwhile, the 15 patients deemed to have contracted COVID-19 overseas all returned to Taiwan in the period March 16-23. The countries they had visited were the U.S., the United Kingdom, New Zealand, Spain, Malaysia, Monaco and Mexico.”
Taiwan is still allowing foreign migrant workers to enter the country, as they need them for their economy.
IIRC, most early US cases came from Iran and Italy.
> There are also millions of Taiwanese that either live or work in the PRC
Taiwan has a population around 23.78 million. So you are saying at least 1 in 20 live or work in the PRC...
Of course Hong Kong has its own legal system and maintains its own customs and immigrations. However, mass epidemological response is carried out in accordance with the demands of mainland China, and so it is no surprise that Hong Kong is not being distinguished from mainland China as the OP expected.
Hong Kong seemed to have its own strategy, which makes sense, since it’s culturally unique to Beijing. Also of note, when Beijing published infection statistics, it excluded Hong Kong.
> Now, however, Hong Kong is providing a very different object lesson -- what happens when you let your guard down too soon. The number of confirmed cases has almost doubled in the past week, with many imported from overseas, as Hong Kong residents who had left -- either to work or study abroad, or to seek safety when the city seemed destined for a major outbreak earlier this year -- return, bringing the virus back with them.
These steps are more drastic than the "do nothing" approach we saw from some Western governments in the early days, but far less drastic that what those governments have had to resort to because they dropped the ball at the outset.
Edit: Taiwan's case count is also low enough that they're still reporting updates using confirmed case numbers to track the spread from different cases.
Some graphics and stats make this distinction more obvious--others sort of roll it all together.
1. They can make someone with a temperature wear a mask immediately, reducing transmission to others on the plane, and containing them on arrival.
2. It avoids crowding and possibly cross-contamination on arrival at a testing station.
3. It prevents delays for passengers.
Seems too early to conclude this has been contained yet.
0: https://www.reddit.com/r/Coronavirus/comments/fo4pj4/im_joon...
Fake news, profit motives, political expediency, political correctness, and so many other social factors have made this a real CF for anyone trying to make sense of this and genuinely do the right thing.
I am sorry if I don't have anything positive to contribute, I'm just so disappointed in the state of affairs right now and how selfish forces have coopted the means of causing positive, effective action.
Making tests well before they had their first case.
When my country got its first cases they were still saying it isn't that contagious and everything is fine.
I suppose, just like every country has a military or people managing their transportation infrastructure, there should be a "pandemic watch". (Well the US had a good one until Trump/John Bolton defunded it)
The west was never going to believe what was happening in China because it is impossible to know without invading them.
https://ktvz.com/politics/2020/03/21/washington-post-us-inte...
Some of the politicians did heed the advice, at least when it came to managing their share portfolios, taking the opportunity to sell up while telling their constituents there was no imminent threat:
https://www.propublica.org/article/senator-dumped-up-to-1-7-...
It should be mandatory for any politician or government clerk to take an exam in differential equations. There _was_ time to prepare, and there was a chance to contain the situation.
You could literally rephrase the pandemic as: "Imagine total cases are dollars, then $country has 1000 dollars on their account, with 30% daily interest capitalized daily". Maybe that would've gotten through better?
Oh, they know how exponents work. They only care when it affects their bottom line. It's clear that the working class are just lambs for slaughter when the corporate overlords look at them.
They've all had fewer cases than Luxembourg so far.
I've yet to see a good explanation for it, other than maybe the premise about seasonal temps and humidity (northern vs southern hemisphere). There's no evidence they're massively lying about their numbers (which would show up in the form of a demolished hospital system and thousands dead of pneumonia). Vietnam has also done incredibly well overall, showing no indications of being crushed by cases, despite their proximity to China.
Mexico is also not being crushed at all by the virus, despite being right next to the US as Vietnam is right next to China. Mexico shares enormous trade and traffic with the US. They should be buried in pneumonia cases given their overall context (population size, economy, testing rate, healthcare system). They have just over half the cases of Finland (obviously Mexico isn't testing at a high rate, I'm sure it's more than just 600). If many thousands of people were dying of Covid in Mexico right now, it would be showing up blatantly. Latin America's case load has largely been low vs population sizes (with only a few exceptions), as with the rest of the southern hemisphere. Mexico is technically northern hemisphere, and I wonder if they don't have some of the southern hemisphere benefit (as perhaps India does), limiting the rate of infection vs nations that are further north. And will that flip at all in the coming months.
https://i.imgur.com/EH8OkTd.png
It'd be very interesting to see a comparison of avg temps and humidity among nations most affected (or least) during the outbreak timeframe. Including looking at locations such as Italy, France, Germany, Spain, NYC, Texas, Southern California, Seattle, South Korea, parts of Mexico, Thailand, and so on.
Basically, due to seasonal temps and humidity, is South Korea's task made far easier than Italy's task? Does that considerably alter the infectiousness of SARS-CoV-2 in South Korea vs Italy? Is their equation half the effort they've put in (and credit on that), and half good luck of location. Mexico sure as hell isn't avoiding being overrun by it due to maximum testing.
I spent many hours last night doing a deep dive on the latest research on the impact of humidity on viruses, infectiousness and the respiratory system. It's fascinating stuff.
That effect even showed up somewhat in Russia, in heightened pneumonia cases (they're now admitting it's likely far more widespread than the positive case results would imply). It's not easy to hide or disregard if you have high figures, which one would expect of poorer, very vulnerable nations with huge populations so close to China - unless there's another explanation. These nations didn't implement the type of disciplined system (matched with mass testing) that South Korea followed, and there's no sign of crushed healthcare systems with many thousands dead from pneumonia.
Meaning - they don't have cases because they weren't testing them and weren't reporting them truthfully.
Youth certainly has a big impact on mortality rates with Covid, and not such a huge impact on ICU rates. Close to half of the most serious cases in eg NYC and France are of people under 50.
We'd see the system overload in places like Thailand and Mexico, as their ICUs would still flood with people over the age of ~20 (and as you note, they'd potentially have a lower mortality rate due to fewer old people as a percentage of the population; although Mexico does have a very high obesity and diabetes rate in their specific context, which might complicate their mortality factors (recently noted as a concern by one of their govt health officials)).
This one had a table with the major cities hit and their avg temp/humidity every month since Nov https://www.researchgate.net/publication/339852916_Temperatu...
https://en.wikipedia.org/wiki/COVID-19_testing
There's your explanation right there.
But there are several axes that could matter just as much as quarantine/lockdowns: Humidity, sunlight (as proxy for vitamin D levels, or simply UV), pollution (which also affects sunlight), median age (47 in Italy, 30 in Malaysia, that's huge), and mask use.
Bergamo has low sunshine in Feb and March comparatively. Places hard hit, and their average sunshine on selected months:
* Wuhan: 100 (In Feb)
* Paris: 79-129 (Feb-March, North France harder it by # of cases, cannot find death info)
* Bergamo Italy: 100-150 (Feb-March average)
* Seattle WA: 100-150 (Feb-March)
* Iran sunshine varies a lot by locale. But some places like Rasht, its very low light: 90, 78, 71, 113 for Jan, Feb, Mar, April
Places less hard hit:
* Bangkok 250-275 (Feb-March)
* Kuala Lumpur 185, 192, 208 (Jan Feb March)
* Ho Chi Minh City, 272 (March)
* Seoul: 175-200 (Feb-March) South Korea contained it of course, but their lethality numbers are also lower, and its the lethality that I find odd in all this.
NYC should be cranking humidifiers, pushing humidity up to 50% in every space where people exist (except hospitals). It'll dramatically slow the infectiousness of SARS-CoV-2 imo. Super low human space humidity is the best friend of a respiratory virus.
Why aren't San Antonio and Houston buried in cases? Same reason Mexico and Los Angeles are not (relatively speaking, and especially compared to eg NYC).
Las Vegas should be buried in cases, they have tons of international traffic, a zillion opportunities for the virus to be transited around, spread to casino workers and everywhere. Their ICUs should be overflowing to an epic degree. Las Vegas has an inverted humidity map, peak humidity there is November to March, and avg high temps stay up near 55 to 60 degrees (influenza at least hates temps over ~60-65+ F).
How about Santa Fe or Phoenix? Super low case loads, as with Houston and Austin and other similar locations.
Florida isn't seeing a particularly bad outbreak in its cities.
Albuquerque and Phoenix have inverted humidity seasons, their peak humidity times are roughly October/Nov to March.
Wuhan's low sunshine season is November to March. Temps are often well below 50 degrees during that period (and essentially never get to 65+), not high enough to interfere much with influenza or probably SARS-CoV-2. It gets cold enough during flu season there to require persistent indoor heating, which dries everything out, lowering indoor humidity levels dramatically, amplifying potential infectiousness.
Due to international travel, and especially citizens returning home, the different strains are coexisting within the same country.
They have even used strains and genetic trees to trace individuals that transmitted the virus.
Side note: when at the time of death you have 4 or more illnesses, and one of them is CV, on what basis is the cause of death attributed to just a single condition? It seems Russia has taken a different stance to the West in this regard but it's not clear to me which is correct. It doesn't seem ideal to ignore co morbidities.
None of these things are available to health departments in the United States unless someone voluntarily allows it.
The United States has a weak federal containment strategy when it comes to pandemics since most of the decision making is left to Governors. Louisiana allowed Mardi Gras. Florida didn't issue guidance on their beaches until most of spring break was over. One state next to another such as Illinois and Missouri have vastly different mandates.
The United States lost the battle of containment. The only thing left is the war to not overwhelm the medical system.
Also, I think it's important to clarify that:
"Every cell phone user has to be tracked so the cell network knows how to route their calls ..."
... would be more accurate if we said:
"Every cell phone has to be tracked ..."
Many pieces of the cellular network have no idea who the handset (or other device) is assigned to, or who is using it - they just know that that SIM card is up on the network, and needs to be routed appropriately ...
Of course the telecom itself, for many purposes - not the least of which is billing - needs to know a personal identity behind a SIM card.
What I am saying is that individual cell sites - and other pieces of the cellular infrastructure - are only indirectly (or not at all) connected to personal identity of the mobile subscriber. Call routing can be done just fine without any idea of subscriber identity in meatspace.
There's another thing these countries have in common: Masks are worn by the majority of the people. They may work better than advertised.
It’s too late for the rest of us. Extreme measures are now the only option.
As a cruise ship the passengers tend to be older, but the crew tend to be younger.
Doesn't matter if you test 1 million people or 10,000 people, if you aren't doing statistically significant tests, it's meaningless to draw conclusions.
If physical distancing is successful in reducing the reproduction number (R0), you will then want to track, trace and isolate every case to prevent further outbreaks when you relax the rules.
That means a lot of testing.
"better understanding of the virus' properties, like the distribution of symptoms, severities, and mortality rate"
Random and self-selecting testing doesn't seem to offer much in that. Imagine going to a Nics game and asking everyone there who they support, chances are you'll get a lot of Nics fans.
How does that give you a better indication of mortality rate or severity if you have no idea how many people actually have it, because you only have a statistically insignificant tests.
Sure, if you're in the stage where you want to lock down specific people (like South Korea) then random widespread testing works to increase the number of locked down people.
But if you're in a country where you've locked down everyone already, then testing could well be increasing the risk.
If the population assumes they've tested positive, and acts like they are, then what does testing add?
Globally there have been fewer than 5 million tests performed since the start of January.
That is a fair point, and I agree that testing is most important when there are a limited number of cases - a stage which was essentially missed by Western governments but hopefully will have another opportunity.
I don't agree that populations are acting like they have tested positive, though, or can do that en masse.
If you know yourself to be positive, you should ideally be taking stricter measures - like having people leaving food at your doorstep.
Only people who are not infectious should be involved in food and resource distribution.
In order to enact that, you would need to actually test.
To the extent that mortality rate may depend more on transmission rate, health service dynamics and availability of people and equipment than on the disease itself.
This is very different from the mortality rate in a non-pandemic situation.
But, the benefits of widespread testing are there for every nation, at any stage of the pandemic, to access if they have the will and competency in leadership to do it.
But if you look at the outcome and impact on entire country investing in aggressive testing and tracking cases seems better return on investment even with higher number of cases.
One potential problem I see with this is locking everything is easier to implement and has less risk that it won't work at all. With a week delay between your actions and the results, not restraining your population and instead hunting cases might put you in a situation where you suddenly learn your actions had no effect and now it is too late for drastic lockdown to rein in the cases.
One example: https://www.fiercepharma.com/pharma/biogen-parts-way-employe...
Meanwhile, China is able to build an emergency pandemic hospital in 10 days.
If you scroll down the page there's a graph that helps to visualize it: https://www.worldometers.info/coronavirus/country/south-kore...
For European countries and the US, the curve looks asymptotic. There's no telling how high it'll go at this point.
The rest of World which includes once capable nations (who have now outsourced everything and now don't have capacity to produce even bandages for their population) is now screwed.
Lesson learnt: Self reliance is key.
I'm not a student of politics, but I wonder if self-reliance also makes a country more willing to start unnecessary wars.
If so, I'd wonder which strategy has a higher death count.
Additionally, in many Western countries healthcare systems have been wrecked by neoliberalism profit-first ideology (Germany, UK), by austerity following the 2008 financial crisis (Italy, Spain, Greece) or by decades of incompetency (USA), combined with the end of stockpiling of critical assets such as face masks, gloves and other PPE after the end of the Cold War.
The key point of "shutting down" is to avoid overloading the healthcare systems, or at least to try to limit the overloading.
Considering that, you'd expect South Korea or Japan to do better than Germany, Germany to do better than the US or Italy. And even within Germany, you'd expect large cities to do worse, with Berlin leading the charge. Would Hamburg be affected as much if it wasn't for their holidays falling right into that time?
Well, yes and no. They might have been more willing to accept that 30-40 years ago, but definitely not these days. They've been always known for militant labor unions, religious fanatics, and political extremism -- the last two attributed to the outbreak in South Korea this time around. There are still religious groups defying the gov't's plea not to hold mass services in South Korea today.
> in many Western countries healthcare systems have been wrecked by neoliberalism profit-first ...
South Korea suffered a much smaller coronavirus, MERS, not too long ago and they found out that they were awfully unprepared for a public health crisis of that scale (only 130+ were infected and 30+ death), so they spent the next several years preparing for the "next" crisis. Their gov't removed all potential legal/legislative barriers that had hindered their response last time around and private biotech companies started working on reagents and the medical infrastructure almost as soon as the outbreak in Wuhan became known.
So we hope that there's a vaccine coming next year, but we're certain that there will be no vaccine this year. This will definitely be going on for many more months no matter if it "cannot be maintained".
Don't get me wrong, I do think that some Asian countries took great measures to contain the virus, and some western countries failed to do so, but I doubt the same measures would be equally as effective everywhere. This is relevant because the spread of the virus is a multifaceted and complex issue, and reductionist explanations might take us down the wrong path if not careful.
The American cavalier "invincibility" attribute seems to be truly at play here - witness the kids in Florida - whereas in South Korea, a state composed, traditionally, of an enslaved population: the obedience bit has been key.
It's an uncomfortable thought, but it is rugged American hubris which is propagating the virus right now throughout the country. And it was Korean humility and selflessness which brought it down to controllable levels. This article is a flowery way of pointing that out, imho ...
I always thought it was weird when people say things like “the US is the worst in the developed world on so many measures!” A bit like someone saying “I’m one of the shortest people in the world who’s 180cm or taller”.
Maybe sometimes the USA is just incompetent and usually it can get away with being incompetent without consequence because nobody wants to poke the 800lb gorilla, but sometimes consequences do happen.
NY did almost as many tests in a day as some european countries have done total. Of course they are going to have a spike in cases. No-one believe (in Europe at least) that the number of cases are the truth, and we pretty much know that a lot of people aren't being tests. Portugal until 2 days ago was rejecting tests still of people that had no 'known' chain of contagion. (Source, ex-wife works in the frontline of this crisis)
It is difficult to compare reported cases across countries, and certainly there are many countries that have dropped the ball (Iran especially comes to mind). At the risk of sounding unfeeling, a clearer picture will probably emerge once the deaths start rolling in, since dying is a very binary state and less subject to measurement bias due to gov (in)action.
My question is, what is happening in Japan? Except wide spread mask usage, they have systemic undertesting at 1/6 capacity, no social distance measures, nothing shutdown, old population like Italy. Their hospitals should have been overwhelmed with dead by now. Are they just leaving the old to die at home? France and Italy aren't counting deaths at home as part of statistics. Maybe something similar? Which loops back to S.Korea, why so eager to trust their numbers. Their politics is fairly corrupt.
https://foreignpolicy.com/2020/02/27/coronavirus-south-korea...
source: https://www.bloomberg.com/news/articles/2020-03-19/a-coronav...
And they didn't even try to shutdown churches, bars and clubs, while churches consistently have been the largest sources of mass infection. And your may also want to know that literally every single media has been criticizing every single action taken by the government. What an authoritarian government.
> Which loops back to S.Korea, why so eager to trust their numbers. Their politics is fairly corrupt.
They earned their trust by reporting 7000 cases, taking the risks of huge political disadvantages. All the other first world countries were reluctant on doing that due to the exact opposite motivations. And unless you have some ideas on the modern political landscapes in S.K., I would recommend not to inconsiderately speak up a such fairly strong opinion.
Yeah, they could have found a working formula, but they could also be lying like other first world countries that we know are under reporting deaths via recatorigzation of likely covid deaths to other deaths to depress the impact. SK corruption and transparency index is comparable to France and Italy who already acknowledged doing so. Add the geopolitical layer of western media trying to grasp at any alternative strategy that doesn't involve Chinese style lockdown. Very few reports even mentions SK contact tracing is closer to Chinese techno-authoritarian techniques than not, which ultimately makes SK response not a useful model for these countries until they get desperate. Which is my main point, media is fixating on SK testing and contact tracing when latter is not possible in many first world countries.