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Comment by icelancer | Hacker News Reader

Comparing the SF health officer from 1918-1919 to Dr. Fauci is a bit rough since Dr. Fauci was anti-mask and also said the risk of coronavirus was miniscule in mid-February.

https://www.usatoday.com/story/news/health/2020/02/17/nih-di...

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> Short of that, Fauci says skip the masks unless you are contagious,

I think since February we’ve learned more and more that people without symptoms are contagious. The only way to follow Fauci’s advice in that case is to wear a mask because we don’t know if we have the virus or not.

See this email from a government doctor on Feb 23: https://www.nytimes.com/2020/04/11/us/politics/coronavirus-r...

https://static01.nyt.com/images/2020/04/11/us/politics/11dc-...

> I think since February we’ve learned more and more that people without symptoms are contagious.

Here's an article from January[1]:

> "There's no doubt after reading this paper that asymptomatic transmission is occurring," said Dr. Anthony Fauci, director of the National Institute for Allergy and Infectious Diseases. "This study lays the question to rest."

I've noticed a lot of excuses for poor decisions, as well as rewriting of history that's only a couple of months old. I doubt we're going to see much accountability for the way the pandemic was mishandled.

[1] https://www.cnn.com/2020/01/31/health/coronavirus-asymptomat...

Not for nothing...that paper was later debunked. Fauci was way out over his skis on that one:

https://www.the-scientist.com/news-opinion/report-of-asympto...

Current thinking is that there's statistical evidence for pre-symptomatic transmission about 2-3 days before symptoms appear:

https://www.sciencedirect.com/science/article/pii/S138665322...

Unfortunately, respectable publications have been pushing that paper recently as proof we knew about asymptomatic transmission back in January for stupid, partisan, political reasons.

It's very easy to forget that current decisions and past decisions operate on vastly different kinds of knowledge.

It's easy to look back in time and say "Someone knew the right answer."

It's very hard to stand in the present and say "Of the 20 people who each have a different answer they believe is right, I am going to select the really right one."

Often, the optimal decision is to hedge and delay until information becomes clearer.

Anyone citing that paper recently is being irresponsible. It was debunked about a week after the pre-print went up on the server.

The question then in context become if mask helps during those 2-3 days before symptoms appear. There is a few links above that links to the effectiveness against coughing and sneezing, but I would guess those are symptoms.

Nobody knows. We know that "real" masks (i.e. n95 or better) are effective when worn properly, but many people don't wear them properly.

The evidence for effectiveness of other kinds of masks in the prevention of virus transmission is weak, at best.

In this case, you can read the email from Dr Robert Kadlec, the US Assistant Secretary for Preparedness and Response at HHS (Edit: provided corrected title), in February that I embedded in my original post

He was shocked to learn of the asymptomatic transmission in mid-late February. This is a key person in determining the US strategy. Not rewriting history, it’s a email that was sent at the time.

As someone else pointed out, that preliminary report from Jan 30 Fauci referred to was debunked within a few days as that specific person actually was showing symptoms.

The mortally of corona is minuscule in the 3rd world populations that have born the brunt of previous epidemics.

IT's deadly primarily in populations of people(usually elderly) who can afford the health care needed to keep chronic health issues managed through medication.

the failure of covid-19 to materialize in the slums of Nairobi or poor rural districts of Thailand caused a lot of complacency among western planners who presumed that if it did not hit there it would not affect them.

From the same article: If that testing shows the virus has slipped into the country in places federal officials don't know about, "we've got a problem," Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, told USA TODAY's Editorial Board Monday.

So when the situation changed, his view also changed.

He was also anti-mask, as I pointed out, as was the CDC/WHO despite a decade's worth of use by Asian countries who didn't wait on RCTs.

It's going to require better citations than that to label Fauci "anti-mask."

Your source possibly supports "ambivalently-mask," but even that would be debatable.

His comments seem fair given the situation and knowledge at the time, as well as the political balance he was striking with his public comments.

"When the facts change, I change my mind - what do you do, sir?" -- John Maynard Keynes

Yeah because he knew that there was a supply crunch at the time and wanted them to go to first responders. Morever there is not solid evidence that mandatory masks are necessary, as Singapore hasn't mandated them, and amidst other social distancing procedures and testing regime, they have kept numbers relatively low.

Singapore has mandated masks effective April 14, and cases have recently exploded largely due to unchecked transmission in dorms for foreign workers.

https://en.wikipedia.org/wiki/2020_coronavirus_pandemic_in_S...

And this whole discussion is about some presumed opinions about masks from February.

And since February, we all learned a tremedous amount about Covid-19. I'll take advice from experts who change their opinion when data and information changes over any expert who never changes his opinion by virtue of having been right once early on. because the latter part is usually as much "luck" as anything else.

Many of the experts in Asia with first hand experience of dealing with SARS (eg professors Gabriel Leung, Yuen Kwok Yung etc [0][1]) were calling for masks to be worn in late January, or earlier even. Their simple advice has been right on the money and is basically unchanged since than.

Whereas the advice from the WHO and their dependents has been muddled, illogical, and inconsistent, with increasing amounts of 'wriggle room'

Also the hospitals where there are zero cases of staff infection and care homes free of infection spread are using PPE levels well above what the WHO recommends.

[0] https://www.youtube.com/watch?v=dcbJdRb6mds [1] https://www.youtube.com/watch?v=Jv7trxYtMzY

IMHO this shows how important cultural differences are. In Asia, it is kind of normal to wear a mask in public. At least Europe, not so much. So there is this barrier to overcome.

And then there is messaging. There are still not nearly enough PPE going around for medical professionals, back in february it was even worse. Calling for people to wear masks would have made this situation even worse. Now, this kind comes around to bite officials, it was still the right thing to do, if you ask me.

And then, back in February, Europe had a lot less cases.

Agreed - South Korea was wearing masks long before the CDC's announcement that masks could be useful in stopping the spread.

Also, from the post it says that masks were useful in stopping the Spanish Flu. It's amazing that we didn't learn that in 100 years.

Japan and Singapore also have prevalent mask wearing, but are seeing a resurgence in cases.

> but are seeing a resurgence in cases

It's a reasonable low-value point in the broader discussion, however it's absurd as a reference of much consequence, given the outcomes in Japan and Singapore have been nothing less than extraordinary.

Compared to the US and Europe, Japan is sitting next to Wuhan. They have the oldest large population on earth. They have 127 million people. They have a per 100k persons Covid mortality rate of 0.17 --- 1/30th that of Germany, 1/68th that of the US, 1/169th that of France.

Read that again. Japan's per capita mortality rate is 1/169th that of France. Not a typo.

Mask up accordingly.

Time will tell.

Comparing mortality rates per capita at the start of a crisis when it hasn't spread at the same time/rate in all countries isn't very illuminating (and yes we are at the start, not the middle and certainly not the end). It needs to get to a certain number of cases before it can start to spread exponentially.

After a slow start Japan now has an out of control outbreak and has just declared a state of emergency - it's probably too late to contain it in cities like Tokyo. I sincerely hope they do manage to get it under control because as you say they have an elderly population but apparently hospitals are already close to overwhelmed in Tokyo and a resurgence has happened in Hokaido.

I think New Zealand (where mask wearing is not prevalent) is also a counter-example to your thesis that mask wearing has significantly changed outcomes. Not even hard lockdowns have helped in Europe (though they probably help get it under control). Test and tracing to eliminate outbreaks in detail has definitely been the most significant factor IMO, as practiced in both in New Zealand and South Korea, and interestingly Germany - which has probably seen as many early cases as France/Italy/Spain/UK due to being at the centre of Europe but has kept this relatively under control so far without tight lockdowns and without mask wearing.

There will certainly be a lot of interesting studies after this is all over comparing mitigation measures - at the moment it is not so clear which ones work, and at which stage in outbreaks they are most useful.

>There will certainly be a lot of interesting studies after this is all over comparing mitigation measures - at the moment it is not so clear which ones work, and at which stage in outbreaks they are most useful.

So many variables. I wonder how clear things will become even in hindsight. Of course, it doesn't keep people today from being very certain and very dogmatic and very strident today about the right things to do on Twitter, Facebook, and elsewhere.

What happened in Germany is weird. The Italian outbreak seems to have originated there, but for some reason it was much worse then the German one, and I don't think Germany had the kind of widespread testing back then that they do now and the total number of cases they were reporting seems a little low for them to be exporting cases.

They did do a lot of testing compared to other EU nations like the UK which was even slower to start testing. I too am puzzled by their very different figures and extensive testing seems to be the answer (500k tests per week) - the UK is still not testing in the community in contrast and is doing far fewer tests. This is the only major difference I can think of.

https://bgr.com/2020/03/26/coronavirus-testing-explains-germ...

Singapore previously discouraged mask wearing. Only recently it mandated them, and now community transmission is plummeting. The resurgence in cases is only in migrant worker dormitories, where unfortunately 10-20 people share a room and it's extremely hard to prevent transmission. https://www.moh.gov.sg/news-highlights/details/38-more-cases...

I'm really not sure there is a causal link there between masks and cases, singapore is also doing extensive tracing and testing (except for their migrant workers it seems).

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