Hacker News Reader

Comment by thoraway1010 | Hacker News Reader

Yep - when I questioned my local health authorities guidance that if "healthy" I should take off my mask on crowded public transit and when working with the very elderly (adult day health) I was told to avoid "disinformation" (in writing) and to follow surgeon general and their guidance and take off my mask on public transit and while working with the elderly.

A month later they flip-flopped on that ironically. I wonder if they started to believe some of the "disinformation" that wearing masks is a low cost though imperfect way to reduce spread.

I've found actual scientists working with these diseases are pretty on it for logic, but folks like epidemiologists are sometimes totally horrendous. Is epidemiology less rigorous then other infectious disease educational tracks?

View on HN

Epidemiology during a pandemic is about one part science to three parts PR. Sending a consistent message to the public and getting them to change their behaviour at all is more important than getting the details right.

In the case of masks, the WHO decided early on that masks for the public were of limited use in slowing coronavirus spread: they'd stop some infections but could be detrimental if misused and could threaten the supply to medical professionals. This was a reasonable conclusion at the time. To communicate that to the public, the party line was: masks no good. Many national organisations took their cue from the WHO.

Now the risk/reward tradeoff has shifted: better research shows that masks, even ersatz ones, are good and the supply lines for professionals have improved. So the message has to change: masks good.

The actual scientists know that it's not black and white, but pretending it is is a useful tool for health organisations.

At some point I expect we'll see a flip-flop on the party line that "there is no evidence that covid-19 infection confers immunity against future infection". It's nonsense - there are hundreds of years of circumstantial evidence - but it's just about defensible in that there haven't been any sufficiently powerful blinded trials to directly demonstrate it specifically for Covid-19. Once it's deemed to be in the public good, they'll accept some study showing exposure does indeed confer immunity.

Is it reasonable to ask the public to believe absolute messages that contradict themselves?

Maybe what the boy who cried wolf meant was “I am not sure whether a wolf is in the forest. But the potential damage from a wolf a attack, combined with the increased likelihood of a wolf presence due to the observation of fresh wolf droppings, exceeds the damage from sheltering in place.”

But the like the epidemiologists, simply said “There’s a wolf in the forest! Run away!”

That's a question for the PR experts. I expect the majority of people are swayed by the absolute advice and the flip flopping doesn't damage the message too much. After all, we have always been at war with Eastasia.

The flip flopping from folks who keep on saying "believe the science" is ridiculous.

How can science be trusted if it has these huge flop flops within a week with really no change in underlying research?

It's not just that.

In the beginning the assumption was that asymptomatic people aren't (very) contagious. That meant that contagious people would know about their status (from the symptoms) and mostly stay at home.

When we found out that you can be contagious and not have a clue about it, the recommendation to wear simple "community masks" changed.

The scarcity of "real masks" and the wish to save them for the health sector played into the public statements that authorities made (partly because it was a true concern, partly because it's an explanation that people understand easily).

In hindsight, those statements were a mistake, because many people now think the authorities flip-flopped.

They did, but because there was new information.

I wouldn't be surprised if in various post-mortems we will conclude that advising against face masks even though they do 'work' was a mistake.

It's understandable that our governments might advise against their use because of limited availability, but I think 'doing PR' on this issue hasn't really helped when it comes to our trust in said government in our information age.

Perhaps it would have been better for the government to be honest from the start, explain that they believe masks are crucial for care workers and of relatively limited use to the rest of us, and either leave it at that, or actively disallow ownership and usage if necessary.

Lying about the whole thing just feeds the flames of a public that already has a large amount of skeptics.

I wouldn't be surprised if in various post-mortems we will conclude that advising against face masks even though they do 'work' was a mistake.

I'll be very surprised if we don't conclude that. I put this in the same category as abstinence-only proponents lying about the effectiveness of condoms.

The really frustrating thing here is that mask shortages are not a fundamental law of nature. If you have a t-shirt, scissors, and rubber bands, you can have two reasonably effective masks in 5 minutes. And there are millions of people with sewing machines who would be happy to help out, as happened in the Czech Republic.

> The actual scientists know that it's not black and white, but pretending it is is a useful tool for health organisations.

Coming from a family of doctors (thought not one myself), I've assimilated the background knowledge to recognize the official BS surrounding face masks and the like. It's been eye-opening, and it certainly made me trust the official story far less. If they're 'stretching the truth' about face masks, what other information about the virus is less than honest?

The pretense is good PR - as long as people trust you, and don't know better. What epidemiologists and PR folks need to realize is that the Information Age has left most people in my position, with more information than they used to have. That means useful lies are seen as such, and the population stops beliveing the approved experts, because there's plenty more with great credentials online saying other things.

> What epidemiologists and PR folks need to realize is that the Information Age

I don't think we have begun to understand what effect this will have on age-old institutions that relied on inside knowledge to maintain their ivory tower existence (and privileges). We already see some sword-rattling and expert communities becoming increasingly defensive. Doctors and other experts are obviously still in charge, no serious web service will give actual medical advice without referring to "your physician" - but it's a matter of time before that will change if the current trends continue. Let's check back in 30 years or so.

As long as deviation can be successfully labelled as 'conspiracy theory', the institutions probably won't have too much trouble. It's when the majority of people begin to see the BS in at least one area, that things will likely change. But that also depends on critical thinkers.

The science of mask use and potential benefits has not shifted. That's the issue. Masks work. We had people wearing masks telling us they didn't work. We had the santa clara health official LICK HER FINGERS to turn her page on live TV while telling us masks don't work to help reduce hand to mouth contact.

Do folks in public health / epidimiology not understand how this total BS messaging (masks don't work) - really undermines their messaging.

Online on facebook was even worse, lots of epidemiologists with clearly no view of actual "mechanisms" this virus might move by making up just ridiculous negatives to mask wearing.

Masks and face covering are CHEAP compared to other interventions such as lockdown.

And no, there really aren't good studies showing masks increase transmission.

Honestly, the answer to the question "is field x less rigorous" is almost universally no. Some fields tend to attract smarter people than others, but that doesn't mean there aren't very smart people in pretty much every field who are doing good work and exploration at depth.

For this question I think that beyond the politics and what was a deeply ill-advised strategy for managing a limited resource (masks), it may also have to do with the type of studies they tend to use and give authority to.

The scientists you're talking about probably are looking at smaller scale things where plausible mechanisms are investigated and confirmed. Epidemiologists though have many examples in their toolkit where such common sense findings don't extrapolate to population level interventions.

For whatever reason, epidemiology doesn't seem to embrace a more bayesian approach where you operate with a good guess and try to revise it as you learn more. They tend to stick to confirmed models.

Reply on news.ycombinator.com