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Comment by yashap | Hacker News Reader

It’s insane to me that we don’t just make masks 100% mandatory when you’re outside your own home. We don’t have exact numbers on how effective masks are, but when everyone is wearing them, evidence suggests “very effective.” Anecdotal examples - a man with a dry cough, that was later diagnosed to be COVID, wore a mask on the long flight from Wuhan to Toronto, had extended/close contact with 25 people, but he was wearing a mask, and none of them contracted it from him [1]. 2 hairdressers in Missouri had COVID, but they and their clients all wore masks, they had extended close contact with 140 people and none of them got COVID [2]. We know masks are most effective when the infected person wears them, and we know that asymptomatic spreaders are common, so really we just need everyone wearing masks for all close personal interactions.

We could keep the economy decently open AND keep COVID cases down dramatically with a simple law to mandate masks 100% of the time when outside your own home. In plenty of professions people are wearing masks all day long now, it’s uncomfortable at first, but you get used to it. Crazy that this isn’t being strongly considered.

[1] https://www.cmaj.ca/content/192/15/E410 [2] https://www.washingtonpost.com/business/2020/06/17/masks-sal...

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  just make masks 100% mandatory

That would require me to confess that other people might know more than me. Which some conflate to total loss of all personal liberty.

As a counter-argument thought experiment to try and understand how some people might feel that way, imagine this situation:

We've got an epidemic of terrorist shootings in the US. Some law enforcement experts suggest that not only should open carry be legalized everywhere in the US, but that carrying a gun should be mandatory while in public. It's the only way to stop the shootings.

I'm not going to suggest that this is in any way a 100% equivalent argument, far from it. But it might help you get a feel for why some folks are opposed to mandatory masks, even if they seem entirely sensible.

I think if I spit on your face is illegal (probably assault) so we could apply the existing laws, if someone without a mask gets close to you while speaking existing laws could be apply because is basically spiting germs on you.

I am wondering if this would be accepted by a judge and no new laws will be required.

Masks cannot end someone's life either on purpose or accidentally.

A better example is seat belts or government issued ID, which are already currently mandatory.

I would respectfully disagree that things which are currently mandatory are better examples. We're talking about making new rules in response to a newly emerging phenomena. A change to the status quo, as it were.

Asserting that a change to the status quo is the same as the existing status quo that you already "bought in to" 5-50 years ago (for most of us) is in a lot of ways not the same at all.

Further it's possible to opt out of seat belts by not driving and you can kind of opt out of government IDs also by not driving or flying. It'd be difficult but if you really, really cared you could.

I'm not saying that these people's reaction is entirely rational. But if you want to try and understand them a bit better I think my very, very loose analogy might help you. If you don't want to understand them feel free to ignore entirely!

> Further it's possible to opt out of seat belts by not driving and you can kind of opt out of government IDs also by not driving or flying. It'd be difficult but if you really, really cared you could.

Not driving (or being the passenger in a car) is all but impossible in the vast majority of the US. In fact, it’s almost equal to saying “just don’t go to any public places” in response to your gun requirement hypothetical.

It seems like you shifted your argument there.

> A change to the status quo, as it were.

You didn't thought things through. If you're talking about a global pandemic then quite obviously you aren't talking about a scenario where the state of things already changed radically.

Moreover, I fail to see how keeping things as they are can be passed as a rational argument against something. You're actually arguing that things should not change because otherwise things would change, which makes absolutely no sense at all.

> You didn't thought things through. If you're talking about a global pandemic then quite obviously you aren't talking about a scenario where the state of things already changed radically.

I agree that the state of the world has changed radically. What we're debating is how the law should change. The world will get over C19 in another year or two. We're still stuck with a PATRIOT Act from 2001. That's 19 years ago now. https://en.wikipedia.org/wiki/Patriot_Act

> Moreover, I fail to see how keeping things as they are can be passed as a rational argument against something. You're actually arguing that things should not change because otherwise things would change, which makes absolutely no sense at all.

I was attempting to suggest that there's a difference between "things which already are a given and have been for a long time" vs "new things which we're going to decide are a thing newly, right now".

Yes seatbelts are essentially mandatory (if you drive) and have been so for the last 30-50 years depending on state. But I think it's not entirely fair to compare new mandates/requirements/laws to existing ones. The existing ones have had a chance for their long-term implications to play out. The new ones would be new. We don't know all the long-term implications of the new thing. It's probably impossible to know what the long term implications would be.

What I don't see (sadly) is anyone saying "hey lets make masks mandatory until expiration on Jan1 2021 with possible 6mo extensions after that". So people who are worried about government overreach have every reason to be worried! The pandemic is very, very unlikely to last forever. The laws that get passed are very, very unlikely to ever be repealed. PATRIOT Act was a temporary measure until we "got" the terrorists. It's nearly 20 years later. It only took a decade in Afghanistan to bankrupt the USSR. We're going on two decades. These concerns may not be entirely foolish.

Government issued ID's are not mandatory nor is seatbelt use on any private property.

and mask use on private property wouldn't be mandatory either

Most businesses are on private property.

It seems you're entirely oblivious to the fundament difference between discussing property ownership and whether a space is opened to the public.

Don’t assume ignorance on my part. Words have meaning, and I think the distinction is important. There is a fundamental difference between regulating public spaces and private businesses, and we should treat that with the seriousness it’s due.

For what it’s worth, I think a mask order is reasonable.

Assumptions not required. Spaces open to the public does not equal Public spaces. Public spaces are necessarily spaces open to the public but spaces open to the public are not necessarily public spaces.

Also, think of a man as underwear for your face. You can strut around your house naked all you want, but you can't walk down the street that way, and I'm fairly certain the grocery store can't unilaterally decide to be a nudist friendly operation either. If the Venn diagram of places where you can be legally naked and places you can not wear a mask were basically the same, the original commenter' version of "everywhere" would be sufficiently met.

But need a public license to operate which could be revoked unilaterally by a government

> Government issued ID's are not mandatory

Perhaps not in the US, but it's mandated in pretty much across all western society.

And the US's refusal to adopt a standard ID system also leads to pseudo-ID schemes and proxies such as social security numbers and driver's license.

> nor is seatbelt use on any private property.

That's a great example.because no one is requiring anyone to wear facemasks while they are in their own home. The key take should be that the goal of these measures is to mitigate the risk that a specific threat poses to the public. You are required to wear a seatbelt while driving in public roads because the risk of being involved in a traffic accident is relatively high. You are required to wear a face mask in public because the risk of transmitting the virus is relatively high. Once you cease to be in public then the risk you pose to others is negligible.

> And the US's refusal to adopt a standard ID system

We do have a standardized ID system: https://en.wikipedia.org/wiki/Real_ID_Act

It's not mandatory

It is if you want to fly, starting next year (was supposed to be this year but was delayed).

It's not in the UK, we have a serious political taboo against what's seen as a "papers please" kind of authoritarianism. Tony Blair tried to introduce mandatory ID cards and even with his massive majority it was politically impossible.

The ironic thing is that despite this widespread attitude, we have genuinely scary levels of mass surveillance.

Seat belts are mandatory, but not for example on public transportation. And in most jurisdictions you can’t pull someone over if the only reason is because you think they aren’t wearing a seatbelt. In MA, for example, it can only be added on top of another infraction.

So even a common sense policy which saves many lives from a public health perspective has some clear limits to when and how we enforce it as part of the overall social contract.

Particularly with regard potentially discriminatory police actions which can be non-uniformly enforced, think for example homeless people who might not have access to a clean mask being targeted.

Making up a new kind of law which can be used to fine/arrest literally anyone just for walking down the street “the wrong way” is a big deal.

Car insurance is mandatory, and is more analogous to masks (liability limitation).

Technically speaking, car insurance is not mandatory in the US; two states do not require it.

Maybe that makes it a great analogy -- it's a state-by-state patchwork just like mask laws :)

> Seat belts are mandatory, but (...)

I fail to see how any of the examples you pointed out have any relevance to the subject.

The point was that there are plenty of examples of behavior that's deemed mandatory in order to uphold the common good. Wearing face masks during a pandemic fits the bill. You don't negate this by cherry-picking unrelated examples that aren't covered. I mean, not requiring seatbelts on public busses is just as acceptable as not requiring facemasks while staying within private property and for the same reasons: the negligible risk that's presented to both the public and the individual.

Beyond the nuances of where seat-belt law is enforced, I’m also speaking of tempering the social cost of policing the policy.

We know that both policies obtain a public health benefit. Both policies are also not “blanket policies” but rather should be carefully tailored based on expected benefits changing depending on circumstances. For seat-belts it’s mainly the type of vehicle, but then remember there’s also variables like child seats which vary depending on age, height, and weight and it can get complicated. For masks it’s even more dynamic. E.g. it can’t be expressed simply as “everyone wear masks”.

Both also have, or need to have, limits on how strictly they are enforced, even if that means imperfect compliance.

The reason we (culturally) accept this trade-off is because the enforcement is accomplished through a form of sanctioned violence by the State, and that sanctioned State violence carries a cost / public health risk of its own!

After all this is said and done, recall it’s not a binary switch. Mask wearing is a continuum for each addition interrupted transmission. By the time we’re done with all this, how much have we moved the needle?

Lastly, keep in mind focusing on implementing one policy comes at the cost of having the time and political capital to implement some other policy. Politicians which claim they can “walk and chew gum” at the same time are generally over-estimating their own capabilities.

> Beyond the nuances of where seat-belt law is enforced, I’m also speaking of tempering the social cost of policing the policy.

If you're really interested in framing the problem that way then in the very least include in your analysis the social cost of dealing with thousands of deaths that otherwise could be easily avoided if everyone just wore their facemasks in public.

So far the US alone experienced over 150k deaths by covid19. What's the social cost of that?

Would those deaths actually be avoided, or just delayed?

Masks are just one part of a multi-pronged approach to reducing transmission which includes testing, contact tracing, maintaining physical distance, practicing good hygiene, as well as quarantining after travel, maintaining consistent limited social groups, staying outdoors, avoiding large group functions even with distancing, and going even further than all of that for high risk individuals or during surges if ICU capacity is stretched, to implement shutdowns and lockdowns, until ultimately, herd immunity is reached naturally or through vaccination.

All together it still hasn’t stopped COVID in its tracks, and with tens of millions of active cases, there’s no scientific basis for expecting that it would.

Short answer; it’s possible some percentage of them would be delayed.

I think it makes people feel better to have something to blame, particular when it sounds just so simple.

Death can never actually be avoided. Everyone eventually dies. All health care simply delays death.

> Seat belts are mandatory, but not for example on public transportation.

So... that's because public transportation vehicles, like busses, are big. When you smash your small car into a big bus, the bus is fine, and you're a pancake.

On a train, were it to derail, your seatbelt won't help you.

Nothing nefarious going on here.

I agree completely! The point is the policy is not blanket, but modulated based on the particulars of the situation. I expect that we would need equally nuanced (if not much more-so) policy for mask wearing.

Unfortunately masks can end someone's life:

https://abcnews.go.com/US/driver-crash-passed-wearing-n95-ma...

Ya, you can die from swallowing a toothpick too. Passing out from a mask is either a fluke, or a separate, serious underlying issue.

N95 masks? That's a pretty rigorous level of filtration. It's not a cloth mask. If someone isn't taking it off if they aren't getting enough oxygen it could lead to this kind of problem.

Rare? Sure. But so is a COVID death of a healthy young person.

Seat belt laws should not be on the books. Yes you should wear it, but the government should not be allowed to make rules that only protect you - so many other draconian rules would disappear if they could only outlaw things that show clear danger to third-parties.

And I wear my seatbelt always when driving, though not necessarily if I am backing into a spot.

Ok, but if you don't wear a seatbelt and get into an accident and fly out the window onto the pavement, are you going to expect all the government services, police, firemen, public hospitals to eat the cost of your accident that will likely be much more severe due to your lack of seatbelt?

I just point out that the government already mandates we wear clothing in public and a mask is basically just a shirt for your face.

Not wearing a mask during covid == indecent exposure in my book.

If that is your argument then I would counter that I do not believe the government should have any say on the clothing you wear. Though I would not be comfortable with going naked, we should not pay any consideration to religious feelings, be they Muslim or Christian - and that is all US clothing regulations are based on.

Being uncomfortable having to explain to a child what a dick is because they saw one hanging out while walking to the bus is not something I should be forced to give a shit about. Taking simple steps to prevent spreading an infections disease is.

That’s great, but my point was it’s already illegal and no one complains about that on the regular. In my view the two viewpoints are identical, so those who argue against masks should get out there and argue against clothing too if they were truly consistent.

If they are actually experts, and this is an actual epidemic with an equivalent death potential, then sure! Give me the gun. What's the problem?

Is the equivalent to a cloth mask a BB gun?

I think you're talking about a zombie apocalypse type situation, in which case yes if there are zombies roaming the streets trying to eat everyone's brains it might be wise for every sane person to carry a shotgun in public.

There’s a difference between admitting other people know more than you and giving up entirely on the use of your own rational faculties. Blindly trusting that masks work, in the face of (at best) low predictive power and (at worst) outright contradictory evidence, is an example of the latter.

My rational faculties tell me that masks sure as heck work equally well or better than no masks. Also that there is no downside whatever to me from wearing one (ego damage doesn’t count — this is real life, not a game). Put those together and it’s my personal responsibility to wear a mask until the evidence tells us it’s of zero value. (Maybe it’s not clear: masks are to protect other people from you, not vice versa.)

> there is no downside whatever to me from wearing one

The eternal refrain of economically innumerate people who can’t multiply.

The logic the Netherlands used to counter the "only can help" argument is that wearing cloth masks can lull people into a false sense of security where they are less observant of social distancing because they are overconfident in the protective power of the mask.

I'm not aware of any study that confirms or debunks this but from a neutral point of view I would say it's at least plausible.

For the record, I wear a mask.

> The logic the Netherlands used to counter the "only can help" argument is that wearing cloth masks can lull people into a false sense of security

That line of reasoning makes no sense because it leaves out the fact that the conclusion is drawn from the comparison between a) wearing a mask in public and b) stay locked down indoors while avoiding all social interaction.

The conclusion was never drawn from a comparison between a) wearing a facemask in public, and b) not wearing a facemask in public.

Additionally, during the onset of the covid19 pandemic there were indeed some health officials that argued against mass adoption of facemasks and other personal protection equipment such as latex gloves. However, their rationale was that this would increase demand so radically that it could jeopardize their availability to frontline workers.

> The conclusion was never drawn from a comparison between a) wearing a facemask in public, and b) not wearing a facemask in public.

Well, in fact, that's exactly what the conclusion was drawn from. If you're in public and not wearing a mask during a pandemic then the logical thing to do is to keep a lot of distance between yourself and others. There's a non-trivial amount of people who believe that masks are providing much more protection than they actually are and this misunderstanding could have an impact on people's behavior in public spaces.

There is evidence that wearing masks spreads disease?

It is easy enough to imagine several ways it could do so: making it less likely for people to socially distance, making it more likely that people spread the disease (or for that matter other diseases) by increased touching etc.

> Blindly trusting that masks work, in the face of (at best) low predictive power and (at worst) outright contradictory evidence

Care to point out where you got your denialist news from? Because your personal beliefs fly in the face of any reason or evidence.

What about my right to use tiktok? We give up rights all the time.

If they create a law based on a real necessity, I don’t think you can call it a liberty violation. For example a law states you cannot carry grenades.

Often, the problem for menis not that I don’t trust what others know, but that things like these get to be imposed without educating the public what it is necessary, the evidence etc.

Okay I will let you in on the secret, but for the love of God keep your mouth closed.

The disease is as you suspected drastically overblown, although not entirely fake. Bill Gates is absolutely using it to spread his vaccines and the masks do very little.

The masks are there for us to counteract facial Bill Gates facial surveillance, not to stop the disease. That is highly hush-hush though so wear your mask but don't tell anyone.

Mum told me lying was wrong, but if it works?

Those two studies you cite aren't strong scientific evidence. There is no control group, so we don't know what would have happened if they had not been wearing masks. Also the sample size is quite small (n=2 across the two studies).

I've seen some studies that have good controls on influenza, in particular there is a college dorm study that compared no intervention vs. masks vs. hand washing: https://www.cidrap.umn.edu/news-perspective/2010/01/masks-pl... . This specific study doesn't give strong evidence that masks stop influenza spread.

Also, the individual rights argument is pretty strong. If mask wearing is already at 70% without any government mandate, I'd want really strong evidence and strong reasons to justify government intervention just to push that number a little higher.

Wearing pants would be higher than 70% without government mandate -- does that mean that a law that you must have your junk covered an impingement on individual rights?

Of course. So is having to wear a mask.

A mask is justified in the short term, the fact that you don't want to see my junk rates no higher than me not wanting to see your sportsball t-shirt. Unfortunately one of them is illegal and it isn't the sportsball t-shirt.

The individual rights argument is not pretty strong. Here’s a partial list of things I did today for the sake of my neighbors/community that are also government mandated:

- Wore a shirt

- Turned on my headlights and used my turn signals

- Held on to my empty coffee cup until I got to a trash can when I could have just dropped it on the ground

- Kept my dog on a leash and picked up his poop

- Parked in a parking spot instead of conveniently stopping my car in the middle of traffic directly in front of the grocery store door

I’m sure there are plenty others. Being a member of society comes with a lot of privileges and a handful of obligations but it only works if we all do our part. No freeloaders, right?

Edit: An extra word

These are objective concessions. Most of these concessions took tens (or thousands) of years to become objective.

> - Wore on a shirt

Where do you live where this is government mandated?

I’m a woman so my nipples are criminalized in most of the United States.

That's terrible. I'm glad that this is not the case here in Canada. It does make no sense whatsoever for it to be like this in the US. I agree with your other examples, but this one is clearly unjust and should change.

In many parts of the U.S., it's not actually illegal for women to be topless, they just don't. It is often a requirement for a liquor license, however. For example, where I live in Austin, Texas, state law does not prohibit a woman being topless, and Texas is not generally among the most liberal of states.

Proactively mitigating the abuses that would emerge from a state that doesn't need to encourage more low paying jobs that have a very high rate of sex trafficking? At least the Bud Light at the strip club isn't $12 like that place I went in Las Vegas.

Just wanted to add that it's legal for women to be topless in NYC. There's even a celebration day for it at the end of August.

It's legal statewide and specifically because it would be unfair for men to have the exclusive privilege.

If you’re a woman this might be considered indecent exposure in many parts of the US unless you’re at a beach or in a resort town.

In stores pretty much anywhere.

That's not government mandated.

But the anti-maskers insist on having the right to not wear a mask in stores as well when the business has clearly marked masks are required and staff ask them to leave.

If the anti-maskers respected the rights of others around them as much as they insist on others respecting their rights, this would be nearly a non-issue.

I had assumed it was state laws for ostensible health reasons. But it turns out to have sort of an interesting history and, as you say, apparently isn't legally mandated in any state according to this article: https://people.howstuffworks.com/where-did-shirt-shoes-requi...

In the case of masks, you have a big change in human tradition. There are very few societies that have ever required all people to wear masks all the time. I can't think of any examples. A small handful of modern societies require it for specific subgroups, but that's it.

Generally, extraordinary claims require extraordinary evidence. In the case of masks, I want to see very strong evidence that masks are very necessary, and other approaches wouldn't have similar or better results with lower change to human tradition. So far, I haven't seen that at all. The scientific evidence that masks are effective or necessary is weak. Alternate approaches (eg. wearing a mask if you're symptomatic, staying at home if you're symptomatic) may be just as effective.

The examples you cite have roots in human tradition, and have been established for many years, mostly with strong evidence.

What harm will befall people who see my breasts and what strong scientific evidence can you provide to substantiate that theoretical harm?

To be honest that topic people can debate. Men are allowed to walk around without a shirt. Women breastfeed in public pretty frequently.

There is however a long history and tradition of humans wearing clothing to cover their genitals. Even very primitive societies have this norm, and it has pretty obvious reasons behind it.

Doesn't have to be "scientificaly substantiated" harm.

Killing someone is not a scientifically substantiated harm either. Of course we harm the other person's health (that's objective), but that in itself is only bad in the sense that "life is good" and "we should respect life / not kill". And that is not a scientific argument but a moral one. The universe doesn't care either way.

What does "scientifically substantiated" mean to you?

The same thing anybody would understand by the term. Did something gave you a different impression?

That there's a scientific proof that harm is being done by an action.

But harm is a moral term, and science is not about moral judgements. It can help inform them, but the guidelines for what is "harm" or "good" come from morality ultimately.

E.g. what is "good for society" is based on a value judgement / decision by said society based on its goals, what it wants to conserve or change, etc.

Science can tell you that X technique is more productive for example. But whether "more productivity" is desired is a matter of social values/priorities, not a scientific matter.

Usually the root of the argument boils down to your exposed breasts will titillate men and cause them to act out of the lust in their heart. If you dig, you’ll often find statement to that effect made by the legislators or lobbyists responsible for laws against exposure of breasts.

It contrasts with professed love of freedom, but humans are always creatures of paradox.

Then we should also ban advertising, because it causes people to act out of envy in their heart.

In the case of seatbelts, you have a big change in human tradition. There are very few societies that have ever required all people to wear seatbelts all the time. I can't think of any examples. A small handful of modern societies require it for specific subgroups, but that's it. Generally, extraordinary claims require extraordinary evidence. In the case of seatbelts, I want to see very strong evidence that seatbelts are very necessary, and other approaches wouldn't have similar or better results with lower change to human tradition. So far, I haven't seen that at all. The scientific evidence that seatbelts are effective or necessary is weak. Alternate approaches (eg. improved driver training) may be just as effective. The examples you cite have roots in human tradition, and have been established for many years, mostly with strong evidence.

https://youtu.be/9_Af8w2SAT4

Well, seatbelts aren't the be-all, end-all, either... And people have indeed complained about them when they were mandated. So, it's not like "one could say the same thing about seatbelts, so look how absurd it is". Someone else might easily reply "my life, my choice" about wearing one (same as for drinking, smoking, over-eating, etc).

But even so, we can consider seatbelts as a necessary wearable/accessory for car use, which is also a recent development (cars and driving). Masks are different in that they affect people going on about doing things people did for millenia without requiring a mask.

You still have freedom loving individuals in places like New Hampshire who embrace beltless freedom, or even more stupidly riding motorcycles without helmets.

At least in those cases, that “freedom” usually kills only them when things go wrong.

United States, 1918.

Instead of projecting arrogant puffery, why don’t you think about the potential consequences of prioritizing your comfort and self aggrandizement to people whose lives are put in danger.

I have a neighbor who unknowingly was infected early on and likely infected several of her elderly clients, most of whom are now dead. She is devastated... think about how you will feel if you did the same thing, without the innocence of being ignorant.

>- Wore a shirt

I still insist you wear chaps on top of pants or your short trousers. Pants are fashion, chaps protect.

>I'd want really strong evidence and strong reasons to justify government intervention just to push that number a little higher.

Why?

Look I know we've all heard the Friedman quip about temporary government programs, but that refers to normal situations. It's one thing when a program might drop off the political radar and outlast its mandate by decades, but in the case of COVID-19, there is absolutely no way on Earth, at all, that people could just forget that it happened. If the COVID-19 pandemic were a war, it would already rank among the 50 deadliest ever.

Our rights are not devalued in the long term by rapid action in a pandemic which, by the best available estimates, could kill over a million Americans if left to run unchecked. They are not devalued in the long term because it is always going to be easy for people to know whether we are experiencing this kind of emergency. The loudest deniers on Facebook are not representative of the population: most Americans do recognize the threat, despite one of the largest disinformation campaigns in human history.

So what if there's a small chance we might be too strict about masks? It's not a large injustice, and it's not a slippery slope.

> So what if there's a small chance we might be too strict about masks? It's not a large injustice, and it's not a slippery slope.

It very strongly depends on exactly how the mask requirement legislation works. If it's "all persons in a public in the state of California must wear a face covering until December 31, 2020. Failure to do so will result in a fine of no more than $150", that's probably fine. People will still complain, somewhat justifiably, that this legislation is safety theater rather than an actually useful law, but in the grand scheme of things it just wouldn't be that big of a deal. However, if it's "any person who knowingly performs an action which endangers the health or well-being of others is subject to a fine of up to $10,000 or 5 years in prison", we now have yet another law that most people are arguably in violation of at least some of the time, which allows bad actors in government to impose enormous pressure to comply with unreasonable or illegal demands under threat of large fines or jail time.

I personally worry quite a bit that something more like the second will be passed, and will be very selectively enforced.

The state of New Mexico currently mandates the use of masks while in public with the penalty of a small fine (I forget the exact amount, but it’s only a couple hundred dollars). So in practice, the former is what is already being done. And yes, people do still complain, but as far as I can tell almost everyone complies.

If we’re having this much trouble sorting out individual egos and absolutist ideologies with masks, where the choice is so simple and risk-free, we are REALLY going to be in the soup when vaccines start to come out.

Sorry, but this doesn't sound like "no strong evidence":

Without adjustments for other variables, the two intervention groups had about a 10% reduction in overall ILI incidence over the 6 weeks compared with the control group, but this was not statistically significant.

However, when the researchers analyzed the ILI rates for each week of the study and adjusted for other variables (age, sex, ethnicity, baseline hand washing practices, sleep quality, alcohol use, flu vaccination), they found that the FMHH group had significantly lower rates than the controls in weeks 4, 5, and 6 (35%, 44%, and 51%, respectively).

The adjusted rates for the mask-only group also were lower than those of the control group in weeks 4, 5, and 6, with reductions ranging from 28% to 42%, but this did not meet the authors' significance criterion of P<.025.

The authors say several factors may explain why a significant reduction in ILI was found only during the second half of the intervention period. One is that recruitment of students continued through the first 2 weeks of the intervention, increasing the sample size by 11%. Also, the proportion of FMHH participants who wore their masks more than the average 3.5 hours a day increased in the later weeks of the study, and confirmed flu cases on campus peaked in weeks 4 and 5.

Well, it depends on what you think is "strong" evidence. A 10% reduction doesn't seem very compelling, and when you introduce the more advanced statistical analysis, that hurts the case in my eyes. There are probably less disruptive ways to get a 10% reduction.

I found that study from this meta study here: https://pubmed.ncbi.nlm.nih.gov/20092668/ which reviews a lot of these studies for influenza. Note, however, that most of the studies only look at if the masks protect the individual, not whether masks stop the spread of influenza, but the evidence seems pretty inconclusive.

I agree that 10% reduction is not much in normal situation but not when ICU are at capacity or economy is shut down.

Results from weeks 4, 5 and 6 are interesting. Another study could see if this can be reproduced.

> There is no control group, so we don't kno

It is unethical to have a study with a control group which involves a live virus.

There is enough evidence that masks are effective that they should be required until it's proven they are ineffective or the virus risk is reduced.

Where is this evidence? Is this evidence for n95 masks, or the cotton nonsense most people wear?

There are doctors, experts and even whole nations that disagree with you that there is evidence masks are effective.

This is the problem with arguments like this. It inevitably turns into a fight over who gets to pick the evidence and experts, as there is always reasoned disagreement.

Heck, China is an existence proof that mask wearing doesn't stop the virus in any meaningful way. Sample size, a billion. Checkmate. Are we done?

China, Hong Kong, and Taiwan all have lower infection rates than we do, and one of their biggest ways of controlling it has been masks. Taiwan in particular has never had more than a few cases and they are near neighbors to the epicenter of this whole thing. They controlled it by cutting off travel and using masks and they've never had to do a shut down.

You don't actually know that using masks cut it down, you're just assuming it.

You're also assuming the Chinese numbers are reliable, etc etc. I mean there are just so many ways to slice it. Suffice it to say, COVID happened in China despite widespread mask wearing. If you want to prove masks work it'd take a much more rigorous analysis than cherry-picking countries and attributing their numbers to masks, that's my point.

This is such an asinine comment. What’s the need for any law, since ~70% will comply anyways? And this of all cases? Where a few rogue “super spreaders” can give it to thousands of people?

>What’s the need for any law, since ~70% will comply anyways?

Codifying morals is done for the purpose of having cheaper and fairer enforcement.

The individual rights argument is based on community norms so if it's 70% already it becomes weaker, not stronger.

> There is no control group

There's no ethical way to do a control in a study of infectious diseases. You'd have to mandate that some study participants not wear masks, when your hypothesis is clearly they the masks will keep some of them from getting sick or dying.

You're asking for far too much here. Masks are known to stop disease spread from (literally) centuries of use. We don't have to throw all that intuition out with covid, even though the numbers may change.

And again: why should we have to prove this technique via completely impractical research constraints when it is very likely that it helps, in a situation of dire urgency.

> It’s insane to me that we don’t just make masks 100% mandatory when you’re outside your own home.

It sounds reasonable in closed spaces (like in the examples you gave). But I'm reluctant to wear a mask outside in low-density area (I would if there were strong evidence it made any difference).

> man with a dry cough, that was later diagnosed to be COVID, wore a mask on the long flight from Wuhan to Toronto, had extended/close contact with 25 people, but he was wearing a mask, and none of them contracted it from him [1]

I'm nitpicking here, but by itself it doesn't sound as a strong argument in favour of masks. If I understand correctly, without any containment measures, the propagation rate (R0) of the virus is around 3. Which means that a sick person is going to contaminate on average 3 other people. I suppose the average person can have quite a lot of interactions (starting with their family, colleagues) during the time they are contagious. So even without mask, it's not obvious the guy in the plane would have infected anyone else.

That being said, I agree with you that masks should be mandatory (in closed spaces).

Outside in low density areas appears to be fairly safe, but it's a behavioral problem, and if masks are mandated and normalized, this thing'll be over in a jiffy and we can meet down at the pub for a pint.

R0 is an ensemble average, not a useful metric for any given person. It's likely that transmission is wildly variable, and that superspreading events are major contributors to transmission. Basically, households slowly pass the disease between each other, and occasionally one person manages to get a shitload of people outside their household sick. Masks appear to be extremely effective at stopping the superspreading events, which has a huge effect on R0.

> It sounds reasonable in closed spaces (like in the examples you gave). But I'm reluctant to wear a mask outside in low-density area (I would if there were strong evidence it made any difference).

I agree with this. 100% mandatory outside of your home would mean I would have to wear a mask while running, which seems unnecessary when I see a grand total of 1 or 2 people on my entire run (and cross the street to keep plenty of distances between us).

This is one danger of applying a solution for 100% of everyone, everywhere without taking into account any nuances.

That said, mandating masks indoors + outdoors when you can't maintain 6 feet of distance seems like a no brainer. Perhaps in higher density areas it could be worth requiring them 100% of the time, even outdoors, but I'd like to see the data first.

I generally agree, and I personally don't wear a mask outside when I walk in my neighborhood for this exact reason (very low density, plenty of space).

With that said, it appears that if there is any gray area in the rules then the general population is almost sure to abuse them. In this case, I think it's better to err on the side of caution and make it 100% mandatory so there is absolutely no gray area.

I mentioned this in another comment already, but this is what’s being done in New Mexico.

The mask order was extended to, basically, “wear a mask if you’re outside your house”. This includes exercising outside. Personally, I find that part a bit excessive; however, my understanding is that it’s meant to counter exactly what you pointed out: as long as there are any exceptions, some people will reason their way out of compliance. A 100% mandate is just easier and simpler to follow.

I now wear a mask when walking in my neighborhood after I noticed other people wearing masks too. Chalk it up to peer pressure I guess, but to me it’s a very small price to pay if it helps enforce mask-wearing in other contexts.

One of the problems with "masks should be required" is that it lacks nuance. Around where I live--exurbs of a major NE US city--they're required and pretty much universally used in stores as far as I can see. However, outside, it's very mixed and personally it seems pretty reasonable. But I'm sure to some people it seems as if people aren't being reasonable.

Certainly I'm not wearing by myself in the woods. But perhaps that's seen poor practice by some. No idea what things look like in the city. Perhaps I'd find it uncomfortable.

Most of the mask orders I've seen take that into account though, requiring masks indoors and in outdoor spaces where social distancing is not possible or enforced.

It is. Although some people seem to feel strongly that's not enough.

The lack of nuance is a feature and not a bug. It takes the decision out of the individual's hands since people can have any number of reasons ranging from valid to incomprehensible for why their specific activity doesn't require a mask. We have already tried leaving it up to individuals for the last 4+ months and that clearly hasn't worked. The choices going forward appear to either be to put stronger precautions in place until there is a vaccine or continue to let tens or hundreds of thousands of more people die unnecessarily so we can be slightly more comfortable while outside our homes.

Well, where I live which is about as blue as it gets in the US, people are being good at wearing masks inside based on what I've seen--essentially universal. And they may have masks for walking around in close contact outside but they're not required or generally worn when people are, for example, sitting down and eating outside or walking separated by some distance.

My understanding is that is pretty much the situation even for places where that are relatively enforcing masking in the US.

Strongly agree.

Public health policy and individualised medicine are, or at least can be, vastly different things.

If you tell everyone they must wear a mast at all times, some people still will not.

If you tell everyone a more complex set of rules than masks at all times when out of your usual place of residence then people will fabricate all types of fictions that exempt themselves from the rues.

At this point, I don't care about the effectiveness. It is a sign of respect for those of us who have lost family and friends as a result of this global pandemic with what will amount to millions dead over the next 1-2 years. It is a very visible sign that shows that you care about yourself and the people around you.

I'm very, very pro-mask; I'm optimistic that getting people to wear them could drop R0 << 1 and bring an end to this. That said, it seems unethical to me to mandate (read: enforce with fine/imprisonment) it for the purpose of ... what sounds like virtue signaling?

Better idea, use positive reinforcement. Walmart, et al raise prices 15%. Mask wearers get 15% off. Everyone else pays full-price.

Sorry, illegal due to the ADA since some people can't wear masks.

Like who?

False. If a store makes accomodations, then you cannot use the ADA defense. Currently >95% of stores (maybe higher) have curbside pickup, so this excuse is dead in the water.

Wouldn't have to mandate it, if people would just do it...

They have to mandate N95 masks indoors if it is indeed aerosol-based superspreader events.

That is magical thinking. SARS-CoV-2 is now endemic in the worldwide human population. Wearing masks in public for a few months won't change that reality.

The scales fall from tetrometal's eyes .... yes, a huge amount of the discussion around masks is pure virtue signalling.

That's why there's this huge focus on masks stopping the spread by pre-symptomatic people, which is a highly dubious and never-before tried idea, for which basically no reliable evidence exists (masks pre-COVID being intended to stop you getting sick, not other people), and which is an absolutely pure form of virtue signalling. It's literally a highly visible sign that someone is suffering discomfort for someone else's health, except, that only works if you believe it's actually true.

Look at the Nordics. In Sweden there's no mask requirement because the epidemic is disappearing. In Norway they pointed out that given the tiny number of infected people, even if you assume masks work perfectly, 200,000 people would need to wear a mask constantly to stop one new infection. And this is a virus with an IFR of about 0.1% so you end up needing millions of people to wear masks constantly to stop just a single death, almost certainly of a person very close to the end of their life anyway.

The numbers just don't work, at all, once the epidemic has faded away. And as Sweden and other places shows it can fade away without any mask requirements.

Masks are less important, if people socially distance and practice good hygiene.

If you don't give the virus a chance to spread, it cannot spread.

The problem is that in the US and elsewhere, people cannot seem to follow the social distancing and hygiene, so you need to find a way to physically distance people with masks and other protections.

To say that masks do not work, is untrue. There is a reason why doctors and others wear masks in their own professions.

By the way, when you say it is disappearing, that doesn't mean let the guard down. Look at what is happening in Vietnam. 100 days clean and they let their guard down and look at what is happening now.

Sweden has far and away the highest death rate of the Nordics, over 11 times that of Norway. I really don't think the data supports your point. https://coronavirus.jhu.edu/data/mortality

I don't even bother getting into death rate discussions any more because it is pointless.

You read the Survivors Groups on FB [0] and the real problem people aren't understanding is that this isn't quick death we need to worry about, it is the long term health effects that will lead to a lifetime of medical issues.

[0] https://www.facebook.com/groups/COVID19survivorcorps/

Norway indeed basically hasn't had COVID. Perhaps they will when they have fully finished releasing their lockdown, or perhaps COVID is more like seasonal flu, which does hit some countries and not others for unexplained reasons every year.

However, the point stands. Sweden has not had particularly bad outcomes, being as it is in the middle of the pack, and with most deaths being in care homes where Sweden has many other severe problems, e.g. many staff who can't speak Swedish. In fact in one care home they ended up in a spot where none of the staff spoke Swedish causing problems for a resident who couldn't communicate with them to get food! So given Sweden's dependency on immigrant labour for care homes it's maybe not a surprise they've had problems protecting those homes. For the general population however, COVID has not been a problem.

Yeah, well I don't actually care about theater versus what's effective.

I'm not sure I'd characterize it as theater. This isn't a play or performance, it is a global pandemic and people, including myself, are losing loved ones.

You wrote "I don't care about the effectiveness." So, yes, it's theater if you want to require things that don't actually do any good.

It does do good. I said that I don't care about the effectiveness. That doesn't mean it isn't effective. Nor does it mean that you shouldn't wear one.

why are you reluctant?

> It sounds reasonable in closed spaces (like in the examples you gave). But I'm reluctant to wear a mask outside in low-density area (I would if there were strong evidence it made any difference).

It gets weird because there are many non-closed spaces which are very crowded. Imagine a concert, or the boardwalk.

That's because the evidence all points to indoor transmission via airborne particles. There was an article here earlier today wherein it was pointed out that being outside there is a very small chance of getting infected. It's being indoors with poor air circulation that where the infections happen.

The way I see it, every law we pass is, roughly, choosing a tradeoff between liberty, safety, and economic productivity. We don't allow people to drive as fast as they like. On the interstate, we limit that to say 75 mph. That leads to more deaths than if it were 25 mph. Collectively, we have decided that 75 mph lies near some optimum. Certainly, some view it as too fast, some view it as too slow. Not everybody has the same risk tolerance.

It's no different with masks.

My main question is: For how long?

First, presume COVID will never be completely eliminated. (Certainly it will never cease to be detected by widespread RT-PCR testing with a 1-2% FP rate).

If you won’t grant me that, presume that equally deadly (to certain demographics) diseases will always exist.

Do we never get to go around outside without a mask on again?

Some cultures think that’s the right choice. Some do not. There are valid arguments on both sides, so I think it’s not appropriate to belittle either perspective.

Being required by law to wear a mask whenever you are out in public (and not eating?) is a major cultural shift. It’s reasonable that people will have different readiness to enact, e.g. a Federal law with major financial or criminal penalties involved.

My ancillary point would be that COVID is not the same level of risk in all places and at all times. So, e.g. a Federal mask policy with a $1,000 fine that applies in FL and MA all the same, where MA cases are basically at the noise floor of the test right now, is not justifiable. Or, likewise, a single policy which applies to nursery schools and nursing homes.

Particularly for large heterogenous countries, there is a huge benefit to local and regional government being able to set appropriately strict policies for their own jurisdictions.

There is also absolutely the need to be dynamic in your level of response. Look at Melbourne for example. You can’t lock down as hard as they will be doing indefinitely. Perhaps you can do it for a short time in response to an acute event. That’s just an extreme example in the overall scale of phased response protocols. Legally mandated masking is just somewhere further down that spectrum.

These have been some of my main concerns in the beginning. What is the exit strategy? Nobody can tell you. Back in March, I get a phone alert ordering me to start inside.

For how long? What criteria must be met for this order to no longer be in effect?

There was no mention of that. It was neither time limited, nor data limited (e.g., automatically goes out of effect when infection rates drop below x per million).

Furthermore, this was an executive order by our governor, not passed by the legislator, which make it all the more unpalatable.

Yes, covid is deadly. More deadly than the flu. But the flu is also deadly. We take none of these precautions for the flu. How much more deadly than the flu must a virus be for all of this to be justified.

Worth noting there have been multiple flu strains throughout modern history which have been more deadly than COVID has been so far.

Aside from 1918 Spanish Flu there was also the 1958 Asian flu which killed ~2 million.

COVID is also less deadly than even an average flu for about half of people who get it, but many times more deadly than the average flu in about a quarter of cases.

The bottom line is unless you have a set of sustainable measures which can keep R below 1, then you’re back to just bending the curve to keep hospital capacity available.

Realistically I think that locations that have a very low herd immunity percentage cannot be successful in keeping R below 1 without intensive shutdown and lockdown measures, which of course must be sustained indefinitely.

However once a certain level of herd immunity is reached in a community, a more sustainable set of measures can be enough, in concert with the innate benefits of herd immunity, to keep R below 1. I believe this explains the current dichotomy we see in places like NY and MA versus FL and CA.

It’s not a question of “MA does better wearing masks than CA” it’s a matter of masks plus MA’s herd immunity keeps MA below 1 while masks with the lower herd immunity in CA keeps them above 1.

You don’t have to be much above or below that R=1, after 30 days the results compound either way.

I like the idea of not supporting laws you're not willing to enforce by gun.

I think people should be encouraged to wear masks, but not strictly mandated.

>I like the idea of not supporting laws you're not willing to enforce by gun.

Speaking of which, this whole covid thing with the masks, the travel bans, etc. is really a great illustration of the differences between legal, enforceable and politically palatable. Of course nobody is learning these lessons because we're all busy arguing about masks.

> I like the idea of not supporting laws you're not willing to enforce by gun.

That's a really low bar.

For example, I think shoplifting should be illegal. 99.9% of the time no guns will need to be involved. But if someone is sufficiently willing to escalate, it becomes a matter of letting them steal whatever they want from stores, whenever they want, or enforcing it with a gun. You could fine them, but someone with that attitude would just ignore the fine. So yes, I'm willing to enforce shoplifting with a gun, as a last resort.

But if shoplifting is my point of comparison... I think right now that not wearing a mask is worse than shoplifting. So yes, let's enforce it. Try extremely hard to keep guns out of it, but don't just give up on making it a rule at all.

- On the other hand, -

all of the above is assuming that someone would go to ridiculously escalated and brandishing measures to fight the law. If we assume they won't do that, the situation is completely different. No guns would be necessary to enforce either of those laws, so just enforce them with safe measures. There's no need for your rule of thumb in that case.

Because I shouldn't have to wear a mask when I am riding my bike alone in the woods, or when I am walking my dog. It is uncomfortable, and outside transmission is rare so it is not that beneficial. We have to find a balance between saving lives, and taking away comfort and freedoms, just like we do with things like cars.

No cop is going to be hiding behind a tree while you are alone in the woods. When you are walking your dog, you are passing by numerous people on a sidewalk? If so, wear a mask. If not, no copper is going to be hiding in the bushes running a mask check. We can have the same balance we have with cars. Most people vaguely obey something close to the speed limit and sometimes people who are way over or just unlucky get nabbed and it happens often enough that (again), most people obey closely enough. Mask usage doesn't have to be perfect, it just has to be better than florida, texas, and southern california (LA county and surrounding) are doing it. That's not a high hurdle.

Most people haven't got the message yet that governments are acting irrationally. If governments mandate a mask law, then everyone becomes a cop. The other dog walker you see on the path, who is terrified of what they think is a disease that has killed 7% of the population[1], will report you and because it's the law you'll be punished even though it makes no sense.

Look, we're in an environment where rationality has disappeared. Now is not the time to be radically changing human interaction, possibly forever, on the basis of atrociously poor statistics and data handling.

[1] https://www.kekstcnc.com/media/2793/kekstcnc_research_covid-...

" The other dog walker you see on the path, who is terrified of what they think is a disease that has killed 7% of the population[1], will report you and because it's the law you'll be punished even though it makes no sense."

Sorry but this is utter nonsense. The authorities don't have time to track down every citizen-reported non-mask wearer. You are imagining a deep-state dystopia that simply does not exist.

Is it really ? How far removed is that from angry mob that will cancel you in situ ?

Yes it is really nonsense. No law enforcement is going to issue a fine on some informant's say so. When you drive over the speed limit, do people "report" you? No. As far as "cancel." Frankly, I have no idea what you are talking about. Unless you are a public figure, I would posit there is no such thing.

It's insane to me that people want to make such large-scale changes to people's behaviour based on some anecdotes.

Are you American by chance? This is also anecdotal, but on the internet I'm seeing wearing a masks considered "such large-scale changes to people behaviour" mostly from American commenters. In Asia they just do it, in Europe we just do it (and I live in maybe the most government-hostile country in Europe).

Mandating face coverings for everyone who leaves their house is a large-scale change. No, I am not American. I'm also now not really European, so that should tell you where I am ;)

Edit: I decided to clarify why I think it is a large-scale change. I cannot think of any other action we are actively obliged to do by law, except for possibly covering gentials, when leaving our own house/property. Introducing any such obligitory action is, in my opinion, a large-scale change in mandated behaviour.

> No, I am not American. I'm also now not really European, so that should tell you where I am ;)

i am probably missing something obvious but no, there are plenty of places that are not america or Europe.

> I'm also now not really European

It was a light-hearted comment about a country that was part of Europe and now isn't.

Tell me you mean EU, or enlighten me which country is no longer part of Europe?

> in Europe we just do it

Maybe in some European countries. The Dutch public health authorities are very skeptical about the usefulness of masks and continue to resist a mask requirement except in places where distancing is impossible (like public transport).

Where in Europe we do it? Most of the countries agree the evidence is rather weak, I wouldn't do such broad generalizations about Europe. No masks in Finland where in at, neither in Estonia or Latvia that I visited.

Japan has pretty much 100% mask coverage, but the number of cases is still rising rapidly.

To be fair, not nearly as fast as the US, but masks are not a panacea.

They don't need to be perfect, you just need to find an acceptable combination of measures that push the replication rate low enough.

No one is saying masks are perfect. But Worldometers shows Covid-19 deaths at 480 per 1 million in the US and 8 per 1 million in Japan. New cases in Japan are but a tiny fraction of the United States.

Masks have been mandatory where I'm at since March, along with full lockdown for months, and the virus is still making it's rounds. The president here is a laughing stock because he recently stated that everyone is going to get it no matter what, so be prepared -- so everyone is asking what was the point of having the shutdown then. We know lots of people that have COVID now or have had it and they are all fine (except for one elderly lady that passed). Getting sick is pretty normal here. Mass hysteria is not.

I agree they should, but a lot of these small businesses are restaurants and bars where you have to remove your mask to put food and drinks into your mouth.

> It’s insane to me that we don’t just make masks 100% mandatory when you’re outside your own home.

How do you intend to enforce this mandatory order?

> a man with a dry cough

Anecdotally, this could have been the reason the other 25 didn't contract the disease, and not really the mask.

I don't think so. A dry cough does not mean like bone dry. It means no mucus coming up from the deep lungs. Plenty of droplets are produced by dry cough.

Asymptomatic-like. I understand.

>It’s insane to me that we don’t just make masks 100% mandatory when you’re outside your own home.

We can just reopen reopen right now. Yes covid spread easily but we already know that majority of covid cases its either asymptomatic or only mild symptom.

At this point lockdown create more problem than it solves.

For an example of what people are doing in this space: Melbourne, Australia (where I live) just did this.

Kinda sorta. They want any face covering. Stick a handkerchief or bandanna over it. Or a faceshield - my pet hate as they stop immediate droplets but do nothing for aerosols.

For details: https://www.dhhs.vic.gov.au/face-coverings-covid-19

That ship has sailed.

When COVID was politicized, that chance died.

> a simple law to mandate masks 100% of the time when outside your own home.

Far too many people see that as one stop before Nazi Germany for that to happen.

Edit: I am not one of them, lol.

Where would you rank 'employees must wash their hands before returning to work' signs in restaurant bathrooms on your road to Naziism?

I do not view it that way. I wash my hands and wear a mask.

I do know people who object to those handwashing mandates though. Knew a guy who occasionally wiped his hand on the sign in protest of it.

Those are the sort of selfish people who are dragging America down.

You need to take into account culture and mentality. Making people wear masks 100% of the time might work in a country like Japan where people are disciplined and conforming but will not work in many other places where the attitude is a bit more lax.

The best way for those place is to give people mask off time in non critical places so they will be more likely to wear them in the critical places. For example, there is no point pressuring people to wear a mask while walking in quiet street where they can easily keep distance or hardly pass by other people, but you should force them to wear it when in a shop or a crowded main street.

They have a strong social conformity rate in Japan and their numbers are rising too. Masks are just kind of effective.

Japan, a country of 126 million people, had fewer cases yesterday than Georgia, a population of 10 M people. Masks work. Nothing is 100% effective.

Would you characterize Australia as a disciplined, conformist society? I'm in Melbourne, where masks are currently mandatory, and most are complying. In practice, you see people sipping from coffees while walking down the street, then putting the mask on as they pass people.

Compared to US, absolutely. I'm in Washington State, and we do have a mask mandate here - but if you go into more conservative areas, it appears to be routinely ignored. I've seen a gas station diner where 90% weren't wearing masks.

For another point of reference - in Australia, do you have police officers who openly refuse to enforce such laws? Because it's pretty common in small towns hereabouts.

> We could keep the economy decently open AND keep COVID cases down dramatically with a simple law to mandate masks 100% of the time

We could already keep the economy open with little ill effect. At this point, if you’re still concerned about the health effects of covid, you should either support wearing masks 100% of the time anyway (e.g. for influenza prevention) or you’re a statistically illiterate hysteric.

Tell that to people who have died or are permanently disabled because of covid. What an idiotic, false, and asshole thing to say.

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