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Comment by BrendanEich | Hacker News Reader

On Fauci, see https://twitter.com/BrendanEich/status/1342752109486166016 among other tweets from me naming him.

I think Fauci fell a beat behind the narrative marching band in March when he said no to masks for the general population, and so had to make up a dumb story in June about how he nobly lied to save PPE for frontline workers in March. This is obviously false (HCWs wear fitted N95 or better masks, must maintain and keep both good fit and a working backup; these masks are not for gen-pop) and still bad for credibility (lying for the greater good is lying, and the greater good story of PPE conservation was itself a lie).

Fauci is a dishonest careerist who has harmed many people over decades and misspent huge budgets. Larry Kramer knew this. Kary Mullis agreed: https://www.youtube.com/watch?v=AtgUGxxzB_c.

On masks, see https://rationalground.com/mask-studies and read the linked papers yourself, don't rely on Wikipedia. The Danish RCT was held up for political reasons (https://twitter.com/AlexBerenson/status/1317875526997102594), then published only with some weasel words added as quote-bait to deflect from the actual results: https://www.acpjournals.org/doi/10.7326/M20-6817.

Coronaviruses show strong latitude-dependent seasonality per Hope-Simpson's pioneering work on respiratory viruses. NPIs don't much affect disease progression. Correlation is not causation but anti-correlation is a big problem for those arguing masks help:

https://rationalground.com/mask-charts/

https://rationalground.com/more-mask-charts/

I'm old, and per the CDC's estimated age-cohort IFR (https://www.cdc.gov/coronavirus/2019-ncov/hcp/planning-scena... — see Scenario 5 column, note IFR figures there are per unum not percentages), therefore more at risk of death from Covid-19. I wear a mask in any bad, mixed, or unknown-quality indoor air environment. This is my risk analysis and my choice, not yours. I don't wear outdoors and no one should, all contact tracing studies I've read agree on this (so do the many hypocritical politicians who've gone maskless without fear). So I object to gray-area-legal mandates for all, especially for young people.

The policy reversal on masks last spring was not based on new science. It was in part a big rip-off (Newsom paid 4x and spent >$1B of the California taxpayers' money, this was obviously skimmed here before net-settled to China), and in large part a compliance exercise. That you jump into HN to police my dissenting stance is frankly worse in my view than Fauci being a corrupt careerist. I expect better from hackers and engineers.

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> It was in part a big rip-off (Newsom paid 4x and spent >$1B of the California taxpayers' money

Are you really claiming that Fauci is making national statements because he is trying to provide cover for Newsom? You live in California so Newsom's policies are in the front of your mind, but people outside California don't give a rat's ass.

COVID-19 is a new virus and at the time Fauci made that statement there were a few hundred cases total in the US and research had barely begun. We've learned a lot more about the virus since then, and I'd be surprised if the advice hadn't changed over time, similar to the early aggressive use of ventilators.

I never said Fauci did something connected to Newsom. Read more carefully, stop jumping to conclusions. Also, Fauci was a beat behind in March by arguing against civilian masking, so how could he be helping Newsom? He didn't flip-flop until April, and no one said this had a thing to do with Newsom. It had to do with general narrative shift to push masks on the general population.

The Newsom-overpaying example was just one of many. Mask profits shot up due to mandates. This was front-run by sharpers.

https://twitter.com/BrendanEich/status/1345074213107892224

> COVID-19 is a new virus ...

Please educate yourself better before coming at me with such gaffes. COVID-19 is the disease, SARS-CoV-2 is the virus, and as its name suggests, it's not entirely novel. Masks were known not to help with respiratory viruses (Flu, CoV, etc.) and WHO + CDC policy advised against mass masking. Asian populations did start masking due to SARS1 and those habits endured, but there is simply no evidence this mattered across real populations. Cherry-picked two-week-long studies in Kansas to the contrary notwithstanding!

On ventilators: they were abused to control nosocomial spread to the point of causing lung injury. This was inexcusable, it was not just innocent "ignorance" of a "new virus". Dr. Cameron Kyle-Sidell blew the whistle in early April, but the NY medical staff who overused vents had no excuse in March. Sweden and other countries' medical professionals knew better.

> I never said Fauci did something connected to Newsom. Read more carefully, stop jumping to conclusions.

The comment I was referring to was this statement of yours:

> The policy reversal on masks last spring was not based on new science. It was in part a big rip-off (Newsom paid 4x and spent >$1B of the California taxpayers' money,

You talk about Fauci flopping his stance on masks, you talk about policy reversal on masks, you talk about Newsom's mask expenditures, you call Fauci a corrupt careerist in the comment I'm replying to and mostly in consecutive sentences.

No doubt my reading skills could be better, but perhaps you should stop and realize that while what you intend to say may be crystal clear in your head, you perhaps could have stated things more clearly.

> Please educate yourself better before coming at me with such gaffes. COVID-19 is the disease, SARS-CoV-2 is the virus,

Are you always this pedantic? And always so belittling?

as a Scandinavian, Sweden is one of the worst examples you could've picked for how COVID was handled.

https://ourworldindata.org/coronavirus-data-explorer?zoomToS... (Baltics and UK added for perspective).

The fact is Sweden lies in middle of the Eurozone pack. It had low excess mortality in recent years, which left many very old people likely to die of/with Covid if they were not protected. I'm not switching topics to defend Sweden's policy. My note was about pop. density.

If you want to go at it about Sweden vs. other countries in Scandinavia, we can take it to Twitter:

https://twitter.com/geenlid/status/1360771792105730049 (thread)

https://twitter.com/jhnhellstrom/status/1354051901751484419 (radial excess mortality plot)

The fact is Sweden lies in middle of the Eurozone pack.

But at the bottom of the Nordics: It is somewhat suggestive that none of Sweden's direct neighbours show significant excess mortality in 2020...

There are differences among these countries, but first, let's talk about reporting. Sweden says any death within a month of a Covid diagnosis (no PCR+ required, another can of worms) is due to Covid. Other Nordics are less sloppy. This makes Sweden count more deaths.

Finland is a hot mess on all health stats.

Norway has done better but also disavowed lockdowns.

Policy concerning covid diagnosis is not relevant when the metric under discussion is excess mortality.

I agree (modulo "top" vs. "bottom" when we're talking about worse being greater-than), but your "at the bottom of the Nordics" was not about excess mortality.

Quote: "It is somewhat suggestive that none of Sweden's direct neighbours show significant excess mortality in 2020..."

Also, I wonder what you mean by Norway disavowing lockdowns? Because they did institute fairly strict measures on March 12, eventually going so far as forbidding people to travel to their cabins to avoid putting strain on rural infrastructure.

Was there some sort of public disavowal after the fact?

The “bottom of the pack” was in reference to ourworldindata cumulative Covid deaths (counted differently in different countries). Could you please link me to the multi-country excess morality data?

> Could you please link me to the multi-country excess morality data?

Not sure if there's something better, I just clicked through https://ourworldindata.org/grapher/excess-mortality-raw-deat... via 'Change country'.

As the graphs can be misleading due to the different scaling of the y-axis depending on the country, I also pulled the data and did my own analysis, eg comparing 'Sweden' against 'all Nordics' and 'all Nordics but Sweden'.

For Denmark, Finland and Norway combined, there were fewer deaths at the beginning of the year compared to the previous 5-year average, and a bit more deaths in April and May - basically a wash, ie 'no worse than the flu'.

The situation in Sweden is different, with significant excess mortality.

Thanks. Any age-cohort data?

No, my own dive down the Covid rabbit hole has been fairly shallow so far (I used to keep track of local numbers, but eventually stopped; a couple of weeks ago, I looked at excess mortality in the Nordics because Sweden continued to pop up in online discussions).

It depends on what you are optimizing for...

Agreed.

In any case, Swedish doctors knew not to abuse ventilators, as did doctors in many other places. This point got lost in the usual assumptive attack on Sweden, but it's the only reason I mentioned that country. A friend in biotech talked to an ER doc in Stockholm who confirmed that they would never intubate + vent on a closed system, as NYC hospitals apparently did in an unethical attempt to control spread.

> as NYC hospitals apparently did in an unethical attempt to control spread.

I am curious where did you git this from? In the spring 2020 COVID patients in New York City ICUs were intubated not to control spread of the virus (there were many more actively shedding virus patients on regular hospital floor) but to sustain patients' life when their oxygen saturation drops dangerously low. Some patients were so bad that they were put on ECMO. Putting people on a ventilator was not an issue in itself, it is keeping them on ventilator for weeks on time that was problematic.

> Masks were known not to help with respiratory viruses (Flu, CoV, etc.)

The Cochrane Library 2010, Issue 1 - emphasis mine:

Physical interventions to interrupt or reduce the spread of respiratory viruses

Although respiratory viruses usually only cause minor disease, they can cause epidemics. Approximately 10% to 15% of people worldwide contract inﬂuenza annually, with attack rates as high as 50% during major epidemics. Global pandemic viral infections have been devastating because of their wide spread. In 2003 the severe acute respiratory syndrome (SARS) epidemic affected ~8000 people, killed 780, and caused an enormous social and economic crisis. In 2006 a new avian H5N1, and in 2009 a new H1N1 ’swine’ inﬂuenza pandemic threat, caused anxiety. Single measures (particularly the use of vaccines or antiviral drugs) may be insufﬁcient to interruptthe spread. Therefore, we searched for evidence for the effectiveness of physical barriers (such as handwashing or wearing masks) in reducing the spread of respiratory viruses, including inﬂuenza viruses.

We found 60 studies including randomised controlled trials (RCTs) and observational studies with a mixed risk of bias.

Respiratory virus spread can be reduced by hygienic measures (such as handwashing), especially around younger children. Frequent handwashing can also reduce transmission from children to other household members. Implementing barriers to transmission, such as isolation, and hygienic measures (wearing masks, gloves and gowns) can be effective in containing respiratory virus epidemics or in hospital wards. The more expensive, irritating and uncomfortable N95 respirators might be superior to simple masks. It is unclear if adding virucidals or antiseptics to normal handwashing with soap is more effective. There is insufﬁcient evidence to support screening at entry ports and social distancing as a method to reduce spread during epidemics.

Shorter form: N95s might be better and "barriers to transmission and hygienic measures (wearing masks, gloves and gowns) can be effective". This is mush.

The RCT papers on hospital mask users I've read either count only N95s, or confound them as the main mask type by including polypropylene masks too. The statistically significant results support N95s when fitted well.

Mask mandates for civilians are polyprop or even cloth. Not N95s, which are infeasible for general population members. WHO and CDC did not recommend masks for general populations in past respiratory virus outbreaks/pandemics. Are we done yet?

For reference, the paper I cited is available online [1], but it's different from the version I used. In particular, the section I quoted from now reads "We found no evidence that the more expensive, irritating and uncomfortable N95 respirators were superior to simple surgical masks".

A citation of interest might be [2].

> Are we done yet?

I probably am, but feel free to comment if you think there's still something of value to add.

[1] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6993921/

[2] https://pubmed.ncbi.nlm.nih.gov/19797474/

I've read other studies that show N95s as superior, which you'd expect. They are fitted, they use an extra polyprop layer. But we can stop here, because this finding (like the many I read for N95 superiority among HCWs) did not cause WHO or CDC to advise mask mandates for all. That was novel last spring, and WHO later backed off for children.

I follow you on Twitter and think some of your ideas are great. That being said, a lot of the COVID graphs you retweet ignore population density and contend that COVID isn’t a pandemic. (Some suggesting it’s the same as a cold.)

Also, flatly saying that mask mandates don’t work is wrong. The evidence is (and has been) that they are effective if used properly. (Don’t touch them, wash hands, and single use or clean them.) Unfortunately, lots of people don’t use them properly and that lessens their effectiveness. You have retweeted things implying that masks don’t work.

I don't believe I've ever said "it's the same as a cold" or linked to anything saying that. Cite it if you can. I don't delete but I'll quote-tweet it to correct the record.

If you can't cite, as I suspect, what are you doing here?

Population density early tweet: https://twitter.com/BrendanEich/status/1259222845353103360?s... (worth a look at the linked thread).

Pop. density, latent immunity due to ancient CoVs (this seems to matter a lot in Asia), other particulars do not excuse the NYC and NY state record. Also you hear people claim Sweden has low density but that's not the case.

Your second paragraph shows you didn't read the comment from me to which you replied, in particular this part:

"NPIs don't much affect disease progression. Correlation is not causation but anti-correlation is a big problem for those arguing masks help:

https://rationalground.com/mask-charts/

https://rationalground.com/more-mask-charts/"

What "The evidence is (and has been)" do you mean? Cite it. Use those famous hyperlinks we worked so hard to make useful back in the day at Netscape. Ignoring what I wrote and asserting your assumptions is not helpful.

Hopefully 0-10 help illuminate what I’m talking about.

I think 11 and 12 point to masks being a good idea. The graphs you linked ignore population density and seasonal increases in transmission of viruses. An increase after a mask mandate isn’t proof that the mandate had no impact.

0. https://twitter.com/kerpen/status/1360069067017748480?s=21 — “Reminder: with flu and RSV down ~98% and replaced by COVID, which is far less dangerous to children, we are in literally the mildest respiratory illness season for children in recorded history.”

1. https://twitter.com/brendaneich/status/1336918916895965185?s...

2. https://twitter.com/brendaneich/status/1336920895344975873?s...

3. https://twitter.com/brendaneich/status/1335840898807070720?s...

4. https://twitter.com/brendaneich/status/1335346330500141056?s...

5. https://twitter.com/davidbcollum/status/1329789976683409408?...

6. https://twitter.com/ianmsc/status/1333851832205012992?s=21

7. https://twitter.com/hold2llc/status/1328879434456330242?s=21

8. https://twitter.com/ewoodhouse7/status/1323115034239737856?s...

9. https://twitter.com/ianmsc/status/1320811573682728960?s=21

10. I can’t go back far enough, but there were a series of graphs from EthicalSkeptic which seemed less than ethical.

11. https://apps.who.int/iris/rest/bitstreams/1279750/retrieve

12. https://www.cdc.gov/coronavirus/2019-ncov/prevent-getting-si...

You wrote "(Some suggesting it’s the same as a cold.)" and I asked you to cite even one tweet saying "it's the same as a cold". None of the links you gave says any such thing. Were you lying?

You seem upset about tweets that I RTed or replied to, which I can and will defend, but you can't attack them on substance. In particular, your [0], from https://twitter.com/kerpen, is correct per CDC Flu and RSV monitoring. Those viruses are way down in 2020, no one knows exactly why, but given antibody studies, it seems SARS2 spread widely and preempted them, possibly in the human nose (not lungs). This needs more study but it is nothing like saying "it's just the cold".

Kerpen is right (again, CDC has IFR by age figures) that Flu and RSV are much deadlier than Covid for children.

So you don't like my opinions but you can't refute them, yet you can gather a bunch of tweet-links. What's the point? If we are not going to argue substance, all you've done is identify me as on Team Reality. But we knew that. What's up?

There are multiple replies and retweets that compare COVID-19 to flus/colds in a “COVID-19 is the same” context. Or suggesting that drastic measures are unwarranted or unreasonable.

The kerpen tweet thread is troubling because it suggests that the CDC is both providing accurate data and that they are only providing guidance for political reasons. So they aren’t lying, but they are? Then he compares COVID-19 to the flu and cold, ignoring that transmission by children can affect adults.

Here is another one (in addition to the one above about children):

> No lockdown in 2017-2018 cold season!

https://twitter.com/BrendanEich/status/1335873383209177088?s...

That is ignoring that the fatality rate and transmission rate is significantly higher in COVID-19.

Maybe all of these things comparing the equivalence of the cold and COVID-19 mean nothing to you, but they seem significant to me. Perhaps you’ll defend these by saying, “in isolation this data is accurate.” That point falls flat when taken in context to our situation — they are marketing a perspective.

You asked me for some citations for my comments and then criticized that I provided citations for why I said what I said. Nobody said you’re on “Team Reality” but you.

(Oh, and also: I can’t go back further than 10/10 on your tweets but there were a number of retweets from EthicalSkeptic saying that the death count was a lie and suggesting that COVID-19 wasn’t a big deal.)

Edit: Here is a comment from someone in the thread discussed. This is the “subtext” I see. https://twitter.com/MarkChangizi/status/1282074580350312450?...

No one in any tweet said "it's just the cold" so you were misreading or misrepresenting — which is it?

From my "No lockdown in 2017-2018 cold season!" tweet you linked, straight up the thread two tweets, everyone can see the quoted tweet:

https://twitter.com/MarkChangizi/status/1330594561635315724

where Mark Changizi wrote:

"Overwhelmed hospitals everywhere!

...in 2017/18 cold season.

US: https://nytimes.com/2018/02/02/health/flu-symptoms-virus-hos...

UK: https://nytimes.com/2018/01/03/world/europe/uk-national-heal...

Italy: https://thelocal.it/20180119/italy-worst-flu-season-in-14-ye...

Japan: https://japantimes.co.jp/news/2018/02/22/national/science-he..."

Obviously the point is that we had overwhelmed hospitals in 2017-2018 (almost every year, the Guardian runs an "NHS overwhelmed" story in the UK) but no lockdowns.

This was not to make light of that (bad) flu season, or to say "it's just the cold". Rather, the link pointed out that we didn't lock down over elevated mortality in bad flu years. That is relevant because WHO and CDC long-term policy guidance was and is against lockdowns:

CDC 2007: https://cdc.gov/flu/pandemic-resources/pdf/community_mitigat... p. 25:

“... the effectiveness of pandemic mitigation strategies will erode rapidly as the cumulative illness rate prior to implementation climbs above 1 percent of the population....”

WHO 2006: http://upmc-biosecurity.org/website/resources/publications/2... argues against lockdowns.

If you can't follow this context without misreading as "just the cold", I say it's time to stop reading Twitter and HN right now.

(BTW, Alex Petrescu in that thread ended with a gracious concession about overreacting by using troll-form rhetoric: https://twitter.com/SeyelentEco/status/1336043936238845953?s....)

What does the word “suggesting” mean to you (in the sentence as I used it)? I’m guessing “some leading the reader to believe that it is the same as a cold” would have been more clear.

No, "suggesting" doesn't help, you are still misreading. The argument was about no lockdown in 2017-2018 in spite of bad cold season. It was an argument against lockdowns, not a claim that Covid-19 is just the cold.

Perhaps you are assuming lockdowns are good policy and help. Or you think Covid mortality is much worse than the worst post-1918 flu pandemics. Neither is true.

The argument against lockdowns was based on it being comparable to a cold/flu season.

The number hospitalized so for COVID-19 in the US exceeds the 2017-2018 season. Additionally, the mortality rate is an order of magnitude higher (61k in 2017-2018 flus vs ~500k+ for COVID-19 so far, US). Dealing with dying patients is harder on hospital staff. Treating a new illness was challenging for hospitals. That result is with the extraordinary measures that we, as a society, have taken.

>Neither is true.

I’ll admit, it’s tough to say what the lockdowns did to/for us. I’m not prepared to assert the truth as willingly as you are. I’m going to have to defer to the only study I could find on this: https://www.nature.com/articles/s41586-020-2404-8

> The argument against lockdowns was based on it being comparable to a cold/flu season.

No:

CDC 2007: https://cdc.gov/flu/pandemic-resources/pdf/community_mitigat... p. 25:

“... the effectiveness of pandemic mitigation strategies will erode rapidly as the cumulative illness rate prior to implementation climbs above 1 percent of the population....”

WHO 2006: http://upmc-biosecurity.org/website/resources/publications/2... argues against lockdowns.

The argument against lockdown as ineffective above 1% spread is based on models, see the references. Whether these are good models or not, that's what CDC policy guidance was.

Western lockdowns with many essential workers spreading the virus, especially nosocomially, are even less justifiable. Wrecking the economy, including health care sector employment and facilities, while leaving people worse off on all other health fronts (deferred checkups and treatments), plus the psychological toll culminating in elevated suicides, is not worth hard-to-measure reduction in spread. Lockdowns actually focus spread into shared housing, notably nursing homes. They also select adversely in the face of mutated variants.

Lockdown policy guidance was not based on cold vs. flu or severity of either. I have no idea why you thought this.

I'd like to point out the obvious but those links are written about flus.

Here is the advice that replaces that 2007 CDC paper (from 2017):

https://www.cdc.gov/mmwr/volumes/66/rr/rr6601a1.htm

> NPIs can be phased in, or layered, on the basis of pandemic severity and local transmission patterns over time.

It goes on to explain that it may suggest "lockdowns" if the pandemic is severe enough.

Here are the two actual papers that other link is based on (the 2nd of these is more applicable):

- https://wwwnc.cdc.gov/eid/article/12/1/05-1370_article

- https://wwwnc.cdc.gov/eid/article/12/1/05-1371_article (see phase 6)

Some quotes:

> A 1959 WHO consultation concluded, "In the Northern hemisphere at least, the opening of schools after the summer holidays seems to have played an important role in initiating the main epidemic phase" (13). Despite the propensity of influenza epidemics to be amplified in primary schools (14), data on the effectiveness of school closures are limited. Apparently no data or analyses exist for recommending illness thresholds or rates of change that should lead to considering closing or reopening schools.

> Apparently no controlled studies assess the efficacy of mask use in preventing transmission of influenza viruses.

> As noted above, influenza virus isolation rates decreased, but since multiple measures were implemented, the contribution of mask use, if any, is uncertain (20). In case-control studies conducted in Beijing and Hong Kong, wearing masks in public was independently associated with protection from SARS in a multivariate analysis.

These papers are from 2006. They are also very clear that the circumstances matter. Regarding international travel, it seems they suggest that restricting travel would be difficult, if not impossible. They suggest closing schools if a link is unknown or found between schools and transmission.

School closure efficacy has been well researched, you found the same links I did when I researched this years ago. We were talking about lockdowns, so why switch to school closures? No need to answer.

Viral family, Flu or CoV, is not material to the modeling work as far as I can tell. The models consider respiratory viruses and attack rate and other such parameters.

No authority that I know of has suggested lockdown in the past for anything similar in mortality to Covid-19. If it's severe enough... but it isn't. Please focus on this. The CDC IFR estimates show Covid-19 as worse for older cohorts, much less severe for younger, than Flu.

I'd like to add a couple of points:

1. It's not that hard for the general population to wear an FFP2 mask properly. I'm reasonably sure that this also applies to N95 masks. If you'll read the instructions that come with e.g. Dräger or Moldex masks, you'll see that the fitting procedure doesn't include anything as complicated as smell tests, but instructs the wearer to do a rather obvious leak test instead.

Dräger is now selling FFP2 masks directly to end customers: https://ffpshop.de/de/ffp-maske/draeger-x-plore-1720-ffp2-ma.... Check out the instructions, it's nothing fancy.

2. There are studies that indicate that surgical masks reduce risk even at population level. I've referenced them in a previous comment - https://news.ycombinator.com/item?id=25479729.

The conclusion of was "Any type of general mask use is likely to decrease viral exposure and infection risk on a population level, in spite of imperfect fit and imperfect adherence, personal respirators providing most protection. Masks worn by patients may not offer as great a degree of protection against aerosol transmission."

Finally, I'd like to address the RCT you've linked to from Denmark which I found interesting, but not particularly consequential. For me the biggest concerns are that:

* many things were self-reported.

* previous studies have found massive differences in wearer protection for surgical masks. Did they get a crap batch from China? It's not clear to me how they used masks. I can't reconcile 1.7 masks per weekday with the idea that such a mask should not be worn for more than a couple of hours or until it gets wet and the typical shift duration of 8h.

* didn't look at disease severity (or maybe I missed it?)

* didn't (couldn't) look at source control. For an individual it's important that they don't get sick (FFP2 preferred), for a government it's important that not too many people get sick (anything preferred, as long as it reduces transmission, even if it makes the wearer sick).

"as long as it reduces transmission, even if it makes the wearer sick"

So the only risk in life is Covid, there's no such thing as relative risk, masks could never be a net loss for anyone? No. Again, by all long-term studies, and with anti-correlation headwinds all over the place, mask mandates are not justified.

At least in Germany the potential social benefit was weighed against the personal discomfort and the latter was not considered significant enough. There are people that can't wear masks for various reasons and they can get a doctor's notice for that. In fairness, that's not working so great, since they're exposed to a lot of social pressure, especially since it was discovered that some doctors rubber-stamp these notices.

In the end, even a surgical mask will prevent e.g. the janitor from spitting on me for the 5m he comes by to check on things. If I'm wearing a FFP2, I'm also quite safe from aerosols, so it's a win, especially since maintaining distance is not something humans are reliably able to do.

Take this and multiply it by hundreds of situations and millions of people and you're bound to reduce contagion risk. I don't see why that's bad... especially since surgical masks are really cheap and not too inconvenient. Now if everyone were mandated to wear an FFP2 mask which is inconvenient maybe that would require more consideration.

Masks that don't seal tightly against skin vent (backwards as well as up and down). You feel "quite safe from aerosols" but the empirical studies don't back this up across real world large-N groups. So mandating an insufficient mask is worse than mandating one that might make a measurable difference, but in any event: mandates are not justified in my view, on also not advised by long-term WHO and CDC guidance, and they are in a legal "gray area" in the US.

Germany and USA: https://twitter.com/ianmSC/status/1359677558829191169

Just going to preface with I don't agree that masks didn't help.

The clean fit to a face is pertinent to zero exposure. This is a common test in the military: dawn your mask, cover the vents, and suck in. If you don't feel immense pressure on your face, if you can't shake your head and do it again then you're metaphorically dead. Part of this fit is having a mask that fits your face and being clean shaven.

I don't know that COVID protection needs to hit this mark, since this is designed for nerve agents and nuclear fallout. It seems like trapping quantities of the virus is good enough, since it takes some threshold of exposure to get someone infected.

Microdroplets, aerosol flows. This isn't a matter of stopping large droplets, where masks are more effective provided they don't nebulize. See also

https://link.springer.com/article/10.1007/BF01658736

https://ncbi.nlm.nih.gov/pmc/articles/PMC2493952/pdf/annrcse...

for surprising null or even slightly negative result of surgeons masking vs. surgery patient wound infections.

Assuming linear scaling or other naive-model benefits from masks runs into large-scale gen-pop experience, which has now been studied by enough RCTs to cast doubt on the assumption. Long-term WHO and CDC policy guidance was based on empirical science showing non-pharmaceutical interventions are not very effective against respiratory viruses.

I am not a large-N group though, so my main interest is whether a properly worn FFP2 mask can protect me. Everything indicates that it can. My only worry was FFP2 vs FFP3, since the former is not actually recommended to be used to protect against aerosols, but it seems that it's the default even for medical personnel - high aerosol inducing procedures aside.

The fact that others are wearing surgical or even FFP2 masks is a protective bonus for me, even if the former vent or it doesn't protect them in all cases. I believe this was the reasoning of the German original fabric mask mandate starting spring/summer 2020: mask + no mask = 0, but mask + mask = good protection against droplets. Whether that made any significant difference with the transmission in aggregate is probably impossible to tell now, but it probably did prevent at least some infections. More importantly it made masks more normal, compared to spring where you were looked at like a maniac for wearing one.

Regarding the graph, Germany was and still is in a lockdown, so numbers will be going down masks or not. Upgrading the mandate to surgical/FFP2 was done more out of fear of the new mutations and it wasn't FFP2 only because it's economically / socially not tenable. I don't know why the US decreased, but the US is way ahead on vaccines and also had more infected, so I assume it will continue to do so.

> police my dissenting

Lots of that going around, thanks for standing up.

> I think Fauci fell a beat behind the narrative marching band in March when he said no to masks for the general population, and so had to make up a dumb story in June about how he nobly lied to save PPE for frontline workers in March.

Consider this interview, done early March, in which Fauci argues against masks: https://www.youtube.com/watch?v=PRa6t_e7dgI . You don't even have to read between the lines because he explains his reasoning bluntly: "Exactly, that's the point. It could lead to a shortage of masks for people [(healthcare workers)] who really need it." He never at any point thought masks were ineffective. When he did say so in March as you see from this interview, he said it because he was concerned about shortages for medical staff. There doesn't exist evidence with which one can credibly accuse him of committing this sort of revisionism.

Bringing up Kramer betrays a lack of familiarity with Fauci's history. Kramer and Fauci eventually came to be very close friends, and Kramer is on record saying Fauci was LGBT community's best friend. Mullis lost his marbles later in his life, sounding fringe views on HIV, astrology and lots of other stuff. His contribution of PCR technique is undeniably one of the great discoveries in chemistry, but he's not an authority on much else.

I read reports of Kramer patching things up with Fauci. Excluding the ones from after Larry died that were sourced to Fauci alone, what do you know? Thanks for any links.

March 8, 2020: https://www.youtube.com/watch?v=p6pEcgDmEUk&feature=emb_logo

This video shows Fauci saying people should not wear masks, that they get a false sense of security, that there are unintended consequences: fiddling with masks, touching masks, dirtying masks/failing to clean, etc. At end "you should think of healthcare providers and people who are ill."

Also, that last point about conserving PPE doesn't apply to cloth, which health orders allow instead of polyprop. Surgical masks were plentiful in March.

Again, right there in this video, Fauci did not argue against civilian masking solely based on shortages. He really did say that most people should not be wearing. Right or wrong, he was giving advice consistent with the US Surgeon General, CDC at the time, and WHO (which has varied its advice in the last year).

> Fauci did not argue against civilian masking solely based on shortages.

No, he did. You linked the same clip I linked, except minus the 20 seconds where he reveals his reasoning. Please refer to slightly longer version: https://www.youtube.com/watch?v=PRa6t_e7dgI

I agree it wasn't a great thing to play down masks to the extent he did, but as someone else pointed out, explaining the nuance of the situation to 350 million people is a tough task. Remember the toilet paper situation? Imagine if he'd sold masks as the solution, people would try to get their hands on one at all costs, they would not have faith in home-made cloth masks, they'd want what doctors are wearing because those are the ones that really work (is what they'd be saying)! Stories like these would be commonplace: https://www.dimsumdaily.hk/160-pieces-of-n95-surgical-masks-... I frankly don't know how else he could've handled this if at the time the information available to them indicated a possible shortage of masks. What would you have done in his place at that time in that situation? And coming back to my original point: doesn't Fauci deserve a pass on this one, considering how sticky the situation was?

Give me a few minutes to find a link on Kramer talking about Fauci

I saw the longer version, it ends with Fauci saying "that's the point." But he made several points, as did the Surgeon General. The policy guidance was not in favor of mandates for several reasons. I don't know how else to say this clearly.

It seems from a recent comment from somenone in Taiwan (https://news.ycombinator.com/item?id=26139550) that masks were not mandated apart from trains and certain private settings until recently. There may be ancient inherited CoV partial immunity operating across much of Asia, people may be tidier and more careful, etc.

Masks are just one of several tools, with downside risks. From the Danish RCT and many others, they seem not significantly effective in general populations against respiratory viruses. Mandates, especially with such selective enforcement and hypocrisy in high places, plus overpaying and probably skimming a la Newsom, stink.

In saying "that's the point, it could lead to a shortage of masks for people who really need it" he's giving away his awareness of the need for masks, and the reason for why he at all suggested to avoid masks in the first place. That's to say he never had a change of mind about the effectiveness of masks.

Here are two links I could find in which Kramer talks nicely about Fauci: https://www.esquire.com/entertainment/books/a32688094/anthon... < As recently as March of this year, Kramer said of Fauci, “We are friends again. I’m feeling sorry for how he’s being treated. I emailed him this, but his one line answer was, ‘Hunker down.’” > & https://www.nytimes.com/2020/05/27/health/larry-kramer-antho...

There should be a quote of him saying something to the effect of "Fauci is LGBT community's best friend" dated around 2015 but I'm unable to find a source for this at the time, I'll continue my search though and link when I find it.

The downside risks to mask-wearing are marginal next to its benefits. I'm reviewing Danish RCT and other papers you linked now.

I'll say one other thing: I think it was poor form on my part to steer this thread off and bring to view here before everyone something you'd said that I perceived to be bad. Because I think that goes against the principle of giving everyone the benefit of doubt, it goes against the principle of charitable interpretation and really it's bad form to unnecessarily remind folks of past wrongs (because indeed when we just _expect_ better of people, they come through most of the times, so one really ought to just forget old wrongs and be more forward-looking). For your part in being one of the initial designers of Rust, you deserve some leeway anyway. Crucially though, I in a way made the error I accused you of committing in slandering Fauci. For this, I am sorry.

Thanks for that last paragraph.

Regarding Danish study, here's what I found: the authors concluded that “the 95% confidence intervals are compatible with a possible 46% reduction to 23% increase in infections among mask wearers. These findings do offer evidence about the degree of protection mask wearers can anticipate in a setting where others are not wearing masks and where other public health measures, including social distancing, are in effect. The findings, however, should not be used to conclude that a recommendations for everyone to wear masks in the community would not be effective in reducing SARS-CoV-2 infections, because the trial did not test the role of masks in source control of SARS-CoV-2 infection.”

Although this was a well-designed study, it had several key limitations. During the study period, there was a low burden of community COVID-19 infections in Denmark, and the study intervention only lasted for 1 month. Cafés and restaurants were closed for the first half of the study. Mask adherence relied on retrospective self-reports. Participants in the mask group had more documented household COVID-19 infections (n= 52) than in the control group (n=39). The antibody test used for diagnosis of COVID-19 infection had a sensitivity of only 82.5%. Finally, there was a trend toward protection in the mask group, which could have been significant had more subjects been recruited to the study or if the community burden of COVID-19 had been higher.

Please consider following two writings:

[1]: https://www.medrxiv.org/content/10.1101/2020.07.31.20166116v...

[2]: https://wmjonline.org/wp-content/uploads/2020/119/4/229.pdf

Wow, this is not a good look.

There was absolutely a shortage of PPP among healthcare institutions in the areas that were hit by COVID.

If 350 million Americans in a giant panic, decided to make a run on PPE, then there would be serious supply chain problems and it could have adversely affected the medical system.

The strategy of prioritising Hospitals, in face of a pandemic (and they use all kinds of masks, not just N95) - was actually quite rational.

In the initial phase of the pandemic, masks should be allocated where they have a very obvious effect.

Then, once they can be produced in much greater quantities, then it makes sense for individuals to start wearing them whereby we can help a little bit with transmissibility in the general population.

'The Lie' was to downplay the effectiveness of masks early, and then embellish the effectiveness later on - but that is the communications strategy behind a rational plan.

In a war, it's probably more important that the soldiers have access to weapons, they are the most effective at leveraging them. Having weapons at the home front might be helpful, but much more marginally so.

There was a 'policy reversal' due to material facts on the ground with respect to PPE availability, but that's consistent with the overall strategy.

As far as 'mask wearing in public' - it's not just 'your decision' because of the fact that you're putting others at risk and that due to the high nature of transmissibility, it becomes a systematic problem.

It's not like wearing seatbelts where it affects mostly you.

It's like if you were in an accident and not wearing a seatbelt, and as a result, you hurt 10 other people.

Daigou shoppers did buy up all over-the-counter masks in January and February, for some strange reason :-/. Amazon N95 and hazmat stocks ran low in those months too:

https://www.junglescout.com/blog/coronavirus/

Purell and water bottles ran short and gougers gouged.

By March when Fauci spoke against mask mandates, civilian-mandated mask supply chains had recovered. We bought a bunch then without trouble.

But early shortages and gouging for various products are all beside the point. Mandates on civilians that passed in March and April by county and state health orders were for people to wear polypropylene and cloth masks, not N95s or hazmat suits.

Cloth and polyprop are not used by HCWs, and Fauci was not saying "yes" to people wearing those mandated kinds of masks, while saying "no" to people buying N95s. He was saying no to masks, period, full stop:

https://www.youtube.com/watch?v=06a4RriBrhg&feature=emb_logo

He gave the same long-standard talking points against mass masking that the WHO and CDC, as well as the US Surgeon General, had made.

So there are some things that are 'slightly off' in your statement, enough to cause some odd conclusions - especially in the context of public communications.

With respect to timing, there was no pandemic in January, we're not going to see 'public fear and pandemonium' until it hits home, which wasn't until March. It wasn't until this point could there have been a true run on anything at least in the US.

The delineation between HCW PPE and 'civilian' PPE is basically moot: both N95 and surgical masks are widely used by civilians and HC.

Given the above, if there were any real impetus by 'the nations top doctor' to buy masks there would have been a massive run on all kinds of masks.

The reason that 'you are able to buy something' is precisely because the policy was 'masks are not important'.

Understand that in 2020 (and arguably today), nobody knew the difference between the various kinds of masks. 'N95' was not in the public lexicon. Masks are Masks. If the 1/2 of Americans that seem to be concerned about COVID felt that they needed masks, they would have bought them.

It would be impossible for Dr. Fauci or anyone else to say: "Buy this kind of mask over here, but that other kind of mask, don't worry about that, you don't need it" - this is beyond the threshold of complexity of something you can effectively message to 350 Million people.

The amount of pricing pressure etc. would have made it clearly more difficult for HCW around the world to get access to much of the gear they needed - we know this because even without face masks doctrine, there were a lot of shortages.

Doctors in many facilities were resigned to having to re-use a lot of gear - including masks.

If there were a public stampede for those masks, they would have had critical shortages that would have materially affected outcomes.

It wasn't until summer 2020, when COVID numbers started to come under control, that 'resource sharing' started to become effective, and that supply chains truly started to be able to handle demand did things start to seem more reasonable.

Only in June/July did a lot of HC centres across the nation start to receive major shipments of PPE.

At that point 'we made it through Phase 1' - at which time, it started to make sense to make masks part of the public health strategy.

So then the communication shifts: they start telling us how great masks are, how they can help us, and that we should wear them.

Obviously, this feels disingenuous, but it's not.

Given the risk in the system, even in hindsight, it was a perfectly reasonable strategy.

Finally, it was not 'Dr. Fauci' - it was the same across the Western world. UK and Canada started mandating in July, France in August.

Stick to the topic: Fauci said no masks (of any kind), then flipped. He did so on no new science.

People knew in January and were ringing the bell. UW made their own test based on the viral genome finally released on or around the 12th of January. The Daigou shoppers were in the US stripping shelves, and I linked to a chart of Amazon sales in the first two months of the year.

What's slightly off is your rewriting of this history to make it sound like nobody new anything. Many knew, and took steps. I don't fault Fauci for what he said in March, because it was consistent with longstanding policy guidance. But his claim in June that he lied nobly for the greater good is b.s. and it doesn't stand up to any scrutiny.

Polypropylene (surgical) masks don't stop aerosol transfer of the virus. This was known for ages. They're for fungi, pollens ,and droplets, not microdroplets. Cloth masks are even less effective and quickly become moldy face-fomites.

If you want to defend mandating these for everyone, even small children, do it directly. But don't excuse Fauci on the noble-lie pretext as if his March "no masks" advice saved polyprop or cloth for HCWs who cannot use those masks on the job. The polyprop masks come in boxes with black letter language disclaiming their ability to prevent infection. The noble-lie excuse makes no sense.

1) "It was Dr. Fauci" --> This is not true.

(Edit: As per 'BrendanEich' - point below, I had misread his earlier statement with respect to his view that this was mostly about Dr. Fauci - he didn't indicate that it was specifically about Dr. Fauci directly. That said - statements are all directed at Dr. Fauci when these policies are fairly consistent around the West and even in the US, these policies decisions are made by the CDC, Fauci, others.)

It was Dr. Fauci, the CDC, the WHO and the entire Western World i.e. Canada, UK, Germany, France, Europe etc. (not so much Asia).

"There is no specific evidence to suggest that the wearing of masks by the mass population has any potential benefit. In fact, there's some evidence to suggest the opposite in the misuse of wearing a mask properly or fitting it properly,"

Dr. Mike Ryan, Executive Director of the WHO, March 30

The same policy in Canada, UK, France, Germany.

Here is UK's policy evolution over time [1] [2].

So why are you focused on Fauci, who is doing the same thing (in coordination) with everyone else?

2)"Dr. Fauci said no masks" --> This is a misrepresentation.

Here is the WHO policy in late March:

"Dr. Maria Van Kerkhove, an infectious disease epidemiologist with the WHO: "We prioritize the use of masks for those who need it most, which would be frontline health care workers. In the community, we do not recommend the use of wearing masks unless you yourself are sick and as a measure to prevent onward spread from you if you are ill" [3]

Here is a public statement by Dr. Fauci, via CBC/60 Minutes, early March:

"In March, Dr. Fauci told 60 Minutes that masks should largely be reserved for healthcare providers. In April, the recommendations were broadened to include simple masks for the general public." [4]

Dr Fauci + CDC, Late March:

"The idea of getting a much more broad, community-wide use of masks outside of the health care setting is under very active discussion at the task force. The CDC group is looking at that very carefully, Fauci told CNN. The thing that has inhibited that a bit is to make sure that we don’t take away the supply of masks from the health care workers who need them," he continued. “But once we get in a situation where we have enough masks, I believe there will be some very serious consideration about more broadening this recommendation of using masks.” [5]

The policy was always, and repeatedly: "Don't wear masks, because our healthcare workers need them" - and they do, HCW use both N95 and Surgical Masks.

There's tons of evidence available as to the material shortages of masks and other PPE well into summer.

3) "Polypropylene masks don't stop aerosol transfer of the virus." --> this is a misrepresentation.

Yes, it's public information Surgical Masks do not filter the virus directly - do you think that millions have been duped, that the 'World Powers' have tricked us, if only we could read the label?

Here is the Mayo Clinics statement:

"A cloth mask is intended to trap respiratory droplets that are released when the wearer talks, coughs or sneezes. It also acts as a barrier to protect the wearer from inhaling droplets released by others." [6]

Surgical Masks won't directly filter COVID, however, there is evidence to support the notion that COVID is spread often in water vapour and droplets, and that Surgical/Cloth masks can at least help to minimize the risk via these vectors.

See here for a litany of studies which provide some evidence as to the effictiveness of surgical masks in HCW environments [7]

3) "But don't excuse Fauci on the noble-lie pretext as if his March "no masks" advice saved polyprop or cloth for HCWs who cannot use those masks on the job. "

The objective was to prevent a run on N95s as much as Surgical Masks - and everything else.

It wasn't a 'lie' it was 'guidance' or what we call 'Public Communications' and it's what we do in Emergency Situations to try to get 350 Million people acting consistently within a short period of time.

4) "Don't re-write history" - the timeline is in full public display.

This is what happened, it happened in public, for everyone to see, and it was orchestrated by the WHO, CDC/Faci, and his equivalents in the rest of the modern world.

It's hard to tell how much of an effect the March 'save the masks for hospitals' policy had, however, it's very rational policy, even in hindsight.

[1] https://www.bbc.com/news/uk-politics-53397617

[2] http://www.crassh.cam.ac.uk/blog/post/mask-or-no-mask-a-look...

[3] https://www.cnn.com/2020/03/30/world/coronavirus-who-masks-r...

[4] https://www.cbsnews.com/news/preventing-coronavirus-facemask...

[5] https://www.politico.com/news/2020/03/31/fauci-mask-recommen...

[6] https://www.mayoclinic.org/diseases-conditions/coronavirus/i...

[7] https://ncceh.ca/documents/guide/masking-during-covid-19-pan...

When you reply to me seeming to quote my words, try using exactly what I wrote. I did not write "It was Dr. Fauci" anywhere in the parent at https://news.ycombinator.com/item?id=26138420, so your "This is not true" is refuting someone else or knocking down your own straw-man.

Also, kindly cut the "misrepresentation" nonsense. I wrote polyprop masks don't stop aerosol transfer and that's true as stated, and relevant. In returning to mask efficacy vs. droplets (which in no way refuted the problem of microdroplets smoking around polyprop mask margins) you also left out how masks can nebulize droplets, which all else equal makes things worse.

Fauci had no reason to lie in March to save polyprop or cloth masks as HCWs do not use either in Covid-isolated floors. As I wrote way above, by the time he said this, polyprop were in good supply — we bought many.

However many fancy link footnotes you add, you can't overcome the problem that his March no-mask advice was based on sound long-term policy, no new science arose to revise it, and mandates arriving in our county and state that same month allowed cloth(!) in addition to polyprop.

Let's talk about cloth masks. Anyone can make a cloth mask. If you contend Fauci was saving cloth for HCWs (obvious nonsense), please cite the hospital that allowed cloth masks, and show the evidence of nationwide cloth shortage.

If you think Fauci was lying about cloth, but that cloth masks (as allowed to satisfy the mandates) save lives, then how dare Fauci cost lives! Right?

was no pandemic in January

It was known in January.

On January 24, 2020, the Senate Committees on Health and Foreign Relations held a closed meeting with only Senators present to brief them about the COVID-19 outbreak and how it would affect the United States.

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

Responding to _ketamine:

"In my state close to 50% of deaths were attributed to nursing homes. So either N95 wasn't available or healthcare professionals were careless. Either way it led to a lot of deaths."

So the problem with this statement is the implied assumption that 'masks are the thing'.

They are not 'the thing' just 'one of the things'.

LTC homes are very sensitive, we didn't have policies and procedures for protecting everyone. They are not Hospitals with highly paid professionals. They don't always have the best PPE. They know nothing about transmission, procedures etc. and generally have nobody to support them whereas Hospitals are full of smart, connected people.

My hunch is that many of them were totally caught off guard, had no idea as to N95 or Surgical, they don't have any special supply chain power, they didn't have testing.

They were in a chaos state and realized too late they had major outbreaks in their homes and then reacted - in some cases, too late.

Your "hunch" is wrong. Here's the letter sent by LTC worker organizations immediately upon learning of Cuomo's deadly order on 3/25 to discharge recovered elderly Covid cases to nursing homes:

https://paltc.org/sites/default/files/AMDA-AHCA-NCAL%20State...

Any fool by that point in March knew that the virus was highly transmissible. Nursing homes and LTCs did not have extra staff or isolation wards, sanitarium-level protection — but they could have. Funds wasted on the Mercy ship and Javits Center, which were barely used, should have been spent on isolation.

Civilian mask mandates have nothing to do with this, but even with N95s, nosocomial spread is a problem in hospitals, never mind nursing homes. NY intake was mixing known-infected with unknown-status/no-symptoms patients. This too was not a case of being "caught off guard". It was negligent or worse, and it relates to vent overuse.

I see masks as having two distinct purposes : 1. To protect me and my family members when we need to enter a "hot" area such as a virus-denier-owned business or other place with large numbers of people and poor ventilation. We use best available N95 type masks (KN95 for example are widely available now) for this purpose. 2. as a signal I can read from other people as to whether or not they take virus spread mitigation measures seriously. So if I see someone not wearing a mask in a store, I can reasonably assume that person is more likely to transmit the virus. Not because the mask they're not wearing is not effective, but because the lack of mask tells me that they probably mix with other people, frequent places with large numbers of other people, are friends with people who don't take quarantine seriously, and so on. So even if masks had zero effectiveness for virus transmission, they're still very useful to me in identifying people and places to avoid.

I agree with both of these as good personal policy in mixed indoor settings.

I reject "virus denier" as bait. Look at Newsom and the many other hypocrites caught in flagrante maskless. They were not denying the virus exists in their public words, but their nominally private deeds said something about their sense of relative risks that doesn't fit your cult-like "denier" language.

Ok, I admit there are "virus-lazy" people as well as virus deniers. I'm in Montana and here I believe it's a reasonable assumption that someone without a mark in a mask-required scenario is a denier, based on my f2f (outside!) discussions with people. Many deniers. Full blown FoxNews regurgitation.

LTCs are like hotels with under-paid immigrants changing diapers.

Of course they knew 'there was a transmissable virus' - but what does that mean?

"Nursing homes and LTCs did not have extra staff or isolation wards, sanitarium-level protection"

How?

With what money?

Who is going to mandate it?

Who is going to 'hire a bunch of new, trained staff immediately'?

This would bankrupt Private LTCs and the Public one's had no access to funds.

How does the mid-level manager of an LTC have the knowledge or ability to come up with emergency protocols?

These hotels were not prepared, they responded with PPE, by isolating workers to floors and residents, they increased testing, closed of visitors - and possibly, as you say did something about the air ventilation.

.. and masks were one part of the policy ...

... and now it seems they have it mostly under control.

> How?

With the money blown on Javits, Mercy Ship, Seattle field hospital that went utterly unused, etc.

Lots of money was spent last spring: https://patch.com/new-york/harrison/new-york-coronavirus-sta... is one link.

I've been through this line of argument before. First it was "no one knew" (just a hunch). When I produce evidence in the form of that letter from PALTC et al., the argument shifts to "nothing could have been done" — at the same time that tens of millions were misspent on underused or unused facilities.

Public spending went way up, including (Newsom's $1B rip off) on masks. Why are you so keen to feign helplessness and avoid accountability? Trump family taxpayer rip-offs get and deserve condemnation, but it's ok when Cuomo or Newsom does it? A pox on all of them.

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