Comment by timr | Hacker News Reader

Comment by timr | Hacker News Reader

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The only randomized controlled trial for masks and Covid-19 found no statistically significant protective effect. Jeremy Howard didn't even bother citing it in the review you're linking:

https://www.acpjournals.org/doi/10.7326/m20-6817

The Howard review is, in general, of extremely low quality. The top-line conclusions of some of the cited articles are completely mis-interpreted, and the citations within are sloppy and misleading -- bold assertions are made without evidence, and the reader is led to assume that a leading/trailing citation provides support for the claim, when it does not. There are far better reviews of the available literature. Here is one:

https://www.cebm.net/covid-19/masking-lack-of-evidence-with-...

The meta-study commissioned by the WHO is another:

https://www.thelancet.com/journals/lancet/article/PIIS0140-6...

You'll note that they found a small positive effect for masks in the community, only when including and aggregating a large number of low-quality studies. They admit that the evidence base is weak.

In general, there's a great deal of uncertainty around the effectiveness of masks in the hands of the general public. There may be a small positive effect, but we simply don't know. One of the biggest mistakes of this pandemic has been the political weaponization of this issue, and the exaggeration of certainty -- on both sides of the debate.

I'm pretty happy with how it was handled in Germany. Masks clearly aren't marketed as a perfect solution, but as a key element in a mix of other measures that are social distancing, work from home, leave home for necessities, keep your distance during visits to the supermarket, etc.

I'm really surprised that masks turned out to be such a cause for drama. At the worst they caused discomfort, especially for people with big beards/prescription glasses, but if it turns out wearing masks helped just by a margin, isn't that already worth it, in the grand scheme of things? Isn't 1 live saved out of a 1000 already with the negatives?

It just baffles me.

Yes, I agree about the German approach. Japan (which I follow closely) is similar -- the issue of masks is drama-free, and much more pragmatic than in the US. But when I say "pragmatic", I mean it on both sides: you also don't see the insanity of people scolding other people over something with uncertain marginal effect. That's the part I can't stand here in the US.

I do think that of all of the things we have done in this pandemic, the act of forcing someone to wear something -- and on the face, no less -- is fairly obviously a politically fraught act. I'm not terribly surprised that the symbolism of the act became the story.

it's like a condom for your face. What's not to love? I plan to keep wearing it even after this is all over.

In smarter countries, people wear masks whenever they are sick as a thoughtful courtesy to protect those around them. I'd like to see that attitude worldwide.

> it's like a condom for your face. What's not to love?

I know you're being cheeky here, but just to be serious for a moment: there's a HUGE literature on the subject of condom use and public-health messaging from the 80s and the HIV crisis. Condoms are...not exactly popular, of course (the TL;DR is that shaming doesn't work very well. Honesty and education >> scolding and shaming when it comes to behavioral change that is intimate and unpleasant).

It's continually astounding to me how many lessons from that pandemic seem to have been forgotten.

There is no "uncertain marginal effect." The science is in, and it's clear.

https://www.nature.com/articles/d41586-020-02801-8

As for "politically fraught" - people are forced to wear things called clothes literally every day. Some are forced to wear business suits and other eccentric, uncomfortable, and context-specific attire.

People are also forced to wear seatbelts and act in other ways which show responsibility for public health - for example by not smoking in public areas.

The political point here is that masks - which have now been proven to be helpful - are only considered a 'politically fraught act' by people who want to politicise the Covid response.

For people who are rational about this, there is no issue.

For people who are hostile to public rationality, there is.

> There is no "uncertain marginal effect." The science is in, and it's clear.

Statements like this help no one. "The science" is not a noun. It is not "in". There is a great deal of uncertainty in what we actually know about masks. The article you're claiming is definitive proof admits as much:

"being more definitive about how well they work or when to use them gets complicated. There are many types of mask, worn in a variety of environments. There are questions about people’s willingness to wear them, or wear them properly. Even the question of what kinds of study would provide definitive proof that they work is hard to answer."

Again, please read the Lancet, CEBM and DANMASK links I linked above. You will see that there is a great deal of uncertainty.

That was the issue initially where scientific messaging clashed with public messaging.

People said "Will masks protect us?" and scientifically, the answer is no. No mask will 100% protect you

Unfortunately people take that and run with it to mean masks are useless and do nothing at all. If this has taught us anything, is that you can't give the layperson scientific information because they don't really understand the impact.

If the message from the start had always been "No it won't completely protect you, but wearing any kind of mask will drastically slow the spread" then maybe people would've been more receptive (And maybe the US wouldn't have politicised mask wearing)

I find this need for certainty to be the most embarrassing part of this whole pandemic. What kind of person really cares how effective they are? They cost next to nothing, they’re comfortable and convenient. If they save one life, that’s worth wearing a mask.

Again to echo the person you’re replying to, the fact we still have to have this conversation is embarrassing.

> I find this need for certainty to be the most embarrassing part of this whole pandemic. What kind of person really cares how effective they are?

A scientist.

There are a great many things that we did during this pandemic that had no evidence whatsoever, and turned out to be wrong. Some turned out to be harmful (over-ventilation, for example). Are mask mandates one of these things? I have no idea. Neither do you.

It isn't wrong to admit that we don't know, because that's the first step to finding the answer.

The one thing that defines fervent anti-maskers, anti-vaxxers, the "let's open for business while people are still dying" crowd, and others with bizarre beliefs is that they make their statements with absolute certainty, and with no admission that they might ever be wrong.

Medical understanding of Covid has made huge strides over the last year, precisely because doctors and researchers never claimed to be omniscient about the virus.

Meanwhile the deniers are still claiming the virus is "just a bad case of flu" and "masks don't do anything" and "lockdowns don't work" in spite of the accumulated mountain of evidence that those statements are nonsense.

> The one thing that defines fervent anti-maskers, anti-vaxxers, the "let's open for business while people are still dying" crowd, and others with bizarre beliefs is that they make their statements with absolute certainty, and with no admission that they might ever be wrong.

You have now commented twice in response to me, and in one post you cited an editorial in Nature as definitive proof of "the science" on masks, and now you are making black and white claims that would seem to group together people who question masks with "anti-vaxers" and other negative charicatures.

To the extent that I am making a claim here, it is that we need to be more circumspect in our discussions of science. I am advocating for less certainty, and more humility.

You seem to be making claims with a great deal of certainty.

This is unkind and frankly untrue.

Quotes from OP, in this thread:

> The one thing that defines fervent anti-maskers, anti-vaxxers, the "let's open for business while people are still dying" crowd, and others with bizarre beliefs is that they make their statements with absolute certainty, and with no admission that they might ever be wrong.

> Meanwhile the deniers are still claiming the virus is "just a bad case of flu" and "masks don't do anything" and "lockdowns don't work"

> There is no "uncertain marginal effect." The science is in, and it's clear.

> The political point here is that masks - which have now been proven to be helpful - are only considered a 'politically fraught act' by people who want to politicise the Covid response.

> For people who are rational about this, there is no issue. For people who are hostile to public rationality, there is.

All of these are examples of black/white thinking, straw-man and red-herring logical fallacies.

And again, this is cruel and divisive. At this point, you’re not being a scientist or even being critical. You’re just being cruel because you need to be right. That’s beyond me, dude.

Quoting someone is cruel?

I have never spoken to an individual with less understanding of humans or human emotion than you. That's almost amazing except that at this point, it's pathetic and dangerous for the world. Your entire tone is egotistical, overly aggressive and rude. Now no more of this, I genuinely wish that I had never engaged with you.

Your argument would be sound except that masks are regarded as being completely safe. They are a no risk shot at saving lives. So again, what is the purpose of sowing this type of division amongst people?

> Your argument would be sound except that masks are regarded as being completely safe.

Prove it. So many assertions...so little actual evidence.

And for the record, I'm not talking about silly stuff like "wearing a mask raises my CO2 level". There's a very serious debate to be had about risk compensation -- because of the over-the-top messaging about masks, a large number of people think they're personally protected when wearing them. That can make people do risky things. Howard's review skims over the issue and pretends it is settled. It is not.

It's not clear at all that masks -- and in particular, mask mandates -- have a positive net effect. The RCTs on the subject certainly do not support strong claims of effectiveness.

No bud, after how you chose to speak to TheOtherHobbes, I'm not interested in continuing this. I have no interest in trying to educate you because with all due respect, you're far too unkind for me to devote more time to.

You've made up your mind and all you're doing is hurting people. This is pointless and I'm not going to be fodder for more of your bullying.

Ah yes...I'm "hurting people"...by asking questions and talking about evidence. An illustration of the major intellectual tragedy of 2020.

If we cannot ask questions and discuss them rationally without being accused of "hurting people", science is dead. This is a fundamentally anti-intellectual reaction, it is a way of villainizing people who question your opinions, and pointing it out is not unkind.

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