I still think facemasks are selecting for more infectious strains and likely won't be effective enough in a few years unless vaccines bring us to herd immunity fast enough or the virus mutates into something less severe.
In US and Europe, policies and behavior (such as mask-wearing and social distancing) have become stricter as the number of cases rise and more lenient as the number of cases fall. This means that the reproduction number hovers around 1.
If we imagine that R_0 for Covid-19 is 2.0, no measures are taken, and a variant which is twice as infectious appears when there are 10^6 cases (in a population of 10^9), then the variant will have only infected ~10^6 people by the time we have herd immunity (a very rough estimate).
On the other hand, if measures halving the spread rate are imposed when 10^6 cases are reached and the variant appears, then the variant will still spread exponentially while the original strain is curtailed, resulting in most people catching the highly infectious variant.
I have no background in medicine or epidemiology, so I'm keen for people to point out flaws.
Edit: I am not advocating that no measures to stop or slow the spread of Covid should have been taken.
Anyway, on a related vein, non-infection-protecting vaccines can do exactly what you’re saying and select for more virulent/pathogenic strains. Take a look: https://journals.plos.org/plosbiology/article?id=10.1371/jou.... Because all the COVID/19 vaccines do not prevent infection nor transmission (they reduce it but don’t fully block it), our incredibly shortsighted mass vaccination campaign is likely to select for more pathogenic strains. Go science!
> Could some vaccines drive the evolution of more virulent pathogens? Conventional wisdom is that natural selection will remove highly lethal pathogens if host death greatly reduces transmission. Vaccines that keep hosts alive but still allow transmission could thus allow very virulent strains to circulate in a population. Here we show experimentally that immunization of chickens against Marek's disease virus enhances the fitness of more virulent strains, making it possible for hyperpathogenic strains to transmit. Immunity elicited by direct vaccination or by maternal vaccination prolongs host survival but does not prevent infection, viral replication or transmission, thus extending the infectious periods of strains otherwise too lethal to persist. Our data show that anti-disease vaccines that do not prevent transmission can create conditions that promote the emergence of pathogen strains that cause more severe disease in unvaccinated hosts.
Can you point me to a non mechanistic non associative study that demonstrates that face masks work to prevent community transmission of SARS-2?
EDIR: I can’t reply to the child comment about condoms (does HN have a nesting limit?) but suffice to say we only have 1 RCT on SARS-2 so playing the significance game is silly. You can’t point to a single RCT showing an effect because it doesn’t exist. That’s the problem. We’re mandating an intervention that is unproven to work and rests on theoretical assumptions that are now known to be false.
You can go look at non-SARS-2 RCTs if you want but those also look abysmal. For example go read Macintyre’s cluster-randomized controlled trial of cloth masks in healthcare workers. It’s not encouraging.
> Face masks ... don’t work to slow transmission whatsoever
and when pushed on it, you imply that this is true because there’s been no trial on it, which is not how implication works.
You then also try and suggest the presence of an unfalsifiable hypothesis which you don’t try and explain, and seems suggestive that you don’t know what the term means?
That’s the brilliance of “my mask protects you”. It’s not feasibly falsifiable. “My mask protects me” is very easy to falsify. That’s why we have one RCT that studied exactly that and failed to reach significance.
Again, the theoretical MoA of masking only makes sense if SARS-2 spreads via respiratory droplets. If it spreads via aerosols, the sub-micron aerosol particles stay aloft for minutes-hours and bypass the comparatively giant holes of the mask with ease. The sightly altered directional flow is largely irrelevant. You can watch any of the many videos of someone vaping with a mask on/off to see what I’m talking about. Imagine that every time you exhale.
That’s not what that means.
Do condoms work against sexually transmitted diseases? 5 out of 10 RCT studies reported statistically significant effect. Do condoms work against unwanted pregnancy? 0 out of 4 RCT studies reported statistically significant effect.
Forgive my tone but...just wow.
So is the mentioned mask RCT study. They should be quite comparable.
Masks reduce respiratory disease transmission in hospitals. They work outside of hospitals, too. Covid-19 spreads like any other respiratory disease.
If you don't want to wear a mask, then stay at home. I have the right to participate in society without catching a dangerous disease from you.
If your mask is uncomfortable, then try some different ones. I use masks made by Burlway [4]. They are very soft. They fit my face perfectly and haven't stretched or shrunk. I have 10 of them. I keep clean ones in a drawer near the door. My going out ritual is now "keys mask phone wallet."
[0] https://www.governor.wa.gov/news-media/inslee-announces-stat...
[1] https://vtdigger.org/2020/07/24/scott-orders-mask-mandate/
[2] https://www.newscentermaine.com/article/news/health/coronavi...
[3] https://ig.ft.com/coronavirus-chart/?areasRegional=uswa&area...
You're essentially saying that the disabled (illness is a disability) should be excluded from society.
Shun the unclean and diseased?
You have the option of staying inside if you're afraid of mingling with certain people.
“Freedom” does not extend to not wearing masks during a pandemic. Your freedom stops when you are a potential asymptomatic/symptomatic spreader of a potentially deadly disease to others.
Therefore, masks should be required for everyone.
Also, I am disabled and I agree with this poster’s comment. It was definitely not ableist at all. It was 100% in support of masks when out in public.
I guess condoms must be mandated since antibiotic-resistant STIs are almost inevitable right now.
I guess we have to outlaw unprotected sex.
I'm not expressing an opinion here; I'm trying to understand why you would take for granted that everyone thinks such behavior is ok or inevitably legal, setting aside the specific context of COVID and current partisan conflict.
So something like masking is required even if someone seems healthy. It's a regime of constant anxiety and latching onto any and every doom scenario.
So with the same logic, we should be assuming every sex partner has an incurable STI. Especially with the emerging threat of antibiotic-resistant strains, the most risk-avoidant with respect to SARS-CoV-2 would only be consistent by likewise being in favor of extreme measures like mandated condoms, quarantining, forced testing, etc. with something like STIs.
I don't agree with this at all - but it's clear that there's a fixation with COVID that doesn't get applied to other large aspects of society.
If we care about people's health - why don't we lock up fat people and force feed them a strict diet until they're a healthy weight? It's hard for me to see anything under the current public health/political regime that wouldn't justify this.
From what I read on the internet, it's long been a custom in many places in the far east to wear a mask whenever one has or might have the cold or flu or whatever.
At this point, I'm thinking why shouldn't we westerners adopt that, going forward?
It appears that wearing masks drastically reduced flu transmission, which seems logical given that it's much less contagious than covid-19. That presumably saved many lives.
And the common cold is not worth developing an advanced vaccine against, but what would we be losing if we prevent its transmission?
So I don't see why masks are a bad thing even if covid vanished tomorrow. There are so many measures we take to mitigate things that have substantial known and unknown risks, so it's mysterious to me why people are so vehemently against one with no downsides.
Humans have millions of years of evolution searing into their DNA the impulse to socialize with other humans.
I think you're underestimating the effect of completely obscuring the face - how people indicate subtle social cues, emote, and communicate.
This ignores that masking is a nuisance, I don't care what other people say: they're virtue-signalling, Stockholm syndrome victims in my opinion.
Breathing fresh air, unabated, is one of the greatest pleasures in life.
Nobody has this right. This positive right has never existed. And for good reason. It leads to all manner of evils taken to the extreme.
Is this an example of the positive right that you say never existed and leads to all manner of evils?
Do you think the proponents of it are uniformly politically aligned with the people in favor of masks for COVID?
Anyway, I don’t believe in throwing someone in jail for such an act. Some people do.
But I don’t think that invalidates the point that such a right does not exist, because “spread disease” is a superset of “knowingly spread disease”.
Ironically here in California it is legal to knowingly spread AIDS to someone, because democrats, yet that same political faction thinks that you are responsible if you unknowingly spread COVID-19 to someoen. (As an aside the absurd “infecting Grandma in the grocery store” doesn’t happen anyway because that’s not really where COVID spreads but I digress)
This has mostly been falsified in at least one controlled study [1].
The Danish study is the closest thing we have to RCT on masking [2] which found no statistically significant result from universal masking.
Wearing a mask while symptomatic seems like a good idea though, if you're unable to stay home for some reason, though that's good advice for most airborne contagious illnesses. I appreciated the culture of doing this when I was in Japan - if for no other reason than it told me who to keep my distance from.
There is overwhelming evidence that the virus is spread by fine aerosols: https://www.thelancet.com/journals/lancet/article/PIIS0140-6...
It is widely reported (and noted in the article above) that cloth masks are not effective against such particulates.
One of the only studies on the topic found that cloth masks were penetrated by ~97% of such particles: https://bmjopen.bmj.com/content/5/4/e006577
Not to mention make versions for unusual face sizes (big and small). I cannot find one large enough for my face.
[0]: https://www.cdc.gov/niosh/npptl/respirators/testing/NonNIOSH...
N99 and P100 masks typically include a gasket which improves the seal dramatically. They also come with the bonus of filtering substantially more fine particles. Given than the size of the aerosols in question are less than 5 microns and that the ratings are in relation to 0.1 microns, getting a higher rating is probably a good idea.
Even better still is a silicone mask which is trivial to leak test by covering the filter cartridge inlets (negative pressure) or exhaust valve (positive pressure).
[1] Optrel Swiss Air: https://industrial.optrel.com/fileadmin/optrel/redaktion/pdf...
[2] CleanSpace Halo: https://cleanspacetechnology.com/wp-content/uploads/2019/11/...
Do N95s work for source control though? They certainly do work for self infection but I haven’t personally read any N95 studies on source control so am not sure.
If everyone was wearing a particulate mask (e.g. N95), source control wouldn't matter as much. Masks with an exhaust valve are significantly more comfortable and comfort is the reason the CDC is currently citing in regard to their recommendation for people not to wear particulate masks.
If your protection plan relies on everyone else doing something complicated correctly, you have already lost. I think controlling the spread of a virus in the general population using source control is not something our species is capable of.
Sure, cloth masks were widespread for about a year but by now usage of FFP2 masks is becoming extremely widespread, especially since the supply is by now overwhelming.
Kind of ironic that you’re not allowed to wear an N95 with an exhale valve, but are encouraged to wear a surgical mask, bandana, cloth mask, or dirty T-shirt, none of which provide any source control.
Again, the elephant in the room is respiratory viruses in general, and SARS-2 in particular, spread via aerosols. Non-N95 face coverings cannot block aerosols. Indeed mask wearing leads to deeper breaths to maintain homeostasis (this has been studied), therefore lead to a greater net volume of air, therefore lead to increased aerosol emission before even accounting for the potential to nebulize large droplets into a shower of tiny aerosol particles. But I digress.
Masks incur costs; at a minimum you must admit they alter risk appraisal if nothing else.
Anyway, nobody in this thread has addressed the point that masks don’t even work in theory if aerosol transmission is the dominant transmission mode. That’s before accounting for the incredible cross contamination and misuse of masks that you see in the community.
There has not been a surge of new cases.
Throughout 2020, Broken Bow, OK received millions of tourists, it was the #2 short-term vacation rental destination in the country, according to VRBO.
It's a small town with crowded bars. Very few locals or visitors wore masks.
There was not a significant rise in severe Covid cases, and schools mostly kept masking optional.
Is this your concern with the covid vaccine? That a strain which would have killed someone unvaccinated, that person will now instead stay alive and spread it?
The viruses used and discussed in that study had between a 60% and 100% fatality rate. This is pretty different than covid 19
So yes, that is my concern. But I mainly mention it because it’s a handy counter to the utilitarian collectivist argumentation without having to argue against the ethics of collectivism itself.
https://bmjopen.bmj.com/content/5/4/e006577?fbclid=IwAR1eSyc... - cluster-randomized controlled trial of masking in hcw. Compared cloth masking to “standard practice”, not a no-mask control, but results caution against usage of cloth masks due to abysmal filtration efficiency and the increased infections in the group relative to standard practice
I’d have to cite like 10 different studies to show the full story on aerosol transmission and I’m on mobile so I’ll leave that as an exercise to the reader for now. But I’d like someone to at least answer this:
If you take it as fact that SARS-2 primarily spreads through aerosols, what does that imply about the efficacy of masking for source control of SARS-2? There is a reason that the health authorities advocating community usage of masks (which they never did for any respiratory pathogen pre-COVID btw) maintain that SARS-2 spreads through large respiratory droplets. It’s because otherwise the whole concept of community masking is absurd.
But why would they keep saying it? Maybe they are effective. Maybe it's the politician's syllogism. Maybe they're worried that back-peddling would hurt their credibility. Maybe they create enough of a sense of both safety and fear to keep society functioning.
Is that actually a fact though?
So let’s try again:
If you take it as a given that SARS-2 primarily spreads via aerosols, what does that imply about the efficacy of strapping a warm, damp piece of cloth over your breathing holes?
Worsening rosacea
Difficulty communicating with the hard of hearing, language learners, etc
Reduced ability to convey info via facial expressions
Altered risk appraisal
Having to stand closer or speak louder to convo partner
Psychological discomfort
Bacterial pneumonia
Cross-contamination (hand to mask, mask to hand, hand to face)
Mild negatives from uncomfortable pressure on ears
Sends a message of societal fear that there is something to be afraid of (you might consider this a positive, I don’t personally)
Encourages viewing the wearer as just a vector for disease
Increased CO2 buildup
Calling the risks minimal to acne makes no sense. It’s one of the worst contributors to acne in any person’s daily life.
Even if I agreed with your exponentiality argument the whole point is that I’m saying masks don’t reduce spread. You seem to think there’s only possible upside, but there is equally downside wrt xmission; that is, masks run the risk of worsening transmission.
Furthermore, there is nothing to suggest that masks run the risk of worsening transmission. I see from your other comments that you're familiar with the mask clinical trials (presumably you're referring to the Danish study). That study was inconclusive (also note that it was _severely_ underpowered), and considering that _nothing_ in our previous knowledge suggests that they worsen infection rates, your reasoning is once again flawed.
They increase net volume of air exchanged, therefore all else equal they increase the release of aerosols. There’s furthermore a strong chance that they actively nebulize respiratory droplets into fine aerosols; ie they incresse the relative aerosolization and therefore the absolute aerosols.
They make convo partners stand closer together or speak louder.
They alter risk appraisal.
It is foolish to rule out any downsides. At best you’re advocating for a condom full of holes. At worse you’re advocating for a condom that magically worsens STI transmission.
The other arguments are of the "seatbelts cause more accidents" variety, which honestly aren't worth refuting. But I'll just note that social distancing has much weaker evidence of affecting virus transmission than even masks (there is no real justification for the 6 feet number and mostly unlikely it makes much of a difference). Hell, social distancing is even much more difficult to comply with than wearing masks so your argument makes no sense at all.