Everyone should have been masking up as soon as possible in the pandemic. Case counts were low, we didn't know much about the route of transmission, and we also thought it was even more dangerous than it turned out to be. Precautions were indicated, but health authorities were decrying mask use as late as the end of March.
But it turns out that the primary vector is aerosols, not droplets or fomites. Any mask will mitigate droplet contamination, and the resulting fomites: this is why influenza has practically disappeared, masking is very effective against influenza, where those are the primary vector.
But no mask will do much to filter aerosols on exhalation. That's simply not how they work, positive pressure puts most of the gasses out through the sides of the mask. Even a P100 filter with cartridges won't do it, that's why they have a vent, otherwise the face seal would be broken every time one exhales. To be generous, I'll say that a cloth mask catches 30% of aerosols. It doesn't, but say it does: that's not nearly good enough. Which case counts after universal masking mandates illustrate quite clearly: they rise, and fall, and the masks don't have anything to do with it.
A good mask will filter some aerosols when inhaling: but a cloth mask won't. So once aerosols were identified as the culprit, WHO and CDC should have emphasized air filtration, which is quite effective, limiting the number of people indoors on the basis of how many air exchanges a HEPA or ULPA filter was capable of doing. Messaging should have emphasized that cloth and surgical masks are completely useless, and that at-risk people should stay home, and if they can't, should get a proper mask (KN94, (K)N95, P100) and learn how to use it. COVID doesn't survive on surfaces very long, so reuse is more-or-less ok, and there were plenty of proper masks by June, which is when these facts were available. If WHO and CDC had listened to them.
I vape, so I can illustrate this to myself quite easily: I can hit the vape through a cloth mask, but not a KN94. And with any mask, I can take a hit, put it on, and exhale a visible cloud of, yep, aerosols, around the side of the mask.
I still wear a KN94 indoors, it's the best I can do. But I'm walking around in indoor spaces with no HEPA filters, surrounded by people who are unprotected, just wearing a talisman. This was preventable.
The study in this article [0] is still in pre-print but it claims that a change to mandatory mask wearing was a critical factor in crushing the virus in Melbourne's second wave.
I've seen some comments on HN that masks aren't effective but from what I've read and observed in Melbourne/Australia they have been very effective.
[0] https://www.abc.net.au/news/2021-04-14/face-masks-number-one...
Melbourne did everything they could think of, and the sum of it worked. This included a very severe lockdown, contact tracing, masking in the very limited public interactions which were allowed, and starting with a relatively low case count. I'm fairly confident that masks were the least important part of this, and that shutting down basically every part of public life was the most.
I did say that masking early on was indicated, and that WHO and CDC failed us there. I sort of glossed over the part where case counts were low, but it's there, and it's pretty important.
What the US and Europe needed early is what New Zealand and Australia (and Taiwan, Korea, maybe a couple other Southeast Asian countries) actually managed: universal masking, a nearly-complete cessation of public life, widespread testing, contact tracing, and central quarantine for the infected. Instead, we got dithering and "wash your hands".
It was too late for that suite of interventions to be effective by 1st April at the latest. Earlier for Europe, which had the early wave epidemic in Italy.
So of course, that's when masking was adopted, as a totemic symbol that the powers that be were "doing something". But we had crossed the point where it could help, and it was always the least important thing.
I took a look at your sibling comments, but I don't see any sources linked that suggest cloth masks are so ineffective as to be useless.
Here are a couple studies suggesting they aren't useless (searched "cloth mask aerosol protection" via DDG):
https://pubs.acs.org/doi/10.1021/acsnano.0c03252 (effectiveness had a very wide range, depending on weave, thread count, etc.)
https://www.nist.gov/publications/filtration-efficiencies-na...
I get what you're saying in general, that "cloth mask" means many different things, and that those things aren't going to have the same levels of protection, but you seem to be pushing the idea -- without evidence -- that all cloth masks are worse than useless. Science doesn't seem to agree with you?
There's an issue with statements like that. "Cloth mask" is not well defined - are we talking literal layer of cloth, or the cloth-synthetic-cloth design recommended in some countries. Either way there's some gradient between 100% protection and nothing - cloth masks will still be better than nothing, but purpose-designed masks will outperform them.
This is not a trivial scenario to talk about, so the more specific we are the better.
I don't think it's accurate to say that those are better than nothing. The false sense of security could easily lead to people staying longer indoors, or entering indoor spaces which they would consider dangerous if they didn't have the misconception that cloth masks protect them. It's a very small amount of protection, so it doesn't take much moral hazard to overwhelm it.
Could you maybe get a little less sick, if say 10% less viral aerosols passed through the mask? Ok, if I'm going to be very generous, sure. At the margins, someone is going to inhale a sub-infectious dose of aerosol who would have gotten a just-barely-infectious aerosol dose.
But this is like talking about condoms with holes in them. Most of the semen would stay in! It's not as pregnancy inducing as going bare! But I wouldn't call it birth control either.
https://www.wired.com/story/the-teeny-tiny-scientific-screwu...
It's really good, I learned a lot of new things. Please read this if you're at all interested in the subject: and who among us isn't at this point?
Any source for that? I mean it has always seemed likely that both aerosols and droplets would be a factor but where did 'primary' come from?
https://www.scientificamerican.com/article/protecting-agains...
I suggest, without intending to be dismissive, punching "covid aerosols primary" or the like into your search engine of choice and going to town. It's been a long debate, and by late last year every prestigious organization except CDC and WHO were in the aerosols camp. Even they have kind of low-key admitted it, while insisting that the measures to control it they promoted on an erroneous theory are still the correct ones. Which is, of course, nonsense.
A droplet is just a large blob of the same saliva that makes up the aerosols. If it gets in your lungs, it will make you sick. This is pretty easy to avoid behaviorally, and with face shields for workers who have to have contact with the public. Wearing a mask will also mitigate this, but it isn't necessary (just don't point your face at other people) and it isn't sufficient, because of aerosols, which are therefore the primary source of transmission.
When a droplet lands on a surface, it becomes a fomite. Picking these up with ones hands, and transmitting them to eyes, nose, and lips, is a major route of infection for influenza. It does not appear to be a significant route of infection for COVID.
Diseases which spread primarily through droplets do so by forming fomites. Unlike someone spitting on your face, it's very easy to touch a surface someone else spit upon, and people touch their faces a lot.
I think it was a difficult situation, I don't think they handled it the best they could have, but the response (in the context of massive amounts of hoarding) was understandable.
I know that this will not be a popular take here.
Weirdly, medical professionals were also being told not to wear masks. Multiple nurses were either fired or quit over the issue, because hospital policy didn't allow general mask-wearing out of a fear of scaring people:
https://www.wbrc.com/2020/03/23/nurse-claims-he-was-fired-we...
https://www.medpagetoday.com/infectiousdisease/covid19/85760
https://www.dallasobserver.com/news/nurse-fired-wearing-mask...
Which is the greatest irony of all. Nothing is more terrifying than finding out you are being lied to, it's actually way worse, and leadership has no clue what it is doing.
I am curious if that is due to the WHO messaging or just because with thousands of hospitals, the probability of having a stupid manager approaches 1.
* Masks don't help, there's no point in wearing them
* Lots of people are gonna get infected, all we can do is tamp down this current spike
* We'll go back to our normal lives in a month or two
were all well within what was reported to be the expert consensus at the time.
or worse. Keep the aerosol vector, but make it even more effective. Increase the effectiveness of surface transmission. Throw in greater resistant to surfactants (soap) and hand sanitizers.
boom!
This coronavirus might have spread to ~10,000 people and already jumped to Italy before anyone was aware there was a brewing medical crisis.
In this sense, HIV doesn't seem like a particularly good model for anything like a coronavirus pandemic. Aerosol transmission just totally changes almost every aspect of the resulting pandemic.
What lessons do you wish we had learned from HIV?
https://www.econlib.org/great-moments-in-epidemiology/
He did enormous damage in 1983 by speculating about casual transmission of HIV within households even though he admitted to not having read the paper. He was slow to get up to speed on aerosol transmission this time around.
The comment at the bottom of that page also contains this gem from Oprah Winfrey in 1987:
> Research studies now project that one in five—listen to me, hard to believe—one in five heterosexuals could be dead from AIDS at the end of the next three years. That’s by 1990. One in five. It is no longer just a gay disease. Believe me.
Obviously that never happened. I was 12 that year and this sort of stuff terrorized us, even though it was based on highly dubious modeling, plus belief by public health officials in the promulgation of nobel lies.
I think we should have learned that groupthink and motivated reasoning can lead to all sorts of ancillary damage not just to psychological health, but to reduced trust in institutions, heightened political polarization, massive misallocation of resources, and putting focus on the wrong places.
We should have learned that being honest about what is known and what isn’t known and placing trust in the public leads to the public placing trust in public health authorities when it really matters. Credibility is extremely important to maintain, and protecting and encouraging a robust debate is paramount to discovering the truth and making better decisions.
I don't hear or read people saying "we should follow what Dr. Fauci says". I hear and read saying "we should follow the science", and that necessarily means (for a novel disease, whether that's HIV or COVID-19) entering into a process in which things are not certain, opinions differ, new information emerges. "The science" isn't a single, fixed answer for any situation, and even less so for a novel disease. Pretending that "the science" can essentially be identified with a single person is tremendously foolish, both for those who want to believe that person and those who want to tear them down.
Yet we've also seen intelligent non-experts rise to the occasion. An entrepreneur like Balaji Srinivasan who was sounding the alarm about how serious this was a month or two ahead of public health officials and was mocked for stepping outside of his lane[0], a programmer/sociologist like Zenep Tufecki who has written a series of important analyses over the last year and who later admitted that she felt like she was risking her career by advocating for masks when all the public health authorities were lined up against it [1], or economist Emily Oster who has done a better job of clear communication to the public about how to balance risks and understand the different levels of certainty we had on any given COVID related topic and published clearer analyses of school safety that many states' policies still flatly ignore.[2]
These are all people who have a wide range of experience and interests but were able to make timely contributions that experts may have been too blinkered to develop.
It's not about tearing down any individual, and I apologize if comment went too far in that direction. But we should be concerned about institutions that reject well-argued analysis of available evidence because its coming from the wrong place, or failing to even consider counterarguments and their full slate of implications. One concept that I recently learned about is the 10th man rule which Israeli intelligence adopted after the surprise attach that led to the Yom Kippur war. Essentially that if there are 10 people in a room and the first nine all express the same opinion, it becomes the duty of the 10th man to argue the opposite case regardless of what he or she believes. There are a lot of 10th men out there who had their opinions or voices excluded for too long.
Whatever it is that filters intelligent arguments from outside of the establishment is something that should be addressed before we need to go through something like this again. We would also do well to find ways to include a role for smart dissenting outsiders in conversations like these early.
[0] https://www.vox.com/recode/2020/2/13/21128209/coronavirus-fe...
[1] https://www.nytimes.com/2020/08/23/business/media/how-zeynep...
> When the Centers for Disease Control and Prevention told Americans in January that they didn’t need to wear masks, Dr. S. Vincent Rajkumar, a professor at the Mayo Clinic and the editor of the Blood Cancer Journal, couldn’t believe his ears.
> But he kept silent until Zeynep Tufekci (pronounced ZAY-nep too-FEK-chee), a sociologist he had met on Twitter, wrote that the C.D.C. had blundered by saying protective face coverings should be worn by health workers but not ordinary people.
> “Here I am, the editor of a journal in a high profile institution, yet I didn’t have the guts to speak out that it just doesn’t make sense,” Dr. Rajkumar told me. “Everybody should be wearing masks.”
[2] Articles in various publications + https://explaincovid.org & https://www.qualtrics.com/news/national-covid-education-dash...
The slavish subservience to authority and desperate clamor to lick boot sickens me. I mean, Vietnam, Iraq, Afghanistan, Libya, the gun running and drug smuggling and interventions in South and Central America, banking corruption and laundering, the subprime crash, the Panama Papers, Congressional insider trading, corporations paying no taxes while politicians clutch pearls and wring hands about how they're using legal loopholes so there's nothing they can do about it, intelligence agencies spying on congress and on citizens, fabrications of stories about collusion with Putin, the list is endless.
And yet again, like clockwork, once again the "experts" and "journalists" know what is best for us and once again the followers are all falling over themselves to prove their devotion by putting on their big shows of faith, and denouncing and bullying all the heretics and traitors who dare to ask questions.
I have to laugh if it wasn't so sad. For some stupid reason I had some hope, but after seeing it all play out again it seems like old Dick Cheney could come and start talking about Iran and WMDs or denounce the next Gaddafi, and Fox and the NYT and all those other "trusted experts" would duly start regurgitating their lines, and pretty soon everyone would fall in line and anyone who didn't want to go to war (read: send others to war) would be un-American traitors.
Have you considered that the "desperate clamor" might just be a clamor to do the best thing ? And just how would we do that?
Your entire attitude seems to be predicated on the idea that nobody actually knows anything, there's no point listening to "experts" (even putting the quotes around the word is intended to be dismissive), and there's no way to spend time learning more about something.
I thoroughly reject that POV.
Look, you've provided a great list of terrible things that the US (and other) governments have done (though it's necessarily incomplete and mostly rather recent). But in the context of your point, so what?
What about the experts that know how to build bridges properly? What about the governmental policies that actually result in positive changes? What about the doctors, engineers, designers, architects, farmers who actually do have a better understanding of their fields than an average person?
I don't disagree with you about the lamentable actions of our government and the processes/structures that allow them to happen. But I reject the implication that this requires me to just be infinitely cynical about everything.
I have considered that, and rejected it.
I'm not talking about people who don't really know and genuinely get their information from whatever their TV or internet or friends tell them and they just go along with it but generally live and let live in the face of differing opinions.
I'm talking about the hateful bullying mobs going around attacking people, and the people and corporations who actually look into the information which is quite easy to see those "authorities" are hardly a good source of truth, yet they grovel down on their hands and knees to lick boot.
> Your entire attitude seems to be predicated on the idea that nobody actually knows anything, there's no point listening to "experts" (even putting the quotes around the word is intended to be dismissive), and there's no way to spend time learning more about something.
That's not my attitude.
> Look, you've provided a great list of terrible things that the US (and other) governments have done (though it's necessarily incomplete and mostly rather recent). But in the context of your point, so what?
The context of my point is that journalists, politicians, and other self-proclaimed "experts" are not. It is more the rule than the exception that they are self-interested corrupt liars and manipulators.
I'm not talking about, say, the scientist who develops climate models or the medical researcher developing vaccines. I'm not talking about actual experts.
> What about the experts that know how to build bridges properly? What about the governmental policies that actually result in positive changes? What about the doctors, engineers, designers, architects, farmers who actually do have a better understanding of their fields than an average person?
What about them? None of them are manipulating the populace into going to war, or drumming up their throngs of pathetic subservient bootlickers and brownshirts to attack and bully anybody who questions them. So I'm obviously not talking about them.
> I don't disagree with you about the lamentable actions of our government and the processes/structures that allow them to happen. But I reject the implication that this requires me to just be infinitely cynical about everything.
There was no implication.
Do you believe that people who write (long form articles, books) about a subject have nothing useful to say?
It's not always easy, but in the case of COVID there were a lot of obvious shysters who were slavishly worshipped by the mob.
Opening your eyes and thinking for yourself, and not being desperately and pathetically subservient to "authority" or to mob mentality is a good start.
> Do you believe that people who write (long form articles, books) about a subject have nothing useful to say?
I do not.
Fauci didn't think so in 1983.
"But if ''nonsexual, non-blood-borne transmission is possible, the scope of the syndrome may be enormous,'' writes Dr. Fauci of the National Institutes of Health in an editorial to be published Friday in the Journal of the American Medical Association."
https://www.nytimes.com/1983/05/06/us/family-contact-studied...
But dissemination of one by a govt. scientist in a prominent medical journal, however, indicates that they think it likely enough to be true.
Suffice to say both sides love to “follow the science” when it supports their political views.