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Comment by Ensorceled | Hacker News Reader

> During the early stages of the pandemic, high ranking officials suggested we should not use masks because it was not yet "proven" the virus was transmitted via aerosols. And this was a catastrophic decision.

It was criminal. There was a ton of circumstantial evidence: SARS-CoV-1 was thought to spread via airborne droplets, the high rate of transmission, the types of transmission, medical staff infections, reduced rates of transmissions in countries where mask wearing while sick was common, ... we would have convicted COVID19 on less evidence.

But no double blind experiments, so no proof. Go about your day citizens!

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It was criminal for way wait too long. If you look at the study of infectious diseases the aerosol transmission model has been discounted for way too long due to inability to “prove” it. If you can’t design an experiment to prove or disprove an idea that doesn’t make it automatically wrong. For example, the aerosol transmission model for influenza was flatly rejected for a long time, even when key scientists found it plausible and had some experimental evidence which wasn’t air tight. In covid’s case the CDC and other experts were grossly exaggerating their confidence that the aerosol transmission model was wrong. My partner was treating covid and in late 2020 after a lot of evidence indicated it was plausible, she still had infectious disease experts make fun of physicians for asking about aerosol transmission. They were grossly confidently incorrect about a theory that had no evidence on either side but had some plausibility (because similar diseases had aerosol transmission). Again, the way the community acted in an area of unknown where it was impossible to prove or disprove was very unscientific.

It was only over a year (with a lot of evidence) that the CDC said “aerosol transmission is maybe sorta kinda possible maybe”.

There are multiple ways to validate an idea, and sometimes you can’t design a blind rct. We know parachutes work despite never having proven it in an rct trial.

> We know parachutes work despite never having proven it in an rct trial.

In fact, the one study examining parachute use showed no effect! ;-) https://www.bmj.com/content/363/bmj.k5094

> Compared with individuals screened but not enrolled, participants included in the study were on aircraft at significantly lower altitude (mean of 0.6 m for participants v mean of 9146 m for non-participants; P<0.001) and lower velocity (mean of 0 km/h v mean of 800 km/h; P<0.001).

> ... [T]he trial was only able to enroll participants on small stationary aircraft on the ground, suggesting cautious extrapolation to high altitude jumps.

Hah. Ah, yes. Always read carefully!

That is by now more than frustrating. Yes, everyone from WHO down to the CDC and there counter-parts in other countries screwed up the mask recommendation. At first, under very difficult circumstances. They corrected that, so, rather quickly. We would all do ourselves a favor and stop bringing this up every single time we talk masks.

...and then someone actually did a cluster RCT for masks and Covid, and found that cloth masks don't have any effect, and surgical masks have a truly minor effect on transmission:

https://vinayprasadmdmph.substack.com/p/do-masks-reduce-risk...

We really need to stop repeating the talking point that "everyone screwed up". The original evidence base was that masks don't do much to stop respiratory illness. "The science" changed in the span of a week in early 2020, based on little more than propaganda. No actual science was ever performed, and once we did some, we found out that the early evidence was pretty much correct.

I find it disturbing that everytime someone points out the actual science of masks (ineffective for stopping viral transmission) they are immediately downvoted or shouted down online.

The cynic in me says that they’re so popular with governments because mask mandates mean that people can wag their fingers and shame the people not wearing masks rather than the politicians who were caught with their trousers down. Masks put the onus on the individual rather than the state for public health, no wonder politicians are loathe to give them up despite patchy evidence for their effectiveness.

It’s also CYA among politicians, and the comforting illusion that you’re doing something. Same part of human nature that leads people to wear lucky charms to ward off evil spirits.

Society has left religion behind but dogma is still with us

They may mostly be security theatre, but most anti-mask people are exactly as coherent as that guy who gets petulant about removing his shoes at the airport. Still, I don't understand the strong pro-mask sentiment among the vaccinated. Things to add to my shopping list: a face mask proclaiming "hug me, I'm vaccinated".

It's absolutely crucial to distinguish between the different understanding people have of the word masks – cloth masks, gaping-at-the-sides "surgical masks", N95/FFP2 masks, N100/FFP3 masks.

Each random person's picture of masks will be very different from what the next person is thinking.

And it's also very important to distinguish between the different meanings of viral transmission – of what virus, and according to what scientific results it's being talked about.

A lot of the friction comes from this.

In SARS-CoV-2 transmission specifically, I speak about it as airborne or aerosolized, based on all the papers that are out that confirm that now, and I when I say "masks" I tend to think of gaping surgical masks or better, and no, those don't work well enough.

However in the sense of the word masks as N95/FFP2 masks or better—often called respirators—then those masks are almost unreasonably effective at stopping transmission.

Here's the data I base my perspective on, in the nutshell form of some tweets from scientists, tweets linking to scientific papers. (Some are peer-reviewed, some at the preprint stage.)

https://twitter.com/JenniferKShea/status/1449748053548752903 — We've summarized the literature supporting airborne transmission of COVID-19 & several other respiratory pathogens. Guess what? #COVIDisAirborne

https://twitter.com/mjb302/status/1409628852867850240 — Important new research examining the real world impact better PPE has on workplace acquired infections of SARS-CoV2. — TL:DR - FFP3 respirators provide 100% protection to healthcare workers looking after patients infected with SARS-CoV2. 1/25

https://twitter.com/andymoz78/status/1441355141051936772 — A thread on our recent pre-print “The removal of airborne SARS-CoV-2 and other microbial bioaerosols by air filtration on COVID-19 surge units” (*Pre-print -not peer reviewed*) — TL:DR Hospital air is dirty, we can clean it

https://twitter.com/DFisman/status/1454776521818886145 — Remarkable new work from Korea shows the extraordinary impact of masks on SARS-2 transmission on public transit. — Parameterized based on *aerosol* simulator. (Because SARS-2 is airborne). Distancing helps, but less important (b/c SARS-2 = airborne).

https://twitter.com/caruzycki/status/1360635674324463616 — 2/ If this disease were only spread by droplets that fell to the ground within 2 metres, [plexiglass barriers] would be a perfectly fine solution to limit transmission. Unfortunately, we unequivocally know that aerosols are important with this disease.

The data for respirators was always better than the data for "masks" (and much better than the non-existent data for "face coverings", whatever those are), but...all of the existing studies of respirators took place in hospitals.

People keep dismissing this, but respirators in hospitals are very different than respirators in the hands of the general public. Fit matters more than anything else, and hospitals have staff and procedures to ensure that PPE is used correctly.

This isn't a small or theoretical concern. Even a tiny gap negates the effect of the respirator, and people don't fit their respirators properly -- in large part because properly worn respirators are annoying and hard to tolerate for long periods of time. I regularly see people walking around with KN95 masks on their faces, with massive gaps around the nose and chin. These masks are pure viral theater.

(Also, not for nothing: two of the twitter links you cite are about respirators in hospitals. the other two are mechanistic studies, which are basically useless. Every failed intervention or drug in the history of medicine has a mountain of plausible mechanistic studies supporting it. Most things don't work, but everything we try has someone claiming that it's a sure-fire solution, based on a lab study.)

One recurring thought I’ve had about the requirement for N95/FFP2 respirators/masks to be closely fitted: Any gap in the seal will drastically reduce efficiency, but a respirator worn in a reasonable manner will always be more efficient than a square mask with enormous high-flow low-resistance gaps on both sides.

In hospitals, high importance is rightfully placed on correctly fitting N95/FFP2 and up – this is so that they function to spec and can be formally assumed to work like the specification indicates so they can be applied as a tool in general use by, well, by a population of staff.

This does not mean that respirators which are worn in a reasonable manner will ever be as poor filtration devices as gaping masks, especially not if the pathogen is airborne / aerosolized and operates almost purely as air flow, not droplets with mass and inertia to consider.

And COVID-19 is airborne and must be considered as airborne. There were five links, and the fifth is a collection of papers :) There is also a significant amount of detail and discussion and framing and context in adjacent tweets i all the links.

Sincere thanks for the reply! I will learn from it.

Downvotes to this? Lol.

If you have any issues with my comment above which is based on clearly delineated and reasonable personal opinion and includes links to the scientific results it is based on, you have a duty to respond, not downvote.

You should really read the rest of the comments in this thread. People are still asserting masks do "zero" to stop the spread.

Dr. Tam, who is responsible for both gross incompetence AND intentionally misleading the public WRT COVID19, mistakes that literally killed people and, is probably still killing people, remains in her position as Chief Public Health Officer of Canada. This is why I can't let it go.

Firing her during the pandemic would be very unwise politically

So the next time they're about to mess up nobody remembers how incompetent they are?

No, of course not. Because we also continue to listen to people that only were "right" once due to sheer luck that parts of the utter BS they spread turned out to be not completely wrong in a single instance.

On a serious note, how often did they really mess up? In a sense of having consequences that are close to impossible to fix? Not once, if you ask me.

They were supposed to be the experts. In practice your dog was a better expert than they were.

Being once wrong disqualifies then? What I really hate is that some parties have to be right all the time, while others only once. An expert is not the one who is never wrong, but the one who knows why he was wrong and changes his opinion once data and information changes.

There was sufficient data available from China before even COVID19 hit the US. You had to be either incompetent or malicious not to recommend masks.

Or you had to take one look at the toilet-paper shelf at your local grocery store, leading to the realization that if the same thing were to happen with PPE, it would be apocalyptic.

Not all lies are malicious. Some are necessary. "Masks aren't helpful" was one of those. Everyone with a three-digit IQ should have understood what was really going on, and everyone else was better off believing the lie.

I love how mask-off this comment is.

(Shrug) Realpolitik is real.

Here probably the hidden motif was that the masks do not go out of stock, so the medical personel has enough.

The real question is why hasn't the CDC ever funded a study on the efficacy of masks?

There are hundreds of studies. And, it’s pretty conclusive that masks have zero efficacy for stopping viral transmission. But, you’ll get shouted down by the mob for pointing this out. Nobody reads the actual studies.

The article references a study:

https://www.pnas.org/content/118/4/e2014564118

but based on your own contention, you won't read it, so here's a key sentence from the abstract:

The preponderance of evidence indicates that mask wearing reduces transmissibility per contact by reducing transmission of infected respiratory particles in both laboratory and clinical contexts.

> There are hundreds of studies. And, it’s pretty conclusive that masks have zero efficacy for stopping viral transmission

Could you link some?

What I have read seems to suggest otherwise, for example "Efficacy of face mask in preventing respiratory virus transmission: A systematic review and meta-analysis" [1]

Key conclusion: "Meta-analyses suggest that mask use provided a significant protective effect"

[1] https://pubmed.ncbi.nlm.nih.gov/32473312/

N95 masks have crushed it in every study I’ve seen. Is there a study that shows they’re ineffective?

Conflating N95 respirators with masks indicates you are not arguing in good faith.

And at this point, nearly 2 years into the pandemic, claiming that cloth masks do nothing is not arguing in good faith.

A number of studies have been linked in sibling comments, studying the effects of cloth masks. They work to significant reduce exhaled contaminant load.

> In one study, during talking, unmasked subjects expelled more than 5,000 contaminants per 5 cubic feet; 7.2% of the contaminants were associated with particles less than 4 μm in diameter (68). Cloth-masked subjects expelled an average of 19 contaminants per 5 cubic feet; 63% were less than 4 μm in diameter. So overall, over 99% of contaminants were filtered. The second study used the same experimental setup, but studied a wider range of mask designs, including a four-ply cotton mask. For each mask design, over 97% contaminant filtration was observed (69).

> https://www.pnas.org/content/118/4/e2014564118#abstract-1

Also, at this point we know that even if you catch COVID-19, the viral load that you catch plays a factor in how seriously ill you get. Masks reduce the viral load that a sick person exposes others to.

>> Conflating N95 respirators with masks indicates you are not arguing in good faith

Why?

I am not the parent and also not a native English speaker - is it not common to call respirators also "masks"? Does that term refer to surgical masks only? I live in the Czech Republic and the Czech word "maska", which is translated as "mask" (and I assume comes from the same latin origin) is pretty general term used to refer to basically anything that covers something.

If it is not a general term, do people in the US still really use surgical masks with the intention of protecting themselves from Covid? Where I live we would be talking about FFP2 and above, discussing surgical masks as covid protection would be irrelevant because no one wears them (granted, many people do not wear anything). Is it not like that in the US?

Late to reply, but yes. I'm a native English speaker, and everyone I know refers to N95 masks as masks. I don't know a single person who refers to them as respirators, even though that's the technical term.

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