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Comment by toolz | Hacker News Reader

This is a bit of a tangent, but I don't understand generalized masking. At best they flatten the curve, which I think at this point I believe flattening the curve is dangerous. We have pretty well defined risk demographics and if we could have covid seasons come and go quickly I think it gives the high risk demographics the best chance of applying multi-layered defenses against a shorter season of risk.

There is of course the "overcrowded hospital" issue, but I have a hard time coming to terms with that being a real problem - if it were a real problem why has hospital capacity been in decline this entire pandemic? Is it an unsolvable problem or is it just not a real problem outside of fantastically clickable headlines? I lean heavily towards the latter but I could be convinced otherwise.

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The issue for me is I have elderly parents one of which does have a health condition (serious) that makes some breathing and other issues hard. They wanted to fly out to visit me. The absolute best way to avoid covid for yourself in my view is an N95 masks with a vent, because you can actually wear that thing for hours comfortably.

I have friends who treated folks with covid wearing N95's and did not get covid.

So I really wish we could let folks make the personal health decisions here a bit more. If you want to wear a bubble helmet with filters in it - go for it. The full respirator (almost always with an exhalation valve)? Go for it. The N95 with an exhalation valve? Go for it.

Instead, delta airlines says no full cover, no N95 with exhalation etc. So now you have people who don't want to wear masks forced to wear them, and they are preventing folks who really DO want to be protected (while on a flight) from fully protecting themselves. This is all in the name of "science" which really is not science but "public health" mumbo jumbo.

It goes back to this issue of basically not realizing folks have different risk profiles / tolerances. If I'm allowed to wear my N95 with an exhalation valve for 4 hours, I frankly don't care if the guy 2 rows back has his mask off his nose.

This mistake is lecturing everyone (often with bad info) and then blocking folks from solving their own problems. remember when the anti-body rapid tests had to have a chip, an iphone app and a medical professional in the mix?

And no, I don't believe in those cloth masks, and surgical masks on a plane for 5 hours? Hard to imagine that being highly effective.

Personally I don't think any kind of mask works on people who don't want to wear them. I hypothesize the reason general population shows little or no benefit with masks is because wearing masks effectively is significantly more tedious than just having one on most of the time where people require them.

People who don't want masks aren't getting fitted properly for n95's, they aren't shaving, they aren't behaving consciously in the many ways you can behave that render masking ineffective.

Agreed. I laugh because folks have masks on their necks, off their noses etc, when eating, when drinking etc. I don't blame them, a lot of masks fog up glasses etc if they actually are restrictive and don't have an exhalation valve.

I shave (this comes from scuba diving where shaving provides similar benefits). I have my own reasons not to want to get covid. So I like doing some things that I'm confident reduce my risk meaningfully. But I don't lecture others, I solve my own problem here.

N.95 without shaving does seem to still confer some additional protection, though arguably you're wasting over half the potential when you do.

Its pretty noticeable, If I shave, I get a tight suction feel on an indrawn breath. This is same experience you get with a scuba mask.

That's interesting there is some protection, I could believe still better than things like cloth and surgical because the strapping tends to be tighter.

Does it render masks "ineffective" or "less effective"? I think I see so much absolutist language whereas I wish we would use more relative language.

A LOT less effective, especially for filtering sub-micrometer aerosols.

https://imgur.com/a/Of4rDAu

Source: https://arxiv.org/abs/2106.00375

I appreciate you sending the source. I guess I still have the same argument. A LOT less effective does not equal ineffective. Or maybe I just see certain words like "ineffective" as binary words, either it works or it doesn't, and have a reaction to that. It may be a lot less effective to have facial hair while wearing an n95 compared to no facial hair and a properly fit n95, but is that still much much more effective than not wearing any face mask?

ineffective is not binary - it depends on your endpoint, which is subjective.

If your endpoint is to not catch covid and someone ineffectively wears their mask such that they would not have caught covid if they wore it correctly - then the mask was ineffective even if statistically they _maybe_ had lower chances of catching covid than without wearing a mask at all.

and I say maybe very strongly here...we do not understand transmissible diseases nearly as well as many would like to think - there are plenty of observable datapoints that correlate mask usage with increased transmission...my gut feeling would be to explain those away with confounding variables, but my gut feeling is not science and no substitute for a testable understanding of the problem and solution

Ah, yeah, I think it was just a misalignment on the word ineffective. I think when I hear many people use it, I assume they mean pointless, ineffective for all, whereas in you saying it, it sounds like you meant ineffective in that particular instance based on what the outcome was. I see you seem to have a lot more nuance in your perspective than I may had been assuming. I'm sorry. Thank you for clarifying.

What is this "it" you're referencing specifically? I'm not sure which point you're asking about, but any of the points aren't like to have great data. Not many masking studies go outside of modeling and the lab and the ones that do aren't that detailed (that I can recall).

Maybe I just read too deeply into your statement:

> People who don't want masks aren't getting fitted properly for n95's, they aren't shaving, they aren't behaving consciously in the many ways you can behave that render masking ineffective.

Maybe you weren't saying not shaving renders an n95 ineffective.

The most mindbogglingly dumb part about masks on planes is that there's still meal service on longer flights, at which point everyone takes off their masks at the same time to eat the food. Are we supposed to believe that the virus takes a little nap while everyone eats, and then only goes back to spreading itself when everyone has finished eating?

Detailed rules always lead to insanity. The best way is always to be upfront about the risks, how to mitigate them, and then let people make their own risk assessment and do whatever they're comfortable with.

But instead of saying "Flying carries a risk of exposure to this virus and others, here's what you can do", we're saying "If everyone engages in this piece of safety theater, flying is perfectly safe and fun for everyone!"

Exactly. That's all I want to be able to do. Skip the meal, wear my "medical professionals only" N95 mask with exhalation valve so I am comfortable.

Then I won't care if someone has their mask on their chin while they eat some food.

Instead, I can't wear the mask I want, and we play this stupid game of forcing folks to wear ineffective masks in a highly closed off space who don't care / don't want to / have already had covid and don't believe the doctors claims that there is no element of natural protection as a result.

I would imagine if the flight is 5 hours long and the eating time is only 0.5 hours, then there would only be 0.5 hours of breathing virus into the air than 5 hours of it. That being said, yes, most would be unmasked at that time and likely to breathe it in, I guess I just see overall as limiting the total amount of virus breathed into the air by requiring masks most of the time.

Half an hour is long enough to get infected, we know this.

If masks work, they work on a mechanistic, physical, level. They filter air, and if you use your masks wrong, or take them off, they stop filtering air.

But if you look at how people are actually using their masks, they pay zero attention to the mechanics of it, and 100% attention to the appearance of it.

Someone who wants to wear an N-95 mask for the duration of the entire flight, and who won't remove it for eating, understands the mechanics of how they work. That behaviour is not theatre.

Someone who wears whatever because they're told to, crams it in their pocket now and then, removes it while eating, and still believes they work, do not in fact understand how masks work. And whoever is making rules and mask mandates that allow for this behaviour also clearly do not understand how masks work. It's all theatre. It's masks as make-belief lucky rabbit's foot talismans, and yet we're supposed to believe that the rules are based in science.

I still don't see it as all theatre—maybe I just see it more like a probability function. 100% of people won't use them properly, no matter how much instruction or how foolproof the design is (because one way to fix improper usage is to improve designs instead of blaming the user). Will 50%? Maybe 10%? OK, if 10% use them 100% properly, what if another 30% use them at 50% effectiveness? I'm making up these percentages but just showing that I don't believe it's all theatre if not 100% of the people comply 100% perfectly.

So yes, people can get infected at half an hour. Are their odds much higher to get infected at 5 hours than 0.5 hours? I'd assume yes.

Heck, even people who wear it over their mouth but don't cover their noses, yes, they're potentially leaking covid out of their nose and breathing it in thru their nose. But if they cough, I imagine a percentage of the covid comes out their mouth and gets trapped in the mask...even despite them not wearing it 100% properly.

I'm saying that some of it may be theatre, or maybe much of it is (by theatre being ineffective but trying to appear effective), but I don't think it's all theatre.

At this point it's not even "public health" it's "safety theater" [0].

[0] https://en.m.wikipedia.org/wiki/Security_theater

The rule was not made to protect passengers, but to protect the crew who are stunk in a tin can with hundreds of different people every day. The risks will add up over time.

Also, male doctors and nurses are require to shave before donning their masks for a shift because even the slightest overnight stubble will ruin the seal. The chances of general public wearing an N95 correctly to get the most benefit out of it is close to nil.

I have no idea how to respond to the overcrowded hospitals.

https://www.nytimes.com/interactive/2020/us/covid-hospitals-...

Hospitals have been jam packed the entire time. There is data everywhere to support this. Tons of procedures are not being done due to beds and ICUs being full. Ask anyone who works in a hospital. Call one if you'd like.

Then why did the USS Mercy which was in New York during the beginning of the pandemic only ever treat 48 patients? 77 while she was in Los Angeles. https://www.nbcsandiego.com/news/local/military/infected-usn...

https://news.usni.org/2020/05/15/usns-mercy-leaves-los-angel...

This is second hand from someone close, but not too close in the military, so details are off but the narrative is on track:

The Mercy was deployed after some communication between New York hospitals, and the understanding at least was that it would mostly be handling emergency, trauma, and routine patients (what military docs are good are at as a stereotype), and free up capacity for the hospitals to deal with COVID. The "normal" medical stuff promptly dropped in demand with lockdown, between fewer accidents and deferred care. So there wasn't much for the Mercy to do, the few covid patients sent over were about all of an "unknown air transmissible virus" (working theory at the time) that it was really equipped to handle, because that wasn't the mission they were expecting.

That makes sense in New York but we knew more about the situation when she was in LA and when the USNS Comfort was in New York later on. (Also I put USS Mercy when it should be USNS Mercy)

"Another of the Navy’s two hospital ships, the USNS Comfort, was sent to New York City to treat non-coronavirus patients. However, after treating only a few dozen patients, the Comfort changed its rules to allow coronavirus-positive patients on the ship.

The Comfort had been docked in New York Harbor in Manhattan since March 30 but departed last month for its Norfolk, Va., home port after treating just 182 patients."

https://thehill.com/policy/defense/497987-usns-mercy-leaves-...

Damn! You finally figured it out! It was all just a fake thing we made up. You win!

ICUs are at max capacity all the time pre-pandemic. In fact a study done in 2013 IIRC showed that you could pick any random date and any random hospital in the U.S. and there was a 16% chance it was at max capacity.

So again, my question is this - if hospital capacity is truly a crisis, why have staffed beds been in decline since the beginning of the pandemic? Half a million healthcare workers have left their jobs since just the start of the pandemic. If this is a crisis, why isn't there any initiative to get them back? Instead the only initiative we've seen with regards to healthcare workers is massive layoffs firstly because of lockdowns, but then later also massive layoffs because of vaccinate rules.

So either this is a terrible problem with no solution, or the problem is exaggerated and it's not really a crisis.

I like how the public health folks don't connect the dots. MEDICAL PROFESSIONALS are tired of the stuff they are hearing.

I know some folks who had covid, and just don't want to trigger their bodies systems again with a series of shots.

For some reason, if you have other diseases your immune system likely provides some protection against re-infection, but we are being told covid is different. This just seems so likely to be a lie its mind boggling.

Let healthcare works test their blood for cross-reactivity with omicron / antibodies. If you are equal or better than some threshold (pfizer vaccine from 10 months ago) you get a card and are good to go.

> For some reason, if you have other diseases your immune system likely provides some protection against re-infection, but we are being told covid is different. This just seems so likely to be a lie its mind boggling.

I don't know what you're talking about. There is some protecction, it's not enough to make things safe, what's the lie?

If you're talking about those people still having to get a vaccine, that's a whole mess of tradeoffs but also not based on lying.

"So either this is a terrible problem with no solution, or the problem is exaggerated and it's not really a crisis."

Either of these means this isnt something to worry about

Thats just not true. I found the study you're referencing and it says in 2013 mean ICU occupancy was 68%. If you zoom out on the map you'll see the US avg is 83%. Did you even look at it? Some states are like 9/10 at 100% capacity.

Staffed beds are not in decline, and of course hospitals are trying to get more workers, they are offering crazy pay incentives right now.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3840149/

The mean capacity doesn't disprove what I said in the slightest.

https://i.imgur.com/s8RRK76.png

the dark gray represents ICUs in the studied time window (which wasn't 2013, it was a study done in 2013, the study measured ICUs from 05-07)

Here's an interesting fact[1]. 2020 hospital capacity in the US after the start of the pandemic never even got up to the projected capacity as projected using data from 2015-2019. So no, I don't believe these scary-tale anecdotes I've been reading the entire pandemic. They are not backed in data they are backed, at best, in bullet points without context designed to scare the ignorant.

[1]https://www.kff.org/health-costs/issue-brief/trends-in-overa...

Here's a really good breakdown in canada of capacity with ventilators - you'll note almost every single graph shows higher numbers in 2019

https://threadreaderapp.com/thread/1479547900598366220.html

> if it were a real problem why has hospital capacity been in decline this entire pandemic

We filled hospitals over capacity and burned out healthcare workers. They decided to quit rather than work in such conditions. Don't overwork healthcare workers and maybe they won't burnout so quickly.

Generalized masking reduces R. R<0.8 and the pandemic ends.

Yes, but that doesn't mean reducing R from 8 to 7 (example numbers) is all that helpful without a plan to get from 7 to 0.8.

It should be the other way around: non-essential-workers only leaving the home for groceries and other essentials reduces it from 7 to 1.5, keeping distance at the grocery store reduces it from 1.5 to 1.1, wearing masks at the grocery store reduces it from 1.1 t o 0.8. Something like that. Made-up numbers.

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