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Comment by amatecha | Hacker News Reader

Ah, this is the perfect summary to explain to people when they ask "why are you still wearing a mask? COVID is over" or similar queries invalidating my caution around this virus.

Worth noting is it was the 4th-leading cause of death in 2020 and 2021.

Not sure why this is being downvoted into oblivion, as I regularly get some hassle from people about my strict adherence to wearing a mask indoors around people, and the more I can say beyond "I don't feel like getting COVID", the better. Otherwise I have to go into a story about how, directly via COVID infection, a friend's mom died, a coworker's wife is left wheelchair-bound and can't even complete a phone conversation without being left breathless, one of my favorite musicians has called it quits after a complete loss of hearing in one ear.. etc... As a programmer I highly value my clarity of thought and am not going to risk that because people apparently feel the need to bother me about being cautious. Honestly cannot figure out why anyone feels the need to even comment on it, as it has no effect on them, and in fact helps keep them safer.

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This is just something to think about. After I was called back in to the office and started seeing people more often I came down with what I would have sworn was covid three times. Absolutely the worst flu-like symptoms I'd ever had that I could recall, each affecting me in a novel way, but negative on covid each time.

They could have been false negatives, of course, but I suspect I just hadn't been training my immune system for many months and it wasn't prepared to handle the normal cold or flu viruses I would normally be able to handle otherwise. Since that period of time, I haven't come down sick since.

Not saying that covid is nothing to worry about, but it's something you might want to consider down the road. I don't know your situation or what health concerns you might have, but being too protective can have it's downsides as well.

There is no scientific evidence for being able to "train your immune system". There is plenty of evidence the opposite happens. Covid especially can cause permanent immune damage.

We have an innate immune responses and adaptive immune responses. Innate immune responses look for common attributes of certain pathogens and then trigger an adaptive immune response if needed. Adaptive immune responses are highly specific to certain pathogens and can provide long lasting immunity to some of those pathogens, such as measles. How would vaccines work if we only had innate immunity?

So being exposed to certain pathogens can trigger a lasting effect, the length of which depends on the pathogen. If that effect has gone away or lessened severely over many months then it makes sense that only the innate immune response would be available against those pathogens, and the adaptive response would need to be learned again.

https://www.ncbi.nlm.nih.gov/books/NBK21070/

For stuff like colds, the adaptive response is typically hampered by genetic change/drift in the virus rather than lessening of the response.

Of course the ability to produce the not quite right antibodies is still often valuable.

There's actually pretty good evidence that being overly clean and sterile is bad for an immune system. Yes, getting exposed to highly dangerous diseases like Ebola, polio, measles, small pox, etc. is bad, covid with a vaccine doesn't really rise to that level.

People shouldn't bother you about wearing a mask, or bother storekeepers who request patrons mask, but a reason to push back on state-mandated masking isn't that COVID isn't serious (it clearly is), but rather that the empirical evidence for masking, especially vs. the new strains, is quite weak

>the empirical evidence for masking, especially vs. the new strains, is quite weak

If you're wearing an N95 or KN95 the filtration efficacy is quite high. Most of the mask studies looked at whether mask policies lowered covid.

If you wear a mask in class but then take it off in the cafeteria or outside of school, the mask no longer has an effect.

If, however, you wear a mask with high filtration efficacy while outside of the house, that's a different story. To my knowledge we have no challenge trial of people wearing such a mask when exposed to an infectious agent.

It is folly to ignore the physical mechanism of such masks when reasoning about them, and defaulting to only considering the studies we have, which simply cannot measure efficacy when the mask is worn.

This study on parachutes is a good analogue: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC300808/

N95 vs. KN95 seems like an instructive example: people equate the two based on the effectiveness of the filtering media, but the salient difference is in the attachment mechanism --- most KN95s are ear-loops, and don't achieve especially tight coverings (similarly: the reuse concerns about N95s are less that the filter media can't be "recharged" or whatever, but rather that the elastic gives out).

At any rate: masks as worn in the real world seem pretty performative, for a variety of reasons.

If you're wearing them carefully, that's great, and I appreciate it. Nobody should be messing with you regardless.

You can look epidemiologically at this stuff and see that states with laxer regulations fared pretty well in the early COVID years, and appear to have fallen off only with the introduction of vaccines, which really seem like the high-order bit of COVID control.

Completely agree that an ear loop is less effective than a headstrap. The question is: by how much?

This beard length mask study is a good source of data. They actually measured fitted filtration efficacy at different beard lengths, including zero beard.

N95 was near 100%. KN95 was between 80-90% (surprisingly, higher with a small bit of beard, around 0.5-1mm).

Now, you could certainly argue that 80-90% filtration is performative, but on what evidence?

We know from hepa filtration studies that lowering the concentration of virus in the air lowers infection amongst those in a room. So from physical mechanisms we would expect that reducing inhaled virus by 80-90% should likewise reduce risk of infection.

https://pubmed.ncbi.nlm.nih.gov/34006963/#&gid=article-figur...

I don't know! But in mandatory masking regimes, ordinary people do a clownish job of masking (and some of the masking rules are themselves clownish, as with the "mask until you get to the dining table, and then unmask as soon as the water arrived", which was very much the regime in Chicago when dining opened back up in 2021).

The bigger point would just be to look at the epidemiology. I get that questioning masking pattern matches to COVID nihilism. I'm not a COVID nihilist. It was a big deal for me and I take it seriously. But the data I see suggests that the most significant bit in controlling it is ensuring people are vaccinated, and that most of the rest of the controls don't seem to do much.

One problem with "look at the epidemiology" as an approach is that the virus is such a moving target. I'm citing these figures from memory, so apologies if I mangle them, but with OG covid you could mask up properly and spend an hour in an enclosed space with viral particles in the air and have a low risk of infection, while with omicron you had maybe five minutes masked the same way before you'd catch an infectious dose.

More generally, the trouble with evaluating masking is all the confounders. I spent the early pandemic in Japan, where ubiquitous masking was a highly effective barrier to spread. One reason it may have worked as well as it did is that people talked less with the masks on. But there were already strong social norms against talking in confined public places, and the public health authority stressed airborne spread. How much did that contribute?

I feel like the mask issue is irretrievably lost at this point in the US, but it's important to stress that in places like Japan and Taiwan it worked quite well, at least until omicron got so infective that even stringent adherence was no longer adequate. But there's no way to untangle it from the changes in social behavior that accompanied it, some of them a physical result of the masks (less talking), some due to social signaling aspects of mask wearing, and many unrelated.

Yeah, I thought I captured that but didn't. It's an important caveat; there was a much clearer case for masking in 2020-2021.

I don't know what's "performative" about it. The respirator has a clear mechanism of action. They filter out almost all airborne viruses and are even better at filtering bacteria (which are larger). They also have the side benefit of making the wearer not want to eat airline "food" which I've noticed leaves me feeling better when I arrive. They are designed to be worn effectively even by illiterate manual laborers, so it's not as if you need to be a PhD to get one on your face.

What I like about wearing a mask on a plane is that I rebreathe some exhaled moisture.

Though I did a flight in mid 2020 and I'd inhale, move mask, take bite/sip, exhale while putting mask back, and then breathe normally through mask. Was probably a bit unnecessary when the flights were basically empty, but reduced-risk eating/drinking is possible.

I noticed something similar: no nosebleeds. I have only taken a few flights in the last several years though and I can't rule out that maybe the 737 MAX has a more humid interior atmosphere or something like that. But before I started wearing masks on airplanes I used to shoot saline spray up my nostrils every hour to keep the nosebleeds away.

Also: I find that the air feels warmer in winter when breathing through a mask.

Yeah, it’s up there with water is wet. Ever wonder why your shoulders don’t get dry in winter but your face does?

Yes they are effective, but don’t forget that they’re not perfect - your eyes and ears remain as access ports for the virus even when wearing a mask. Probably eyes is the biggest after respiratory because glasses have been shown to decrease infections if I recall correctly.

It doesn't need to be perfect in order to be effective. What's your point?

Just that the sequence of events is "I'm told masks prevent COVID" => "I was wearing a mask and got COVID" => "masks don't stop COVID" (or it happens to a friend or a friend of a friend etc). You have to explain that masks help prevent it but aren't perfect because your eyes & ears remain open (my hunch is that it's likely the eyes as the next major transmission vector so glasses or full goggles would be almost fully effective).

Personally, I think the ocular route has been under-investigated in transmission.

Well, first off I'm going to say "citation needed", but secondly, I haven't had a single transmissible illness since I started wearing KN95 whenever I'm around people indoors. This includes going to crowded markets, trans-continental flights, a recent concert... Of course, wearing some flimsy loose thing that barely even covers your face (like those "surgical" masks that are typically handed out) is certainly going to be of limited usefulness. A decently-fitting N95/KN95 , well.. it works.

> I haven't had a single transmissible illness since I started wearing KN95 whenever I'm around people indoors

You mean you haven't gotten ill since you started being hyperparanoid about getting ill? Sure, that's not really surprising. Tying the result specifically to the masking itself is still speculative though, as would be generalizing your specific case to the whole population, eg. as you say, "decently fitting N95" is probably key, but how many are going to be that vigilant?

This really gives off to me the same vibes as when doctors were up in arms that washing hands before surgery couldn’t possibly have an effect on the outcome.

We know that such viruses have to enter your body through eyes, ears, nose or throat or there’s no way to get an infection. Why do you think it’s so surprising that blocking access to your respiratory system by a filter that is small enough to exclude the virus (whether cold, flu or COVID) prevents you from getting sick?

Furthermore, if I recall correctly there’s studies showing efficacy of having even a basic cloth covering helps because the thickness of the material means that even if the virus is small enough to get through, the probability of crossing all the layers through the cloth is harder. Picking up illness from contact with a surface -> touching your face is a much more difficult infection vector than the direct access port available through the communication ports on your head.

> We know that such viruses have to enter your body through eyes, ears, nose or throat or there’s no way to get an infection. Why do you think it’s so surprising that blocking access to your respiratory system by a filter that is small enough to exclude the virus (whether cold, flu or COVID) prevents you from getting sick?

I never said it would be surprising, I did however say that taking that seemingly plausible argument and immediately concluding that masks would meaningfully reduce infections in a whole population is premature. As you just said, viruses enter the body through multiple mucous membranes, so if everyone who wears masks doesn't wear them properly, or still touches their eyes and doesn't sanitize their hands properly before eating, the effect of masks could still be minimal.

> Furthermore, if I recall correctly there’s studies showing efficacy of having even a basic cloth covering helps because the thickness of the material means that even if the virus is small enough to get through, the probability of crossing all the layers through the cloth is harder

It's important to keep in mind that 50% of studies in medicine fail to replicate. Don't put too much stock in "I saw a study".

> Picking up illness from contact with a surface -> touching your face is a much more difficult infection vector than the direct access port available through the communication ports on your head.

Is it? Do you have empirical data to support this claim? I'm sure it seems plausible to you, just like it seemed plausible to those old doctors you mentioned that a gentleman's hands were always clean, but I think the real lesson is that we should rely on empirical data and not only on seemingly plausible arguments from seemingly plausible assumptions.

Which isn't to say that advising people to wear masks is necessarily a bad idea either, but there's a world of difference between "this seems like a good idea if you're cautious or want to reduce your changes of getting sick" and "you're a terrible person if you don't do this because this is proven to work".

> Is it? Do you have empirical data to support this claim?

Yes. There’s all sorts of papers to this effect. The primary transmission vector by far is nose and mouth and masks are very well established to substantially reduce infection rates. Glasses also reduce rates but not as much. The claim that studies are frequently not replicated is a good general rule of thumb. It just don’t apply to COVID where there have been many many studies on the efficacy of masks. Not to mention many studies prior to COVID on influenza, SARS and other respiratory/airborne viruses. Sure, studies can always be better and all studies have flaws, but there’s overwhelming evidence afaik that masks are highly effective. I’ll let you do your own arxiv/pubmed research to find the studies because they’re quite easy to locate.

It’s a fair argument about whether masks at population scale / mark mandates are effective because people do fail to wear them properly and frequently. So it’s hard to estimate the true efficacy of masks in the wild, but it’s definitely well above 0 where we have fairly good A/B examples between populations that did adhere to masking and those that didn’t and corresponding COVID infection and hospitalization rates. This stuff really shouldn’t be so controversial.

> so if everyone who wears masks doesn't wear them properly, or still touches their eyes and doesn't sanitize their hands properly before eating, the effect of masks could still be minimal.

That’s not an accurate representation of the research afaik. The infection rates for contact based COVID in particular is vanishingly small. Like maybe the virus can survive on surfaces for a bit but there’s no evidence that it’s at all a meaningful infection vector. Same goes for hand sanitization. I could be wrong but my understanding is that the dominant vector by far for COVID is aerosol transmission. My uneducated hunch is that that this is also likely generally true for most other viruses like the common cold and flu - contact transmission maybe happens but nowhere near at the same rate as for direct inhalation.

> but there's a world of difference between "this seems like a good idea if you're cautious or want to reduce your changes of getting sick" and "you're a terrible person if you don't do this because this is proven to work".

I think you have displayed why you’re so resistant to the suggestion that masks are highly effective and it’s nothing to do with the science. It’s that you feel that people recommending masking have placed a value judgement on people who don’t and I totally get that. But notice I did nothing of the kind. All I’m saying is that the efficacy of masking is very well established. The value judgement piece has nothing to do with science and as anyone who tried to be super strict about it hopefully learned during the pandemic is that strict adherence is very difficult. But similarly the lasseiz faire “but mah rights” crowd swung too much in the other direction and didn’t even try. And yes, it’s also been established that communities that didn’t mask as effectively had more COVID infections and deaths because of hospital overwhelms. It’s also interesting that the anti-mask and anti vaccine crowds seem to have a lot of overlap. It’s an identity thing and science can’t resolve identity issues. Same reason fundamentalists go for the god of the gaps theory - it’s hard to admit a mistake and easier to believe that support for your position remains in the gaps that existing science research inevitably has.

If it turns out in the future that masking is ineffective and there was some massive flaw in all the studies attempting replication, I’ll gladly I admit I was wrong. But I’m the absence of any information, it’s stronger to assume that masks are effective because we know it’s a respiratory and airborne illness and it stands to reason that masks would inhibit the mechanism of action. That we do have studies around this and the majority support that properly worn masks are effective is bonus gravy. But again. Identity issues are not solvable through scientific research or we wouldn’t have flat earthers and people who believe the Bible instead of evolution.

> The primary transmission vector by far is nose and mouth and masks are very well established to substantially reduce infection rates.

Which doesn't at all explain all of the studies that found little to no effect to pervasive masking. If the effect is as strong as you're suggesting, then even partial masking would show an effect, even at population levels. This issue is simply not as settled as you're portraying.

> It’s that you feel that people recommending masking have placed a value judgement on people who don’t and I totally get that. But notice I did nothing of the kind.

This thread started on this premise, and I replied along those lines, and then you replied to me. I've made no assumptions about you other than you're clearly pro-mask and convinced by the evidence, and the only position I've staked is that the evidence is plausible but not as clear as you and others have been portraying.

> Which doesn't at all explain all of the studies that found little to no effect to pervasive masking

Not sure what you're referring to here. Statistically, there will always exist studies that show the null result. That doesn't mean that there's no evidence of effect. There's been lots of repro.

Here's a link you can use to start exploring this topic with links to studies:

https://coronavirus.delaware.gov/covid-19-myth-or-fact/myth-...

I'm sure you can find other studies. But ultimately clearly no amount of information here will change your conclusion that there's no evidence that masks are effective so I don't know what more to say here. Good luck.

> hyperparanoid

That is really far beyond polite - and I'm guessing against guidelines. Especially since it is a psycological term.

You can disagree without being disagreeable.

I have only gotten sick once in the last 2 years and I haven't worn any type of mask since restrictions lifted.

I haven't really had a strong illness since before covid either.

I did finally have a 99.9F fever for a day recently that felt a lot like a vaccine shot.

I haven't been particularly careful about anything for the past 2 years I think.

There is a lot of empirical evidence supporting the effectiveness of masks against COVID-19, and I would not call it weak. In my own quest for actual research instead of single data points ("I never mask and have never gotten COVID"), I found that out of 27 peer-reviewed studies, 22 of them show masks are effective: https://github.com/mbevand/masking-effectiveness

>but rather that the empirical evidence for masking, especially vs. the new strains, is quite weak

https://medium.com/incerto/the-masks-masquerade-7de897b517b7

I am a developer, not a doctor, so I just rely.on health authorities as imperfect as they are: https://www.cdc.gov/mmwr/volumes/71/wr/mm7106e1.htm .

Public health authorities didn't exactly cover themselves in glory from 2020-2022. Scientists did! But there's a world of difference between a public health practitioner and a microbiologist or physical chemist or chemical engineer.

Are you suggesting that microbiologists, physical chemists, and chemical engineers now claim that properly fitted N95 masks are ineffective in reducing the transmission of current strains of COVID?

What a weird conclusion to reach from what I've written.

Upthread, you said "empirical evidence for masking, especially vs. the new strains, is quite weak".

Yes, that is so.

I’d be curious to read more on that - any citations?

The air on a plane circulates and causes illness to many people, like people who have had plastic surgery are advised not to travel too soon for fear of infection.

Have you found that it helps there?

I read an article about masking and airplanes that seemed reasonable:

https://www.theatlantic.com/health/archive/2022/07/covid-omi...

The basic advice is to unmask when it is okay to use your laptop. The plane is cruising and cabin air is completely exchanged with outside air every 2 minutes. The biggest risk, according to the article, is when the plane is on the ground.

Thanks, this is a great article.

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