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Comment by dailykoder | Hacker News Reader

I still desperately want to know the current (scientific) state of wearing a mask. On the one side we have people that say 'our bodies need to learn again to fight against viruses' and the other side which wants you to put on a mask even if you have the smallest sign of a common cold. - Though, I do understand the fear of people who have/had long covid, MCFS or do know people who have, but I don't know what conclusion to draw for myelf out of this. Gladly nothing happened to myself. I don't even know if I ever had covid. At least I never had a positive test and I did quite a bit of them. Maybe I just have a lucky immune system (or a good one because I dont fear getting sick and run into all sorts of viruses?)

I myself tend to lean towards the first group, but also recognize that masks during covid might have been a good thing. At least in the beginning when we didn't know what we can expect.

So does anyone have any literature on how good masks are, if we should be wearing them and if so, when we should?

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> our bodies need to learn again to fight against viruses

This is unequivocally false. There is zero benefit to exposure to almost all viruses that infect humans. At best you would get sick and then have limited immunity to that single strain for a period of time, but getting sick is always worse than not getting it. You're not going to get immunity to the flu by "exercising" your immune system with colds or vice versa.

The only exception I'm aware of is chicken pox, where getting it young had better outcomes than getting it in adulthood so it made sense to seek exposure, but we have a vaccine for that now which is significantly better than ever getting it.

That doesn't necessarily mean we should all go around wearing masks always. There are certainly tradeoffs associated with that.

> The only exception I'm aware of is chicken pox, where getting it young had better outcomes than getting it in adulthood so it made sense to seek exposure, but we have a vaccine for that now which is significantly better than ever getting it.

Indeed, please consider a chickenpox vaccination over inducing exposure if it is a choice between the two; there is a significantly lower risk of shingles.

The best case of a virus exposure is not getting sick. Humans have an immune system, which is exactly what was being alluded to

Sure, but not getting sick also won't cause your body to "learn again to fight against viruses" as OP claimed. Regardless of whether you wear a mask or not.

This is out of my expertise but I have a hard time believing that

same here... at a species level, I would expect evolutionary benefits if immunity increased with exposure

My advice is to look at studies done before 2020 when it became political. My research suggests that, while masks probably do something, it's very hard to measure the exact impacts. The prevailing wisdom before 2020 was that masking the public for viruses didn't do anything. For medical professionals, very strict masking protocols were needed to get any assurance of safety.

>For medical professionals, very strict masking protocols were needed to get any assurance of safety.

That's a very good point. As I understood it, even if we ignore the people that don't cover their nose, you have to be very careful when putting one on, to get the desired protection. Most people just don't care enough about it. Also use them to often, yada yada yada...

The prevailing wisdom before 2020 was that almost no virus was airborne; and you needed to assume new ones weren't, lest all hell break loose.

That's how we got the pandemic.

> look at studies done before 2020 when it became political.

Good advice and easy to do. Just use your favorite source to find review articles. You don't need to read many, as conclusions were quite uniform.

When I did the pre-2020 deep-dive I found the studies to be uniformly about the mechanics of the mask (hole size and particle size) and therefore the conclusions uniform on that front.

It was only after 2020 that any studies were done on effectiveness in use. The results are a lot more positive there. However, it was still difficult to do controlled studies so the results aren't as strong as one would like.

A big problem with all the discussion about masks is that there are at least three different types of study, and people tend to mix the conclusions.

1. Epidemiological: "Town A mandated masks and town B didn't. Was there any difference in reported rate of pathogen spread?" Reviews over the past century of epidemic responses indicated no overall benefit.

2. Clinical: "In a controlled situation, was there a difference in rate of pathogen spread between the mask-user group and the non-mask group?" There was soft support for some benefit in non-sterile, close-contact environments.

3. Laboratory: "On a laboratory bench, what degree of pathogen capture was achieved by the mask apparatus?" These studies assume that performance on the bench correlates to performance in the field. The N95 mask is a case in point. On the bench, it performs better, but reviews of clinical studies didn't find a strong effect in field use.

Masks were absolutely good at first as the medical services were at a loss how to treat patients even under the best circumstances, so disease prevention was crucial. There is an argument to be made now that we’re going to have to deal with a perennial virus with recurring infections throughout our lifetime. Some people react more adversely, so why shouldn’t they wear masks?

I’ve seen groups in Asia wearing masks as a gesture of respect for their community. It’s not to say we’ll all fall hopelessly naive to disease if we don’t wear masks, but we would all certainly be happier not getting a debilitating virus at least every year.

FWIW, a lot of the research money has dried up, so I’d be surprised if any longitudinal studies will arise now about disease prevention and masking. Seems like a study tricky to control.

> I still desperately want to know the current (scientific) state of wearing a mask.

100% agreed.

We wore masks pretty religiously (definitely when it was mandated, often when it wasn’t for a while).

Several months ago, our household got COVID, one persons at a time. We always quarantined in a room, and wore a mask for the limited time we left quarantine.

A couple months ago, my mom tested positive, while living with three others. No one ever wore a mask or quarantined, only keeping a distance. Nobody else ended up with it.

Very anecdotal and not scientific at all, but it’s these and other similar anecdotes that make it very hard to understand the impact masks have on spreading/not spreading the virus.

There’s an extremely wide range of viral expulsion rates, both from person to person, and from day to day for a single person. You really have to think about things logarithmically. There’s some viral concentration that is enough to infect you 50% of the time, but most of the time, the actual concentration is either way higher than necessary or way lower than necessary.

The types of masks most people use and the way they wear them maybe filter 70-80%. That’s about 0.5 on a log 10 scale. That will make a difference sometimes, but not that often if the experienced variation in concentration is maybe 4-5 orders of magnitude for a positive person.

If you’ve got someone sick in your house and you don’t want to get covid, you need to do high quality masks on everyone, fans blowing out windows, air filters, intelligent HVAC operation, etc. If you do all of that you can probably get 3 orders of magnitude reduction and likely keep it from getting everyone in the house.

All the legitimate studies that did not find masks to be effective had glaring omissions, such as adherence to guidelines. Would you wear the mask properly or let it droop?

E.g. from https://pmc.ncbi.nlm.nih.gov/articles/PMC8499874/

Results: When the adherence to mask usage guidelines is taken into account, the empirical evidence indicates that masks prevent disease transmission: all studies we analysed that did not find surgical masks to be effective were under-powered to such an extent that even if masks were 100% effective, the studies in question would still have been unlikely to find a statistically significant effect.

Systematic reviews like those done by Cochrane search the literature for relevant studies then apply pre-set standards to exclude those that have a high risk of bias. That's why so few studies were included. It's not their fault that good studies haven't been done.

The answer is to do sufficiently powered RCTs to resolve the question, not conclude that masking works on the basis of low quality observational studies.

Paradoxically, from public health perspective that does not matter. If you study efficacy of masks, adherence to masking protocols is absolutely crucial variable to control.

However, if you study efficiency of masking mandates, you do not get the luxury of controlling masking protocols and *have* to take adherence to masking protocols as population parameter. As expected, studies where actual adherence is in the gutter find masking mandates ineffective at population level.

This exactly my thinking.

I'm still wearing a mask when I have a cold though, especially in public transportation.

> When the adherence to mask usage guidelines is taken into account

Which pretty much in my observation no one back then was wearing masks correctly, was wearing the correct masks that actually had some effect (when worn correctly), or were changing them at a appropriate frequency according to guidelines.

I really depends on the masks. The cloth masks with a couple of layers aren't very effective because Covid is airborne in the sense the particles of liquid it persists in are typically 1-5nm in size and hang on the air and it survives for hours like that depending on the conditions. We know that N95/99/FFp2/3 standards block this very well and a number of studies done in places like a hospital in Cambridge showed they were extremely effective, maybe 100% effective at avoiding infections. The challenge is with these masks is they require a bit of knowledge on fitting and testing they fit correctly. Just drop shipping them into a random village didn't work and people have a tendency to do dumb things like breaking the seal to scratch their nose or taking it down to talk.

But when worn and used correctly they are extremely effective, the physics and engineering on which they are based has never been in doubt.

Cloth masks are not very effective against spreading of covid19, but they are effective against spreading of swine flu. Covid19 and swine flu both hit hard immune system for first time, so mortality rate jumps from 1.1% + 0.1% to 5.4%, or about 5x.

Not arguing but would appreciate sources regarding N95 masks. When I reviewed the literature in 2020, there was no solid evidence that their use led to improved outcomes, even in clinical settings.

One of the issues that came out of the covid outbreak was there was not enough masks for medical staff.

They initially said masks wouldn't help so that the public wouldn't buy them up.

This is covered in the documentary "Totally under control".

No literature, but purely anecdotally ...

I work in medical, and I've been wearing an N95 at work and in public indoors spaces (especially supermarkets) consistently.

No cold / flu / SARS-CoV-2 in over 2.5 years. Actually no noticable communicable illnesses at all. I don't miss that congested nose. I don't miss the shivering cold on a hot day. I don't miss the hacking cough. I don't miss the horrible syrups and weird lightheadedness after taking some of the cold-flu meds.

Masking up is rock'n'roll.

There is no good evidence showing that masking slows the spread of SARS-COV-2 because wealthy nations like the USA failed to use the opportunity of the pandemic to conduct large scale randomized controlled trials testing their efficacy.

The positive studies that everyone is referencing are all observational studies subject to confounders. For instance, the people that comply with mask mandates probably do other things that slow the spread of the virus, like washing their hands. It's impossible to control for all confounders without a priori randomization. That is why RCTs were invented, why they are the "gold standard" of evidence, and why they are the only type of study included in the systematic reviews done by Cochrane.

When the RCTs are systematically reviewed the effect of masks disappears. This is the infamous "Cochrane study" you'll read about. This review is conducted periodically, it has been done six or seven times in the last 20 years, and has failed to find evidence of masks/respirators slowing the spread of any respiratory viruses. However, this same review shows that hand washing slows the spread of the COVID virus. [0]

Maybe masking works but there just isn't the evidence available to say that it does. All medical interventions have a cost and it shouldn't be paid by the public without good evidence that it will be worth it.

This video is an excellent discussion of the controversy with the lead author of the Cochrane review of physical interventions to interrupt or reduce the spread of respiratory viruses and another epidemiologist from the "Evidence Based Medicine" movement which discounts observational studies. They discuss the evidence including the "Bangladesh RCT," the precautionary principle, equipoise, the reaction to the latest review as compared to previous ones and the actions of Cochrane's director. [1]

[0] https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD... [1] https://www.youtube.com/watch?v=P_JTBftjQuA

a) People were also constantly taking their masks off to talk to people anyway (this is not me saying masks work, but it is me kind of implying people knew something was off and they weren't actually so scared, for the most part)

b) Covid (especially when you consider using PCR at high cycles to 'detect' it) relied on a model of asymptomatic transmission, when that was never proven

Wearing a mask, even poorly will reduce the chances of spreading a respiratory virus. Is that reduction meaningful? That's a really hard question to answer in any sort of binary way. Combined with how bad humans are at processing/understanding probabilities, you will never have wide consensus.

As for the specialists, antidotally, I've never heard a medical doctor claim anything other than a mask is helpful and they all seemed to wear theirs quite happily.

I also questioned the vialibily of face masks early on in the the covid scare..

I have grown mushrooms at home for many years and to prevent contamination entering my grain bags and jars, I have to use an extremely fine filters.

I use a Microppose Synthetic Filter Discs which have a 99.97% Filtration efficiency down to 0.22μm (microns).

The standard face mask is 0.3μm and is 95% efficient at 0.3 microns. This means that the filter media is effective at filtering 95% of airborne particles as long as they are larger than 0.3 microns in diameter.

The Coronavirus molecules tend to be about 0.1 microns in diameter

Masks do not prevent Coronavirus molecules from passing through the mask, However, Coronavirus molecules do not float freely around in the air and usually travel around as part of fluid droplets that become airborne created by coughing and sneezing.

These droplets are supposed to be about 0.5μm so the masks could prevent water droplets from entering the body.

I still have my doubts though.

My understanding solidified around this take:

Masks are great to slow the spread of the virus. So if you have a big wedding party coming up you might want to wear a mask in the subway in the weeks before your big day.

But: Masks won't save you from the disease in the long term. There's no way you can escape viral respiratory infections in our society.

> Masks won't save you from the disease in the long term.

Bullshit. 4 years and counting. Understanding your respiratory PPE and utilizing it correctly is a wonderful thing.

Hi there. You’ve left 21 comments about Covid and vaccines in the last three hours, now you’re cussing people out and it’s time to turn your phone off and go to bed.

5 actually, 3 of those replying to followups to earlier posts. I'm not obligated to display patience with misinformation. Did you have anything factual you wanted to contribute here?

To continue on sfblah's comment (just above mine): in France, before the mask mandate that came after the first covid lockdown, I don't remember a single doctor/nurse* to wear a mask to do their job even during intense period of sickness like in winter or even during previous pandemics.

I don't remember anyone wearing a mask either in the doctor's waiting room, even when it was fool of sick people (old and young mixed)

* except for dentists, surgeon and their assistants during

Doesn't it depend on the medical center these days? In Poland everybody was so crazy about it that even police used to go on public transport (trams, buses) to check if everyone have their masks on, but now some doctors ask you to wear a mask (then they provide it as well), some not. Same thing in hospital.

Yeah I think these days it depends on the doctor: some don't care, some asks you to wear one. But I admit I may be wrong here, I'm lucky to be healthy and my family too so we pretty much never go to the doctor.

We had this police operations too, even in restaurants where you had to have your mask when standing up (like going to the toilet, paying the bill, etc..), but you could take it off at your table.

I remember during the first lock down we were forbidden to go 1.5km from home except to go buy food: there was a large parc close to home so a lot of families would go there to chill, play with kids, do running, etc... but after 3 weeks the police noticed and they were going around in the parc to fine everyone. Most people were more afraid to get caught than to get sick, even old people.

Yeah here in Spain nobody does masks anymore either. Except some tourists.

I'm glad, I always found it a super heavy burden, for me even worse than the lockdowns. But this is due to prior respiratory issues and PTSD related to that. For other people it will be a lot easier.

For me I'll just take the risk as it comes, I'm sure it's a bit higher without them but there's many things that can kill you in this life. For me being overweight is probably a lot more likely to do so.

Yeah me too, I could not stand it.

I do agree with you !

Focusing on being healthy is in my opinion way more beneficial to avoid being sick in general than trying to avoid being sick at all cost. Being stacked by millions in cities living unhealthy lives is definitely not helping to prevent being sick. I move to the country side after the last lock down, ~50km from a big city to still be close to work, and it's been very relaxing and good for my family's overall health.

Oh yeah I love living in the city. Drinking and partying in clubs with hundreds of people in a tiny place (so masks really won't help anyway) until 6am. My life is not very healthy I know, but it's very exciting which is also important.

There was a commercial in Holland saying "If you have to watch your life flash before your eyes one day, you'd better make sure it's not going to be boring!". I subscribe to that, although the ad was for the army which I wouldn't find exciting at all :)

But I know many people who love the quiet life. I lived in a small town for a decade but it made me feel so restricted, I deeply hated it. People vary! And I don't have a family even at my age so I'd be pretty lonely outside the city.

I subscribe to that too!

If your enjoy your time that's more than enough to continue doing what you do :D

It's easy: masks helps to avoid infection or/and buys more time for body to fight a virus. Looking at graphs of mortality rate between countries with good mask culture and bad mask culture, it looks like masks reduced Covid19 mortality by 2x at least.

  Country   # of cases   # of deaths
  USA       111,820,082  1,219,487
  UK         24,910,387    232,112
  Japan      33,803,572     74,694
  S. Korea   34,571,873     35,934

That's of course wayyy oversimplified. There are many more differences between those places than just masking culture. You can't come to a conclusion without evaluating all the other factors.

This is exactly the kind of pseudoscience argument people pull in that muddies the water (on both sides of the debate)

This is not a scientific argument (correlation is not causation), but it's an argument supported by numbers, not just words.

If we look at scientific studies, they also confirm the some effectiveness of masks in reducing the risk of influenza or COVID-19 infection and mortality.

One study on mice, I saw, showed that antiviral-coated masks increase the likelihood of developing immunity to infection BEFORE the infection, because fragments of dead viruses enter the lungs and trigger an immune reaction.

Yeah I'm not saying that masks don't help. Just that these numbers don't prove that. There's so many more cultural and medical differences.

Is it not more likely the # of deaths are related to obesity for example, where US has 5-7 times as many obese as Japan for example. Which matches the % deaths statistic you have there quite well.

In other words: it's not easy. There are many factors at play.

I discounted 10x to 2x, or 20% of the effect.

Others have already pointed that mortality rates do not reveal the full picture. There are various factors that affect the mortality rates in different countries – masks being only one of those factors. There are more critical factors at play such as age, obesity, co-morbidities, access to affordable health care, etc.

While masks are shown to slow the spread of infection, ultimately the larger problem with handling the COVID-19 pandemic was the lockdowns and isolation. Lockdowns and isolating individuals definitely helped reduce the spread of the infection and probably saved a lot of lives but prolonged isolation actually reduced the overall immunity in our population. Human immune systems require constant exposure to all sorts of germs to keep it humming along. Isolation does the exact opposite and while it is useful in the short term, prolonged 'clean room' type conditions created due to isolation and lockdowns are harmful.

The only science you need to know is: the disease can't spread if you don't breathe it onto someone.

You can literally plug your last sentence directly into Google and get good information.

I did that and clicked through the first 5 links. Doesn't sound that obvious to me. I found this one interesting: https://pmc.ncbi.nlm.nih.gov/articles/PMC10446908/

> More studies found that masks (n = 39/47; 83%) and mask mandates (n = 16/18; 89%) reduced infection than found no effect (n = 8/65; 12%) or favoured controls (n = 1/65; 2%). Seven observational studies found that respirators were more protective than surgical masks, while five found no statistically significant difference between the two mask types.

So as a dummy I conclude that masks do work, as expected. But the question is still: Do we need them?

Do we need them now? Probably not. But if we get another pandemic? Definitely.

> ... Due to a paucity of randomized controlled trials (RCTs), observational studies were included in the analysis ...

I doubt that study will be conclusive, there are so many possible confounding factors that are hard to account for. Particularly the tactical problem where wearing a mask obviously can stop someone getting COVID in any given encounter, but it is much harder to check if it stops them getting COVID during the pandemic.

If we have a control that moves the world from someone gets COVID during the pandemic to ... someone still gets COVID during the pandemic but a month later then it is unclear what mandates are doing. It'd take more than a study abstract to determine that, it'd take a lot of reading through the specifics to see what is going on.

Changing an exponential process that doubles every week to every 2 weeks is basically doing nothing. Half the population will still be infected in the last step. If spreading the infections over 2 weeks instead of one is important then that might be a win, but everyone seemed to abandon flattening the curve pretty quickly as a strategy.

Honestly I think the best advice is to assume masks don't do anything. The point isn't to suggest people run around having parties during a pandemic. The point is to suggest people use distancing as their primary mode of protection. Being outdoors is an excellent defense, as is shown in the data generated by the NFL during the pandemic.

>Being outdoors is an excellent defense, as is shown in the data generated by the NFL during the pandemic.

This is so crazy to me. Maybe it wasn't communicated clear enough, but for me it was always cristal clear that while being outside chances of getting infected are very very small. And people were still afraid and wore masks outside. The government still bullied you, and police could fine you, if you took a stroll during lockdown in germany.

No, I didn't want to go outside or to a party to infect others. I wanted to take a stroll to not kill myself and because I knew there is almost no chance in getting infected or infecting anyone else. And I still was scared of any police car driving past, because the government fucked up. I even remember the news stories of people getting fined because they read a book on a f-in park bench, because they werent allowed to linger outside

The weirdest part to me is that we were well aware being outside was relatively safe early in the pandemic.

There is another world where the pandemic became about telling people to focus on good ventilation and being outside as much as possible. Imagine classes and meetings conducted outside, and everyone just hanging out at the beach and parks.

It almost sounds like we could have ended the pandemic feeling like it improved our mental health.

No. Sorry. Google, whether through fault of its original creators or not, is actively known to do partisan censorship (which is a hard thing to consider, seeing as how a search engine points at internet sources, but it's still true)

It's pretty much a no-brainer. Do masks reduce emissions of airborne infectants? Yup. Can you tell, at any point in time, if you are asymptomatic but contagious and emitting infectants? Not without testing frequently, which I'll venture you don't. Can you tell who around you is immuno-depressed and might suffer debilitating consequences from being infected? Nope. And finally, is wearing a mask when you're out in public onerous? Nope!

So there you have it. At very little cost to yourself, you can help protect strangers around you. I promise you those strangers to whom it makes a difference will notice, and you will have their gratitude.

Mind you, if you are only asking from the angle of your own personal well-being, and making a difference to strangers at very little cost to yourself is not something that you can find much interest for, then it's a different question entirely.

The reality is that effectiveness of masking is dependent on relatively strict protocols for masking. While masking does work in clinical environments, early research on covid spread has shown that there was very little if any public health effect attributable to masking mandates in particular.

Think of it as running publicly facing web service based on an extremely popular software. The sheer amount of skiddy traffic ensures that unless you are diligent and methodic at applying protective measures something will eventually slip through. If your cumulative probability of "catching" something over certain period approaches 1 with a "security" measure on, that measure is effectively ineffective even if you can show efficacy.

Imagine you are an admin on some computer network and notice that a particular node is infected with some worm. Intuitively (or following best practices) you isolate that node first and foremost instead of deploying some protective measures on the rest of the nodes. This approach is more effective due to 1:n relationship in infection spread, where your spread block probability is multiplied by the number of healthy nodes if deploy protective measures on healthy nodes instead of the infected one.

This is masking. Masking is much more effective when deployed on the sick, however for many diseases detection lags behind spread due to symptoms lagging behind infection. So you have this weird tautology. Masking is only effective if the majority of the population, including asymptomatic, uses masks correctly. Otherwise the sheer amount of viral particles one is bombarded with still ensures infection ratio larger than one.

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> On the one side we have people that say 'our bodies need to learn again to fight against viruses'

Sorry, but this is scientifically dumb take. Yes, immunity against repeat exposure does build up, but you are playing russian roulette. There are no benefits to contracting a "full" disease while there are risks associated with that. Prevention carries much lower risks at similar or better reward.

> On the one side we have people that say 'our bodies need to learn again to fight against viruses'

I never really understand this line of thought. A) where does this the prescription come from? and B) you realize this fight comes with life expectancy deficits, right? You're just borrowing from later in life to pay off today. Why not just avoid it today?

Regardless, it's not difficult to avoid masks being actively harmful to public health.

Russian disinformation

I can't be the only person deeply dissatisfied with that as an answer.

It's just the truth

Even if you didn't notice that back then, all the no-vax groups (that I'm aware of) ultimately became overt supporters of Putin and his invasion of Ukraine.

There was no opposition to the first, much more drastic, measures; that began when governments finally came to do something right (masks and vaccines), and towards things insignificant compared to the previous restrictions.

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