While I suspect that the hypothesis is correct, the article is in no way conclusive or authoritative. There is no attempt to control for other variables which could explain the observations.
For example, the seafood and chicken processing plants had a 95% asymptomatic rate among the infected.
I would love to see some studies which compared this against rates that are normally seen for the same age/gender/heath ect.
Similarly, how do these observations fit in to the greater picture. Are there other processing plants that used masks but had higher rates of symptoms?
Also, another way to view this data is that perhaps we are vastly underestimating total number of asymptomatic cases overall due to reporting and testing biases.
Can wearing or not wearing a mask to protect oneself from covid-19 be regarded as an example of natural selection at work? Where mask wearers are most adapted to survival in their environment and non-mask wearers are not?
The mortality braze is high among elders who likely had their children already or won't get any. Younger people suffer from other conditions primarily.
Both theory and empirical evidence. Mask wearing at least has the former: catching your own aerosols so you don't get other people sick so easily.
The best is remedies that have both. But don't think evidence without good theory is fine. I'm not sure it's even that much better than theory without good evidence.
That doesn't consider the possibly of a significant portion of the population infecting themselves. Remember, most people do not have the training to make a proper mask and use it correctly.
That's the reason we need randomized trials. How do masks work outside of the lab?
Also, it isn't accepted science that Covid-19 infects through aerosols.
Isn't containing coughs and sneezes (along with hand washing, etc) one of the most fundemental parts of our understanding of how to prevent the spread of infectious diseases. The NHS has had the "catch it, bin it, kill it" motto for years as a way to prevent flu / common cold. There may not be studies specifically into covid-19 on this topic. But we do know that this is one of the primary spread vectors for basically every other similar respiritory disease. It's worth studying covid specifically just to be sure, but it would be bizarre if covid was different in this respect. And IMO it's completely wrong to say we have no evidence tht masks work.
> There may not be studies specifically into covid-19 on this topic.
There is only one study that looked at cloth masks and it was completed in 2015.
> And IMO it's completely wrong to say we have no evidence tht masks work.
I never said that. I'm saying that a high standard of evidence has not been met and there isn't much interest in running trials on cloth masks. The only one I could find is in Guinea-Bissau.
Mask wearing seems unlikely to be genetic. If it was genetic, there might be slight evolutionary pressure favouring those genes. I think the pressure would be slight as people of reproductive age are very likely to recover from the virus.
Not sure about that. There are known genetic influences for risk aversion. If risk averse folks wear masks, and suffer less/survive more, then this potentially could be an evolutionary mechanism.
Yes, but risk aversion has implications on things other than mask wearing. It's pretty unclear that risk aversion will be selected for because of the pandemic. The least risk averse are probably more likely to find a partner this year for example. Plausibly risk aversion might even be selected against!
Mask mandates were mostly introduced after the first wave of deaths. And there's apparently no second wave in most places, even when the tests indicate a second wave of positive RT-PCRs.
So - no. Mask wearers aren't going to experience any difference in death rates in the vast majority of places because COVID deaths have already ended. And of course, when they were occurring, there was a lot of bad reporting there which conflated people who were dying anyway with people unexpectedly killed by the virus.
On the one hand, we don't know for sure if the number of virus particles one is exposed to correlates to severity of disease with SARS-CoV-2 in humans because we don't have rigorous studies that say so. On the other hand, it would be less surprising if it were true than if it isn't, and we should probably proceed on the assumption it's probably true. (Though I'm not an epidemiologist except to the extent that we've all become amateur epidemiologists these days, so don't take my word for it.)
As I understand it, it's always better to be infected with few viruses than with many.
Think of it like this: I you get infected with 10 instead of 1.000.000 of a virus that grows x10 each day, your immune system has 5 extra days to fight it.
[Disclaimer: I'm a random software guy who reads a lot, not in any way a virus expert]
This was my take on the article as well: Masks = lower initial viral load, which seems logical to me. And, this doctor isn't saying anything much past "Wear a mask, dummy!" which I'm perfectly fine with.
The problem with severe COVID, as I understand it, is an immune system that did nothing until it was too late, at which point it overreacts and releases a cytokine storm.
The hamster study did not show a big difference in outcome with higher viral load, contrary to what the article suggests.
If you trust in the science of conservation of energy you can release a iron ball on a pendulum from your nose and stand there waiting for the return, without taking a step back.
If you trust in the science of viral load not mattering, you will pick randomly when given the choice of having 1 or 5 novel viral particles placed in your nasal cavity. Nobody sane trusts that.
Yes, viral load is correlated with higher severity for majority of flu-like illnesses, supported by research. Even if this coronavirus is somehow different, combating viral load is still beneficial for avoiding viral viral co-infection (getting COVID-19 with severe influenza on top).
Those who don't wear mask should also get exposed to "low levels" of viruses but just abit further away than the mask wearers for the same exposure dose. Maybe people with mask are less likely to have bad health habits? E.g. people who dont put the seatbelt on also are worse drivers.
To me, it seems plausible that masks protect better against large droplets (that follow something like a parabolic trajectory) than small ones (that waft around in air currents).
Sure, maybe I'd agree that they are people with masks are more likely to have good health habits, but I'd probably also assume that people with masks have worse health (even if they may have better habits).
I think their health is more relevant than habits in this case. I would guess that people who know they get sicker than most will be more cautious than average, they've been dealing with it their whole life. Maybe not totally independently of how their health habits are taught to them, but I bet a lot of it is just experience.
People know their bodies pretty well, even if they don't try very hard.
Not in COVID, but it's been demonstrated in other viruses. You can't do a challenge study with COVID, so the quality of evidence in COVID is going to be less.
Even if it is true, it does not mean the difference is dramatic. The difference in the hamster study is minor.
It is possible that you need a minimum viral load to elicit an immune response at all and if so, the virus would first need to replicate to that level in vivo.
I have a background in infectious disease research. From what I know, with this particular virus, it would be more surprising if the dose-severity dependence hypothesis was true than if it was not. There has been a lot of discussion of this hypothesis lately, but I am aware of exactly one experimental study that came anywhere close to proving it. That study dosed mice with a nasal titer ladder of flu and observed severity variations. Even that study failed to establish the dynamic range necessary to demonstrate dose dependence (the mice went from all survived to all dead in a single step of the titer IIRC).
There are certainly plausible mechanisms for the dose severity dependence hypothesis to be true, but with fast-replicating viruses I think the parsimonious assumption is transmission chains are dominated by a single event.
This article speaks in a very authoritative tone, but the assertions aren't fully backed by the research it links to.
And it bothers me that the quote, "dramatically less likely" is not a quote from the linked research, but seemingly just a pull quote of the article itself.
I support people wearing masks, even if it turned out to only be marginally better than not wearing one, but this article is borderline overreaching.
If in fact it's still very likely you can get severe Covid while wearing a mask, then sending the message that "wearing a mask will almost certainly prevent severe Covid" will likely lead people to engage in riskier situations with their masks. For instance, it could be that going to a nightclub while wearing a mask is still pretty risky. Telling people that wearing a mask eliminates risk would likely send more mask-wearing people to said nightclubs.
Of course, if wearing a mask was in fact extremely effective at stopping severe Covid, then one could make the argument that it's now worth doing these higher risk activities.
In the long run, it's worse to make overstating claims because it undermines trust in the original message. The main criticism of conspiracy theorists (pick you brand) is that they do not follow the evidence trail. If you want to be on "the right side", you need to ensure your claims are better backed up, otherwise its just two sides making stuff up until one person gives up.
As with OP, I support wearing masks and do so all the time if needed (not American though, so it doesn't have the political bent here it does in the states).
The truth can be valuable in ways that aren't immediately evident.
For instance, if evidence emerges that masks have some harmful effect, an over-estimation of the protective effect of masks can lead to a skewed cost-benefit analysis that results in a net-harmful pro-mask policy remaining in place.
Lies can also undermine credibility, and sometimes necessitate more lies to cover up for the first, leading to less effective and efficient communication amongst people.
It's not about the benefit for you. The whole point of wearing a non-N95 mask is to prevent your breathing from infecting others if you happen to be asymptomatic but positive.
However, the linked study concludes, "
All told, current understanding about SARS-CoV-2 transmission is still limited. There are no perfect experimental data proving or disproving droplet vs aerosol-based transmission of SARS-CoV-2."
That's not the conclusion, and cherry-picking those sentences is misleading because makes it sound like the article is citing a totally inconclusive paper. The next sentence is "The balance of evidence, however, seems inconsistent with aerosol-based transmission of SARS-CoV-2 particularly in well-ventilated spaces."
That "particularly in well-ventilated spaces" is doing a lot of work.
In normal times, people spend a lot of time with other people in not-very-well-ventilated spaces - including, unfortunately, many conference-rooms, classrooms, small shops, bars/nightclubs, etc.
So in all those actual places, Covid-19 is aerosol-transmissible.
Also, in just the few weeks since that JAMA discussion, more actual examples of Covid-19 almost certainly transmitted by aerosols have been compiled; see for instance study/stories linked at:
I didn't use the word "conclusion". The article does conclude with the sentence I quoted as well as what you quoted. If you honestly read what I wrote, you would see that what I wrote is in the linked page, as is what you wrote, and the sentence from each of our posts is orthogonal to the support that was being sought for the article.
I was not restating the conclusion, but showing how the original article was quoting support from a place that did not support what was being said.
That is a weird wording on the last sentence, because the virus doesn’t transmit by magic. All epidemiologists I’ve read sofar seem to speak of mostly droplet transmission with some role for aerosols, which is indeed still studied afaik.
Any good links for that? I haven’t seen anything beyond speculation that suggests that, and the patterns of infection in places I’m aware of aren’t consistent with airborne.
I agree. That is why the article for this post is so odd. It links to many pages that do not support what is being stated. It's almost as if they chose 100 random places to link, possibly from only looking at the first hits on google searches.
> In a more recent report from a different cruise ship outbreak, all passengers were issued surgical masks and all staff provided N95 masks after the initial case of COVID-19 on the ship was detected. In this closed setting with masking, where 128 of 217 passengers and staff eventually tested positive for SARS-CoV-2 via RT-PCR, the majority of infected patients on the ship (81%) remained asymptomatic, compared with 18% in the cruise ship outbreak without masking.
> A report from a pediatric hemodialysis unit in Indiana, where all patients and staff were masked, demonstrated that staff rapidly developed antibodies to SARS-CoV-2 after exposure to a single symptomatic patient with COVID-19. In the setting of masking, however, none of the new infections was symptomatic. And in a recent outbreak in a seafood processing plant in Oregon where all workers were issued masks each day at work, the rate of asymptomatic infection among the 124 infected was 95%. An outbreak in a Tyson chicken plant in Arkansas with masking also showed a 95% asymptomatic rate of infection.
It makes intuitive sense that a face covering would reduce the viral load one is exposed to. I've heard of other studies that have shown that the degree of virus exposure affects outcomes. Those involved exposure time and exposure distance to symptomatic patients with COVID-19. If a face covering reduces the viral load you get exposed to, seems like it would have the same effect as getting a lower dose exposure due to being a greater distance away or because of a reduced exposure time with a contagious individual. I hope more research supports the benefits of masks as it sounds like good news.
The viral load thing came up in some podcast I was listening too. So experiments were done with the flu Or cold virus and a smaller load resulted in a less severe infection.
They obviously can’t repeat the experiment with COVID. They suspect the same thing happens but they aren’t sure.
Oh the off chance it really is true, I’m wearing a mask!
would be great if someone can find them, but pretty sure there was a study done during the SARS 1 outbreak in the Canadian hospital that attempted to demonstrate that physical proximity to severe cases (and highly symptomatic individuals?) was correlated to viral load and further correlated to severity of illness. At least I saw people early on in Novel Coronavirus days of Jan/Feb speculating about the meaning of said study.
That cruise ship didn't issue masks until after the outbreak had occurred: "The first recorded fever on board the ship was a febrile passenger on day 8. Isolation protocols were immediately commenced, with all passengers confined to cabins and surgical masks issued to all. Full personal protective equipment was used for any contact with any febrile patients, and N95 masks were worn for any contact with passengers in their cabins. The crew still performed duties, including meal services to the cabin doors three times a day, but rooms were not serviced. Expedition staff helped with crew duties at meal service."
So passengers were already infected when that 81% figure was computed.
The comments on the WaPo article are very high quality but show that we have no idea what's going on because the reporting of scientific data is uselessly vague in the critical details.
I think the hypothesis could be correct, but as presented, those observations are very poor data. For example, we would want to see if these few examples generalize to other cases, or are they just outliers.
While there's no single slam-dunk study yet proving this with SARS-Cov-2 (Covid-19), there's so much mutually-reinforcing suggestive evidence that the authoritative tone of this UCSF professor/researcher/doctor seems justified, to me. In particular, there's a lot of evidence from other similar respiratory viruses.
Now also, there are patterns observed in masked-vs-unmasked Covid-19-hotspots for which the idea "masks cut initial infectious dose enough to make infections milder or totally asymptomatic" fits really well.
You can watch Dr. Gandhi presenting on this topic with slides & multiple paper/incident references, during a UCSF 'Grand Rounds' a few weeks ago - here's a direct link to where her talk starts:
It compares the Diamond Princess outbreak, which occurred in the hot spot temperature range (40s-50s F, mid-humidity), to a cruise around the Antarctic peninsula, which looks like it was about 20 degrees below the hot spot range and way outside the humidity range.
Is it possible that a very very low exposure can cause your body to ramp up an immunity response? I'm wondering if fatality rate has gone down because most people by now have had some exposure to the virus: not enough to get sick (not even asymptomatic), but enough for the immune system to prep that something is in the environment.
It's interesting that the word used for inactivated viruses is "killed" rather than, for instance, "destroyed". Destroyed might not be a better word choice because it may imply that the structure is completely taken apart but point being: (not to throw semantics into the mix just for kicks) does modern science consider viruses to be alive?
I don't believe there is such a thing as a bad philosophical question. Perhaps some questions aren't yet worth the time investment to think about. When we engineer self-replicating machinery (or rather, before then) this caveat is worth defining.
Deciding where on the spectrum between non-life and life we declare something to be alive is endlessly debatable and non-actionable. The fact that in time technology will add more points on that spectrum does not change this fact.
The precursor to modern methods was to obtain a little bit of smallpox and inoculate yourself with it. It was vastly less deadly than being exposed in the normal course, though not really safe. It still demonstrated the principle, that a little bit of smallpox was quite a lot safer than being exposed to a lot of it. This is not a good idea generally, it worked on smallpox when there was no other option. Still, dose can absolutely make a difference in how deadly a virus is.
The first real vaccine was to inoculate with cowpox instead, which was safe for humans but induced immunity to smallpox as well.
Modern methods are substantially safer, usually by entirely deactivating the virus before using it, but there are still some vaccines that use live virus (the oral polio vaccine is a live attenuated virus).
That is how vaccines can work. I think that saying "more or less" is disingenuous, when there are also toxoid, subunit, or conjugate. None of these broad classifications mention the adjuvants that are present. Look at the mRNA vaccines that are being tested for sars-cov2, such as by Moderna. Vaccines are not always attenuated or inactivated.
I'm curious about this too. I'm no epidemiologist, but as I've kept walking around my low-to-mid-density DC neighborhood I've wondered, if an exposure level likely to cause symptomatic illness is on the order of a minute's close contact with a sick person, then maybe it is good to get a second or two of exposure per week?
I feel like this is more of an immunology question, and really it depends on the amount of a viral load you would need to elicit an immune response without systemic signs and symptoms. And then you're basically reinventing the wheel of vaccination.
Yeah, IANAE also, but I half wonder if this is how a new variant of regular flu gets started. Kids immune systems handle it like any kind of flu virus. The older you are, the weirder this thing looks to your immune system, and less likely able to handle it. If you're introduced to it slowly, the more able your immune system is able to figure it out.
So I'm wondering if this thing never goes away, the vaccine never works 100%, but in a year or so it's not much different from any flu in all age groups.
Fatality has gone down because we are testing a much higher percentage of infected people. When 20+% of tests are positive you’re testing seriously ill people. When ~4-8% of tests are positive your testing people who may recover before becoming seriously ill.
That doesn't explain western Europe, where for example France has gone from 1000 deaths per day to 10, with the same infection rate in the 2nd wave. If this was due to just testing, that would imply testing was off by 2 orders of magnitude, which would imply half of the population has already contracted the virus, which we know from antibody testing is not the case.
You see the same thing in New York, where fatalities per day has gone down from 1000 to 7, while cases per day is only down 90% from peak. Crowded cities it may be impossible to avoid exposure completely (which crazily may be a benefit!).
Rural US is where the fatality rate isn't going down much, which would make sense since there's higher chance of someone having had zero exposure to the virus and then getting a bunch of it at once by coming in contact with a sick person.
NOTE this is not based on any research other than some guesses as to how these numbers could line up. Do not use this as a source for anything!
> which would imply half of the population has already contracted the virus, which we know from antibody testing is not the case.
Antibodies disappear quickly so antibody studies aren't a perfect indicator of spread.
See for example:
> The UK study, meanwhile, suggested that antibodies could disappear completely within three months. The research tested more than 90 coronavirus patients for antibodies over 94 days. The results showed that three weeks after infection, just 60% of patients had developed a "potent" antibody response. In the weeks that followed, a mere 17% of those patients maintained that level of antibodies, The Guardian reported. In the other patients, antibody levels declined 23-fold or became undetectable within three months.
Note that even a single viron can cause disease, as per [1]. Maybe a trickle of tiny doses could help trigger an immune response, but there's always a risk of getting sick before then.
Many, many links in that article, but in the only study I see, this is not an experiment, it's observational study.
There are lots of reasons to believe wearing masks might be correlated with other mitigating behaviours (hand washing, going out less, etc), which would also reduce contact with the infected.
Also, I see no mention of studying possible side-effects of universal, permanent mask wearing, which makes this study irresponsible at the least.
With you on considering the possible causation in other associated mitigating behaviors, but:
> studying possible side-effects of universal, permanent mask wearing
Can you suggest a model which would imply there are likely to be any side-effects?
I'm also sortof baffled by the suggestion that there's anyone doing "permanent" mask wearing. I've been pretty fastidious about face coverings since early on but I don't think I've ever kept one on for more than 6 hours at a time, and it's hard to imagine anyone doing so outside of a long shift at work.
Why does ANYONE believe this bullshit narrative anymore?
You are ALREADY "dramatically unlikely" to get it. You don't know ANYONE who died of covid 19. You know someone who suffered because of these idiotic claims like "quarantining healthy people is good", and now the imaginary claim of "face-diapers are good".
People need to grow a spine and start giving a collective "fuck off" to these assholes who get paid off taxpayer money and don't have to suffer the economic consequences of the evil/stupid policies these blatant lying "studies" are pushing.
Better than losing your life or the life of a family member, which would make your "signals developed over many hundreds of thousands of years" either sad, or very very quiet.
Please don't fulminate on HN. If you want to express a minority or contrarian view, that's fine, but do it thoughtfully and substantively. Posting like this just starts flamewars and discredits your view more.
> In an outbreak on an Australian cruise ship called the Greg Mortimer in late March, the passengers were all given surgical masks and the staff was given N95 masks after the first case of Covid-19 was identified. Mask usage was apparently very high, and even though 128 of the 217 passengers and staff eventually tested positive for the coronavirus, 81% of the infected people remained asymptomatic.
Does anyone know what the baseline to compare with is? What was the rate of symptoms in Diamond Princess?
- U.S. Surgeon General Feb 6
> Americans should be more concerned about the flu than coronavirus [...] As surgeon general, I’m telling folks the number one way to protect ourselves is to get a flu shot.
- U.S. Surgeon General @Surgeon_General Feb 29
> Seriously people- STOP BUYING MASKS!
> They are NOT effective in preventing general public from catching #Coronavirus, but if healthcare providers can’t get them to care for sick patients, it puts them and our communities at risk!
- U.S. Surgeon General, Mar 6 [Deleted Tweet]
> Early am flight. No one with masks (they aren't recommended for general public) but noticed several people using antibacterial wipes on seats (I do this too). I'm not worried about #COVID19 - I'm worried about #flu & the guy reclining all the way back into me before takeoff. :/
"Surgeon general says administration "trying to correct" earlier guidance against wearing masks" July 12
> We're trying to correct that messaging, but it's very hard to do.
So what do we call this? Criminal negligence?
The World Health Organization played World Trade Organization and warned against banning flights from China. The U.S. General cared more about hardware stores not running out of masks, so medics could still get the masks that the government neglected to store or produce in case of a pandemic. The greatest U.S. authorities (including Azar and Fauci) did not trust the intelligence of the general public enough to promote mask usage, as they were afraid we were going to infect ourself by licking the front the mask when discarding it. "Better to just avoid sick people" they said, completely ignoring the impossibility of identifying sick people with asymptomatic spread or avoiding other people in busy cities. "Only wear a mask when you are sick" they said, condemning people who thought for themselves and read the research, and wore a mask to protect themselves and their caretakers, to the status of Leprosy sufferers.
> U.S. Surgeon General Feb 6 > Americans should be more concerned about the flu than coronavirus [...] As surgeon general, I’m telling folks the number one way to protect ourselves is to get a flu shot.
On Feb 6, if you lived in the United States, your likelihood of catching and dying from the flu was very possibly higher than COVID19. It's very possible the US Surgeon General wasn't saying to never worry; rather, that it was too early to worry at that time. I got a very bad flu-like illness in late January in Las Vegas. My assumption is that it was very likely the flu, based on estimated base rates of the diseases at that time.
> U.S. Surgeon General @Surgeon_General Feb 29 > Seriously people- STOP BUYING MASKS!
If masks have higher ROI for healthcare workers than average citizens, and there's a limited supply of masks, then telling average citizens to not buy masks makes perfect sense to me.
> They are NOT effective in preventing general public from catching #Coronavirus, but if healthcare providers can’t get them to care for sick patients, it puts them and our communities at risk!
> U.S. Surgeon General, Mar 6 [Deleted Tweet] > Early am flight. No one with masks (they aren't recommended for general public) but noticed several people using antibacterial wipes on seats (I do this too). I'm not worried about #COVID19 - I'm worried about #flu & the guy reclining all the way back into me before takeoff.
Yeah, I cannot come up with any defense for these statements. These statements were clear mistakes by the US Surgeon General. I hope he regrets them and learns from them.
We call this "lying to manage supply", which is worse than negligence. The US Surgeon-General could have instead said something like "We need the best masks for healthcare workers because they are at the most risk, but we don't have enough right now. Here's how to sew your own cloth masks: $LINK. The general population is at lower risk, so please leave rated respirators for healthcare, where they can do the most good."
The Czech republic told its citizens to make masks for each other. That could have been a good move too.
Mask use has been legally mandatory in Texas for 2 months now yet deaths are still high. Whatever this effect is it doesn't seem "dramatically less likely".
I live in Texas, it seems likely that it's technically true that 85% of people sometimes wear masks... but it's not anywhere close to that if you go out and about, sometimes it's 0%, sometimes 50%-80%. Except where masks are required, e.g. the grocery store.
(this is wealthy/educated austin suburb statistics btw)
Looks to be about on par with other areas that made masks mandatory. Lots of people probably self isolate and let their spouse or other family members go out to shop so they don't wear a mask since they don't go out.
- Compliance with and enforcement of the mandate is low.
- There could have been even more deaths without the mask mandate.
- People might be more negligent with social distancing when they think masks will protect them; e.g. I can go to that keg party with 200 people as long as everyone is wearing a mask. (as happened with seatbelts)
- Concurrent opening up has led to more cases anyways.
In Europe the 'non mask' countries are doing better, in Spain you have to wwar one everywhere but the virus is not stopping what do ever, in countries like Finland where it's not mandatory the things are much better. Basically all the country's follow the same path here.
It will be interesting to see how we view this in the years to come. I was here, and had certain (once reviled) views, so I remember these closely:
1. Masks don't work! -> Nope, they do.
2. You need training to make masks work! -> Nope, you don't.
3. If you don't wear your mask perfectly, you're going to get the disease. The outcome is binary. -> Doesn't look that way.
There are a few still in line to be determined, supposedly:
* This disease is novel in ways that no other disease is. So a large percentage of those who get it will experience life-long adverse effects causing substantial loss of QALYs. -> I don't think so, but we'll see. Sure, a few people here and there will have life-long breathing issues but nearly everyone will have practically identical QoL as they did before.
* Single group activities are the biggest determiners of whether there will be an increase in cases in America. -> I don't think so. I think it'll be whether we have large scale openings. i.e. protests are not as big a deal as letting people go to restaurants (the latter will dwarf the former)
* Outdoor activities are spreading the disease at a substantial rate in America. -> I don't think so. It's not the beach-goers. It's the guys mostly indoors.
We'll see. Ultimately, thinking in Bayesian terms, this virus is less likely to be novel in multiple ways than it is likely to be novel in one way. So far, that looks to have been a good assumption. Let's see what else it holds up on. There was always a lot of "We don't know enough. This could be the end of civilization" going around and I think we always knew enough. We did and we continue to.
We will see when we have time to look back and this virus has infected a much larger and more uniform population. One paper is only one paper. It shifts my priors upwards as to whether this is the case, but it doesn't set them to 1.
From your first link: "However, exactly what these findings mean for patients' heart health in the long term is unclear, the authors said. The heart abnormalities seen in the study occasionally occur with other respiratory diseases such as influenza and may be temporary"
News has a motivation to sensationalize, i.e. only time will tell if this was a lot of panic over nothing or if 20% of the people who caught COVID will drop dead over the next 10 years.
First of all, I didn't mention the CDC. Much of what I was talking about was about what HN and forums like this talked about. However, some of these things do apply to health authorities. Fortunately for me, I don't need to rely on my recollection.
> They are NOT effective in preventing general public from catching #Coronavirus, but if healthcare providers can’t get them to care for sick patients, it puts them and our communities at risk!
And of course, Fauci told everyone not to wear masks. But that doesn't matter. This is the Surgeon General saying "They are NOT effective in preventing general public from catching Coronavirus". That is a categorical statement.
I stand corrected! I had forgotten that the Surgeon General said that.
My theory is that when people think that the guidance has radically shifted throughout the COVID-19 epidemic, it's because they are getting their information from non-authoritative sources. But like your example, sometimes the "authoritative sources" are super wrong.
Dr Fauci did eventually admit that the guidance on masks was not optimal:
> "We have to admit it, that that mixed message in the beginning, even though it was well meant to allow masks to be available for health workers, that was detrimental in getting the message across," Fauci said in an interview with Mary Louise Kelly of NPR's All Things Considered. "No doubt about it."
Points 2 and 3 are HN responses to my comments or adjacent ones. It's going to be a bit hard to find them now, but I'll post them at the bottom. Listen, I really don't want to Gish Gallop you, but there's no way for me to claim people were saying this without showing you people saying this: (and there are way more people saying this on Reddit and Twitter, but time is short, so I can't do any more research for you)
Ah, I misread your original post. I thought you were talking about the official recommendations being wrong and then changing. The "general public shouldn't wear masks" is one example where the guidance changed, but I'd argue that overall it's been relatively consistent.
If you are just looking for random people on the Internet being wrong, then yes, there are lots of examples of that!
Well, it started with the officials because let's just say we're not working with very good raw material here. It's like the tar sands, you know. We have the tar sands, some other guys have shale, and some others have some delicious light crude.
I agree 100%. The US's response to this entire pandemic was, and still is, a cluster fsck. A lot misinformation could have been prevented with strong and consistent leadership.
That is Dr Fauci himself on 60 minutes in early March saying that Americans should not be wearing masks. I guess he changed his mind. People want to say, "Yes he changed his mind due to new evidence." Ok what evidence? I want to see it. And it better be from just before they changed their views and not after they changed their views.
>They are NOT effective in preventing general public from catching Coronavirus
The N95 masks weren't, and aren't, in the sense he meant. People have said over and over, the way the masks we're wearing now are effective is in protecting others from us, should we be infected.
I used to accept that the "party line" changed, but now I think it's just a misunderstanding.
N95 masks very likely do provide a lot of protection from airborne virus droplets and aerosols, but they are still unavailable in most parts of the world including the US. I was able to find some Korean KF94 masks though. There is no evidence for one way protection btw. It may be true but right now it is entirely speculative.
The public health experts didn't say "Masks don't work", otherwise there wouldn't have been such an issue to getting masks to health care workers.
There also was a very robust debate at the time about whether masks worked or not, and which types of masks worked, hence why lots of researchers immediately started to study these issues.
I'm not saying there wasn't incorrect information out there, but it wasn't nearly as binary as you are making it out to be.
Yes, I believe your thinking on this is correct, and it seems to be where the consensus is anyway (not in the media, or the average person, but among experts): transmission is concentrated in indoor activities with sustained exposure without masks.
I would add to your list that contact-based transmission, in contrast the the obsession over surface sanitizing procedures, is not a meaningful transmission risk. Derek Thompson called it "hygiene theater", similar to the post-9/11 security theater.
> This disease is novel in ways that no other disease is.
It is a novel disease, but it is close to SARS-CoV-1 from the 2003 outbreak. There is a lot of long-term research on the quality of life indicators. One paper listed 20% of hospitalized with full disability due to chronic fatigue syndrome 5 years after hospitalization.
Young people with viral pneumonia and mechanical ventilation still walked slower than 60+ seniors (very little restoration of lung capacity).
> a large percentage of those who get it will experience life-long adverse effects
Mental health also influences QOLI. From SARS, MERS, HIV, and other severe viral infections, we know that this can have severe impact on mental health (many from SARS-CoV-1 and MERS suffer from PTSD and depression if not degenerative bone necrosis == constant muscle pain).
People report trouble smelling or speaking months after COVID. There are support groups popping up for people with persistent problems, chronic fatigue and sleep problems being one that seems to linger for months.
Early research from Italy:
> Patients were assessed a mean of 60.3 (SD, 13.6) days after onset of the first COVID-19 symptom; at the time of the evaluation, only 18 (12.6%) were completely free of any COVID-19–related symptom, while 32% had 1 or 2 symptoms and 55% had 3 or more. None of the patients had fever or any signs or symptoms of acute illness. Worsened quality of life was observed among 44.1% of patients. [...] a high proportion of individuals still reported fatigue (53.1%), dyspnea (43.4%), joint pain, (27.3%) and chest pain (21.7%).
"The protective efficiencies were 33.3%, 11.3%, and 6.1% for the surgical, bandana, and dust masks, respectively. The N95 mask protective efficiency was 89.6%. In conclusion, the surgical mask protected the best of the three face masks tested. However, it is important to note that all three masks offer very little protection when compared to the N95, and wearing these face masks may produce a false sense of protection."
> Conclusions This study is the first RCT of cloth masks, and the results caution against the use of cloth masks. This is an important finding to inform occupational health and safety. Moisture retention, reuse of cloth masks and poor filtration may result in increased risk of infection. Further research is needed to inform the widespread use of cloth masks globally. However, as a precautionary measure, cloth masks should not be recommended for HCWs, particularly in high-risk situations, and guidelines need to be updated.
Important to note: This study was conducted for _health care workers_. Not the general public.
Cloth masks aren't designed to protect the wearer, rather protect everyone else around them by catching droplets / reducing nasal spray / etc. It only works if everyone 95% of people are wearing one, especially indoors.
The linked article is making an assertion that cloth masks protect the wearer by reducing the viral dose, leading to many more asymptomatic cases. It is saying that mask wearing alone is enough to reduce your risk from coronavirus.
That is actually the headline from the article: "Cloth masks do protect the wearer – breathing in less coronavirus means you get less sick"
There is no evidence that cloth masks are better at filtering out than they are at filtering in. They are not designed to be one way valves. They are pretty bad at both due to the massive amount of space between threads which virus droplets can just sail right through.
No one should be wearing cloth masks if surgical masks are available and no one should be wearing surgical masks when N95 or equiv masks are available. This cannot be repeated enough.
"If you are looking for “Why Face Masks Don’t Work: A Revealing Review” by John Hardie, BDS, MSc, PhD, FRCDC, it has been removed. The content was published in 2016 and is no longer relevant in our current climate."
The original paper was asking the question: Do surgical masks provide adequate protection against disease transmission for dentists and patients in a clinical context? And their conclusion was: no.
This is an entirely separate question from: Do masks provide enough protection against disease transmission to be worth wearing/recommending in public places during a global pandemic, despite their imperfections? The answer to that, from many other studies, seems to be clearly yes. I can imagine that anti-mask folks started using this article as ammunition, due to the catchy headline ("see, this article says face masks don't work!"), and the publishers felt it was doing more harm than good and took it down for that reason.
>the publishers felt it was doing more harm than good and took it down for that reason.
Then the publishers should come out and say so by putting a tagline or disclaimer at the top of the article. Pulling the whole article to "supervise[] conduct and morals" [1] is textbook censorship.
/shrug It’s self-censorship. Publications commonly unpublish bad articles for a wide variety of reasons. Should one not supervise one’s own conduct and morals?
> Do masks provide enough protection against disease transmission to be worth wearing/recommending in public places during a global pandemic, despite their imperfections? The answer to that, from many other studies, seems to be clearly yes.
A randomized trial with surgical masks during Covid-19 will be published soon. Here are some quotes and commentary:
> “All these countries recommending face masks haven’t made their decisions based on new studies,” Bundgaard said in an interview in Copenhagen.
> He says there’s evidence to suggest that the only effective face covering might be a visor, because the virus can spread through all mucous membranes, including via the eyes. He worries a cloth covering that only protects the nose and mouth provides a “false sense of security.”
> Bundgaard says the simple rules that currently exist in Denmark -- hand-washing, social distancing, self-isolating if you’re sick -- are effective because they’re easy to remember. He worries that using face masks might lead people to be “sloppy” in following the other guidelines.
> Bundgaard’s study on masks is due to be published next month. In the meantime, he says he hopes they don’t become mandatory in Denmark.
Unless you're being sarcastic (apologies if so, and no mean to offend if not), I take the opposite conclusion though, which seems borne out by reality. Public messaging and for social cohesion in service of the greater good is the hardest problem affecting any large-scale coordinated response, especially with propaganda, doublethink, and flat-out unwillingness to learn being so common. I gather that the article the previous commenter mentioned was removed so that such propagandists couldn't willingly misinterpret it to pass on to their sycophants.
Improper usage of any medical device can be a serious problem for the user. I don't think we should continue a therapy if it's a net negative at the margin.
It's obviously hard to critique a study that hasn't been released, but I [again] find it bizarre how the "introduction" and "conclusions" in the abstract you linked seem to be asking two separate questions.
The intro says "This trial investigates whether the use of face masks in the community will reduce wearers' risk of SARS-CoV-2 infection." (emph. mine) ie. if everyone wears masks, does my risk go down? This seems like the correct question to ask. But then the conclusion says "We will study whether a face mask protects the wearer of the mask against SARS-CoV-2 infection" which is a different question entirely!
If what we have been hearing over the past months is true (masks provide marginal protection for the wearer, but catch a significant portion of aerosol droplets & therefore protect society against the wearer) - I would expect the answer to the first question to be "yes" and the second to be "no"!
I think we should introduce a law that surgeons should stop operating on people with masks on if said person thinks masks don't stop the spread of infected droplets.
After-all there is probably a way to cherry-pick an argument that surgeon without a mask is more accurate therefore safer.
Wearing mask is not a big inconvenience, same as not dropping trash on the street.
You just need a person that is not consumed by their self importance.
I swear there will soon be people claiming that not only sun revolves around the earth but it revolves around that single person.
Regardless of if masks work or not there are many self-inflicted conditions like obesity, diabetes, and heart disease. Coincidentally those conditions are the reason the health system almost became overwhelmed in the US. If we want to put a litmus test on treatment it would probably effect 90% of Covid-19 hospitalizations.
This is also a good article on the subject. The revisionists claim that WHO and the CDC changed their mask recommendations based on new evidence but they never actually cite the studies which presumably were published just before the policy changes. I think that may have something to do with the fact that the recommendations were not evidence based.
> wearing these face masks may produce a false sense of protection
However, it is important to note that seat belts from ropes, seat belts from cotton strings, and seat belts from elastic bands offer very little protection when compared to a properly tested and fitted seat belt, and wearing these seat belts may produce a false sense of protection (resulting in no avoidance of speeding or driving too closely to the person in front of you, the best general public guidance we currently have to avoid corporal damage from car crashes).
Masks' efficacy at protecting the wearer is not the only point; their primary purpose is to help protect others, as in "my mask protects you; your mask protects me".
Sure, but being able to say that the mask protects you too will appeal to some people. If people's reasons are selfish but the outcome is the same it's fine with me... I do suspect that it protects the wearer as well though.
I don't know why that was even in serious question unless the only transmission method was putting your fingers in your mouth or something. Of course more filtering will be better.
It's a serious question because theoretically a mask can trap viral particles for later introduction into your membranes, instead of them just passing by in the air.
I've heard that, but where do these viral particles come from? The mask wearer? If so, that's the goal isn't it? And if it's from outside and gets trapped in the fabric... isn't that also a win?
The arguments against wearing a mask have always been weak, the arguments for wearing a mask didn't start so strong but were well established in March/April. Anyone arguing against them after that point was either parroting stuff they heard without understanding, or was making disingenuous arguments that have contributed to a lot of misery and death for no benefit.
I don't think I heard anyone with actual medical training suggest that wearing a mask might be worse than nothing -- except for one scenario, that it might cause a false sense of security. Never once have I heard another reason from someone with actual medical training for why masks might make things worse, at least when it comes to COVID.
That whole idea is totally new, untested and probably nonsense given that it appears the virus spreads just fine even when people wear masks (as this study indicates).
Unless you're going to argue that nobody should ever be in a room without permanently wearing and disposing of a constant streams of masks ever again (not gonna happen), you're going to get the virus at some point. Therefore, as hospital overload never happened there's no real point to any of this.
placebo effect? just like putting stripes on your car makes it go faster. Putting on a mask, boosts the immune system, because there's an inner ninja inside all of us. Ready to kick ass.
well, if we can assume that a placebo effect is due to a state of mind. And a state of mind can be induced using a ritual. Putting on a mask, in a ritual way, might just work better to ready the mind for battle.
Watch some old school Karate movies. There's often a ritual the hero undertakes, to steady and focus the mind, before a battle. Sometimes its a bandana on the head.
That might work too! needs to be tried.
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COVID has really taught me the limitations of data journalism and data science. Both presume trust in the data collectors and data communicators, and many people simply do not.
I think it would be much better to let people "test it" for themselves. Let them be the scientists, ask them basic questions. You can do this with a kid:
1) Where is the virus in our body? (answer: in the lungs)
2) What does it feel like to wear a mask? (answer: hot/stuffy)
3) Why does it feel hot/stuffy? (answer: the mask is keeping your exhalation closer to you)
4) If masks block your breath, and your breath has the virus, does that not then mean that masks block the virus? (answer: yes)
Bonus) Suppose masks don't actually block the virus that well, say by only 10%. Will they still affect the chain of transmission (yes, its "multiplicative": 90-> 81%->72%->...)
This "psuedo-experiment" would not be up to snuff for a journal, but conversations are not publications. Its better to make assumptions and make deductive arguments, because then you don't need to rely on trust in scientific institutions.
I think it’s more a case study of how information warfare impacts public perception.
IMO, the higher quality media outlets have done a pretty good job in a field full of disinformation and propaganda.
Unfortunately, low information citizens are attracted to increasingly fringe sources. My brother owns a marina, and they are struggling with customers and staff who refuse to follow protocols and cite fairly crazy sources to refute things.
Maybe suitable for small kids, but oversimplified.
1) The virus is not only in the lungs, but it is not important here, pass. Maybe insist on the fact it can be in the nose, to encourage people to put their mask on their nose.
2) Good observation
3) That the wrong part. Hot means that heat is trapped, but air definitely isn't, you wouldn't be able to breathe otherwise. That you can't breathe with masks is a common argument used by anti-maskers, and many times shown wrong. Masks can keep your breath closer to you in the sense that you don't project it as far because it makes it slower and more diffuse. It also has a chance to trap droplets containing the virus.
4) masks don't block your breath in fact surgical masks are more effective and more breathable than cotton masks. That's because surgical masks are optimized to stop viruses and let air through.
All of your points are true, and would be brought up by an informed adult or smart kid, but notice how none of them defeat the underlying deductive argument. Simplicity is its strength. If anything, letting them make it complicated by questioning assumptions and revising them will just convince them more, because now it’s sort of their argument, not somebody else’s.
1) It’s not just in our lungs, but in our entire “breathing system”. Still need to control the breath.
2) Masks don’t block oxygen, but they block the wet part of the breath at least somewhat. The wet part is the dangerous part.
You could go back and forth with a so-called “anti-masker” and you’d prob be leagues ahead of where you’d be if you shared a masks article.
Here's a simple argument: death rates from COVID are about the same as a regular flu season in places that didn't do dumb things like close hospitals and send sick people into care homes. In many places they're around the level of flu.
But flu is always around. If we don't wear masks all the time, then why do we need to wear them now?
There is no logical answer to this except "you should wear masks permanently" which many people will never accept, as the benefits are simply too low to justify the consequent problems.
Death rates may not be the only problem though. There is evidence that covid damages the heart and sometimes even the brain. This damage might cause many deaths years from now.
There was also evidence COVID was a terribly deadly disease that would kill at minimum 500,000 healthy people (in the UK), thus requiring urgent and massive shutdowns. Turned out to all be completely false.
So my point stands. If you're going to make simple pro-mask arguments, be prepared for equally simple counterarguments. Excess death data says 2020 is for most countries an unremarkable basically normal year. Even in the few where it's not, it's still comparable to prior years when nobody noticed anything at the time, so hardly abnormal.
"Long COVID" may be the usual problem of slow recovery from viral infection that occasionally happens, or it may hardly be real given the broad array of vague symptoms that are now allowed to characterise the disease. Everything from a runny nose to a headache to full blown pneumonia is classifiable as COVID these days. That means many people with other issues will end up with spurious correlations of the form, "I had COVID symptoms and now I am fatigued" when the cause may not be "COVID". The apparent lack of consistency in these reports, the wildly varying time between infection and onset, etc, all suggests there's a lot of noise in these reports. Definitely not a part of any simple argument for mask wearing.
None of that is really necessary. You can just explain that the masks have small holes in them that are big enough to allow oxygen in and co2 out but small enough to catch most of the covid droplets. Even a child can understand the basic concept. The problem with cloth masks is that the holes are too big for them to be very effective.
> In 2015, researchers tested this concept in human volunteers using a nonlethal flu virus and found the same result. The higher the flu virus dose given to the volunteers, the sicker they became.
198 comments
[ 3.0 ms ] story [ 220 ms ] threadInteresting to note that it is a discussion of models and general implications, but is not actually a study of itself.
For example, the seafood and chicken processing plants had a 95% asymptomatic rate among the infected.
I would love to see some studies which compared this against rates that are normally seen for the same age/gender/heath ect.
Similarly, how do these observations fit in to the greater picture. Are there other processing plants that used masks but had higher rates of symptoms?
Also, another way to view this data is that perhaps we are vastly underestimating total number of asymptomatic cases overall due to reporting and testing biases.
If evidence based medicine isn't an advantage then it's down to luck?
The best is remedies that have both. But don't think evidence without good theory is fine. I'm not sure it's even that much better than theory without good evidence.
That's the reason we need randomized trials. How do masks work outside of the lab?
Also, it isn't accepted science that Covid-19 infects through aerosols.
There is only one study that looked at cloth masks and it was completed in 2015.
> And IMO it's completely wrong to say we have no evidence tht masks work.
I never said that. I'm saying that a high standard of evidence has not been met and there isn't much interest in running trials on cloth masks. The only one I could find is in Guinea-Bissau.
https://clinicaltrials.gov/ct2/show/NCT04471766
Anti-maskers are killing their parents, not themselves.
So - no. Mask wearers aren't going to experience any difference in death rates in the vast majority of places because COVID deaths have already ended. And of course, when they were occurring, there was a lot of bad reporting there which conflated people who were dying anyway with people unexpectedly killed by the virus.
Think of it like this: I you get infected with 10 instead of 1.000.000 of a virus that grows x10 each day, your immune system has 5 extra days to fight it.
[Disclaimer: I'm a random software guy who reads a lot, not in any way a virus expert]
The hamster study did not show a big difference in outcome with higher viral load, contrary to what the article suggests.
If you trust in the science of viral load not mattering, you will pick randomly when given the choice of having 1 or 5 novel viral particles placed in your nasal cavity. Nobody sane trusts that.
Yes, viral load is correlated with higher severity for majority of flu-like illnesses, supported by research. Even if this coronavirus is somehow different, combating viral load is still beneficial for avoiding viral viral co-infection (getting COVID-19 with severe influenza on top).
I think their health is more relevant than habits in this case. I would guess that people who know they get sicker than most will be more cautious than average, they've been dealing with it their whole life. Maybe not totally independently of how their health habits are taught to them, but I bet a lot of it is just experience.
People know their bodies pretty well, even if they don't try very hard.
https://www.latimes.com/california/story/2020-07-21/masks-he...
Variolation is much safer than being exposed to smallpox in the normal way:
https://en.m.wikipedia.org/wiki/Variolation
It is possible that you need a minimum viral load to elicit an immune response at all and if so, the virus would first need to replicate to that level in vivo.
There are certainly plausible mechanisms for the dose severity dependence hypothesis to be true, but with fast-replicating viruses I think the parsimonious assumption is transmission chains are dominated by a single event.
And it bothers me that the quote, "dramatically less likely" is not a quote from the linked research, but seemingly just a pull quote of the article itself.
I support people wearing masks, even if it turned out to only be marginally better than not wearing one, but this article is borderline overreaching.
Of course, if wearing a mask was in fact extremely effective at stopping severe Covid, then one could make the argument that it's now worth doing these higher risk activities.
As with OP, I support wearing masks and do so all the time if needed (not American though, so it doesn't have the political bent here it does in the states).
For instance, if evidence emerges that masks have some harmful effect, an over-estimation of the protective effect of masks can lead to a skewed cost-benefit analysis that results in a net-harmful pro-mask policy remaining in place.
Lies can also undermine credibility, and sometimes necessitate more lies to cover up for the first, leading to less effective and efficient communication amongst people.
To say the least...
The article links to https://jamanetwork.com/journals/jama/fullarticle/2768396 to support, "Most infectious disease researchers and epidemiologists believe that the coronavirus is mostly spread by airborne droplets".
However, the linked study concludes, " All told, current understanding about SARS-CoV-2 transmission is still limited. There are no perfect experimental data proving or disproving droplet vs aerosol-based transmission of SARS-CoV-2."
In normal times, people spend a lot of time with other people in not-very-well-ventilated spaces - including, unfortunately, many conference-rooms, classrooms, small shops, bars/nightclubs, etc.
So in all those actual places, Covid-19 is aerosol-transmissible.
Also, in just the few weeks since that JAMA discussion, more actual examples of Covid-19 almost certainly transmitted by aerosols have been compiled; see for instance study/stories linked at:
https://twitter.com/EricTopol/status/1293276767042416640
I was not restating the conclusion, but showing how the original article was quoting support from a place that did not support what was being said.
> In a more recent report from a different cruise ship outbreak, all passengers were issued surgical masks and all staff provided N95 masks after the initial case of COVID-19 on the ship was detected. In this closed setting with masking, where 128 of 217 passengers and staff eventually tested positive for SARS-CoV-2 via RT-PCR, the majority of infected patients on the ship (81%) remained asymptomatic, compared with 18% in the cruise ship outbreak without masking.
> A report from a pediatric hemodialysis unit in Indiana, where all patients and staff were masked, demonstrated that staff rapidly developed antibodies to SARS-CoV-2 after exposure to a single symptomatic patient with COVID-19. In the setting of masking, however, none of the new infections was symptomatic. And in a recent outbreak in a seafood processing plant in Oregon where all workers were issued masks each day at work, the rate of asymptomatic infection among the 124 infected was 95%. An outbreak in a Tyson chicken plant in Arkansas with masking also showed a 95% asymptomatic rate of infection.
They obviously can’t repeat the experiment with COVID. They suspect the same thing happens but they aren’t sure.
Oh the off chance it really is true, I’m wearing a mask!
I've been astounded and dismayed by people's ability to reason themselves out of this obvious conclusion.
So passengers were already infected when that 81% figure was computed.
https://thorax.bmj.com/content/75/8/693
In a village in Tuscany, over 3000 people were actively tested and 50-75% were asymptomatic: https://www.bmj.com/content/368/bmj.m1165
And among NYC labor and delivery patients, 88 percent were asymptomatic: https://www.washingtonpost.com/outlook/2020/04/20/we-tested-...
This number is not at all unusual in the general population, regardless of mask wearing.
Now also, there are patterns observed in masked-vs-unmasked Covid-19-hotspots for which the idea "masks cut initial infectious dose enough to make infections milder or totally asymptomatic" fits really well.
You can watch Dr. Gandhi presenting on this topic with slides & multiple paper/incident references, during a UCSF 'Grand Rounds' a few weeks ago - here's a direct link to where her talk starts:
https://youtu.be/Cio3rh6ta3w?t=1740
Vaccines are not all attenuated. Often they are killed. See https://en.wikipedia.org/wiki/Inactivated_vaccine for more on that.
This is a (bad) philisophical question for people who do not understand the concept of "spectrum", not a scientific question.
Deciding where on the spectrum between non-life and life we declare something to be alive is endlessly debatable and non-actionable. The fact that in time technology will add more points on that spectrum does not change this fact.
https://en.m.wikipedia.org/wiki/Variolation
The first real vaccine was to inoculate with cowpox instead, which was safe for humans but induced immunity to smallpox as well.
Modern methods are substantially safer, usually by entirely deactivating the virus before using it, but there are still some vaccines that use live virus (the oral polio vaccine is a live attenuated virus).
But yes, that is how vaccines work more or less. Though I believe the virus in the vaccine is either dead or incapacitated in some way.
So I'm wondering if this thing never goes away, the vaccine never works 100%, but in a year or so it's not much different from any flu in all age groups.
See: https://en.wikipedia.org/api/rest_v1/page/graph/png/COVID-19... from https://en.wikipedia.org/wiki/COVID-19_pandemic_in_the_Unite...
https://www.worldometers.info/coronavirus/country/france/
You see the same thing in New York, where fatalities per day has gone down from 1000 to 7, while cases per day is only down 90% from peak. Crowded cities it may be impossible to avoid exposure completely (which crazily may be a benefit!).
https://www.worldometers.info/coronavirus/usa/new-york/
Rural US is where the fatality rate isn't going down much, which would make sense since there's higher chance of someone having had zero exposure to the virus and then getting a bunch of it at once by coming in contact with a sick person.
NOTE this is not based on any research other than some guesses as to how these numbers could line up. Do not use this as a source for anything!
Antibodies disappear quickly so antibody studies aren't a perfect indicator of spread.
See for example:
> The UK study, meanwhile, suggested that antibodies could disappear completely within three months. The research tested more than 90 coronavirus patients for antibodies over 94 days. The results showed that three weeks after infection, just 60% of patients had developed a "potent" antibody response. In the weeks that followed, a mere 17% of those patients maintained that level of antibodies, The Guardian reported. In the other patients, antibody levels declined 23-fold or became undetectable within three months.
https://www.businessinsider.com/coronavirus-antibodies-last-...
- more testing, as you said
- the most vulnerable people are already dead, and those who aren't are taking extra precautions
- currently, most new cases are from younger people, less vulnerable
- we are becoming better at treating it
Less viral load because of masks is just one other factor. There may be others, like weather or mutations.
[1] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2677602/
There are lots of reasons to believe wearing masks might be correlated with other mitigating behaviours (hand washing, going out less, etc), which would also reduce contact with the infected.
Also, I see no mention of studying possible side-effects of universal, permanent mask wearing, which makes this study irresponsible at the least.
> studying possible side-effects of universal, permanent mask wearing
Can you suggest a model which would imply there are likely to be any side-effects?
I'm also sortof baffled by the suggestion that there's anyone doing "permanent" mask wearing. I've been pretty fastidious about face coverings since early on but I don't think I've ever kept one on for more than 6 hours at a time, and it's hard to imagine anyone doing so outside of a long shift at work.
You are ALREADY "dramatically unlikely" to get it. You don't know ANYONE who died of covid 19. You know someone who suffered because of these idiotic claims like "quarantining healthy people is good", and now the imaginary claim of "face-diapers are good".
People need to grow a spine and start giving a collective "fuck off" to these assholes who get paid off taxpayer money and don't have to suffer the economic consequences of the evil/stupid policies these blatant lying "studies" are pushing.
You got conned. Push back, or lose everything.
https://news.ycombinator.com/newsguidelines.html
The paper that the headline is based on does not really support the headline.
Other links are not specific to COVID.
Does anyone know what the baseline to compare with is? What was the rate of symptoms in Diamond Princess?
- U.S. Surgeon General @Surgeon_General Feb 29 > Seriously people- STOP BUYING MASKS!
> They are NOT effective in preventing general public from catching #Coronavirus, but if healthcare providers can’t get them to care for sick patients, it puts them and our communities at risk!
- U.S. Surgeon General, Mar 6 [Deleted Tweet] > Early am flight. No one with masks (they aren't recommended for general public) but noticed several people using antibacterial wipes on seats (I do this too). I'm not worried about #COVID19 - I'm worried about #flu & the guy reclining all the way back into me before takeoff. :/
"Surgeon general says administration "trying to correct" earlier guidance against wearing masks" July 12 > We're trying to correct that messaging, but it's very hard to do.
So what do we call this? Criminal negligence?
The World Health Organization played World Trade Organization and warned against banning flights from China. The U.S. General cared more about hardware stores not running out of masks, so medics could still get the masks that the government neglected to store or produce in case of a pandemic. The greatest U.S. authorities (including Azar and Fauci) did not trust the intelligence of the general public enough to promote mask usage, as they were afraid we were going to infect ourself by licking the front the mask when discarding it. "Better to just avoid sick people" they said, completely ignoring the impossibility of identifying sick people with asymptomatic spread or avoiding other people in busy cities. "Only wear a mask when you are sick" they said, condemning people who thought for themselves and read the research, and wore a mask to protect themselves and their caretakers, to the status of Leprosy sufferers.
> U.S. Surgeon General Feb 6 > Americans should be more concerned about the flu than coronavirus [...] As surgeon general, I’m telling folks the number one way to protect ourselves is to get a flu shot.
On Feb 6, if you lived in the United States, your likelihood of catching and dying from the flu was very possibly higher than COVID19. It's very possible the US Surgeon General wasn't saying to never worry; rather, that it was too early to worry at that time. I got a very bad flu-like illness in late January in Las Vegas. My assumption is that it was very likely the flu, based on estimated base rates of the diseases at that time.
> U.S. Surgeon General @Surgeon_General Feb 29 > Seriously people- STOP BUYING MASKS!
If masks have higher ROI for healthcare workers than average citizens, and there's a limited supply of masks, then telling average citizens to not buy masks makes perfect sense to me.
> They are NOT effective in preventing general public from catching #Coronavirus, but if healthcare providers can’t get them to care for sick patients, it puts them and our communities at risk!
> U.S. Surgeon General, Mar 6 [Deleted Tweet] > Early am flight. No one with masks (they aren't recommended for general public) but noticed several people using antibacterial wipes on seats (I do this too). I'm not worried about #COVID19 - I'm worried about #flu & the guy reclining all the way back into me before takeoff.
Yeah, I cannot come up with any defense for these statements. These statements were clear mistakes by the US Surgeon General. I hope he regrets them and learns from them.
We call this "lying to manage supply", which is worse than negligence. The US Surgeon-General could have instead said something like "We need the best masks for healthcare workers because they are at the most risk, but we don't have enough right now. Here's how to sew your own cloth masks: $LINK. The general population is at lower risk, so please leave rated respirators for healthcare, where they can do the most good."
The Czech republic told its citizens to make masks for each other. That could have been a good move too.
Laws != compliance with laws.
https://www.pewresearch.org/fact-tank/2020/08/27/more-americ...
Do you think speed limits have >85% compliance?
- Compliance with and enforcement of the mandate is low.
- There could have been even more deaths without the mask mandate.
- People might be more negligent with social distancing when they think masks will protect them; e.g. I can go to that keg party with 200 people as long as everyone is wearing a mask. (as happened with seatbelts)
- Concurrent opening up has led to more cases anyways.
https://m.twitch.tv/videos/725630253 (skip to 4:49:00)
Where are the masks? Why is the crowd so dense?
Clearly nobody cares over there: the venue doesn't care, the attendees do not care, the authorities do not care.
It is a matter of time until those events cause a coronavirus outbreak.
1. Masks don't work! -> Nope, they do.
2. You need training to make masks work! -> Nope, you don't.
3. If you don't wear your mask perfectly, you're going to get the disease. The outcome is binary. -> Doesn't look that way.
There are a few still in line to be determined, supposedly:
* This disease is novel in ways that no other disease is. So a large percentage of those who get it will experience life-long adverse effects causing substantial loss of QALYs. -> I don't think so, but we'll see. Sure, a few people here and there will have life-long breathing issues but nearly everyone will have practically identical QoL as they did before.
* Single group activities are the biggest determiners of whether there will be an increase in cases in America. -> I don't think so. I think it'll be whether we have large scale openings. i.e. protests are not as big a deal as letting people go to restaurants (the latter will dwarf the former)
* Outdoor activities are spreading the disease at a substantial rate in America. -> I don't think so. It's not the beach-goers. It's the guys mostly indoors.
We'll see. Ultimately, thinking in Bayesian terms, this virus is less likely to be novel in multiple ways than it is likely to be novel in one way. So far, that looks to have been a good assumption. Let's see what else it holds up on. There was always a lot of "We don't know enough. This could be the end of civilization" going around and I think we always knew enough. We did and we continue to.
https://www.livescience.com/covid-19-causes-heart-damage-hea...
https://www.statnews.com/2020/07/27/covid19-concerns-about-l...
News has a motivation to sensationalize, i.e. only time will tell if this was a lot of panic over nothing or if 20% of the people who caught COVID will drop dead over the next 10 years.
> 1. Masks don't work! -> Nope, they do.
I thought that originally the WHO said that masks are not proven to work, not that they don't work at all. Now masks are proven to work.
> 2. You need training to make masks work! -> Nope, you don't.
> 3. If you don't wear your mask perfectly, you're going to get the disease. The outcome is binary. -> Doesn't look that way.
I don't remember these guidances from the WHO or CDC. Can you provide a source?
https://twitter.com/Surgeon_General/status/12337257852839321...
I will quote it here:
> Seriously people- STOP BUYING MASKS!
> They are NOT effective in preventing general public from catching #Coronavirus, but if healthcare providers can’t get them to care for sick patients, it puts them and our communities at risk!
> http://bit.ly/37Ay6Cm
And of course, Fauci told everyone not to wear masks. But that doesn't matter. This is the Surgeon General saying "They are NOT effective in preventing general public from catching Coronavirus". That is a categorical statement.
My theory is that when people think that the guidance has radically shifted throughout the COVID-19 epidemic, it's because they are getting their information from non-authoritative sources. But like your example, sometimes the "authoritative sources" are super wrong.
Dr Fauci did eventually admit that the guidance on masks was not optimal:
> "We have to admit it, that that mixed message in the beginning, even though it was well meant to allow masks to be available for health workers, that was detrimental in getting the message across," Fauci said in an interview with Mary Louise Kelly of NPR's All Things Considered. "No doubt about it."
https://www.npr.org/sections/health-shots/2020/07/01/8862991...
What about your points 2 and 3?
0: https://news.ycombinator.com/item?id=22777170 (claims that training is required or you're going to get rekt, read thread)
1: https://news.ycombinator.com/item?id=22776396 (while doesn't claim a no-threshold model, the threshold is a hundred viral particles)
2: https://news.ycombinator.com/item?id=22735235
3: https://news.ycombinator.com/item?id=22734656
4: https://news.ycombinator.com/item?id=22734923
5: https://twitter.com/WHOWPRO/status/1243171683067777024?s=20 (the WHO saying not to wear a mask, by the way)
6: https://news.ycombinator.com/item?id=22530340
7: https://news.ycombinator.com/item?id=22610180
8: https://news.ycombinator.com/item?id=22595955
9: https://news.ycombinator.com/item?id=22559272
10: https://news.ycombinator.com/item?id=22528527
11: https://news.ycombinator.com/item?id=22529273
If you are just looking for random people on the Internet being wrong, then yes, there are lots of examples of that!
https://www.youtube.com/watch?v=PRa6t_e7dgI
That is Dr Fauci himself on 60 minutes in early March saying that Americans should not be wearing masks. I guess he changed his mind. People want to say, "Yes he changed his mind due to new evidence." Ok what evidence? I want to see it. And it better be from just before they changed their views and not after they changed their views.
The N95 masks weren't, and aren't, in the sense he meant. People have said over and over, the way the masks we're wearing now are effective is in protecting others from us, should we be infected.
I used to accept that the "party line" changed, but now I think it's just a misunderstanding.
There also was a very robust debate at the time about whether masks worked or not, and which types of masks worked, hence why lots of researchers immediately started to study these issues.
I'm not saying there wasn't incorrect information out there, but it wasn't nearly as binary as you are making it out to be.
https://twitter.com/Surgeon_General/status/12337257852839321...
I'll quote it for you: (but read it in its entirety if you want the whole thing, it's only one Tweet)
> They are NOT effective in preventing general public from catching #Coronavirus...
There is no nuance in that statement (I did not capitalize the 'NOT'. It comes capitalized already).
I would add to your list that contact-based transmission, in contrast the the obsession over surface sanitizing procedures, is not a meaningful transmission risk. Derek Thompson called it "hygiene theater", similar to the post-9/11 security theater.
It is a novel disease, but it is close to SARS-CoV-1 from the 2003 outbreak. There is a lot of long-term research on the quality of life indicators. One paper listed 20% of hospitalized with full disability due to chronic fatigue syndrome 5 years after hospitalization.
Young people with viral pneumonia and mechanical ventilation still walked slower than 60+ seniors (very little restoration of lung capacity).
> a large percentage of those who get it will experience life-long adverse effects
Mental health also influences QOLI. From SARS, MERS, HIV, and other severe viral infections, we know that this can have severe impact on mental health (many from SARS-CoV-1 and MERS suffer from PTSD and depression if not degenerative bone necrosis == constant muscle pain).
People report trouble smelling or speaking months after COVID. There are support groups popping up for people with persistent problems, chronic fatigue and sleep problems being one that seems to linger for months.
Early research from Italy:
> Patients were assessed a mean of 60.3 (SD, 13.6) days after onset of the first COVID-19 symptom; at the time of the evaluation, only 18 (12.6%) were completely free of any COVID-19–related symptom, while 32% had 1 or 2 symptoms and 55% had 3 or more. None of the patients had fever or any signs or symptoms of acute illness. Worsened quality of life was observed among 44.1% of patients. [...] a high proportion of individuals still reported fatigue (53.1%), dyspnea (43.4%), joint pain, (27.3%) and chest pain (21.7%).
https://journals.sagepub.com/doi/abs/10.1177/153567601001500...
"The protective efficiencies were 33.3%, 11.3%, and 6.1% for the surgical, bandana, and dust masks, respectively. The N95 mask protective efficiency was 89.6%. In conclusion, the surgical mask protected the best of the three face masks tested. However, it is important to note that all three masks offer very little protection when compared to the N95, and wearing these face masks may produce a false sense of protection."
https://bmjopen.bmj.com/content/5/4/e006577
> Conclusions This study is the first RCT of cloth masks, and the results caution against the use of cloth masks. This is an important finding to inform occupational health and safety. Moisture retention, reuse of cloth masks and poor filtration may result in increased risk of infection. Further research is needed to inform the widespread use of cloth masks globally. However, as a precautionary measure, cloth masks should not be recommended for HCWs, particularly in high-risk situations, and guidelines need to be updated.
Cloth masks aren't designed to protect the wearer, rather protect everyone else around them by catching droplets / reducing nasal spray / etc. It only works if everyone 95% of people are wearing one, especially indoors.
If this is the only RCT for cloth masks what kind of evidence is behind your claim? Do you have a source?
That is actually the headline from the article: "Cloth masks do protect the wearer – breathing in less coronavirus means you get less sick"
No one should be wearing cloth masks if surgical masks are available and no one should be wearing surgical masks when N95 or equiv masks are available. This cannot be repeated enough.
Masks clearly work, but not perfectly. Better masks work better. Wear one if you want to reduce your risk and risk to those around you.
We knew this prior to this pandemic.
Governments and doctors should stop being so paternalistic and just tell the truth.
We especially do not know whether cloth masks reduce personal risk.
None of the links given in this overly assertive article show that cloth masks work or that they reduce viral load.
All of these are plausible hypotheses and beliefs, but they are still not backed by high quality data.
http://web.archive.org/web/20200625094522/https://www.oralhe...
The article is called "Why Face Masks Don’t Work: A Revealing Review", published October 18, 2016.
This is the webpage as of early July 2020: https://www.oralhealthgroup.com/features/face-masks-dont-wor...
"If you are looking for “Why Face Masks Don’t Work: A Revealing Review” by John Hardie, BDS, MSc, PhD, FRCDC, it has been removed. The content was published in 2016 and is no longer relevant in our current climate."
"No longer relevant in our current climate."
This is an entirely separate question from: Do masks provide enough protection against disease transmission to be worth wearing/recommending in public places during a global pandemic, despite their imperfections? The answer to that, from many other studies, seems to be clearly yes. I can imagine that anti-mask folks started using this article as ammunition, due to the catchy headline ("see, this article says face masks don't work!"), and the publishers felt it was doing more harm than good and took it down for that reason.
Then the publishers should come out and say so by putting a tagline or disclaimer at the top of the article. Pulling the whole article to "supervise[] conduct and morals" [1] is textbook censorship.
[1] https://www.merriam-webster.com/dictionary/censoring
A randomized trial with surgical masks during Covid-19 will be published soon. Here are some quotes and commentary:
> “All these countries recommending face masks haven’t made their decisions based on new studies,” Bundgaard said in an interview in Copenhagen.
> He says there’s evidence to suggest that the only effective face covering might be a visor, because the virus can spread through all mucous membranes, including via the eyes. He worries a cloth covering that only protects the nose and mouth provides a “false sense of security.”
> Bundgaard says the simple rules that currently exist in Denmark -- hand-washing, social distancing, self-isolating if you’re sick -- are effective because they’re easy to remember. He worries that using face masks might lead people to be “sloppy” in following the other guidelines.
> Bundgaard’s study on masks is due to be published next month. In the meantime, he says he hopes they don’t become mandatory in Denmark.
https://www.bloombergquint.com/onweb/face-mask-photo-op-adds...
https://pubmed.ncbi.nlm.nih.gov/32829745/
Seems like an easy problem to deal with.
Unless you're being sarcastic (apologies if so, and no mean to offend if not), I take the opposite conclusion though, which seems borne out by reality. Public messaging and for social cohesion in service of the greater good is the hardest problem affecting any large-scale coordinated response, especially with propaganda, doublethink, and flat-out unwillingness to learn being so common. I gather that the article the previous commenter mentioned was removed so that such propagandists couldn't willingly misinterpret it to pass on to their sycophants.
The intro says "This trial investigates whether the use of face masks in the community will reduce wearers' risk of SARS-CoV-2 infection." (emph. mine) ie. if everyone wears masks, does my risk go down? This seems like the correct question to ask. But then the conclusion says "We will study whether a face mask protects the wearer of the mask against SARS-CoV-2 infection" which is a different question entirely!
If what we have been hearing over the past months is true (masks provide marginal protection for the wearer, but catch a significant portion of aerosol droplets & therefore protect society against the wearer) - I would expect the answer to the first question to be "yes" and the second to be "no"!
After-all there is probably a way to cherry-pick an argument that surgeon without a mask is more accurate therefore safer.
Wearing mask is not a big inconvenience, same as not dropping trash on the street. You just need a person that is not consumed by their self importance.
I swear there will soon be people claiming that not only sun revolves around the earth but it revolves around that single person.
This is also a good article on the subject. The revisionists claim that WHO and the CDC changed their mask recommendations based on new evidence but they never actually cite the studies which presumably were published just before the policy changes. I think that may have something to do with the fact that the recommendations were not evidence based.
However, it is important to note that seat belts from ropes, seat belts from cotton strings, and seat belts from elastic bands offer very little protection when compared to a properly tested and fitted seat belt, and wearing these seat belts may produce a false sense of protection (resulting in no avoidance of speeding or driving too closely to the person in front of you, the best general public guidance we currently have to avoid corporal damage from car crashes).
I don't know why that was even in serious question unless the only transmission method was putting your fingers in your mouth or something. Of course more filtering will be better.
The arguments against wearing a mask have always been weak, the arguments for wearing a mask didn't start so strong but were well established in March/April. Anyone arguing against them after that point was either parroting stuff they heard without understanding, or was making disingenuous arguments that have contributed to a lot of misery and death for no benefit.
I don't think I heard anyone with actual medical training suggest that wearing a mask might be worse than nothing -- except for one scenario, that it might cause a false sense of security. Never once have I heard another reason from someone with actual medical training for why masks might make things worse, at least when it comes to COVID.
Especially when there are many others who are non-compliant - otherwise you get "why should I protect you when you refuse to protect me".
Unless you're going to argue that nobody should ever be in a room without permanently wearing and disposing of a constant streams of masks ever again (not gonna happen), you're going to get the virus at some point. Therefore, as hospital overload never happened there's no real point to any of this.
https://www.sciencedirect.com/science/article/pii/S147789392...
It takes years to train a populous to wear masks. Asia didn't just turn it on.
So were is the reckoning to the medial experts who fought this all the way, who told us to just wash our hands with soap.
These same people chose our complex cancer treatments, yet after 100 years of disease control, masks are a medical argument in the West still.
I think it would be much better to let people "test it" for themselves. Let them be the scientists, ask them basic questions. You can do this with a kid:
1) Where is the virus in our body? (answer: in the lungs)
2) What does it feel like to wear a mask? (answer: hot/stuffy)
3) Why does it feel hot/stuffy? (answer: the mask is keeping your exhalation closer to you)
4) If masks block your breath, and your breath has the virus, does that not then mean that masks block the virus? (answer: yes)
Bonus) Suppose masks don't actually block the virus that well, say by only 10%. Will they still affect the chain of transmission (yes, its "multiplicative": 90-> 81%->72%->...)
This "psuedo-experiment" would not be up to snuff for a journal, but conversations are not publications. Its better to make assumptions and make deductive arguments, because then you don't need to rely on trust in scientific institutions.
IMO, the higher quality media outlets have done a pretty good job in a field full of disinformation and propaganda.
Unfortunately, low information citizens are attracted to increasingly fringe sources. My brother owns a marina, and they are struggling with customers and staff who refuse to follow protocols and cite fairly crazy sources to refute things.
1) The virus is not only in the lungs, but it is not important here, pass. Maybe insist on the fact it can be in the nose, to encourage people to put their mask on their nose.
2) Good observation
3) That the wrong part. Hot means that heat is trapped, but air definitely isn't, you wouldn't be able to breathe otherwise. That you can't breathe with masks is a common argument used by anti-maskers, and many times shown wrong. Masks can keep your breath closer to you in the sense that you don't project it as far because it makes it slower and more diffuse. It also has a chance to trap droplets containing the virus.
4) masks don't block your breath in fact surgical masks are more effective and more breathable than cotton masks. That's because surgical masks are optimized to stop viruses and let air through.
1) It’s not just in our lungs, but in our entire “breathing system”. Still need to control the breath.
2) Masks don’t block oxygen, but they block the wet part of the breath at least somewhat. The wet part is the dangerous part.
You could go back and forth with a so-called “anti-masker” and you’d prob be leagues ahead of where you’d be if you shared a masks article.
Here's a simple argument: death rates from COVID are about the same as a regular flu season in places that didn't do dumb things like close hospitals and send sick people into care homes. In many places they're around the level of flu.
But flu is always around. If we don't wear masks all the time, then why do we need to wear them now?
There is no logical answer to this except "you should wear masks permanently" which many people will never accept, as the benefits are simply too low to justify the consequent problems.
So my point stands. If you're going to make simple pro-mask arguments, be prepared for equally simple counterarguments. Excess death data says 2020 is for most countries an unremarkable basically normal year. Even in the few where it's not, it's still comparable to prior years when nobody noticed anything at the time, so hardly abnormal.
"Long COVID" may be the usual problem of slow recovery from viral infection that occasionally happens, or it may hardly be real given the broad array of vague symptoms that are now allowed to characterise the disease. Everything from a runny nose to a headache to full blown pneumonia is classifiable as COVID these days. That means many people with other issues will end up with spurious correlations of the form, "I had COVID symptoms and now I am fatigued" when the cause may not be "COVID". The apparent lack of consistency in these reports, the wildly varying time between infection and onset, etc, all suggests there's a lot of noise in these reports. Definitely not a part of any simple argument for mask wearing.
I didn't know that was ethical.