According to various reports,
On Thursday, the White House said that it will likely soon adjust previous guidelines that discouraged non-health workers from wearing face masks. The change would be issued as “guidance” from the CDC, but according to the president—who continues to hesitate at exerting federal power during the COVID-19 crisis—it will not be made mandatory.
1. State and local officials could make it mandatory.
2. It is considered a supplement to lockdowns, not a replacement.
3. But my guess is that after we get through the next couple of grim weeks, maybe some locations will experiment with masks as a substitute.
4. I am sure that a lot depends on how well people follow instructions for hygienic use of face coverings. I can understand why one might not be optimistic about that.
5. But face covering doesn’t have to be perfect. It just has to work well enough to slow the spread rate.
Glad this is happening, but would be nice if we could even adequately supply healthcare workers first…
Exporting the masks we have.
FDA blocking imports.
Right. We have stopped hitting ourselves in the head with a hammer… or at least temporarily dropped one of those hammers.
The more I read about masks and face coverings, though, the less interested I become in thinking of them as a solution. It sounds like the masks are effective mainly by preventing us from touching our faces! Do you have better evidence or information than I am seeing?
Their main use is in preventing sick people from spreading it. If you cough, it mostly stays in your facemark rather than getting projected out six feet.
Right now I frequent no businesses. If mask and glove wearing were widespread, especially for employees, I might become a little less paranoid.
I’m about a week away from not even making grocery store trips. If everyone was wearing masks, I would continue on longer, I think.
“Respiratory virus shedding in exhaled breath and efficacy of face masks”
Nature Medicine (2020), published 03 April 2020
Abstract: “We identified seasonal human coronaviruses, influenza viruses and rhinoviruses in exhaled breath and coughs of children and adults with acute respiratory illness. Surgical face masks significantly reduced detection of influenza virus RNA in respiratory droplets and coronavirus RNA in aerosols, with a trend toward reduced detection of coronavirus RNA in respiratory droplets. Our results indicate that surgical face masks could prevent transmission of human coronaviruses and influenza viruses from symptomatic individuals.”
https://www.nature.com/articles/s41591-020-0843-2
THANKS for good ref. In Slovakia, we’ve been wearing masks for a month now.
It has been a huge help. All the more successful Asian countries have been wearing masks.
Even if it does not save you; when sick folk cough, it’s a big reduction. Plus, it’s a big increase in both a) washing hands, and b) reduced face touching. The mask is a very visible reminder of “good habits”, and why you have them.
I’m sure the real world total effect is greater than most lab tests would indicate.
The biggest value of face coverings is that they may embolden, or at least provide political cover, for at least some officials to experiment in lifting some of the most onerous restrictions (Arnold’s point #3). For example, in Boston, they have closed down tennis courts. Last I checked, one could easily play tennis while maintaining 6-ft separation from one’s opponent. Maybe, they will allow people to play tennis as long as they wear masks. (The restriction doesn’t hurt me as I don’t play tennis, but the concern over tennis strikes me as the least of our worries.)
I do see one potential harm from advising the general public to wear masks: eventually, they could be made mandatory even in situations where the masks are unnecessary “just to be safe”, even when the COVID-19 threat has long passed. (You never know when a new virus might emerge. Let’s just play it safe.) The fact that we spent an entire mask-free century without a deadly outbreak will not matter. Some of the very same people that currently argue that masks are ineffective for the general public — either because they want to preserve supply for health care workers or they worry that people will “substitute” masks for other measures — will suddenly argue that masks are essential to stop the wearer from infecting others and, hence, should be mandatory. There really are a significant number of people that follow the mantra, “That which is not forbidden should be mandatory.”
I would prefer we try an approach where we advise/require people to wear masks for specific purposes as a condition for opening specific venues under specific conditions, say requiring or advising restaurant workers to wear masks to allow restaurants to re-open. (I have no idea whether there is a specific reason for restaurant workers to wear masks; I’m just giving that as an example.) The idea is that a mask should be viewed as a piece of equipment that serves a specific purpose in *narrow* contexts. A batters helmet is great for protecting someone from a wild pitch, but I would not want to see a requirement that everyone wear helmets in public because you never know when something might fall on your head or you might trip and hit your head on the ground. We should follow the mantra, “Any requirement should be the most narrowly tailored measure possible to achieve a specific, compelling interest.”
An even better example of a narrow context might be: *people that have a fever or certain other symptoms* should wear a mask to enter a public space *where they are likely to come within 6 ft of another person, or where there will be more than N people gathered, or both, etc.*
In Asia mask wearing is a normal part of everyday life. They don’t wear them all the time, but they do wear them where appropriate. Even if they were made mandatory for a crisis period, seems likely that would be overturned post crisis. This is very much libertarian conspiracy theory.
We should be doing everything we can to encourage a culture in which mask wearing is considered normal or even virtuous during contagious times. Its a huge reason Asia is handling this better.
Taiwan has achieved an almost perfect victory against this pandemic. They totally nuked R0 from the very start. They are a model for the world, so we should copy what they’re doing. Copying success is “The Secret of Our Success”, and not doing so is the reason for our failure, so far.
How did Taiwan do it? With masks. Not special, high-tech masks, but ordinary, surgical masks.
They are not just doing a little better, or twice as good, but several orders of magnitude better than any other big developed country. The US will be lucky if its Covid-19 deaths per capita is only one thousand greater than in Taiwan. That’s not hyperbole; that’s the actual ratio. And again, not total deaths, but the rate taking population size into account. That’s the difference between genuine success and abject failure. I am tired of the losing, and winning or losing is a choice. Choose success, choose masks.
Furthermore, with the exception of some common-sense traveler restrictions, Taiwan didn’t lock down their economy to do it. At all. Everything is humming along mostly like normal, schools, businesses, entertainment events, etc. No draconian measures at all. “Wow! How?” Masks is how.
There is discussion about doorknobs and things like that, but Taiwan has all that stuff and is encouraging people to clean well like in every other place, but otherwise all those theoretical risks show zero sign of undermining their success, so probably aren’t worth worrying about. Humans spreading to other nearby humans exchanging air is what you worry about, and surgical masks are apparently very good at stopping the virus going outbound from contagious people, and going inbound to uninfected people.
They’ve been going at this for over 2 months, and only two days ago, announced some “social distancing” measures so enviably mild any American or Italian would be grateful for such relaxation and relief.
Basic stuff like avoid crowds, stay four feet apart indoors, just three if outdoors, and, oh, their officials are actually telling their own people that they can ignore even those light recommendations, so long as everybody is wearing masks:
If masks, (also traveler-control, and a high-capacity epidemic control bureaucracy with lots of testing and fast tracing), didn’t work, then not shutting down normal life, and taking ten weeks to make these mildest possible recommendations would be the height of recklessness and the hallmark of catastrophe. Instead, it’s the opposite. Here is the latest, and keep in mind Taiwain has 24 million people, that is, three New York Cities.
So, in 10 weeks (their first positive test result was on January 21st), only fifty of their people caught the disease locally, which is fewer than one new local infection per day, in a densely urban place with as many people as Texas. They did this with ordinary surgical masks. Millions upon millions of them.
All the rest of those cases (86% of them) caught it overseas somewhere (the latest were mostly Taiwanese returning home, and who caught it in feckless Western countries).
Their average fatality rate is 1.5%, which is scary and in the range of typical estimates, but keep in mind that, on average over there, that’s just one person every two weeks. Smaller New York is now getting close to having a covid-19 death every two minutes. The question of “Life with masks or no masks?” is answered with another question, “Deaths in weeks or in minutes?” We chose minutes; we chose poorly.
Now, Ed Yong has a good overview of the most widely-discussed science papers surrounding the mask controversy here: http://www.theatlantic.com/health/archive/2020/04/coronavirus-pandemic-airborne-go-outside-masks/609235/
The problem he mentions with effectively communicating the technical definition of “airborne” is bad enough.
But the reality is even worse, because we don’t even have a common and well-defined concept of “work” in terms of what it means when we say that “Masks work” or “Masks don’t work.” That’s why a lot of the discussion and writing and review of the literature around the topic is so messed up and confused and flies in the face of observations we can make with our own lying eyes. Observations like Taiwan’s total success, achieved with ubiquitous surgical masks.
Let me explain. When we ask whether a mask “works”, do we mean:
1. This particular mask type filters the air of a certain percentage of particles in a certain range of size,
2. This particular mask type, if worn correctly and diligently by people in close proximity and exposed to other contagious people, reduces risk of infection by some factor. (standard of no infection is usually no antibodies thus no immunity),
3. This particular mask type won’t stop you from getting infected after lots of exposure, but it will make sure that your original dose of the virus was very small, and such passive variolation can generate the immune response which generates antibodies and confers immunity, but without harsh symptoms, or any symptoms at all, lowering the expected fatality rate by an order of magnitude,
4. If you are contagious, this particular mask lowers the risk of infecting others by some significant factor,
5. If everybody wears this mask all the time as a general social policy, R0 will decline by some significant factor and/or the disease will never get off the ground in the first place.
The answer to question one is useful for construction folks kicking up a lot of bad dust. Questions 2 and 3 are important for health care workers especially, but all individuals choosing their own individual policies to protect their own health. Question 4 is a question for public-minded, considerate individuals perhaps, and any context, even small ones, for people making rules for other people under their control. Question 5 is the Big Policy Question.
There are other possible questions too, and the trouble is that these questions are not investigated in the same ways, and, scandalously, it turns out not at the level of experimental rigor which would have allowed us to dispose of this question definitively a long time ago. Too many of the laboratory tests don’t use any actual biologically active material to test for actual infections in living hosts or living cells in culture or on plates. They often used proxy particles like specs of metal or motes of clay dust or tiny droplets of sterile saline. Also, while animal experiments are already expensive and difficult enough, there is additionally the hard question of how to test a mask designed for a human face and air flows, or whether it’s adequate to test animal-fitted masks using the same materials.
The trouble – and origin of a lot of the controversy – is that there is a major discrepancy between studies counting particles and drops (a lot get through), and studies counting transmission of virus from infected, contagious people to health workers (a lot don’t get through). But since we are interested in lowering transmission of infection and not whether the filtering of drops is poor, we should focus on the former, if we see that it works, even if we haven’t quite figured out the puzzle yet of why it works, given the latter.
There is an analogy to Microeconomics and Macroeconomic here. The micro-level questions are about how well single masks do for healthy wearers, and people in contact with contagious wearers. The macro-level question is about the benefit of universal mask policy, when (1) Success or failure managing the pandemic has a high degree of causal density, (2) Lots of places are doing lots of other things, and not necessarily doing them consistently with a disciplined approach, (3) There is a huge amount of uncertainly and unreliability in the data, and (4) We only get to run the experiment once.
The good news is that in this case we probably can derive the answers to the macro questions with good micro foundations, once we actually do sufficiently rigorous science to answer the micro mask questions and solve the puzzle of the drops, which unfortunately had not been done yet.
But until then, the best we can do is to observe and to try to infer patterns and stories to explain the truly gargantuan differences we see between places that took very different approaches. And one pattern is that a bid difference between places which had tremendous success and those with terrible failure was early adoption of universal mask wearing policies.
Taiwan placed a huge bet on masks, and they won this one, hands down, ‘biglier’ than anyone would have thought. We can turn that rare win into commonly-adopted best practices, overnight, and we should. We should wear masks.
+1
You know the cafe I used to eat at all the time is still doing take out. But I haven’t gone. I don’t see them wearing masks and gloves. What assurance do I have that a sick worker won’t cough on my meal as its getting prepared? None. At least if they are wearing a mask the droplets don’t as easily get on my food, and the gloves protect in case they had virus on their hands.
If I saw them wearing masks, gloves, and taking sanitation seriously (not regular serious, but pandemic serious) I could maybe get on board with using their services. It matters little to me whether there is an official “lockdown” order. I stopped this before any lockdowns. I want to be assured what I’m doing is safe. If its not safe, I’m not interested in it whether the government allows me to use it or not.
The biggest block here is that people still see wearing masks as “weird”. If they don’t see other people doing it, they won’t do it, even if the logical part of their brain tells them it’s a smart idea. It’s peer pressure and social copying all the way down for humans.
I suspect one reason is that there are not a lot of masks out there, and lots of people can’t wear what they can’t get. But, as asdf keeps pointing out, many people won’t wear masks unless a significant percentage of other people do; otherwise they will feel weird and think they look weird. So an effective “wear masks” policy has to start with a lot of masks in people’s hands, masks that they can put on the next time they want to go out. But that just isn’t the case today.
everyone has a handkerchief or scarf
Actually, I don’t. Though no doubt I could jerry-rig some cloth to cover my mouth and nose. I was just suggesting that, as asdf keeps pointing out, lots of people think going out with something covering the lower half of your face makes you stand out and look weird. If 50% of the population suddenly starts doing it, it stops looking weird. That’s a lot easier when 50% of the population can easily get something that looks like a respectable, manufactured mask.
I have said a number of times that with 20-20 hindsight, after the 2009 H1N1 flu, the government should have put in a “strategic stockpile” of surgical-like masks, a hundred for each person. Then, as soon as COVID-19 looked bad, it should have shipped 100 to every person and announced that you could go anywhere as long as you wore the mask and it covered your mouth and nose. If not, you had to stay home. That would have closed restaurants and bars and made selling or eating food at venues impossible but would have made for much less disruption, and would have probably smashed the curve within a few weeks.
Of course, to get people to wear the masks, all politicians, tv reporters and anchors, etc. would have to wear them. And there would have to be at least one well-publicized arrest of a celebrity for going out without one.
“all politicians, tv reporters and anchors, etc. would have to wear them. ”
Right! Tho:
“And there would have to be at least one well-publicized arrest of a celebrity for going out without one.”
That hasn’t yet happened in Slovakia, but ex-commie folk DO know how to obey, and look it, in public.
And all foreign arrivals would be given a package of masks, along with oral instructions and a booklet explaining the requirement to wear.
The idea is to make it easy to obey, and impossible to say, “I didn’t know.”
Trump should hold a press conference where he, and all around him, and all the press, are wearing masks.
This worked in Slovakia, with the leaders wearing masks and the news folk wearing masks.
“No live interviews on TV news w/o masks”. That’s a big part of how to change the psychology.
If we all wear masks or scarves, not that hard, it becomes “impolite” to NOT wear a mask.
Not wearing a mask outside should be seen, during the pandemic, as about as bad as drunk driving. Most drunk drivers, most of the time, have no accidents and get home. BUT, their probability of having an accident is a lot higher.
The probability of a slightly infected person coughing and getting lots of others infected, those “super spreaders”, goes way, way down when they’re wearing masks. I’m sure. Without rigorous experimental proof.
You’ve seen the Slovak President (Prezidentka, she’s a woman) in a color coordinated mask, with the newly elected Prime Minister? Neo had a post (my other favorite blogger) Mar 21:
https://www.thenewneo.com/2020/03/21/fashions-of-the-times/
Stop allowing meetings, interviews w/o masks to be shown on TV, and mask wearing goes way up, really fast.
+1