[renewiltord]

Anthony Fauci quoted below with his primary motivations:

"I don't regret anything I said then because in the context of the time in which I said it, it was correct. We were told in our task force meetings that we have a serious problem with the lack of PPEs and masks for the health providers who are putting themselves in harm's way every day to take care of sick people," Fauci told O'Donnell.

"When it became clear that we could get the infection could be spread by asymptomatic carriers who don't know they're infected, that made it very clear that we had to strongly recommend masks," he said.

"And also, it soon became clear that we had enough protective equipment and that cloth masks and homemade masks were as good as masks that you would buy from surgical supply stores," Fauci added. "So in the context of when we were not strongly recommending it, it was the correct thing."

[d1zzy]

But a leader speaking out to the population is not the same thing as an engineer/researcher formulating a theory and correcting themselves as information comes through in their research notes. One of the important things you have to consider as a leader is political capital, which is a limited resource. Every time you tell people that they should do something that is different from what they wanted to do, you are burning that capital. You cannot change your mind "as new information comes through" every day, soon enough, everyone stops trusting whatever you say and are back to doing whatever they think is best.

So if you think masks _can_ help (now or in the future, with training, used correctly, when we have enough of them in the future, etc etc) then DO NOT say they do not help and then come back to that because you have "new information".

If the problem was sourcing PPEs for health professionals why didn't the government use emergency powers to seize shipments and ban selling of such critical products to the general population? At least temporarily while building stocks for health professionals (which I'm surprised we didn't already have stocks of, you know, that seems like normal preparation procedure for a national health emergency?)

[dhimes]

Yes- he's negotiating a difficult position. At the time there was a big concern that people wouldn't wear the masks properly. "It takes training" was the implication.

[DanBC]

Combined with a lack of evidence that masks work, and some evidence that masks don't work.

[dhimes]

I think the evidence is that people don't wear masks properly- so in that sense they don't work.

And that's what Fauci was indicating at the beginning.

[DanBC]

People should wear masks; masks may help.

But all the good quality evidence we have so far struggles to find a benefit to masks. This is especially true for DIY cloth masks that are being mandated for the public, but it's also true of high quality N95 masks. We only see a benefit when we drop the quality of evidence down, but this means we have less confidence in the result.

https://www.publish.csiro.au/hc/pdf/HC15950

> RCT evidence was limited and showed no effect but accumulated evidence from retrospective case controls and cohorts all showed these strategies decreased transmission. N95 respirator mask OR 0.17 (CI 0.07–0.43), Gloves OR 0.32 (CI 0.23–0.45), Gowns OR 0.33(CI 0.24–0.45), All OR 0.09 (CI 0.02–0.35)

Note that this is for an N95 mask, not worse masks like surgical loop masks or cloth face coverings.

There's some research looking at post-operative wound infection rates. It can't find a benefit to surgeons wearing masks in clean surgery.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7138271/

> Main results

> We included three trials, involving a total of 2106 participants. There was no statistically significant difference in infection rates between the masked and unmasked group in any of the trials. We identified no new trials for this latest update.

> Authors' conclusions

> From the limited results it is unclear whether the wearing of surgical face masks by members of the surgical team has any impact on surgical wound infection rates for patients undergoing clean surgery.

https://pubmed.ncbi.nlm.nih.gov/20524498/

> Conclusion: From the limited randomized trials it is still not clear that whether wearing surgical face masks harms or benefit the patients undergoing elective surgery.

Here's the most recent, very high quality, paper about masks and covid-19. This wasn't available when Public Health organisations were making their recommendations.

https://www.thelancet.com/journals/lancet/article/PIIS0140-6...

> Although direct evidence is limited, the optimum use of face masks, in particular N95 or similar respirators in health-care settings and 12–16-layer cotton or surgical masks in the community, could depend on contextual factors; action is needed at all levels to address the paucity of better evidence. Eye protection might provide additional benefits. Globally collaborative and well conducted studies, including randomised trials, of different personal protective strategies are needed regardless of the challenges, but this systematic appraisal of currently best available evidence could be considered to inform interim guidance.

This para is saying we just don't have the evidence yet. It's saying people should wear facemasks because masks may help, but we don't know, and maybe masks cause harm.

> Interpretation

> The findings of this systematic review and meta-analysis support physical distancing of 1 m or more and provide quantitative estimates for models and contact tracing to inform policy. Optimum use of face masks, respirators, and eye protection in public and health-care settings should be informed by these findings and contextual factors. Robust randomised trials are needed to better inform the evidence for these interventions, but this systematic appraisal of currently best available evidence might inform interim guidance.

Look at the difference in the description of distancing (supported) and masks (optimum use may help).

> Face mask use could result in a large reduction in risk of infection (n=2647; aOR 0·15, 95% CI 0·07 to 0·34, RD −14·3%, −15·9 to −10·7; low certainty), with stronger associations with N95 or similar respirators compared with disposable surgical masks or similar (eg, reusable 12–16-layer cotton masks; pinteraction=0·090; posterior probability >95%, low certainty).

Tucked away in this para is "low certainty". This comes from GRADE. Low certainty means that masks may be much more effective, or much less effective, than they estimate.

https://bestpractice.bmj.com/info/toolkit/learn-ebm/what-is-...

> Low The true effect might be markedly different from the estimated effect