[top_post]

Man, all the WHO bashing comments are getting downvoted pretty quickly, except:

- WHO took a _long_ time to declare a pandemic when member countries were asking for it.

- WHO actively discouraged international border closures for containment.

- WHO took way too long to declare aerosol transmission even when countries had identified it.

In a global scale event like this, there's no individual country who should have been the shepherd. It should have been the WHO, comprised of all its member inputs, really showing the lead here.

Each individual country owns responsibility for their own preparedness, no doubt or question about that, but the WHO needs a re-organization big time.

[rzz3]

Also WHO told people not to wear masks and that it could actually make it more likely to get covid (CDC echoed this as well). “But it was justified lying to protect the mask supply!”—some people already had masks, and didn’t wear them because of this. I had someone literally get mad at me and block me because I said wearing a mask was obviously a good idea, and an N95 is more likely to protect you than a cloth mask.

[avereveard]

WHO straight up told not to close borders with china as initial recommendation as well. so fuck em. until they come out and detail how did they got it so wrong, why, and what actions they are taking not to fuck up again, they have _zero_ credibility.

[samatman]

Ironically, WHO and CDC have done bad messaging on both sides of this. I get slammed every time I bring this up now, because the issue is politicized and, let's be honest, pretty traumatic as well. But I think it's important so I'll keep trying.

Everyone should have been masking up as soon as possible in the pandemic. Case counts were low, we didn't know much about the route of transmission, and we also thought it was even more dangerous than it turned out to be. Precautions were indicated, but health authorities were decrying mask use as late as the end of March.

But it turns out that the primary vector is aerosols, not droplets or fomites. Any mask will mitigate droplet contamination, and the resulting fomites: this is why influenza has practically disappeared, masking is very effective against influenza, where those are the primary vector.

But no mask will do much to filter aerosols on exhalation. That's simply not how they work, positive pressure puts most of the gasses out through the sides of the mask. Even a P100 filter with cartridges won't do it, that's why they have a vent, otherwise the face seal would be broken every time one exhales. To be generous, I'll say that a cloth mask catches 30% of aerosols. It doesn't, but say it does: that's not nearly good enough. Which case counts after universal masking mandates illustrate quite clearly: they rise, and fall, and the masks don't have anything to do with it.

A good mask will filter some aerosols when inhaling: but a cloth mask won't. So once aerosols were identified as the culprit, WHO and CDC should have emphasized air filtration, which is quite effective, limiting the number of people indoors on the basis of how many air exchanges a HEPA or ULPA filter was capable of doing. Messaging should have emphasized that cloth and surgical masks are completely useless, and that at-risk people should stay home, and if they can't, should get a proper mask (KN94, (K)N95, P100) and learn how to use it. COVID doesn't survive on surfaces very long, so reuse is more-or-less ok, and there were plenty of proper masks by June, which is when these facts were available. If WHO and CDC had listened to them.

I vape, so I can illustrate this to myself quite easily: I can hit the vape through a cloth mask, but not a KN94. And with any mask, I can take a hit, put it on, and exhale a visible cloud of, yep, aerosols, around the side of the mask.

I still wear a KN94 indoors, it's the best I can do. But I'm walking around in indoor spaces with no HEPA filters, surrounded by people who are unprotected, just wearing a talisman. This was preventable.

[octodog]

Do you have any sources for cloth or surgical masks not working?

The study in this article [0] is still in pre-print but it claims that a change to mandatory mask wearing was a critical factor in crushing the virus in Melbourne's second wave.

I've seen some comments on HN that masks aren't effective but from what I've read and observed in Melbourne/Australia they have been very effective.

[0] https://www.abc.net.au/news/2021-04-14/face-masks-number-one...

[samatman]

See some sibling comments for my specific thoughts on the matter.

Melbourne did everything they could think of, and the sum of it worked. This included a very severe lockdown, contact tracing, masking in the very limited public interactions which were allowed, and starting with a relatively low case count. I'm fairly confident that masks were the least important part of this, and that shutting down basically every part of public life was the most.

I did say that masking early on was indicated, and that WHO and CDC failed us there. I sort of glossed over the part where case counts were low, but it's there, and it's pretty important.

What the US and Europe needed early is what New Zealand and Australia (and Taiwan, Korea, maybe a couple other Southeast Asian countries) actually managed: universal masking, a nearly-complete cessation of public life, widespread testing, contact tracing, and central quarantine for the infected. Instead, we got dithering and "wash your hands".

It was too late for that suite of interventions to be effective by 1st April at the latest. Earlier for Europe, which had the early wave epidemic in Italy.

So of course, that's when masking was adopted, as a totemic symbol that the powers that be were "doing something". But we had crossed the point where it could help, and it was always the least important thing.

[kelnos]

> See some sibling comments for my specific thoughts on the matter.

I took a look at your sibling comments, but I don't see any sources linked that suggest cloth masks are so ineffective as to be useless.

Here are a couple studies suggesting they aren't useless (searched "cloth mask aerosol protection" via DDG):

https://pubs.acs.org/doi/10.1021/acsnano.0c03252 (effectiveness had a very wide range, depending on weave, thread count, etc.)

https://www.nist.gov/publications/filtration-efficiencies-na...

I get what you're saying in general, that "cloth mask" means many different things, and that those things aren't going to have the same levels of protection, but you seem to be pushing the idea -- without evidence -- that all cloth masks are worse than useless. Science doesn't seem to agree with you?

[viraptor]

> A good mask will filter some aerosols when inhaling: but a cloth mask won't.

There's an issue with statements like that. "Cloth mask" is not well defined - are we talking literal layer of cloth, or the cloth-synthetic-cloth design recommended in some countries. Either way there's some gradient between 100% protection and nothing - cloth masks will still be better than nothing, but purpose-designed masks will outperform them.

This is not a trivial scenario to talk about, so the more specific we are the better.

[samatman]

Alright, that's a decent point. KN94 is cloth, after all, and it's what I use. I was using "cloth mask" colloquially to refer to the masks made of ordinary cloth which have become pretty much standard uniform in the parts of the US with mask mandates. You can do a little better with multiple layers and tighter weaves, but, not much. If it's not specifically designed to filter particles as small as aerosols, it won't, and if it doesn't have a number after its name, it isn't so designed.

I don't think it's accurate to say that those are better than nothing. The false sense of security could easily lead to people staying longer indoors, or entering indoor spaces which they would consider dangerous if they didn't have the misconception that cloth masks protect them. It's a very small amount of protection, so it doesn't take much moral hazard to overwhelm it.

Could you maybe get a little less sick, if say 10% less viral aerosols passed through the mask? Ok, if I'm going to be very generous, sure. At the margins, someone is going to inhale a sub-infectious dose of aerosol who would have gotten a just-barely-infectious aerosol dose.

But this is like talking about condoms with holes in them. Most of the semen would stay in! It's not as pregnancy inducing as going bare! But I wouldn't call it birth control either.

[samatman]

I don't know if anyone is still reading this, but Wired just published a detailed smoking gun on the aerosols question.

https://www.wired.com/story/the-teeny-tiny-scientific-screwu...

It's really good, I learned a lot of new things. Please read this if you're at all interested in the subject: and who among us isn't at this point?

[tim333]

>primary vector is aerosols, not droplets

Any source for that? I mean it has always seemed likely that both aerosols and droplets would be a factor but where did 'primary' come from?

[samatman]

Here's a discussion of the subject from October:

https://www.scientificamerican.com/article/protecting-agains...

I suggest, without intending to be dismissive, punching "covid aerosols primary" or the like into your search engine of choice and going to town. It's been a long debate, and by late last year every prestigious organization except CDC and WHO were in the aerosols camp. Even they have kind of low-key admitted it, while insisting that the measures to control it they promoted on an erroneous theory are still the correct ones. Which is, of course, nonsense.

A droplet is just a large blob of the same saliva that makes up the aerosols. If it gets in your lungs, it will make you sick. This is pretty easy to avoid behaviorally, and with face shields for workers who have to have contact with the public. Wearing a mask will also mitigate this, but it isn't necessary (just don't point your face at other people) and it isn't sufficient, because of aerosols, which are therefore the primary source of transmission.

When a droplet lands on a surface, it becomes a fomite. Picking these up with ones hands, and transmitting them to eyes, nose, and lips, is a major route of infection for influenza. It does not appear to be a significant route of infection for COVID.

Diseases which spread primarily through droplets do so by forming fomites. Unlike someone spitting on your face, it's very easy to touch a surface someone else spit upon, and people touch their faces a lot.

[spankyspangler]

And politicians were encouraging people to go out in the streets and gather en masse to celebrate / protest / whatever, denouncing border controls as racism, etc. Putting positive patients into nursing homes ill equipped to cope with it. It was a huge clusterf...

[unishark]

Another one: refusing to close schools because they served as daycare for higher-priority constituencies.

[warble]

Oddly this turned out to be the right advice.

[whimsicalism]

This was very early in the pandemic, I doubt that many people had masks early, and the problem of people hoarding was very real and medical professionals were having a lot of difficulty acquiring PPE.

I think it was a difficult situation, I don't think they handled it the best they could have, but the response (in the context of massive amounts of hoarding) was understandable.

I know that this will not be a popular take here.

[_delirium]

> medical professionals were having a lot of difficulty acquiring PPE

Weirdly, medical professionals were also being told not to wear masks. Multiple nurses were either fired or quit over the issue, because hospital policy didn't allow general mask-wearing out of a fear of scaring people:

https://www.wbrc.com/2020/03/23/nurse-claims-he-was-fired-we...

https://www.medpagetoday.com/infectiousdisease/covid19/85760

https://www.dallasobserver.com/news/nurse-fired-wearing-mask...

[titzer]

> out of a fear of scaring people:

Which is the greatest irony of all. Nothing is more terrifying than finding out you are being lied to, it's actually way worse, and leadership has no clue what it is doing.

[whimsicalism]

Yes, and that is absolutely stupid and a failure.

I am curious if that is due to the WHO messaging or just because with thousands of hospitals, the probability of having a stupid manager approaches 1.

[mxcrossb]

Half a year into the pandemic the president of the United States was filling stadiums was maskless supporters. The WHO seems completely willing to fall on their sword over COVID, and indeed they failed in many ways. But in the long run, we’re seeing a disaster of anti intellectualism around the world, and the next pandemic may be just as bad as this one.

[SpicyLemonZest]

I mean, I don't think that anti-intellectual trend can be divorced from the general messaging problems here. If you roll back to mid-March 2020, things like

* Masks don't help, there's no point in wearing them

* Lots of people are gonna get infected, all we can do is tamp down this current spike

* We'll go back to our normal lives in a month or two

were all well within what was reported to be the expert consensus at the time.

[PaulDavisThe1st]

> the next pandemic may be just as bad as this one.

or worse. Keep the aerosol vector, but make it even more effective. Increase the effectiveness of surface transmission. Throw in greater resistant to surfactants (soap) and hand sanitizers.

boom!

[raisedbyninjas]

Your scenario only increases infectiousness. Many viruses are more deadly than covid 19. H5N1 is about 60% fatal, more deadly than ebola. It's quite difficult to contract at least until researchers genetically modified it to be airborne. They didn't need permission for this research and didn't even perform it in the highest safety level labs.

[PaulDavisThe1st]

As I indicated in another post, the fatality rate of COVID-19 isn't the big issue with the disease. Extremely deadly diseases don't tell to do well in the long run, so although they may have a huge impact within a short time, they tend not to pose long term threats. COVID-19, however, is a glimpse into what would be a perfect storm of high infectiousness with high levels of required hospitalization/medical treatment for good recovery. COVID-19, with its relatively low death rate and moderate hospitalization levels, has already managed to somewhat overload public health systems in many parts of the world. The death rate doesn't have to increase to make a future pandemic much, much worse.

[lamontcg]

That high level of virulence though works against it just due to being identified much quicker. You're not going to get cryptic spread of a virus which is 60% fatal.

This coronavirus might have spread to ~10,000 people and already jumped to Italy before anyone was aware there was a brewing medical crisis.

[mxcrossb]

I always try to use HIV as my point of reference for COVID-19. We got off lucky by that measure. So maybe my pessimism is unfounded, but I really wish we had learned more lessons from HIV.

[PaulDavisThe1st]

From what I understand, HIV is fairly difficult to transmit, requiring an exchange of infected body fluids. This makes it deeply traumatic because the people you're most likely to infect will be people extremely close to you. To some extent this is true of almost any transmissable disease, but HIV added the twist that infection is very, very unlikely to happen between two individuals that are not physically intimate with each other.

In this sense, HIV doesn't seem like a particularly good model for anything like a coronavirus pandemic. Aerosol transmission just totally changes almost every aspect of the resulting pandemic.

What lessons do you wish we had learned from HIV?

[refurb]

And politicians were claims BLM protests across the entire country weren’t a big threat.

Suffice to say both sides love to “follow the science” when it supports their political views.

[Bancakes]

You can always limit the amount of masks per person.

[_y5hn]

WHO bears no responsibility (better word: accountability) as it is comprised of member states who define and fund it, that do. Findings, medical experts, doctors come from member state contributions.

Given conflicting reports, underreporting, unknowns, denials, how this virus transmits, this could only be handled better with crisis policies.

The world didn't operate in crisis mode until now.

[disabled]

Original submitter comment: Agreed.

However, I am a dual US|EU (Croatian) citizen living in Croatia. I am culturally American.

The US had the expertise, technological capacity, and economic investment capacity to be able to eradicate the virus. Very few governments have similar resources and the ability to scale like the US government, which is quite unique. The issue was the political party that we had in place, with their recent neoliberalism. We also have an uncooperative public, that is unwilling to take temporary pain to minimize a ton more pain (from the virus) for the future.

Croatia actually has great public health infrastructure, and also has a cooperative public that follows public health advice and orders. We also have brave politicians (a lot of them were officers in the Croatian Homeland War) that are willing to take bold, unpopular political risks. They will take one for the team, if that is what it takes.

Early on in the pandemic, Croatia came very close to eliminating the virus, and was rated by Oxford as having the strictest government response (I believe in its first review/publication of the metric?). You could not leave your neighborhood without a digital pass issued by the government, which was only given out for absolutely necessary reasons (e.g. medical care). That’s right: the Croatian police had each neighborhood cordoned off and barricaded, so you could not effectively leave without a digital pass (attempting to illegally leave would mean a big fine!). Croatia also had 30 days of food and supplies for all of its citizens in a government warehouse. Pricing was fixed for critical supplies such as food, and still is, which helps prevent panic buying. Also, if you test positive for corona, you will be issued a rješenje (a government administrative decision) ordering you to quarantine for 14 days. Besides being very cooperative, Croatians would not think of breaking quarantine, as the vast majority cannot afford to. The first violation is a 1,000 Euro fine. The second violation is a 16,000 Euro fine. Oh yeah, the police will stop by your apartment multiple times randomly to check on you to see if you are actually quarantined.

Croatia failed because they chose tourist season over attempting to eradicate the virus.

[eCa]

> Croatia failed because they chose tourist season over attempting to eradicate the virus.

One thing I want to see get researched the next few years is the way the slavic countries pretty much completely avoided the first wave that hit many other parts of Europe so bad, only to then get hit (in some cases much more severely) by the second and third waves.

Since this also happened to less touristy countries like B&H, Bulgaria and Slovakia I do think it is more complicated than that. (But I’m in another part of EU so I might be missing something.)

[stadium]

> The US had the expertise, technological capacity, and economic investment capacity

And incompetent leadership that foundered an opportunity to be the heroes of a generation.

[Khaine]

I'm no trump fan, but his administration did fund operation warp speed, which funded vaccine research and support vaccine production capacity

[_y5hn]

So did the russians, UK, etc.

[refurb]

You mean bring multiple vaccines to market in less than 12 months?

[stadium]

Vaccines don't help the dead.

"According to data from the Department of Veteran's Affairs, approximately 405,000 Americans died in the Second World War while 36,000 lost their lives in the Korean War. The Vietnam War resulted in another 58,000 deaths with the collective toll of all three conflicts coming in at around half a million. As of February 23, 2021, the Johns Hopkins University lists 500,310 Americans as having died from Covid-19. If a minute of silence was held for every death during the pandemic, it would take nearly a year - 347 days - to honor all the people the U.S. has lost."

https://www.statista.com/chart/amp/24252/us-covid-19-deaths-...

[devin]

That is an extremely matter-of-fact reply, and I salute you. I disagree with "WHO bears no responsibility" insofar as the leadership of organizations ought to be able to be held to account. You might need to elaborate on what "crisis policies" you would find acceptable.

[_y5hn]

Of course everyone is responsible for their own efforts. It's just that WHO is no government (NGO) and thus not accountable like one, and also have no authority. Without member contributions, WHO doesn't exist. It reports medical findings from states, but the caveats are denials, misreporting, unknowns, early confusion, etc. which may be expected in an early breakout. The better the cooperation, things can improve. Otherwise, not.

We should of course minimize crisis mode. Without it, expect similar response. I doubt the world will be going back, but will need to tackle more crises.

This one is the perfect mirror for states. Only full lockdown will contain contagion, but many don't have that sophistication yet. Those who didn't lockdown early, got hit hard economically too.

[unishark]

I think identifying pandemics is literally a defined responsibility of the WHO. Regarding which, the WHO-commissioned report states:

"The WHO waited too long to declare a public health emergency of international concern, the panel said, after the reporting of an initial cluster of cases in December 2019."

[_y5hn]

What was reported from China, where people are fearfully in denial?

[cortesoft]

By this logic, do politicians bear no responsibility for anything, either, since they are elected by voters who select and fund their governments?

[_y5hn]

Being citizens, they are accountable within their country.

[realmod]

WHO did maintain from the beginning that transmission via aerosol was highly likely and possible. Although, I do agree that tweeting the study while still openly stating it is possible sends a contradictory message. One thing to not forget is that WHO is a global cooperation organization, and its power is derived solely from its member-states acceptance and cooperation. This means that they have to play the political game and weigh the consequences of their actions versus the benefits.

We have already seen multiple instances where leadership avoided testing to make the virus appear contained. Now imagine what countries would do early in the pandemic if they saw countries essentially sanctioned for trying to contain the virus. Did WHO make the right choice? I don't know, most likely not, but the world is not black and white. They should, however, rigorously go through their actions these past two years to see what they could have improved and what policies to put in place to prevent this from recurring again.

[endgame]

Reminder: 2009 "swine flu": declared pandemic at 74 infected countries ( https://www.who.int/mediacentre/news/statements/2009/h1n1_pa... )

COVID-19: declared pandemic at 114 infected countries ( https://www.who.int/dg/speeches/detail/who-director-general-... )

[spankyspangler]

The WHO lost a lot of credibility (deserved or not). They clearly either did not have a good grasp of the science and evidence while they were issuing their proclamations, or they were attempting to steer reality away from certain problematic scenarios for certain interests that have corrupted the organization. Or both.

The bigger problem was not the WHO, it's very common for such organizations to be highly dysfunctional and corrupted. It was the slavish adherence to authority (aka boot licking), and piling on, bullying and hatefully attacking anybody who dared to question this corrupt authority. Everyone was getting in on the action, from mega corporations to the average "useful idiot" internet bully.

Unfortunately it's a big problem for some people who put politics above reality to cope with that idea, because WHO is on "their side", for various reasons.

[_y5hn]

WHO, being an NGO, has no authority, governments do. States can either improve by cooperation, or become dysfunctional, but they are the authorities in this world.

[spankyspangler]

The subservient bootlickers were quite desperate to give it authority. And the WHO is already dysfunctional and corrupt.

[_y5hn]

Who and what authority was given to WHO? Please explain your rationale.

WHO is just an NGO, a reflection of multiple member states cooperating through it. Not all states are faithful or trustworthy.

[spankyspangler]

What do you mean rationale? Entities have authority according to who and what they can influence and affect. It is false to say a state has absolute authority and the WHO has no authority.

Those who listen to, act on advice from, censor and attack opposition to the WHO give it authority. This seems to be very upsetting to you for some reason.

[_y5hn]

On the contrary, and no need for hostile comments attempting to belittle other posters.

[74d-fe6-2c6]

WHO is also way too understanding towards China and basically owned by Bill Gates.

[sudosysgen]

The WHO absolutely did take a long time to declare a pandemic and certainly did fumble the ball on aerosol transmission.

However given what we now know for sure we can safely say that border closures without an eradication policy (strict lockdowns and mass testing until the cases are undetectable followed by contact tracing) would not have changed anything.

Which is what the models that WHO epidemiologists had used to give the guidance that airport closures would not be very effective used as premises and found.

We know that by the time the border closures were suggested the virus was already definitely already in every country. From then on an extra five or six cases a month don't really affect the trajectory of the epidemic much at all.

Unless you go for an eradication strategy. But in Western states that waited until deaths started mounting to lockdown and then opened back up mostly before they went to zero we can confidently say that airport closures would not have been a factor in avoiding the disaster.

[kortilla]

> However given what we now know for sure we can safely say that border closures without an eradication policy (strict lockdowns and mass testing until the cases are undetectable followed by contact tracing) would not have changed anything.

How do you make the conclusion that without a policy reducing travel wouldn’t have helped? That doesn’t even make sense.

[sudosysgen]

I don't know how your government handled things, but here they waited until it was clear that the healthcare system was going to implode if nothing was done to implement serious restrictions.

If we had stopped travel, we would have hit that point maybe a week or two later. Travel is linear while community spread is exponential.

In the end, given the incredible efficacy of lockdowns, the total amounts of deaths and infected would have been the same or thereabouts, because the point at which it was clear a lockdown was going to happen would just have come sooner.

If you base your public health measures on number of infections, and if community spread is exponential, then adding a dozen cases from travel doesn't change the point at which cases start to decrease, because the cases decreasing is contingent with them reaching a certain amount to begin with.

[rjzzleep]

Couple of points:

1. Lockdown and travel restrictions are not the same.

2. Travel restrictions and reasonable public health safety measure are not exclusive. They only work in conjunction.

I would argue that one of the most damaging things the EU did was take care of these things linearly.

As an example German Pharmacies warned the Government of mask supply issues in February. Maybe even January. I know february because beginning of February they were having those supply issues.

Fun fact, one of the biggest suppliers of machines that are required to make N95 mask threads is German(I think it was german, but could be central European). Yet, just like the US, Germany did not call for domestic mask production until months later. I'm not even sure they did at all seeing how a lot of masks later were cheap chinese masks sold over market value with quality control issues.

Contrast that to Taiwan, where fever wards were established right away, domestic mask production and distribution was increased and regulated, combined with a coherent message and paper contact tracing(i.e. no app to start right away). And before you say "but Taiwan". Yes, Taiwan has a second wave coming that will be way worse than the first one, since the top level government seems to have let arrogance forget a couple of the things they did right early on.

[sudosysgen]

You should re-read my original comment. I said that travel restrictions would not do anything unless the pandemic strategy was eradiction. If the strategy is to "flattien the curve", then there is essentially no effect from closing borders.

>1. Lockdown and travel restrictions are not the same.

Yes, this is the entire point of my argument.

>2. Travel restrictions and reasonable public health safety measure are not exclusive. They only work in conjunction.

This is not correct. Lockdowns work even without travel restrictions. Travel restrictions don't do much without lockdowns (and other non-pharmaceutical interventions).

[rjzzleep]

> You should re-read my original comment. I said that travel restrictions would not do anything unless the pandemic strategy was eradiction. If the strategy is to "flattien the curve", then there is essentially no effect from closing borders.

You should look outside the window there are more countries in the world than just the EU and the USA. Taiwan had effectively zero community transmission for almost a year without lockdown. Travel restrictions were a vital part to that.

The whole flatten the curve argument was a hack to reset a botched pandemic response.

> This is not correct. Lockdowns work even without travel restrictions. Travel restrictions don't do much without lockdowns (and other non-pharmaceutical interventions).

Howd they work out in Europe? How many lockdowns will they have? They actually did Lockdowns without travel restrictions and it did not work. It did flatten the curve a bit, but the end result is still a mess.

Your entire argument is based on an assumption that the outcome is already determined.