[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?

[krrrh]

I’m not who you’re asking but I wish we had learned that a robust debate is necessary and we shouldn’t just assume tha Anthony Fauci has read the latest research.

https://www.econlib.org/great-moments-in-epidemiology/

He did enormous damage in 1983 by speculating about casual transmission of HIV within households even though he admitted to not having read the paper. He was slow to get up to speed on aerosol transmission this time around.

The comment at the bottom of that page also contains this gem from Oprah Winfrey in 1987:

> Research studies now project that one in five—listen to me, hard to believe—one in five heterosexuals could be dead from AIDS at the end of the next three years. That’s by 1990. One in five. It is no longer just a gay disease. Believe me.

Obviously that never happened. I was 12 that year and this sort of stuff terrorized us, even though it was based on highly dubious modeling, plus belief by public health officials in the promulgation of nobel lies.

I think we should have learned that groupthink and motivated reasoning can lead to all sorts of ancillary damage not just to psychological health, but to reduced trust in institutions, heightened political polarization, massive misallocation of resources, and putting focus on the wrong places.

We should have learned that being honest about what is known and what isn’t known and placing trust in the public leads to the public placing trust in public health authorities when it really matters. Credibility is extremely important to maintain, and protecting and encouraging a robust debate is paramount to discovering the truth and making better decisions.

[mulvya]

> From what I understand, HIV is fairly difficult to transmit, requiring an exchange of infected body fluids.

Fauci didn't think so in 1983.

"But if ''nonsexual, non-blood-borne transmission is possible, the scope of the syndrome may be enormous,'' writes Dr. Fauci of the National Institutes of Health in an editorial to be published Friday in the Journal of the American Medical Association."

https://www.nytimes.com/1983/05/06/us/family-contact-studied...

[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.