Hacker News new | ask | show | jobs
by LostJourneyman 1826 days ago
I'm afraid you have a fundamental misunderstanding of what the "burden of proof" means in this context. Let's clarify a few things:

1) there is adequate and persuasive evidence that adding a barrier across the nose and mouth will impede particulate spray during speech and normal bodily functions like coughing or sneezing. It will not act as a micron level filter. To say that cloth masks "haven't been shown to help do anything" is demonstrably false, but trying to treat masks as a full respirator is equally misleading.

2) Using a mask when you have or suspect you have a cold shouldn't be stigmatized, as you are literally helping to make sure that you are minimizing other people's exposure to whatever is making you ill

3) Social distancing is not the same as quarantine. Asking you to stay home as much as possible during a pandemic is a measure to help slow transmission rates. Stopping all travel into our out of a designated area is quarantine. If you're staying home after travel and unable to leave your home, that's quarantine. If you're avoiding restaurants, that's social distancing.

4) the burden of proof test is a legal test in determining who is responsible for providing evidence to back their claim, and the innocent until proven guilty standard is limited to criminal trials. To conflate that with assuming someone is healthy during a pandemic until they show symptoms shows a gross misunderstanding of how communicable disease transmission works. In many viruses, this included, the incubation period comes without symptoms and is fully communicable. You can be actively infecting other people without symptoms. Surely you can understand the reasonable difference between the two.

5) your claim that the standard in the last century has been "survive infection, you should be good until proven otherwise" is also false. This is true for some diseases but not others. Again, flu comes to mind as an example.

I want to address your last point separately. It is well acknowledged and understood that resource, income, healthcare, and access disparity have played a large role in how this pandemic was handled and mis-handled. We have much to learn from our experience here. That said, you cannot simply hand-wave "funny paper" and say that public health doesn't matter. Sure, the society that we live in is heavily reliant on exploitation. Yes, that's a problem, and not a simple one. Yes, because of that people have to work, and people have to take those risks when it shouldn't be necessary. That's all the more reason to place caution over pride and comfort. They are forced to bear undue risk, why should anyone have the privilege to add to that burden of risk when much of it is easily mitigated by limiting how much time we spend in public spaces and by wearing a face covering?

2 comments

To note, extremely sucessful lockdowns were executed by Vietnam, which has a GDP per capita of 2700$, a seventh of the global average. That is to say, if they have a competent government, even poor countries did lockdown successfully.
By true sense of the word "quarantine", means locked up in some room while you recover/pass infection. Someone has to come to you, feed you, observe you etc. So this isn't happening.

What is really happening is:

* Keep megastores and large companies open. With the lower classes going to work, and entire cities cramming into specific stores that are open.

* upper-middle and upper classes staying inside, working remote, and ordering take out.

But let's not talk about specifics, of which these I am sure happened in Vietnam as well.

If you really wanted to reduce mortality for this one chosen disease, then you'd address the biggest risk factors which are obesity and age. So if you really wanted to significantly reduce the risk of death from this you would:

* force everyone who is obese to work out 1 hour daily. * ban high carb and junk foods for the next "2 weeks".

voila! coincidentally those measures would reduce all-cause mortality.

Yes, I did say lockdown and not quarantine though.

Real lockdowns are much more effective than your suggested state mandated diet and workouts though. They, in countries that did it for real, which means not keeping megastores and large companies open but actually locking down everything and using the army and police to deliver food that you then cook to everyone, you can get the mortality rate to basically zero. Which Vietnam did.

> To say that cloth masks "haven't been shown to help do anything" is demonstrably false

From the only RCT I'm aware of having been published during the pandemic[1]:

> the difference observed was not statistically significant

The full quote is:

> Although the difference observed was not statistically significant, the 95% CIs are compatible with a 46% reduction to a 23% increase in infection.

But the important part is the difference observed was not statistically significant, not just because statistically significance is counted as significant for good reason, but because there's a possible 23% greater chance of infection. That's quite the swing, and something that's been seen before[2]:

> 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.

That's without going into the many statements by leading doctors of the public health response during the pandemic (like Fauci or Jenny Harries).

This helpful Spectator article[3] goes over the damning lack of evidence there's been since long before this pandemic and also lists a few to watch out for. Still not heard any demonstrable falsification coming from an rct yet though. I wonder how long we'll have to wait?

Of course, we could always rely on reviews instead of randomised controlled trials, they give much better results… <cough> <cough> Excuse me while I put on my mask.

Note: this response was made in good faith ;-)

[1] https://www.acpjournals.org/doi/10.7326/M20-6817

[2] https://bmjopen.bmj.com/content/5/4/e006577

[3] https://www.spectator.co.uk/article/how-much-do-face-masks-a...

I think you raise important points, that are useful more generally in understanding the process of science and scientific review of papers.

However, the correct answer to a non-significant study is not to assume that there is no difference, rather that we have not been able to detect a difference.

The results section:

A total of 3030 participants were randomly assigned to the recommendation to wear masks, and 2994 were assigned to control; 4862 completed the study. Infection with SARS-CoV-2 occurred in 42 participants recommended masks (1.8%) and 53 control participants (2.1%). The between-group difference was −0.3 percentage point (95% CI, −1.2 to 0.4 percentage point; P = 0.38) (odds ratio, 0.82 [CI, 0.54 to 1.23]; P = 0.33). Multiple imputation accounting for loss to follow-up yielded similar results. Although the difference observed was not statistically significant, the 95% CIs are compatible with a 46% reduction to a 23% increase in infection.

So, overall there were 95 participants who got a Covid diagnosis, of the 6k enrolled, and the 4.8k who completed the study.

This is basically noise. My personal prior is that had this study taken place in the US or Brazil, we would have been able to detect an effect. However, clearly I don't have any evidence for this.

tl;dr that study gives us very little information, because the baseline prevalance of Covid was so low that we don't have enough power to detect a difference between the two groups. This is consistent with a finding of masks don't work, and masks work (but we can't detect the difference in this study).

> the correct answer to a non-significant study is not to assume that there is no difference, rather that we have not been able to detect a difference.

I completely agree (which might be why I didn't write that there is no difference:) In fact, we don't know if there's a difference, or if there is, what the difference is, and right now the evidence (as a whole) points to a negative difference for the outcome we're hoping for. It's essentially a (fairly) open question at this point (which again leads back to the religiosity on show from some "sides" in this debate).

The statement was:

> To say that cloth masks "haven't been shown to help do anything" is demonstrably false

I just want to cut down statements like that, statements that really are demonstrably false* in their certitude.