[NikolaNovak]

It's tricky.

- fwiw, I personally plan to wear n95 mask outside of home in enclosed public spaces for the foreseeable future, and for things like shopping etc (where I'm exposed to strangers) basically indefinitely / as long as social norms and laws will allow.

- I would like for strangers around me to wear masks. There's too much uncertainty and I don't know how to quantify and otherwise address risk from stranger e.g. In waiting / cashier line, or worse yet elevator (enforced enclosed proximity). I really see no good reason to be in an elevator with unmasked stranger.

- how long and where do we legally mandate masks? Whooeee, I'm glad I don't have to make that awful formal call! :-)

But yeah. If risk is forever, than at least some of us will use ways to mitigate the risk forever in turn. It's not binary, it's a sliding scale that's very individual. so... Yeah. Welcome to the new world! Cyberpunk dystopia future is here! :-)

[timr]

> There's too much uncertainty and I don't know how to quantify and otherwise address risk from stranger

You know what would help with this? A randomized controlled trial. This isn't tricky at all, except that we can't do the science because it has become political, because people insist that they know the answer already! And if the study shows what they don't want to see, then they censor it, bury it, downvote it into oblivion, or...write missives about how they're going to ignore it.

Also, are you vaccinated? Yes? Then the answer is almost certainly no risk at all. This much we know from ~all of the data regarding vaccines and serious illness, worldwide.

[NikolaNovak]

>>"Also, are you vaccinated? Yes? Then the answer is almost certainly no risk at all"

That is not my lay person interpretation of the currently best available data.

A vaccinated person can get infected, can get seriously ill, and can spread out to others more vulnerable. It helps, drastically, and I sure as heck got mine, but my understanding is that it does not confer individual invulnerability.

[timr]

> A vaccinated person can get infected, can get seriously ill, and can spread out to others more vulnerable.

I can get hit by a car when I walk down the street, but I've been doing it my entire life and I'm still here. I can die in a horrible plane crash when I fly, but I still do it. I can have a heart attack when I go to the gym, but it's still a net positive for my life.

Do you have a grasp on the actual risks involved here? You do realize that, even unvaccinated, unless you're elderly or obese or severely immunocompromised, the risk from this virus is measured in fractions of a percent, right? And if you've had even a single dose of an approved vaccine, you can take that number and divide it by 10?

At some point, you have to let the terror go.

> my understanding is that it does not confer individual invulnerability.

Who promised you invulnerability?

[NikolaNovak]

I think we agree on a base point of personal risk assessment. With that in mind, some people jaywalk, some take extra minute to get to a crossing. Some run across, some double check both sides. Some wear black pants and leather jacket at night, some have reflective strips. And it's all good. We share the old adage that "whoever drives faster than me is a maniac whoever drives slower is an idiot" - but most of us understand when pressed that different people have different risk acceptance in their life and that's ok.

The Thing that makes covid tricky is which actions am I making for myself vs others. Safety belt and helmet are largely for myself (but still enforced in many places due to agreed societal cost that goes beyond Individual). Mask, we don't have common universal agreement to yet. (this is not to say I don't have am opinion on it, but I understand looking around that while mainstream it's not universal).

So while I think we have agreement in framework, we may disagree on personal implementation. Mostly, I don't know that I agree with "at some point you have to let terror go". This ain't over yet, may never be over, so some mitigation steps may never be over, is the sobering world to raise offspring Into. Alberta took foot off the brake for just a little while and next thing they were begging other provinces for ICU spots. And there's a whole conplicated interlocked system of individual causes and effects rather than some simple binary rule that have rise to that reality.

[mrexroad]

When you cross a busy street, do you use crosswalks and obey the cross/don’t cross signal?

[timr]

Actually, no. I live in a big city. We're apparently all just free-wheeling, death-defying risk-takers here. YOLO.

But you make an excellent point: the average NYC citizen probably takes bigger risks crossing the street on a daily basis than she would by going un-masked.

[NikolaNovak]

replying to "Gladinovax":

>>"I'm doing great without one. No need to worry about longterm risks from a rushed vaccine. 1 year does not equal 10. Ever."

There are categories of knowledge where I'm profoundly uninterested in any individual's experience (best friend or stranger on the internet alike:). Simply put - a person surviving Russian Roulette does not make playing Russian Roulette a good idea, no matter how convinced they are and loudly proclaimed that it worked out great for them :).

I do not know your situation - maybe you've gone hermit; maybe you're in an area of low risk; maybe you're being careful; maybe you're the one asshole around and everybody else is vaccinated/wearing mask/implementing lockdown while you're taking credit for not getting your sorry ass sick; or (most likely but I have no way of judging), you're just lucky - see the Russian roulette above.

But in risk evaluation of this sort, again, I'm far far more interested in verifiable statistics than individual's lived experience.Don't get me wrong - we can have a nice round of drinks and talk about how last year's been to us and approaches we've taken and it'll be interesting and we can share; but it's not a policy-guiding thing.

[PaulDavisThe1st]

> Also, are you vaccinated? Yes? Then the answer is almost certainly no risk at all.

As of the week before last, 28% of all hospitalizations in my state (NM) related to COVID19 involved fully vaccinated people.

[headmelted]

Isn’t this statistic in itself a little misleading though? Given that so many people are vaccinated now, the proportion of hospitalizations would be expected to trend higher in that group as the pool of unvaccinated people is shrinking at the same time.

Also, the eldest people (largely those most at risk of hospitalisation) are substantially more likely to have been vaccinated already, no?

[PaulDavisThe1st]

In the context of the claim that, once vaccinated, you are in "no risk at all" for symptomatic COVID19, I don't think it's misleading: significant numbers of fully vaccinated individuals can and do become sick with the disease. Ergo, even when fully vaccinated, you still face some risk.

None of this is an argument against vaccination, of course.

[vishho]

We cannot do the science, because such a randomized test would be deeply unethical. Compare to having pregnant women smoke cigarettes to study effect on the fetus. You do this only afterwards with observational data.

Next to politization there is also public health, which is more of a management science than an emperical science. And economic concerns.

From all the data worldwide, you only reduce risk of hospitalization and death, not for spreading to your grandmother or catching it from a bypasser sneezing in your face. To act like there is no risk for the leaky vaccinated, is to actually increase your risk. Data shows that asymptomatic breakthrough infections are able to cause long-COVID. Now you did not even feel sick and gave your body and immune system rest to clear the virus. Very risky!

[timr]

> We cannot do the science, because such a randomized test would be deeply unethical.

Thank you for perfectly illustrating the problem. I was actually sort of worried that people wouldn't take me seriously when I said that science has become so political that we actually can't do any. It sounds conspiratorial, doesn't it? But, alas:

1) I post results of RCTs showing that masks do little, if anything.

2) Someone replies that the evidence is insufficient for reasons X, Y, Z.

3) I say "great, let's gather more evidence to resolve those uncertainties".

4) Someone replies "we can't, it's unethical".

Quite a fine castle you've built on that cloud, good sir. Very safe indeed.

[Terretta]

And yet, it’s been done:

In a First, Randomized Study Shows That Masks Reduce COVID-19 Infections

A large study co-authored by Yale SOM’s Jason Abaluck and Mushfiq Mobarak tested the effectiveness of a mask-promotion program in Bangladesh in increasing mask use and preventing symptomatic infections. The study found that masks significantly lower symptomatic infections, especially among older people and when surgical masks [instead of cloth] are used.

https://insights.som.yale.edu/insights/in-first-randomized-s...

[timr]

That's literally the study this thread is talking about. It's great that they did it -- it should have been done in early 2020, all over the world. We should have dozens of other studies just like it.

The fact that we don't is an indication of how hard it's been to pursue any sort of science in this area. Almost nobody funds it, you can't get it published if it doesn't fit the public health narrative, and even if you do, the the news media won't report on it, and it might just get censored on social media.

[angelzen]

Make that zero. To their credit, the authors of the Bangladesh mask study released the raw data. "The difference between the two groups was small: only 20 cases out of over 340,000 individuals over a span of 8 weeks." Drawing any conclusions from such small amount of data is deeply unserious.

http://www.argmin.net/2021/11/23/mask-rct-revisited

[cthalupa]

It isn't a political issue to not do studies that require doing things that actively and intentionally put people at things we know are highly likely to put them at risk of physical harm. The world decided this was unethical long before the current political climate.

[angelzen]

In masks + covid context it feels like "unethical" is used as a thought terminating cliche.

* The pandemic is affecting 8,000,000,000 people all around the world. A large size RCT enrolls X0,000 participants. For example, the Pfizer covid mRNA vaccine clinical trial had 21,728 placebo participants. For every RCT participant, the RCT results are going to inform the course of action for hundreds of thousands of people. This is to say that such RCTs are extremely valuable given the high infectiousness of the virus.

* The risk to the participants is at worst a moderate increase in the chance of being infected with covid. The covid fatality risk to a healthy adult is small. In the US there have been about 50,000 deaths with covid in <50yo age group. An RCT with 20,000 <50yo people on the placebo arm may see about 3 covid deaths assuming all the placebo participants are going to be infected. Realistically, only a fraction of participants are going to actually be infected with covid, thus there is a good chance every single one of the RCT participants will continue their lives just fine, especially if the study designers are careful to not include people with serious comorbidities.

* Vaccines are available to reduce the death risk by another order of magnitude if deemed necessary. Alas, while the vaccines have strong effects in preventing serious covid, they only have a middling effect on preventing infections [edit: after a few months]. The mask/no mask infection effect remains measurable.

* Covid is endemic. Everyone is at risk to to be infected with covid sooner or later. Wearing a mask may decrease the daily risk by a moderate margin, unfortunately integrated over many days the infection probability approaches 1. The RCT is merely speeding the risk by a moderate margin for the placebo arm participants.

* There is a large pool of potential volunteers that don't (want to) wear masks anyways. Adults have the right to volunteer for risky activities, including activities that may result in death.

[cthalupa]

This is a well written argument, and I don't disagree with the majority of it. However, there is one key point that I do disagree with, and makes the rest of it moot:

>* There is a large pool of potential volunteers that don't (want to) wear masks anyways. Adults have the right to volunteer for risky activities, including activities that may result in death.

This is certainly true. But the difference is that once we begin performing medical studies that ask this of people, the medical industry is now complicit in adults performing risky activities that may result in death and is asking people to do so, or if doing so, to do so for the benefit of medical research. This is a line that has not been crossed by the modern medical research industry as it has been long decided that this extra pressure, however small, is a lever they do not want to pull because it is fundamentally incompatible with 'Do no harm.'

It isn't 'do no harm, except a little when we think it might outweigh the downsides'

It's a line I don't think we should cross. I understand why someone would disagree with that.

[lern_too_spel]

The hypothesis for why masks work is due to the laboratory-measured reduction in transmission from the host. The only way to test this is to have a large population where most do not wear masks or most do wear masks. You will not find enough volunteer to make such a test possible. Individual mask wearing does not test this hypothesis.

[timr]

This is a fantastic comment. Thank you for breaking it down.

[GekkePrutser]

But what if those people volunteer?

[vishho]

I feel like I am going insane. Pure psychopathy or scientism to want randomized controls for studying infection of a deadly virus. Absolutely disgusted. No wonder we had a lab-leak...

[cedilla]

It is unethical. All your accusations of narrow-mindedness, but you can't see the obvious, glaring ethical problems with such a trial.

Not the least because it would be completely infeasible. You may pretend that we can "simply" do a "controlled experiment" but you ignore how impossible it is to tell any sizeable group of people to behave in a certain way and report honestly about it.

"Randomised control trials" are the platonic ideal but in the real world, you can't endanger people for your curiosity, and you will have greatest problems to actually enforce your test protocol. It's more than "tricky". Unless you have access to some spherical people in a vacuum.

[collaborative]

You actually want to be exposed to the virus (after vaccination) during the summer and if possible as often as possible after a successful exposure. It's the only way forward. You can't lock it out forever, and you need to play catch up with it as it evolves or by the time you get it your immune system won't know what to do with it