[mcbits]

China doesn't have widespread free (K)N95 mask use either. There's not enough production even in China. Yet they're still faring better than the US so far.

Adjusting for population, the US peaked at the equivalent of 15,000/day after vaccination was underway and most places got rid of mask mandates, followed by a peak at the equivalent of 8,500/day after more than half the population was vaccinated, and another one around 12,000/day with 2/3 to 3/4 of the population being partially to fully vaccinated. Now it's been steadily the equivalent of 1,200 to 2,000/day going on 9 months even though almost everyone should have plenty of immunity from both vaccination and repeated exposure. The numbers are lower than they would be without vaccination, but this isn't sustainable. We know what does work.

[vlovich123]

It’s not an either or though right?. Don’t you need to do masks AND vaccines?

AFAIK countries that effectively masked and distanced until they had a vaccine flattened the curve significantly and their medical system was never overwhelmed. The US is a terrible example because they failed to follow their own pandemic guidelines (Africa did and fared better if I recall correctly).

With vaccines you can be more cavalier with masks - even if you don’t wear it and are near someone with COVID you’re less likely to get it. And when you do, you weather it significantly better. Even ignoring problems of comfort and fit that continue to plague although the “duck” masks with over head loops instead of over ear I’ve found to be reasonably comfortable. Masks are challenging logistically in various environments like dining and just from a social bonding / nicety.

It’s also important to remember that there’s a significant anti-vax movement in the States so no. We’re not fully vaccinated. And the virus mutates like the flu. So you need to keep up to date with shots. Yes. It’s not 100% effective. But it’s an added security measure because perfect masking just doesn’t happen and logistically isn’t possible. With a pandemic (now epidemic) like this you have to deploy multiple measures (masks, vaccines, social distancing), not just one I think - multi pronged battle. The interesting part is that people are reverting to pre-COVID behaviors which makes sense since pre-COVID is the same as post-Spanish flu so COVID is here to stay permanent I think.

[mcbits]

> AFAIK countries that effectively masked ...

... don't exist. There is still not enough production of the types of masks that are known and shown to be effective.

> even if you don’t wear it and are near someone with COVID you’re less likely to get it.

That was the hope, but it's not nearly as true as it needs to be.

> And when you do, you weather it significantly better.

And continue spreading it.

> So you need to keep up to date with shots.

And keep up with producing and distributing N95 masks to actually solve the problem.

> With a pandemic (now epidemic)

Wordplay with no bearing on reality.

> you have to deploy multiple measures (masks, vaccines, social distancing)

Sure. Defense in depth. Vaccines, especially vaccines that grossly fail to live up to expectations, aren't enough.

> pre-COVID is the same as post-Spanish flu

Blatantly false. It's still killing several multiples of the flu. And now the flu is back on top of that.

> COVID is here to stay permanent I think.

Probably true. People are stupid.

[vlovich123]

> ... don't exist. There is still not enough production of the types of masks that are known and shown to be effective.

Except:

Look at this analysis [1] of different country responses. Note that masking is only part of the strategy. Plenty of countries managed to effectively flatten the curve regardless of the availability of N95 masks (eg banning surgical mask exports, using effective contact tracing for quarantining and enforcing quarantine aggressively).

> Statistical analysis showed that the odds of infection were about half for people who reported wearing a mask in public compared with people who didn’t. (Results of this study are reported in terms of “odds ratios” which are related to relative risk, but not quite the same thing.) For people who wore masks “all of the time” (instead of “some of the time” or “most of the time”) the estimated effect was even more significant.

And

> A second part of the study sought to differentiate between cloth masks, surgical masks, and N95/KN95 respirators. Not unexpectedly, N95/KN95s were found to reduce the odds of infection compared with people who didn’t wear any mask. To me, the surprising thing is how effective they were, reducing the relative odds by 83%. Cloth masks and surgical masks were found to be less effective.

Who cares about absolutes. All masks provide some non-trivial amount of protection. Certainly better than not doing anything, especially if you do so consistently.

[2]

> even if you don’t wear it and are near someone with COVID you’re less likely to get it. That was the hope, but it's not nearly as true as it needs to be.

Except I’ve been at parties where people with COVID showed up and no one else got sick. Not even the partner living with them. Now this was earlier so it was the first strain where maybe efficacy was better. And this is anecdotal and not quantitatively scientific. But certainly my anecdote seems to line up with the evidence I read (initially very good at stopping transmission and even today effective at it quite a bit but only for a few months). I don’t know what your threshold is for “as it needs to be”. Mine is “the healthcare system doesn’t fall apart”. AFAICT states and countries that are doing vaccinations effectively seem to be there even after abandoning masks and social distancing guidelines.

> Vaccines, especially vaccines that grossly fail to live up to expectations, aren't enough.

The grossness of the failure to live up to expectations is kind of mostly on you based on what expectations you chose to set I think. People were hopeful but I think realistically we knew it wasn’t going to be a silver bullet. A) we already had other variants by the time the vaccine started to get rolled out B) we didn’t try to stockpile the vaccine and roll it out “instantaneously” en masse. This gives the virus a perfect environment to evolve a resistance. We know this from evolutionary biology and I was fully expecting this result, so I don’t feel underwhelmed by the vaccine. To me I expected the vaccine to cut mortality rates for hospitals and reduce transmission rates for the virus. The latter may not be as effective but we know the former has been ridiculously effective. The amount of deaths is a fraction of the amount that test positive (and most positive cases aren’t even reported anywhere anymore). Same for the need for respirators.

> And keep up with producing and distributing N95 masks to actually solve the problem.

I see the problem. You’re again setting unrealistic expectations. N95 masks aren’t necessarily comfortable and people will avoid wearing them even when there’s a mandate. Half the time I saw people with masks covering just the mouth. And at the end of the day, your eyes and nose are likely other vectors for infection (eg studies that showed that people with glasses had a statistically significant lower rate of infection). And this all also ignores the problem of children playing together. What I’ve heard from people with kids is that kids are an amazing infection vector for the whole family for any disease, COVID included. I fully expect that even with an over abundance of masks, nothing actually meaningfully changes. You may disagree with that conclusion, but I think that’s a problem of expectation setting correctly. My expectations have generally been met by

mask efficacy: N95 would be nice, but any and all masks, especially if worn correctly and consistently, offer meaningful statistically significant reduction in transmission rates

and vaccines: evolution tells us the virus will have pressures from immune systems and vaccines so it’ll probably evolve (few viruses these days can be fully and permanent eliminated by a vaccine). However, I did think that transmission rates will be reduced at least a little bit (statistically appears true although with high enough variance that it can feel false) and more importantly death rate from COVID will plummet (also true).

And social distancing: as rules relaxed COVID rates spiked. But also most places generally paired this with vaccination rates so overall things stayed at least pretty flat or shrunk for the most part.

> Blatantly false. It's still killing several multiples of the flu. And now the flu is back on top of that.

Huh? Aren’t you basically agreeing with me then? To me, the flu returning and COVID running more rampant is a clear sign that people stopped masking and socially distancing (vaccination and natural immunity being roughly equivalent probably and cancel out I think). These two very effective behaviors that are kind of characteristic of a good COVID response, were kind of widely deployed in 2020 when the flu disappeared, and now have been largely abandoned as impractical for day to day living (Asian countries I think does this part better because of better social cohesion and previous experience with SARS).

> Probably true. People are stupid

This we mostly agree on. But also I think even a perfect COVID response sees it sticking around. It’s simply too virulent to not become endemic. Add onto the fact that people make mistakes, we don’t know what the 100% ideal response looks like, and this can’t be globally coordinated because each jurisdiction will enact their own policy which means 100% isn’t attainable anyway. Eg look at the countries that had the best COVID response and they’re still having to deal with neighbors and international travelers bringing variants back anyway.

[1] https://time.com/5851633/best-global-responses-covid-19/

[2] https://www.forbes.com/sites/johndrake/2022/02/04/the-real-w...

[mcbits]

> Note that masking is only part of the strategy.

Never said it wasn't.

> Plenty of countries managed to effectively flatten the curve regardless of the availability of N95 masks

"Flatten the curve" is a post-failure strategy to minimize secondary losses due to overwhelming the hospitals until we have a vaccine with enough efficacy to reach herd immunity and eradicate the virus. That latter part never happened.

> Statistical analysis showed that the odds of infection were about half for people who reported wearing a mask in public compared with people who didn’t.

Sure, and that's not even limiting the scope to N95-level masks.

> For people who wore masks “all of the time” (instead of “some of the time” or “most of the time”) the estimated effect was even more significant.

Naturally.

> Not unexpectedly, N95/KN95s were found to reduce the odds of infection compared with people who didn’t wear any mask. To me, the surprising thing is how effective they were, reducing the relative odds by 83%. Cloth masks and surgical masks were found to be less effective.

Sounds about right.

> All masks provide some non-trivial amount of protection. Certainly better than not doing anything, especially if you do so consistently.

Never said they didn't.

> Except I’ve been at parties where people with COVID showed up and no one else got sick.

Useless anecdote.

> And this is anecdotal and not quantitatively scientific.

Correct.

> I don’t know what your threshold is for “as it needs to be”.

Enough to reduce the effective "R" rate of transmission to below 1 and to keep outbreaks ever smaller and more localized.

> Mine is “the healthcare system doesn’t fall apart”.

Post-failure strategy.

> [Describing how the vaccine could have been rolled out more effectively.]

Yes, it could have been. But even so, by now almost everyone has been immunized either by the vaccine or prior infection and it's still killing huge numbers.

> N95 masks aren’t necessarily comfortable and people will avoid wearing them even when there’s a mandate.

I don't advocate for a mandate. Mandates lead to malicious compliance and people rebelling whenever they can to prove they still have autonomy.

> Half the time I saw people with masks covering just the mouth.

Like that. Fortunately, N95 are thicker and less likely to droop.

> And at the end of the day, your eyes and nose are likely other vectors for infection (eg studies that showed that people with glasses had a statistically significant lower rate of infection).

Practically insignificant.

> What I’ve heard from people with kids is that kids are an amazing infection vector for the whole family for any disease, COVID included.

Yes, household transmission is still an issue. We need to guarantee that people with Covid in the household can quarantine without repercussions.

> I fully expect that even with an over abundance of masks, nothing actually meaningfully changes. You may disagree with that conclusion

I do.

> N95 would be nice, but any and all masks, especially if worn correctly and consistently, offer meaningful statistically significant reduction in transmission rates

The difference between N95 and a surgical mask is far more than statistically significant. (See your own link.)

> Evolution tells us the virus will have pressures from immune systems and vaccines so it’ll probably evolve (few viruses these days can be fully and permanent eliminated by a vaccine).

A virus filtered out before it can enter the host never has a chance to evolve.

> However, I did think that transmission rates will be reduced at least a little bit (statistically appears true although with high enough variance that it can feel false) and more importantly death rate from COVID will plummet (also true).

No argument on the "little bit".

>> Blatantly false. It's still killing several multiples of the flu. And now the flu is back on top of that.

> Huh? Aren’t you basically agreeing with me then?

No.

> To me, the flu returning and COVID running more rampant is a clear sign that people stopped masking and socially distancing

Well, I agree with that. Masks also help prevent the flu better than the vaccines, and we don't even need to develop new masks every year. Just produce enough of the right types of masks that they're free/effectively free so they can do the bulk of the work, and all the other layers of defense can have the best foundation to start from.

Whew, that was a tiring Gish Gallop. Got any more?