[curiousObject]

>A tiny enough dose may even serve to remind our immune system of a pathogen’s existence, boosting our antibody response to keep us protected against it.

This article should be required reading, whatever your views on Covid and other conditions.

Although the attack method of the infection is significant, and the potential victim’s defenses are significant, the raw quantity of infectious agent and the exposure rate are also both important

Nothing is certain. Everything is statistics.

[Sakos]

This is one of the reasons why masks are so important and why they don't need to be 100% effective. Just reducing the amount of viral load could turn a serious infection into something you might barely notice.

edit: Imagine this being controversial. I didn't realize there were Covid deniers and skeptics here, because what I've stated is completely within established science.

[sfblah]

What you said isn’t controversial. It’s definitely right.

The issue with masks is one side started treating them like a talisman that makes infection impossible, which provoked the other side to say they do nothing.

On a population level, masks are probably close to ineffective against a viral pathogen. You can read the relevant Cochrane review to see that.

On an individual level they obviously do something, but you have to consider other factors as well, such as level/frequency of exposure and the like. Studies from prior to the pandemic suggested that a perfectly fitted N95 mask dramatically reduced flu virus penetration. For a more normally worn N95 the reduction was about 70%. For a surgical mask it was essentially nil. Importantly, a perfectly fitted mask required essentially gluing it to the face of a mannequin.

Final point is, with an intervention whose impact is measurable but imperfect, you have to consider the side effects. I personally know several friends of my teenage kids who now have odd (to me at least) social phobias for which the only “cure” is to wear masks everywhere. Just last weekend I was talking to a friend of my daughter who wears masks everywhere except indoors.

[maxerickson]

which provoked the other side to say they do nothing.

This somewhat excuses their reactionary stupidity. Like they weren't "provoked", the use of masks wasn't directed at them.

[sfblah]

Where I live, in Alameda County, California, masks were required outdoors if you were within 30 feet of another person. This ridiculous policy lasted about a year and provoked all kinds of altercations. It also made exercise, a key way to say fit, much more difficult. So, in this case I would argue mask use was in fact “directed at” people.

[maxerickson]

When you say that, you are saying that the policy was put in place in bad faith in order to inconvenience the people that didn't like it. The argument is more ridiculous than the policy.

Here there was never an outdoor mask policy, so I didn't ever have a chance to evaluate my reaction to such a thing. There was apparently a policy banning stores like Walmart from selling seeds (which I interpreted as bureaucratic friction rather than intention, something that was born out relatively quickly in practice, and never in the minds of the reactionaries).

[sfblah]

There’s a fine line between a policy being intended to harm and just being stupid. Regardless of the rationale, I was just trying to demonstrate how such policies were in fact weaponized.

You can do some reading about the Bay Area and debates over whether government policies are in bad faith. I think it’s at least arguable that some are in fact in bad faith (meaning, no one really thinks they’ll serve any public purpose other than punishing groups of people).

[AnthonBerg]

That’s bad policy, and obviously harmful.

There we are in perfect agreement.

That policy is also obviously at odds with scientific knowledge.

Policies like that harm high-risks groups immensely too.

Over here, the bad policies were strict social restrictions. Baseless and arbitrary restrictions of the number of people allowed to be at funerals and strict and severe limits to hospital visits. None of these were necessary from the perspective of the reality of aerosolized transmission and how easy it is to strip the pathogen out of the air we breathe.

It’s so absurd that it took a long time to find an analogy. It’s like repairing the flat tire on your bike with a patch of sod. It doesn’t really work, it’s messy, and people will think you’re crazy.

[kadoban]

> The issue with masks is one side started treating them like a talisman that makes infection impossible, which provoked the other side to say they do nothing.

This is an oddly biased framing.

[AnthonBerg]

The un-cited Cochrane review in question does not say that.

From Cochrane.org:

Statement on 'Physical interventions to interrupt or reduce ... - Cochrane

Mar 10, 2023

Many commentators have claimed that a recently-updated Cochrane Review shows that 'masks don't work', which is an inaccurate and misleading interpretation. It would be accurate to say that the review examined whether interventions to promote mask wearing help to slow the spread of respiratory viruses, and that the results were inconclusive.

Repeating the important part:

the review examined whether interventions to promote mask wearing help to slow the spread of respiratory viruses

Conversely, here’s a good study that shows that consistent use of FFP3 respirator masks drastically reduced transmission among workers on a hospital ward: https://elifesciences.org/articles/71131

Note that the study only had the workers wearing FFP3 masks on shifts, and community transmission was high at the time. Therefore the study “leaked” and good masks work better than the numbers in the study might seem to indicate. Face-fitting masks do work, and very well. Of course they do. It’s all very clear if you dig into the aerosol physics.

[sokoloff]

It looks like FFP3 are analogous to N99 masks.

A mask mandate that permits "wrap a piece of T-shirt over your mouth, some of the time, sometimes even covering your nose" (which is not far from what I saw for much of 2020) is, unsurprisingly, going to be more effective at ensuring grudging compliance with a mandate than it is to reduce the spread of an airborne virus.

[sfblah]

This is the problem with mask absolutists. They take data from masks that are super effective (hospital setting, correct usage, basically gluing the mask to your face) and extrapolate it to some guy on the subway with a cloth mask. It’s a bad way to make public policy, and I don’t really understand the motivation behind it.

[AnthonBerg]

I am not a mask absolutist.

Close family is at risk of severe illness or death from COVID. We provide for a small child. We do not have much margin.

I’d like to ask you to imagine the social repercussions of masking. It’s hard. I do not want to be weird. I do not want to be an outcast, practically speaking. I don’t want to wear a mask.

I just don’t have any margin in the other direction.

Also:

What is it about a hospital setting that makes a given type of mask more effective?

Answer: Nothing.

Hospitals are places where it’s easier to run a trial, and where it’s harder to avoid infection.

Face-fitting masks do not require glue. Fitting a mask isn’t that hard.

Cloth masks don’t work and never did.

The objective is to not die or be maimed by a virulent pathogen, or rather: to have the option. Clarity on effective means for those who want it. I want effective means because I need them. The objective is not social classification of mask wearers or categorization of discussion types or labeling people as cartoons.

The objective is clear information as input into serious personal decision-making. The guy on the subway is not in scope.

[AnthonBerg]

Precisely.

[sfblah]

I would encourage readers to read the “Main results” section of the review for themselves. It takes under 5 minutes. Don’t trust a commenter on any online forum on this topic (myself included), as it’s completely politicized.

[AnthonBerg]

Also read the studies themselves.

And the criticism of the Cochrane-method review.

And the studies not cited.

As well as the studies on the mechanics of transmission.

[sfblah]

I think people can rely on the authors to put the main results in the "Main results" section. What they can't rely on is potential nutters in Internet forums.

[rootusrootus]

> For a surgical mask it was essentially nil.

Is the surgeon wearing a mask to protect himself from me, or to protect me from him?

[AnthonBerg]

The surgeon is wearing it because of an old, old misinterpretation of reality.

This article is factually accurate: https://www.wired.com/story/the-teeny-tiny-scientific-screwu...

[stopping]

Your assessment is a non-sequitur to the article.

Surgeons wear masks to protect the patient, because masks are very effective at trapping both droplets and aerosols that are emitted from the wearer. They are not designed to protect the user from lingering aerosols as masks are too loose to form a good seal, so most air breathed in simply enters from around the sides of the mask.

[AnthonBerg]

Surgical masks defined as the ones that gape at the sides are comparatively ineffective at stopping aerosolized particles.

The idea that ballistic droplets are the primary means of infection is the old, old misunderstanding.

If we compare the objective of preventing transmission of pathogens from surgeon to patient to the objective of covering nudity, surgical masks are as effective as shorts.

Seeing as the objective is the objective, the ends should define the means. Therefore it is clear that any use of surgical masks is a fundamental and entrenched misunderstanding.

[msie]

That Cochrane review is faulty and one of the co-authors (Tom Jefferson) "works for the Brownstone Institute, a Covid-19 misinformation group that is powered by dark money."

https://www.theguardian.com/commentisfree/2023/feb/27/dont-b...

[jimwhite42]

As far as I can tell, the issue is people misrepresenting what the review says, not that the review is faulty.

The review concludes that we have evidence that masks are effective, but the set of papers reviewed cannot be used to conclude we know the level of effectiveness enough to make accurate judgements on tradeoffs in many of the kinds of situations where people were asked to wear masks in the pandemic. So we don't know enough yet.

I read a bunch of the criticisms of this paper and criticism of the anti-maskers misrepresentation of what it said, and none of the ones I found suggested that there were missed papers which provide the precision the review didn't find.

The Guardian article is a mixed bag in my opinion. It tries to get around the idea that we really need more research, it confuses a lot of things.

(BTW, I am not an anti masker, I wore a mask, I find people who whine about wearing them to be a bit pathetic most of the time.)

[pton_xd]

> This is one of the reasons why masks are so important and why they don't need to be 100% effective. Just reducing the amount of viral load could turn a serious infection into something you might barely notice.

It would be nice to have some numbers to back this up. Let's suppose the "viral load" to acquire a Covid infection is 18 particles, the same as norovirus detailed in the article. And let's say you're exposed to hundreds of thousands of viral particles every minute you spend near a sick person [1]. If a mask reduces your viral load by 50%, is that a worthwhile method of avoiding infection?

[1] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7598485/

[sfblah]

There are good studies on viral load reduction from masking with flu viruses from before 2020. After 2020 the topic became politicized so the studies are probably unreliable.

[epivosism]

All the factors you mention are scalar. You can wear 0,1,2,3 masks. You can be 1,2,3,10,20 feet away from the person for 0,1,5,10 minutes. I can come up with any number of such factors involving wind, lifetime of virus, the person's shedding rate, etc.

Given that, there will always be a border at which having an additional 50% coverage is useful. Where the actual line is, we don't know. But as long as protection is monotonic in the factors above, it's always valuable to have more protection, which implies even <100% effective masks are useful.

Trivial proof: Imagine someone with literally 10k masks all around them. You have to admit this is more safe than 1 mask. QED. You can call in meta factors like "in reality nothing matters" but you're arguing by consequences then, not actually disagreeing with the facts, just claiming they don't matter.

[MrLeap]

The assertion is that if you dump a gooey grey gallon of pure covid on someone, their symptoms will be more severe than if they only get 18 virions. Do you suppose that wouldn't be the case?

[Jabbles]

From that link:

Our simulation also shows that wearing a mask can effectively reduce the spread of the viruses.

[pton_xd]

Sure, by some metric masks are very effective at stopping viral particles. After all, in my example the mask will stop tens of thousands of viral particles from reaching you every minute.

Another metric is, will that stop you from getting sick? The threshhold is only 18 particles!

[meowkit]

Established science is an oxymoron.

Science is an on going process, always open to being overturned.

To the point of masks - I agree with your statement here, but a regular mask (filtered masks should help to some extent) will not protect you from an infected person. An infected person with a mask will reduce the chance of spreading their viral load.

This detail is where I feel people are talking past eachother. Most of covid denial to me seems to be about a psychological reactance to being told to mask up when they are not sick.

One might argue that the extra chance of reduced vectorization is worth mask mandates, but that simplistic purely “scientific” approach is its own problem. You have to argue people where they are at and convince them, not force the “right” view on them and then get upset they are “in denial” or skeptical.

https://en.m.wikipedia.org/wiki/Reactance_(psychology)

[verve_rat]

Yeah, there is a weird grouping of rabid anti-maskers here. Seems odd given the nominal audience of this site.

I just don't get the rejection of basic facts.

[JeremyNT]

The audience of the site is very entrepreneurial and as such is libertarian leaning by and large.

Which is to say you shouldn't be terribly surprised that there is a general strain of "don't tread on me" in the discourse. Simply being told what to do is enough to elicit a strong negative response.

[User23]

RCTs show surgical and cloth masks to be ineffective or nearly so for reducing the spread of respiratory viruses. Obviously the kinds of masks used in BSL labs do work to prevent spread.

However there are statistics that areas with more masking had less severe illness. However that’s uncontrolled and some other factors or factors might account for both increased masking and reduced spread. That’s probably the case otherwise the RCTs would show efficacy.

All of the subsequent work is just computer models and doesn’t actually tell us anything empirical. Obviously it’s easier to create a model that produces the desired result than it is an RCT.

[mozman]

There shouldn’t be any requirements for masks. Want to wear one? Great. Should I have to? No.

[amanaplanacanal]

Is fairly common that, if you as an individual are doing something that poses a risk to other people, society will step in to attempt to change your behavior. You can argue that it is “wrong” for society to do that, of course.

[the_gastropod]

It puzzles me that nearly 4 years after the start of the pandemic, this naive libertarian thought fragment is still so widely used. As the saying goes, “Your right to swing your arms ends just where the other man’s nose begins”.

[maxerickson]

So people shouldn't have freedom of association or control over their own property?

Or do you just mean universal requirements imposed by society at large when you say 'any'?

[elsonrodriguez]

The exploration of truth is anathema to those who claim to already have the truth.

[refurb]

No not really.

Infection is binary or not. You either get exposed to enough to actually result in replication inside your body or you don't. If you get exposed to a small amount and your immune system immediately eliminates it, that's not an infection.

The amount of exposure needed to actually cause an infection is different from person to person depending on their immediate immune response.

But it's not like reducing exposure by 50% reduces disease severity by 50%. Biology doesn't work that way.

[explaininjs]

The simple fact of the matter is that having covid every now and then^ is far superior to wearing a mask always.

^ and the more you have it the less severe it is, until it asymptotically reaches a complete non-issue. As with the common cold.

[explaininjs]

The downvoters might explain their distaste. But I cant expect them to do more than echo what the government told them.

[dorfsmay]

> boosting ourantibody response

What I wonder is if we can develop immunity (not boosting, assuming never been infected before) from being exposed to small doses, or do we need at least one full blown infection.

[jameshart]

Not sure why you are suggesting the basic mechanism of inoculation, which has been known for centuries and is the fundamental mechanism behind vaccination, as if it’s a novel hypothesis. Have I misunderstood what you’re getting at?

[beebeepka]

I think your understanding is fine. A friend of my wife once came up with the novel idea of renting books out of big buildins that are loaded with books. Brain farts happen to all of us

[dorfsmay]

Dosage. Vaccines use deactivated viruses, but I don't think they use "tiny amount".

[kbutler]

https://www.cdc.gov/smallpox/history/history.html

To test his theory, Dr. Jenner took material from a cowpox sore on milkmaid Sarah Nelmes’ hand and inoculated it into the arm of James Phipps, the 9-year-old son of Jenner’s gardener. Months later, Jenner exposed Phipps several times to variola virus, but Phipps never developed smallpox. More experiments followed, and, in 1801, Jenner published his treatise “On the Origin of the Vaccine Inoculation.” ... Vaccination became widely accepted and gradually replaced the practice of variolation. At some point in the 1800s, the virus used to make the smallpox vaccine changed from cowpox to vaccinia virus.

[refurb]

Generally the stronger the immune response, the more effective the future immunity (not always).

[vikramkr]

Yep that's called vaccination! No need to get a full blown infection it's how we eradicated smallpox

[dorfsmay]

Vaccination is using deactivated viruses. My question is can we get the same effect from exposure to small doses of live viruses.

The articles says exposure to tiny amount can "boost" immunity, which I assume means an immunity acquired earlier from a full blown infection (or vaccination).

[southernplaces7]

As with many things in medicine, it depends on specifics and context. With some viruses, this might work, and with others it could kill you. Vaccination itself is tricky partly for this very reason as far as I know (not a doctor or epidemiologist).

Variolation for example, the predecessor to the world's first practice of vaccination (against smallpox) involved taking tiny amounts of live smallpox from scabs or pustules and giving them to people intentionally for a much lighter infection course that made them immune without the usually killing or horrifically disfiguring blow of a full smallpox infection. (look up photos of smallpox scars in survivors, warning, it gets graphic. Even many famous figures like Stalin were completely pockmarked by the scars of the virus for the rest of their lives, as you can see in unedited photos of the dictator)

It usually worked, but sometimes the patients got really sick anyhow and died. By the standards of the time, when fully a third of the population could expect to die from some epidemic disease or another, this was considered wonderful. Today it wouldn't be and thus the complexities of carefully calibrating vaccines.

[cutemonster]

Interesting!

I suppose one more dangerous thing with this, could be how popular anti vaccination ideas could become, when the anti-vaxxers start saying that vaccine is live virus

[southernplaces7]

My variolation example above was only a very specific, very antique context of something that did involve live virus but wasn't considered true vaccination as we use it today. However, even today the basic reality is that some vaccines do involve live viruses or other pathogens in a weakened state. This doesn't make them dangerous in any general sense.

And that live pathogens are sometimes used should be known and discussed for the sake of clinical honesty and public health transparency. Either way, for any deeply dedicated anti-vaxxer, it probably wouldn't matter what they hear from even the best source. Once one's fixation on a concept becomes emotional or ideological, the subtleties and details of explaining contrary details stop mattering to them.

[ABCLAW]

Vaccination generally uses an adjuvant to increase immune response to the target antigen in order to provoke a response strong enough to produce lasting immunogenic memory. Antigens alone in small numbers aren't enough.

Taking random adjuvants consistently after minimal exposure to environmental antigens is more likely to give you deleterious allergies or issues associated with chronic inflammation.

[maxerickson]

Vaccines are rooted in a history of doing exactly what you are talking about. Smallpox variolation was done for hundreds of years before the development of the first vaccine.

https://www.cdc.gov/smallpox/history/history.html

[malfist]

Vaccination can use deactivated viruses, but not always.

[yieldcrv]

I’ve gotten lots of anti vaxxers to be into vaccines by saying what the parent said, most of them are just allergic to the word vaccine and don’t know what it means, (specifically I’m referring to using dead pathogens not just a low dosage of live ones)

so just describe the procedure, and call it a secret that big pharma doesnt want them to know, and theyre into it. be anybody but a doctor lol

slam dunk

[dorfsmay]

I'm not anti vaccine, no need to out words in my mouth.

My understanding of vaccine is that they use deactivated viruses but not small doses.

My question is about live viruses, and if we can get exposed to small doses enough that will trigger a immunization mechanism without triggering a full blown infection? Or does it work to boost an existing immunity only.

[api]

There are many different kinds of vaccines that work in slightly different ways. “Vaccine” is a class of treatments akin to “anesthetic” or “antibiotic.”

Some are weakened live agent. Some are killed or neutralized agent. Some are just a protein or other piece of the pathogen. Some like mRNA vaccines are code from the pathogen that causes your body to generate and then sensitize against something. There are probably other types.

I do find the oversimplification in the debate frustrating. Either all vaccines are bad or all vaccines are great when in reality each one is a different thing. As with other drugs some work better than others and some have side effects while others mostly do not.

As near as I can tell the mRNA COVID vaccine is fairly effective at reducing severity and duration of infection but not nearly so at completely preventing infection. There is a small risk of side effects but the danger from a more severe COVID infection is statistically much greater.

Creating a vaccine in a year is nuts. What we came up with is not half bad given that time frame. We will probably have much better COVID vaccines in a few years.

[XorNot]

It's quite possible the biggest issue with the COVID vaccines we have is that intramuscular injection produces a blood-borne immune response but the method of infection is through the lungs, and you get much less response there.

It's why there's been a lot of interest in inhalable vaccines[1] although getting them to market has had a lot of delays.

[1] https://www.nbcnews.com/health/health-news/nasal-covid-vacci...

[yieldcrv]

> I'm not anti vaccine, no need to out words in my mouth.

I didn't write that you were, I wrote that I've gotten anti vaxxers to like vaccines with the same logic.

Its pretty clear that its coincidence that you didn't know your hypothesis was the basis of vaccination, regardless of your predilection.

[dilyevsky]

That’s not vaccination that’s inoculation which is how they originally prevented smallpox before they developed an actual vaccine

[vikramkr]

Its responsive to the parent question in that yes, we can have symptomless exposure to the infectious agent (or some part of it) and develop immunity. Maybe the distinction between using unweakened live pathogens and weakened or fragmented pathogens should have been emphasized but that didn't seem to the important part of the question

[dorfsmay]

Thanks, that was indeed my question.

It'd be interesting to understand if that's true for all viruses and in what quantities.

For example, in the early days of COVID, we were told that being close to infected people outdoor did not expose us to enough viruses to get infected. Could such exposure have provided immunity?

[refurb]

That's not vaccination.

You get a hefty dose of vaccine. The difference is that it's either not an infectious agent at all (just a fragment of one) or it's a low-infectious agent.

[rand0mx1]

It should be exposure time or do you mean something else with "exposure rate"

[wtallis]

"Exposure time" usually implies you're spending some period of time in proximity to an effectively unlimited reservoir of the pathogen (eg. an infected person coughing frequently) and your exposure is at some level of concentration that depends on the type/route of exposure, so that the total amount of pathogen that ends up in your body to challenge your immune system is proportional to the duration of time you spend being continually exposed.

A phrase like "the raw quantity of infectious agent and the exposure rate" is calling attention to the fact that one brief intense exposure vs repeated small exposures over a long time span may have vastly different outcomes despite presenting your immune system with the same number of microbes to deal with.

[slim]

it could mean how many times you have been exposed to the virus in a month, for example