[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).

[jeffbee]

Nothing was "weaponized" by this order, which 100% of people ignored.

[sfblah]

I wish what you were saying were true, but it just isn't. I'm a fairly serious runner -- 40-60 miles per week typically. The amount of nonsense I experienced during that year might surprise you. Dozens of different times I was yelled at on trails, in the street, etc. because I was "too close". I was threatened with violence multiple times. This was all in the context of trying as hard as I could in all cases to stay as far from people as possible -- 10 feet minimum -- and to pass them as expeditiously as I could. I avoided narrow trails in parks completely, etc. People went insane, and it was absolutely due to this policy.

[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.

[sokoloff]

I think hospital workers experience with wearing masks (and the resulting "they have chosen a mask size and from experience have adjusted the mask to make it comfortable and effective") and the ability for the hospital to prohibit facial hair in their workers that's incompatible with effective mask use are key differences between hospital staff and Joe/Jane Public on the streets.

In terms of being weird: there are enough people wearing masks and most people literally care more about what they're going to have for dinner than whether or not you're wearing a mask. If a mask helps your family, don't worry about the epsilon weird aspect (as I'm sure you have already calculated).

[AnthonBerg]

Well said. Thank you.

I think I can also pretty decisively say that hospital purchasing optimizations give face-fitting masks a bad rap. The FFP2 masks that hospital staff wear here are cheap and very uncomfortable. This bleeds into society as a negative view.

There’s also another aspect: The difference between a N95/FFP2/whatever mask as part of the industrial production of a verifiable sanitization chain in a hospital on one hand, and on the other as a piece of fabric that’s ludicrously effective at stripping infectious particles from the air.

There are many more edge cases in a hospital, and many more pathogens. In private life – mine at least – it’s only really COVID that matters. In that case a mask can be reused again and again and it’s OK to touch it, basically.

—

Re. being weird:

I don’t mind.

The weirdness hurts the family. There’s a big, big gap of dissonance between what we need to do and what public health authorities say. This includes flat out demonstrably wrong statements about transmission where I live. This dissonance makes the family weird, and it has caused severe social isolation of a mother with a young child.

I want to assure the reader that we don’t ask for much. We are very, very polite. We don’t demand anything, we are not difficult.

It’s purely the astounding dissonance. People don’t know what to do and just fade away.

It’s a very painful way to be weird. You feel it in your bones and your soul how unnatural it is.

[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.

[stopping]

There are many studies which show that surgical masks are quite good at stopping a majority of expelled particles, even those well within the aerosolized size regime:

Surgical masks reduce outward aerosol-sized particles by at least 74%: https://www.nature.com/articles/s41598-020-72798-7

Surgical masks reduce outward COVID viral transmission by 73%, and viral RNA by 58%: https://journals.asm.org/doi/10.1128/msphere.00637-20

Outward filtering efficiency above 50% is certainly worth it compared to the cost of a surgeon wearing a mask. It's arguably worth it even at much lower efficiencies.

If you read my comment, you'll notice I'm not disagreeing on the aerosol/droplet size boundary. I'm arguing against the apparent subtext of your comment, which seems to indicate that surgical masks aren't effective at protecting patients.

[AnthonBerg]

Well said, thank you. Sincerely!

I’d like to reiterate my analogy of the shorts :)

Not least due to the subtle knock-on effects: surgical masks cast a fog on public awareness of face-fitting masks, which are superior in all respects (including comfort, which – case in point – came as a surprise when I tried one).

—

The effectiveness of face-fitting masks is so much greater that I honestly regard the use of surgical masks as morally indefensible.

[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.)