> As the coronavirus epidemic spread around the globe, the Centers for Disease Control and Prevention provided restrictive guidance on who should be tested, archived pages on its website show. While agencies in other countries were advising and conducting widespread testing, the CDC, charged with setting the U.S. standard for who should be tested for the virus, kept its criteria limited
Well, "other countries" also did the same. Spain, for example, seems to be the 3rd country with most infected and I got pneumonia about 2 weeks ago. Called the agencies here but they still didn't want to test me, even with pneumonia! Still got a cough since then and they still won't test me.
So, the US is not alone. And it does make a bit sense, I didn't require hospitalization, so makes sense they want to save the resources. But I feel like the article author could have done some better research.
Germany does the same. I’m under the impression that there is a big selection bias because I know a lot of friends who have symptoms but can’t get testing because they don’t fit the criteria. And the criteria is having contact with a known corona patient or traveled to a risk area.
Do you have a source for that number? I'm asking, because I somewhat feel like this number is supportive of my assumption that they test the wrong people.
I understand that the symptoms are pretty ordinary and there are a lot of pathogens which could cause it. And you're right, all I have are anecdotes.
My own cough is still going on for almost two weeks now. I'm pretty sure that I got it from a coughing man on my commuting train. Four days later I had a sore throat and on the fifth day I had this cough. If this person was tested, and was positive, there's no chance they could find me.
In terms of 'symptoms', in the US they've kept it very basic with three listed: 1) fever 2) cough 3) shortness of breath. They seem very generic to me and probably result in a lot of unnecessary panicked phone calls.
From the actual descriptions of patients that have gone through it and been hospitalized, there are much worse symptoms, and maybe they should be addressed more immediately. The main one I've come across is the heavy chest pressure. I don't understand why, in the US at least, there isn't more specific messaging so that we can make sure people with more severe or COVID-19-related symptoms have the ability to get through. Not to mention the BS here of having to 'call your doctor' first before getting seen. There are a lot of people out there now without primary care doctors or that can't afford a visit. There have been no federal instructions on how we would get waivers for visits, testing, and possible hospitalization. If you've ever had to fight with medical billing in the US, it's frustrating and will be even more so after all this dies down.
On a side-note:
I was turned away from donating blood yesterday because I admitted to having a runny nose and a bit drainage that caused some coughing. I have seasonal allergies - it's March, it's been raining and plants are blooming, etc. I understand the caution but I had no fever (tested at 36.6 C / 97.8 F), which is about the same temp I've had for the past week (I've tested that and my blood pressure daily, just in case). I was a bit frustrated, because I really wanted to do something immediate to give back but so be it.
While walking home, it did make me wonder why they even bother taking 'healthy' people who could be asymptomatic if it's such a concern. They admitted to having no way to test the blood.
I think there's a lot that needs to be fixed and I hope that this crisis will provide a better future for us all. Epidemics aren't going to go away. We can learn and plan better.
For me it's been pretty clear that governments in many countries have been caught unprepared. Does it really surprise many people that often governments are wont to downplay such situations?
It's pretty much the same story with the masks, which is a political scandal in France at the moment.
The U.S. likes to think of itself as the world leader. We should hold ourselves to that standard. "Other countries" such as South Korea, Singapore, and Taiwan were conducting widespread testing while the U.S. was and still is not.
More importantly, the U.S. could and should have provided global leadership as it did for the 2014 Ebola outbreak.
> The U.S. likes to think of itself as the world leader.
Yeah, we in the rest of the world is very aware of that and frankly a bit tired of it. But my grief about that is nowhere as big as South American or countries in the middle east.
> the U.S. could and should have provided global leadership
Realistically, I don't don't think the US would be able to provide global leadership. Your leaders were denying that this outbreak was even real and the person responsible for the containment is a person who believes prayers can actually solve things. So I don't think anyone is expecting the US to have any real play on the world scene today.
When I wrote "we in the rest of the world is very aware of that and frankly a bit tired of it" I wasn't referring to any particular person, could be Trump, could be Clinton or could be Obama. No one except the US wants the US to keep playing world police/leader.
This is the time to work together, not for one country to be the leader.
I want the U.S to be the best global partner it can in fighting this pandemic and that’s impossible under its current leadership. Leadership doesn't mean telling the rest of the world what to do or being its cop. Leadership means the sorts of things outlined here:
China has ramped their mask production to 200 million masks a day.
Had US government had the foresight and common sense to contract mask manufacturers to even produce half of what China is producing - let’s say 100 million masks, we could have had enough for everyone to have a mask in 3-4 days.
Universal masks for everyone (not only health care workers) together with hygiene protocol should be the way to “flatten the curve”. This would at the very least inhibit spread by those who have coronavirus but don’t know it yet (asymptomatic).
But instead, we’re having these mass shelter in place orders that are destroying our economy, killing businesses and destroying people’s livelihoods.
And I still haven’t heard of massive government contracts to mask manufacturers at the scale needed to provide masks for everyone.
China offered us lower prices, and the lower prices were great. But right now China isn’t selling us those low priced masks. And we do not need China to produce masks.
We know from basic economic theory that there are manufacturers who would either ramp up production or go into production if the demand increased. With China seemingly out of the US mask business for who knows how long there are also fewer available suppliers — another motivator.
Domestic manufacturers should be happy to take our money — it’s simply a matter of timing. We knew of the mask shortage at least by January. I know this, because I was following the news around then, and went to the local stores and saw with my own eyes that they were out of stock. I could only get them at Home Depot. Not Walgreens, not Target, not Wal Mart. Had we been contracting manufacturers to produce masks starting then, we wouldn’t be experiencing as many shortages as we are today, assuming it doesn’t take 2 months for pre-existing manufacturers to ramp up production.
The botched timing in ramping up domestic production in response to a known shortage is the biggest issue, not the fact that China hasn’t been taking new orders for going on 3 months.
> We know from basic economic theory that there are manufacturers who would either ramp up production or go into production if the demand increased.
I'd be hesitant to use Economics 101 theories as a way to model the real world. While they are intuitive theories there is a reason they are 101 theories and even "expert" economists are often wrong. :)
These lines of thought are often similar to how people point to evolutionary reasoning because of how intuitively the "survival of the fittest" explanation comes into play (esp. wrt the capitalist society we live in).
That’s like saying we shouldn’t use the theory of gravity to explain why objects drop because it doesn’t hold at the speed of light. Well, it’s a fundamental theory for a reason, and it holds up a whole lot of the time in practice. You don’t need quantum physics to know which direction your phone will go when you let it go.
But in any case, even tossing that basic fundamental economic theory aside, what about the rest of my comment? Is it not true that we would have more masks in production today if we started producing them in January?
If there was enough additional demand, you bet there would be more production. Let’s say someone in January is suddenly willing to write a 10 billion dollar check for 100,000 masks. Not one additional mask would be produced before March? Because people are scrambling to procure masks now. And additional masks are being produced and even donated.
"In an interview, Bowen said he could make 1 million masks a day if he ran his machines around the clock, a huge quantity for his firm but an amount that would barely make a dent in global demand. He’s hesitant, however, to ramp up production at the facility outside Fort Worth, scarred by the boom-bust mess that occurred after the swine flu pandemic in 2009."
I hope one thing that comes of this outbreak is that all nations develop the processes and capabilities to quickly stop the spread of outbreaks in general.
COVID19 is worse than flu, but not as bad as it could have been. We could get hit with something worse in the future. Imagine a strain of Ebola that gestates asymptomatically longer, or another coronavirus with higher mortality rate. This outbreak is good preparation for that one.
Anytime you’re dealing with a harmful exponential growth process like an outbreak, the best way to handle it is to overreact early, quickly and briefly. Kill it hard while it’s still small and easy to kill, or it will get out of control fast.
Put everything on lockdown/shelter-in-place for a few weeks - [max(gestation period|time to develop and deploy test kits) + safety factor] - test extensively, isolate and treat the infected, stop the outbreak, and then return to normal. Outbreak stopped dead in its tracks, economic damage is minimized and mostly short-term.
This is basically what South Korea did and they got their first COVID19 diagnosis the same day as the US:
People were worried that overreacting (in particular if the outbreak fizzled out, in which case any reaction would have been an overreaction) would damage the economy. Personally, I viewed that as a positive - a decently resilient economy would absorb such short-term shocks without any long-term issues. Easiest way to force-create such an economy? Stress tests (c.f. Netflix’s Chaos Monkey). If governments overreacted 1-2 times every year, people (travellers) and companies (supply chains) would get used to occasional flight blockade, border closure, discontinuity and disruption. We’d build a much more anti-fragile world.
Great idea, 100% agree. Let’s Chaos Monkey all the things, not just Netflix.
> Personally, I viewed that as a positive - a decently resilient economy would absorb such short-term shocks without any long-term issues.
That’s my sense of it too. The markets may fall in the short term, but as soon as the outbreak is stopped, roughly a month later, the markets will recover most or all of their losses.
Politicians so afraid of any stock market fall that they try to minimize the problem instead of treating the root of it are more likely to cause an even bigger market collapse.
Yes, it's terrible that politicians in the us at least were doing their utmost to say this isn't a real problem because they didn't want to hurt the stock market and impact their re-election changes. But there's another side to testing things to failure in the real world, people can die. There are vulnerable people of every stripe. Unlike me they may barely get enough food, barely be able to pay that apt that depends on people going to a restaurant, barely have a way to get their medical care.
Most people aren't as fortunate as us computer programmers. I can get a job in a few days, even with the corona virus, not true of restaurant workers. And even some of us in the "programmer class" are struggling.
Some stress testing is good, but how to do it without killing the vulnerable.
> Some stress testing is good, but how to do it without killing the vulnerable.
Less stress, more often. I think regular random border closures or brief, targeted disruptions of small parts of supply chains would do wonders to curb over-JIT-ting of the economy, while not hurting too many people too much.
That said, I worry it's too little - it doesn't address head-on the incentives that create vulnerable supply chains.
For the past few years we've had almost random border closures, I hadn't thought of it that way. But they do expose horrors, like the kidnappers that take people away when they are turned away from the us border into a hellhole or organized extortion or we kill you.
I agree with you. A few days ago I made the statement that Covid19 is probably the best thing that could have happened to humanity.
People were already warning us years ago about a pontential pandemic and its impact (including Bill Gates), but we all ignored it.
A real pandemic seemed to be the only way to teach us. So I'm really happy for all of us that it's this moderate one, because it could have been a lot worse.
To this date, I have seen no reliable data on how fast the disease spreads, or how dangerous it actually is. Testing only 'people with shortness of breath and high fever for more than 4 days' is so biased it's not even funny. There could be 10x or even 100x more people with milder symptoms that are never considered for testing. Reporting '10% of people tested die' is also very misleading, since we only tested people with severe symptoms in the first place.
We can poll 5 times a week for the chances of Biden or Sanders or Warren to become Trump's challenger in fall. Perhaps we could also perform randomized tests every week and get a better sense of the shape of the danger we're facing. Yes, testing for coronavirus is more expensive than calling a phone number, but shutting down the country indefinitely is orders of magnitude more expensive.
Yeah maybe it'll be in place for next time. But this looks to be about a once in a century event. It happened in 1917 and happening now. I doubt we'll handle it better in 2115.
I don’t know about that. A lot of lessons were learned in the 1918 flu pandemic that were applied here. For example, I’ve seen the comparison between the Philadelphia and St Louis responses multiple times in how governments were reacting.
I’m sure there will be lessons here too. The difference in response of between countries is one obvious comparison. But I think another lesson will be how the virus spread globally. With this virus, we have much more information about how the virus was able to spread globally so quickly.
I've seen the Philadelphia versus St. Louis response, and I guess that may have informed a couple of decisions. But I think we already knew large gatherings are bad when a pandemic is afoot.
The rate of these things will likely accelerate now that the world is far more interconnected. We’ve had a few scares already - SARS, MERS, Ebola 2014. This is the first one that really went global, but probably won’t be the last for another hundred years.
I don't think the lack of pandemics on the scale of the coronavirus/spanish flu for the last 100 years has been a lack of connectivity. The coronavirus would have played out the same in the 40s as today, except it probably would have been worse in the 1940's. The reasons we haven't had one in 100 years is we haven't had the right virus.
Now will we have another in the next 100 years? I don't think anyone knows what the base rate for 1918/coronavirus style viruses are, but there is no reason to think it will happen more frequently than the last 100.
I think a lot of people in medicine, science, economics, policy and the media think what's happening right now is their shining moment, but if you talk to people on the ground -- this is a catastrophe and no one has any clue what's happening and people see that and they are internalizing it.
The experts are f* this up and it is going to have long term implications for already eroded public trust in institutions.
From the casual observer point of view, it appears only some Asian governments have been able to competently handle this crisis. It appears we're going to learn the hard way things that China, South Korea, etc. understood through intuition:
(1) Widespread testing is key. Testing symptomatic people is too little, too late.
(2) You can't rely on people to self-quarantine.
(3) Infected people need to be isolated from their households.
So now we have a massive, economy-strangling quarantine that is not even going to provide any relief, killing the economy and still not flattening the curve. All the pain with none of the benefit.
> From the casual observer point of view, it appears only some Asian governments have been able to competently handle this crisis.
Anything I’ve read indicates China screwed up at almost every step only to have to do what the rest of the world is being forced to do now. Axios did a good timeline that leads me to believe the Chinese aren’t that special and if anything their government acted in such a way that doomed the rest of the world.
Sure, the provincial government screwed up pretty badly, but when the central government locked everything down their response was unprecedented and remarkably thorough. It's important to separate the two different responses. And it's the second, central government response that seems to have suppressed the outbreak.
You wonder though how we're supposed to trust anything that's reported by the CCP when they're engaging in propaganda blaming the US and Italy for the virus. As well as when there's a documented history of shooting the messenger, human rights violations, free speech violations, etc.
Maybe they are effective - it remains to be seen in an internationally vetted way. And they also had an opportunity to disseminate globally that they had doctors reporting issues, but instead they maintained until at least the middle of January (this started in November) that human-to-human transmission wasn't documented.
Nothing they say inspires confidence given their history and current actions, especially when it's ostensibly at odds with the experiences of almost the entire rest of the world with higher living standards and more uniformly modern systems.
Increasingly as time goes on, I have a harder time believing this is anything other than another shooting the messenger, Chernobyl-style event from an oppressive, information-deprived regime.
The experts are, in part, getting kneecapped by politics.
Watch one of the now-daily press conferences and you'll see Dr. Fauci trying to gently (so he doesn't get fired) correct inaccurate information from the President, in real-time from the same room.
Absolutely. One of the worst consequences that we may have to deal with at the end of this is that public trust will go down. In the beginning our leaders failed to act on the guidance of the scientific and medical communities -- almost two months wasted. And now, our leaders are flailing around implementing policy that is not based on reliable data or scientific evidence. They've both failed to react and then when they did react they are in many ways failing to act prudently.
Take a look at this editorial written by John Ioannidis. Excerpt that is relevant, though the whole thing is a worthwhile read:
>If COVID-19 is not as grave as it is depicted, high evidence standards are equally relevant. Exaggeration and over-reaction may seriously damage the reputation of science, public health, media, and policy makers. It may foster disbelief that will jeopardize the prospects of an appropriately strong response if and when a more major pandemic strikes in the future. [0]
Quick BIO rip from wikipedia:
>Ioannidis studies scientific research itself, especially in clinical medicine and the social sciences. He is one of the most-cited scientists in literature. His 2005 paper "Why Most Published Research Findings Are False" is the most downloaded paper in the Public Library of Science, and has the highest number of Mendeley readers across all science."
>Ioannidis is a Professor of Medicine, of Health Research and Policy and of Biomedical Data Science, at Stanford University School of Medicine and a Professor of Statistics at Stanford University School of Humanities and Sciences. He is director of the Stanford Prevention Research Center, and co-director, along with Steven N. Goodman, of the Meta-Research Innovation Center at Stanford (METRICS). He is also the editor-in-chief of the European Journal of Clinical Investigation. He was chairman at the Department of Hygiene and Epidemiology, University of Ioannina School of Medicine as well as adjunct professor at Tufts University School of Medicine.
Ioannidis had [a similar opinion article][0] published last week.
It's worth reading [the rebuttal that followed][1] (as long as we're doing credentials: "Marc Lipsitch, D.Phil., is professor of epidemiology at the Harvard T.H. Chan School of Public Health and director of Harvard’s Center for Communicable Disease Dynamics."):
It agrees that the basic lack of good information is a failing and also certainly creates risk. But we have seen at least twice now the outcomes of doing nothing or almost nothing:
> First, the number of severe cases — the product of these two unknowns — becomes fearsome in country after country if the infection is allowed to spread.
> So acting before the crisis hits — as was done in some Chinese cities outside Wuhan, and in some of the small towns in Northern Italy — is essential to prevent a health system overload.
There are clearly no truly good choices available right now.
I had read that rebuttal. The odd thing about it is as the author himself wrote, I'm not sure that Ioannidis is advocating inaction. Neither would I. Things must be done. It's that it's completely unclear that the "lockdown" stuff that is going to cause a new depression is actually worth it, or effective. And because lockdown is so vague, I mean not allowing people to go outside under threat of imprisonment and fines, or needing papers to travel somewhere. It may be an extreme overreaction, and I personally believe the cure would be worse than the disease. There are other things we can do.
Here's speculation based on data:
I can't help but see the demographics of those who are dying and come to the conclusion that this is not a threat to the general population in the direct sense. No one aged 0-9 has died worldwide to date. No one in Italy under 30 has died. Of those that have died in Italy, 88% had one or more serious comorbidities; only 12% can be directly attributed to COVID-19. It seems that this is killing people who are already sick or in fragile health; it just so happens that the elderly of course dominate those categories. Consider this: nearly 3,000,000 people die every year in the USA. How many of those who will die this year from COVID-19 will overlap with that 3,000,000? In other words, could it be that the excess mortality rate of COVID-19 when amortized over the next two years isn't actually that high? Does it make any sense to throw ourselves into a depression because of this? Remember, the effects of eceonomic downturns affect every single aspect of peoples lives including their health. If we do this wrong even more people may die or have significant, long lasting, hardship because of an ill-considered and potentially unnecessary intervention.
I read a paper this morning that suggested some things that I believe need more attention:
> For example, we are learning that hospitals might be the main Covid-19 carriers, as they are rapidly populated by infected patients, facilitating transmission to uninfected patients. Patients are transported by our regional system,1 which also contributes to spreading the disease as its ambulances and personnel rapidly become vectors. Health workers are asymptomatic carriers or sick without surveillance; some might die, including young people, which increases the stress of those on the front line.
>This disaster could be averted only by massive deployment of outreach services. Pandemic solutionsare required for the entire population, not only for hospitals. Home care and mobile clinics avoid unnecessary movements and release pressure from hospitals.2 Early oxygen therapy, pulse oximeters, and nutrition can be delivered to the homes of mildly ill and convalescent patients, setting up a broad surveillance system with adequate isolation and leveraging innovative telemedicine instruments. This approach would limit hospitalization to a focused target of disease severity, thereby decreasing contagion, protecting patients and health care workers, and minimizing consumption of protective equipment. In hospitals, protection of medical personnel should be prioritized. No compromise should be made on protocols; equipment must be available. Measures to prevent infection must be implemented massively, in all locations and including vehicles. We need dedicated Covid-19 hospital pavilions and operators, separated from virus-free areas.[0]
> In the beginning our leaders failed to act on the guidance of the scientific and medical communities -- almost two months wasted.
Some of them still are. Bolsonaro went on TV to downplay the virus and is actively trying to reduce state agency because state governors aren't waiting on the federal government to protect their citizens.
Rather than just blaming the CDC, I think the real problem here has been the lack of coordination between the CDC and FDA?
CDC: Our test is going to be so much better than the WHO's, we'll test for SARS-CoV-2 in two samples and also test for other simultaneous infections in this third part!
FDA: Approved
Hospitals: Hey, we can't get that third part to work!
CDC: That's ok, just use the first two parts, that's all you really need to diagnose COVID-19. Though I'm sad I won't get any data on simultaneous infections, apparently that was a problem in Northeast China and we want to figure that out for our guidelines.
FDA: Only running the first two tests is not what we approved! Verboten!
*
Laboratory: Let's develop our own SARS-CoV-2 test!
FDA: Sure, just make sure to fill out these forms, be sure to send them to us by mail rather than email, and oh, make sure to test against the original SARS to make sure your test doesn't give a false SARS-CoV-2 reading if they patient just has that.
Laboratory: Uh, sure. Hey, CDC, can I have a sample of SARS to test against?
CDC: NO WHAT ARE YOU CRAZY I'M NOT GIVING YOU THAT! THAT'S SUPER DEADLY!
Exactly why it matters that there was no one in the Whitehouse whose job it was to coordinate the Coronavirus response. Our current situation was predictable. This was written in 2018:
Around the same time that the administration proposed rescinding the funds, the National Security Council dissolved its biosecurity directorate, a small team focused exclusively on global health security threats and led by a director often referred to as the Ebola czar. Again, it’s worth remembering why that office came into existence — a hard lesson. Without a central office to coordinate federal efforts by many agencies, progress was slow the last time the world confronted Ebola. “It took months of wrangling to put things in place,” Mr. Konyndyk said. “If the only way to get resources is through long negotiations with committees, you are giving disease a head start.” It was based on that realization that the Obama administration established the biosecurity directorate and named the first Ebola coordinator.
> FDA: Sure, just make sure to fill out these forms, be sure to send them to us by mail rather than email, and oh, make sure to test against the original SARS to make sure your test doesn't give a false SARS-CoV-19 reading if they patient just has that.
> Laboratory: Uh, sure. Hey, CDC, can I have a sample of SARS to test against?
I've been trying to stay on top of the testing saga, but it's been hard with all the daily changes.
Do you have news links that describe this hypothetical exchange taking place?
EDIT: in particular, the part around the FDA requiring testing against a sample of SARS.
>The officials at the FDA instructed him to test his test against the MERS and SARS viruses, which are also coronaviruses. It wasn’t a terrible idea, Greninger thought. Why not develop a test that catches all these deadly coronaviruses all at once? It did seem strange, however, that the FDA was asking for this in an emergency use application: by this point, COVID-19 cases had appeared in six states. (The FDA did not respond to a list of questions about the process.)
>Still, Greninger complied. He called the CDC to inquire about getting some genetic material from a sample of SARS. The CDC, Greninger says, politely turned him down: the genetic material of the extremely contagious and deadly SARS virus was highly restricted.
I'm still trying to understand why Japan's numbers are so low. You can argue they aren't testing but if the infection rate is similar then the death rate should be similar was well regardless of testing or not.
They aren't staying home. Restaurants, bars, and events are still open. Trains are still packed at rush hour. Festivals are still happening. They're planning on starting school in April.
I can only see a few possibilities
(1) the numbers are false and Japan's death rate is going to accelerate
(2) the numbers are true but it's still coming
(3) Something about Japanese culture already limits the spread.
I don't believe this one. Japanese might wear masks but not all of them wear masks and they are not N95 masks. Japanese are also known to go to work sick, go to cafes sick, visit friends and family sick. Places are crowded. Open and over crowded offices everywhere.
(4) Something about Japanese genetics makes them less likely to have a strong reaction
I have no idea how to tell which of those it is except to see where they are in a few weeks. If the death rate rises it was (1) or (2). If not then it must be (3) or (4)?
Here's their latest graph. The 2 shallow lines at the bottom are Singapore (bottom) and Japan (2nd from bottom). The rest are Italy, Spain, Germany, France going left to right at the top.
> "I don't believe this one. Japanese might wear masks but not all of them wear masks and they are not N95 masks."
Substandard masks are better than no masks, and many people wearing masks is better than few people wearing masks. These are not "all or nothing" matters.
A surgical mask may also do more to prevent a contagious person from spreading the virus (than to keep a healthy person from getting it) because it stops droplets close to the mouth before they aerosolize.
I think the numbers are real. Shanghai is already taking Japan off high alert list and you can be sure they are very cautious. Since they monitor and even quarantine travellers they should have the data.
I am also confused by Japan's situation. The one thing that I don't think Japan can fake is the death rate. As long as the death rate does not significantly rise, somehow Japan is keeping control of the virus without the significant changes to life that were necessary in other places.
One useful "sanity check" for countries under testing is to check the records of imported cases from countries doing rigorous contact tracing and publishing their data. So far, Singapore has 2 confirmed cases arising from Japanese travellers and Taiwan has 1:
This is vs the ~110 British cases and ~50 American cases the two countries have seen collectively.
Flight volume from Japan to both countries is normally quite substantial so this is evidence to suggest that Japan's case is not low solely due to undertesting.
> "I don't believe this one. Japanese might wear masks but not all of them wear masks and they are not N95 masks."
This is a very western belief. Why do we continue to think that asians wearing masks are stupid?
Most importantly, say masks prevent 50% of transmission, and the majority of transmission is via the air (highly plausible), then that would mean drastically less transmission.
Even an N20 mask that reduces risk by 20% would make a huge difference to a population.
It is my prediction that masks are the single most effective means of dealing with the virus at present. Japan’s low infection rates are because they wear masks.
Wearing a bandanna over your mouth and nose just makes sense.
A DIY mask made from a common cotton t-shirt is approximately N70. This article breaks down the effectiveness and breathability of different materials.
I certainly didn't say asians wearing masks was stupid. My implication is they are not effective for either COVID-19 nor cold or Flu viruses. Japanese don't wear N20 masks. They basically wear a piece of cloth that seals no where.
If everyone wears masks that reduce droplet exhalation, that helps, even if a mask didn’t help prevent inhalation of droplets. I chose the words “droplet transmission” carefully.
> less than 50% wear them.
I looked a photo taken in Japan today - certainly looks like more than 50% to me - but hard to get facts on and I only looked at the first photo I could find.
> The majority of people wearing masks in Japan are for hay fever.
I.e. the mask is worn to reduce inhalation of small particles: surely you are contradicting yourself (you say they “seal nowhere” you are implying that they have no effect and that anyone using one for hayfever is mistaken).
I have a box of n95 masks I bought a few years back while living in Singapore (there is an annual smoke “haze” there from neighboring countries burning forest to clear land for palm oil production). I tried to give them to a nurse to distribute to other medical staff, but they couldn’t use them because they are a year or so beyond the expiration. News to me that masks even have an expiration date.
Pretty much everything has an expiry date because the manufacturer has guaranteed its still effective up to that date. Doing that requires time and money. This doesn't mean the masks doesn't work after the expiry date (although it might be less effective) simply that the performance isn't guaranteed and most likely hasn't been tested sufficiently.
Or make the offer right now to health workers who've been it's perfectly fine to interact with covid patients without any mask.
Perfection is the enemy of the good. The amount of medical waste is shocking - as if tools went from 100% effective 100% safe to 0% effective 100% at midnight.
I suppose there is a strong cover-your-ass factor at play, that can only be overridden when they have some skin in the game (as in, risk being infected due to 0 mask)
“CDC/NIOSH believes the following products, despite being past their manufacturer-designated shelf life, should provide the expected level of protection…
That’s because the owner of archive.is blocks DNS resolutions from Cloudflare DNS. They don’t actually use Cloudflare; rather, they have a grudge against Cloudflare, so they return an IP address belonging to Cloudflare when you attempt to resolve through 1.1.1.1. That makes it look as though it’s Cloudflare’s fault when it isn’t.
tl;dr archive.is wants Cloudflare to implement ECS, Cloudflare refused due to privacy concerns, archive.is doesn’t allow queries from 1.1.1.1 to resolve correctly.
The mask guidance is confusing as well. I get they are trying to preserve masks for medical staff. But, they also say it's mainly spread by coughing, sneezing, and resulting spray of bodily fluids. Surely even a scarf around your face would have some benefit? Yes, I get that the virus is small enough to pass through, but some deflection is better than none.
It's very irritating because people don't understand the concept of defense in depth. Are surgical masks going to give you total protection? Of course not, but as you say they provide SOME benefit. Saying "masks don't work because they don't fully stop the virus and users misuse them" is basically equivalent to saying "code review is a waste of time because it won't catch every bug and because devs don't do it correctly". The solution isn't stop doing code review, it's to teach people how to do it and to understand it's limitations.
> Are surgical masks going to give you total protection? Of course not, but as you say they provide SOME benefit. Saying "masks don't work because they don't fully stop the virus and users misuse them"
Surgical masks aren't about protecting the wearer from everyone else, they're about protecting everyone else from the wearer [1]. They may provide the wearer some protection, but that's not really the point.
The emphasis in the rhetoric about masks needs to change. It should not be about individualist self-protection, but about doing your part to protect the community. I think they should be recommended for that reason [2].
[1] Respirators are devices for protecting the wearer, and the N95 type has been much discussed. Everyone should learn the difference to de-confuse the general conversation in this topic:
[2] If there's enough supply. It seems like surgical masks are getting drafted into the role of PPE for medical personnel (which they're poorly suited to) due to the N95 shortage. It's unfortunate that the US hasn't developed a culture where you wear a mask to protect others from your illnesses, so they're not widely available outside of healthcare settings.
>Surgical masks aren't about protecting the wearer from everyone else, they're about protecting everyone else from the wearer [1]. They may provide the wearer some protection, but that's not really the point.
I think you're confusing the normal use for these masks with what they are actually capable of doing. Yes, in a surgical setting the masks are worn primarily to protect the patient from the surgeon, but the masks do work both ways. Here's a citation from an infectious disease specialist:
>“Yes, a surgical mask can help prevent the flu,” Sherif Mossad, MD, an infectious disease specialist at the Cleveland Clinic, tells Health. “Flu is carried in air droplets, so a mask would mechanically prevent the flu virus from reaching other people.” It would work both ways, says Dr. Mossad, preventing transmission of the flu virus to others and for keeping a mask-wearer from picking up an infection.
>> Surgical masks aren't about protecting the wearer from everyone else, they're about protecting everyone else from the wearer [1]. They may provide the wearer some protection, but that's not really the point.
> I think you're confusing the normal use for these masks with what they are actually capable of doing. Yes, in a surgical setting the masks are worn primarily to protect the patient from the surgeon, but the masks do work both ways. Here's a citation:
I wasn't confused. That's why I said they may provide the wearer some protection. The 3M YouTube video I linked even quantifies this, by measuring and comparing leakage between a surgical mask and an N95 respirator.
But that's not the point. Don't wear a mask to protect yourself, wear a mask to protect others.
Yes an N95 mask provides more protection than a surgical mask. That's completely different from whether either mask protects the wearer. Both masks absolutely protect the wearer from infection. I'm sure you understand that, but the way you are wording things makes this unclear.
If you have a mask shortage and there is one mask left in the country, is it better for the society for the sick person to wear it or for healthy person to wear it?
I simply will not stand to be "managed" or lied to. The masks protect the wearer. That is a simple fact. Anyone who states/implies otherwise is either ignorant or a liar.
Now we have the separate issue of the fact that there is a critical supply shortage. In such a scenario I'm more than happy to oblige in managing systemic risk by allocating all the masks to healthcare workers, the critically vulnerable, etc. But don't lie to me along the way.
He is not lying to you. That’s disingenuous. The OP is stating that the very little protection you get by wearing a mask does not warrant you horsing it. Masks should be used by sick people to
Maximize their proficiency. I’m surprised to read such comments in the HN community which is supposed to be focused on engineering and optimization within a set of constraints.
> Surgical masks aren't about protecting the wearer from everyone else, they're about protecting everyone else from the wearer [1]. They may provide the wearer some protection, but that's not really the point.
Normal people using surgical masks in public are definitely also for protecting the wearer, and do offer protection.
"Any type of general mask use is likely to decrease viral exposure and infection risk on a population level, in spite of imperfect fit and imperfect adherence, personal respirators providing most protection."
I know what their stated purpose is, but it is true that wearing a mask protects the wearer as well to a degree. Stating that it doesn't (as many in the media / CDC / politicians have said) is factually incorrect. If they want to say that masks need to be preserved for healthcare workers or sick people, then they should say so and I would agree, but when they start bullshitting to try to trick people into the behavior that they want then it completely undermines their credibility. People then start asking things like "is it actually true that we need to socially distance or is that a lie as well?" The number one thing you should not do during times of crisis is start lying.
For example, I don't trust the WHO much anymore because they lied and said that closing China's borders would not stop the spread of corona behind pressure from the Chinese government.
What's more frustrating is the exact same logic applies to "social distancing." Social distancing will not completely stop people from getting sick. It'll just slow the spread. So, according to the CDC, an imperfect solution for quarantine is totally fine, but when it comes to masks, only n95 or better are worth pursuing.
It's quite likely that in all the scenarios a mask may have a useful effect, N95 or better is the only time it works.
For medical professionals in close contact with patients and dealing with airborne-protocol pathogens (which is what a droplet-mediated pathogens like SARS2 becomes classed as once patients are coughing and being intubated) then a bad mask is quite probably worse then no mask (this has precedent: ineffective masks obstruct breathing, which makes you take deeper breaths and draw more particles in deeper in your lungs - it's a big problem when dealing with fine dusts in construction).
> It’s quite likely that in all the scenarios a mask may have a useful effect, N95 or better is the only time it works.
You’re saying you think anything less than an N95 has 0 effectiveness. Why do you believe this is likely? Are you aware of the data that says otherwise?
“As worn by health care personnel in this trial, use of N95 respirators, compared with medical masks, in the outpatient setting resulted in no significant difference in the rates of laboratory-confirmed influenza.”
To be clear, this trail was for outpatient care — not necessarily applicable to shoving tubes down throats, but probably applicable to people walking down the street.
The data from the Davies paper is not very convincing. The home made solutions offered significantly less protection and and had major problems with fit. Even their conclusions were — it’s better than nothing, but not a proper substitute.
> However, these masks would provide the wearers little protection from microorgan- isms from others persons who are infected with respiratory diseases. As a result, we would not recommend the use of homemade face masks as a method of reducing transmission of infection from aerosols.
Better than nothing is the whole point. N95 masks are not a substitute for avoiding exposure in the first place, but nobody’s saying N95 masks are ineffective because of that fact.
The recommendation here is assuming you have access to something better. If you have no access to something better, a homemade mask is better than no mask at all, until you can get something better. As others have pointed out here, it’s rather odd to suggest we should scoff at this imperfect solution, when there are no perfect solutions short of 100% full and complete quarantine, which is completely unrealistic.
It's highly likely that even basic surgical masks have some impact. A fit-tested N95 is the gold standard, but the widespread use of surgical masks in Asia during the SARS epidemic does seem to have had an impact.
Agree & upvoted; this needs to be better understood. Especially noteworthy is the section you linked to is written for health-care workers, and they’re confirming that a homemade mask is better than nothing (while also recommending the homemade mask dead last.)
Unfortuately, the CDC really is giving out conflicting guidance here. For example, higher up in the section for lay-people is this: “You do not need to wear a facemask unless you are caring for someone who is sick (and they are not able to wear a facemask). Facemasks may be in short supply and they should be saved for caregivers.” https://www.cdc.gov/coronavirus/2019-ncov/prepare/prevention... (In “How to Prepare | Protect Yourself”)
I don't see a contradiction. The CDC is trying to maximize public health benefit. They recommend stronger protection for people with more exposure to higher levels of the virus. Coincidentally, the people with higher levels of exposure also happen to be health care workers, who need the best available protection to save lives
If you are not exposed to high levels and are not required to put yourself at risk to care for patients, you are at low risk. You can protect yourself with milder measures like social distancing and face protection that is not as effective but not in such short supply
Maybe I misread your intent. I thought you were mostly pointing out the section titled “When No Facemasks Are Available, Options Include”, which would mean we’re talking about something that is not in short supply. I thought you were pointing out that, among other things, the CDC is saying that home-made masks are better than nothing, even for health care professionals, and even if it’s a last resort.
I mean I agree, of course, that they’re trying to maximize public health benefit, I just don’t think the guidance is at all clear to the public. The idea that anything less than N95 is useless is pervasive, you can see it right here on HN. My parents and co-workers believe it because it’s been reported in the mass media in the last weeks: “the CDC said masks don’t protect you!”.
For people who need to work or shop in public places, any kind of masks at all might well be statistically significant alternatives for people who are unable to practice social distancing. China seems to be doing it effectively right now; people are required to wear masks to go to work. They’re not telling the public to avoid masks because doctors need them, they’re telling the public not to leave the house and not to enter a work building without something over your face. It seems like the CDC is saying the opposite, you should not wear a mask unless you’re a doctor. If a bandana is even 50% or 30% or even 5% effective, and they want to maximize public health benefit, why aren’t they recommending people start with what they have at home for times when public exposure is necessary? Seems like that would both increase public health and deflect demand for surgical masks & N95 masks at the same time, no?
That's not necessary so. While "not doing social distancing right" will not increase your risk compared to not trying, with masks it's not so clear cut: You have to touch your face to put them on and take them off, and people might touch their face more often to adjust them etc. That increases the risk, at least if you wear them to protect yourself. And people might take greater risks because they feel safe. If this is not counterbalanced by the risk reduction through wearing a mask, it's a problem.
Additionally, if there is a mask shortage, it might increase the risk indirectly, even for those who don't want to spread it.
If there are two "mental tools" I wish we could teach every person, they are exponential growth and statistical thinking. Neither is intuitive, but they would help people understand this whole situation (and many others) a lot better.
My high school math teacher introduced exponential growth by asking the class if we'd take $1M now or $0.01 doubled daily for a month. We, as most people do, wanted the $1M, but the penny turns into more than $5M.
Had to explain this to someone yesterday. They literally wouldn't believe me until I screenshotted an Excel spreadsheet of the daily doublings, despite a finance degree.
I think that's exactly the issue. People can't picture it. You can show them a curve on a graph, but that doesn't translate for people without a mathematical/scientific background into "a shitload of people will get ill very quickly." Our brains seem not to be very well wired to make the connection between mathematical abstractions and reality, and aside from the minority of people who seem to just "get it," people don't understand without a good explanation from a very good teacher.
We technology people don't just inherently "get it", but rather have experience traveling up and down in powers of two for things that are meaningful to us. A month has 30 days - that's easily recognizable as a giga (2^10 ~= 10^3). And a billion isn't even that large to us.
Very true. But it doesn't stop there. One of my pet peeves is that people who believe they understand exponential growth will extrapolate too far in the future. More often than not, processes working against the exponential growth, negligible small in the beginning, will grow even faster and will reduce the grow rate, even without external intervention.
In the example of COVID, it's the chance of interaction of an infected with an uninfected, even without social distancing, just because so many people will be infected, or dead. This effect is completely negligible in the beginning, but dominates in the end. (Of course, all the people modelling the epidemic have this effect in.)
I like to think that every contact outside increases risks. And conversely, to keep my sanity, that every prevented contact helps reduce the risk a little bit
"It's a great pleasure to be here, and to have a chance just to share with you some very simple ideas about the problems we're facing. Some of these problems are local, some are national, some are global.
They're all tied together. They're tied together by arithmetic, and the arithmetic isn't very difficult. What I hope to do is, I hope to be able to convince you that the greatest shortcoming of the human race is our inability to understand the exponential function."
Most people I try to explain the current problems are really not able to understand. I explain that the spread is exponential, and that the problem is that is grows so fast. I say look at the graph from China, look at the graph from Italy.
They answer "ah, the Chinese maybe hid some numbers."
I say, it just doesn't matter, only the shape of the curve matters, and it repeats in every land. Even if the Chinese hid half of the cases, that difference disappears in only three-four days in our locations, where it grows so fast, as it grew in China before they did their measures, much harder than ours.
They don't understand still. They think only "80000 in China is more than "50000 in Italy" and it stops there. That Italy will get from 50K to 100K in four days, that's what they don't understand until they'd see it happened, but it would still, sadly, not convince them in anything.
Whereas, not only it's just the shape of the curve that matters, we know exactly why the spread is exponential, and what has to be done to change the shape: manage to stop the people who have it to transmit the virus to the rest of the population. It's "just" people who spread it -- the virus is not a bacteria, it doesn't live or multiply by itself, it needs a host which will replicate it, and the only host spreading it among the humans is human. There's nothing else that we know to work than that.
The major danger is that 4 from 5 carriers of the virus won't feel so bad to think that they should really stay at home. Most of the carriers aren't aware what they do. They all have their lives where what they do at the moment is "urgent" and "must be done." As soon as the droplets they produce enter the lungs of other people, the virus is spread. The droplets are tiny enough to be normally invisible to us, of course.
It doesn't help at all that the most of the highest politicians, across many different countries, downplayed the seriousness of the situation for a long time. Even less that the scientific ignorance was promoted as a virtue for even longer times.
BUT. Not meeting someone is 100% protection at this poin we need 100% protection for everyone not 100% needed to keep the lights on and people fed.
So yes once you've removed all non essential contact masks add another layer. But people are fairly stupid on average and need simple messages right now.
The whole blaming people for hoarding masks and then the "masks don't work" things have been incredibly frustrating. It is almost like authorities didn't want anyone to start asking why the public couldn't get masks, as they can in say Taiwan.
Most (if not all) distributors and manufacturers of masks has been prioritizing health care systems and governments over retailers since January. Just as they should do. Were there any that weren't? I didn't see any reports of that, but if so of course the proper thing is to report them and talk to them. Not to blame random joe for having a mask.
The fact was since January retail supplies were only existing stock, which as we know was quickly sold out with a lot being sent back to family overseas (no judgement there). And I haven't seen any masks being restocked at any hardware stores or pharmacies since. At no time did I hear about authorities going around every pharmacy or home depot to try to collect any masks. Why? Because they knew there were no supplies and what was there was so small it'd make no dent in the problem. So blaming the public is grossly irresponsible and even put people in danger. I have an immune compromised friend that was responsibly using masks but got harassed for wearing masks "that don't work". And there were plenty of similar reports of such behavior from others.
- If you tell the public that masks are great protection, and the public can't find then to buy, that is a huge source of unrest.
- The messaging (in Spain but looks similar everywhere) has been that you should wear one if you are sick or, more importantly here, if you are at risk. This is a clear indication that they do help protect against being infected. This should have prevented everyone from harassing anyone wearing one ("they must be a risk group"). The fact that people did that is indication that people are not acting responsibly.
I personally hate being told something that is patently false, but I totally understand that, collectively, we need to be lied to for our own protection, because collectively we become a bunch of idiots.
Asymptomatic carriers are showing as a large contributor of spread. We should have a mandate for masks for everyone (since we don’t know who is a carrier or not) and government should contract manufacturers to ramp production ASAP to meet the demand.
China and South Korea has ramped productions and is allocating 2 masks per week per resident.
US has 330 million people. 2 per person is 660 million face masks.
China is currently producing 200 millions masks a day. If we ramp production to even half of that, 100 million masks a day, we can have 2 masks for everyone in less than a week.
There was an act passed (I don't remeber its name, but it was meant for situations like this) that allows government to force factories to produce needed materials. Yet government refused to use it, they refuse to invoke stay in place in remaining states. They blocked states from doing testing, bidding against states for supplies and cherry on top DOJ secretly asked if they can suspend constitutional rights to allow holding people in cells for unspecified time among other things. WTF, it's like they want this pandemic to be as bad as possible.
We already can see most countries working and flattening the infection curve, yet US is still growing exponentially. We are now #3 and looks like we will be #1 (surpassing China and Italy) before March ends.
My bad, last time I heard an expert talking about it that the act was created exactly for this kind of event and Trump was resisting invoking it to not affect private companies. I'm glad he changed his mind.
Still, I think he should stay at home in other states. LA county seems to assume it is beyond containment and now only tests people if that would affect the treatment.
I think a big thing that isn't being said is that the government is also attempting to manage civil unrest. There is an old saying about there being a gun behind every blade of grass in this country. We have a very different culture and risk situation than a place like China where they literally welded people's doors shut and let them starve to death.
I think they know certain things need to be done, but they have to also manage expectations and make enough of the population/media/state govt be "demanding" these enforced lock downs before it is really feasible.
Lastly, I think most companies are doing the right thing. 3M is cranking out industrial N95 masks as fast as they can since the govt dropped liability protection (since they are not rated for medical use). GM and others have offered to make ventilators. The defense production act only needs to be invoked if factories/suppliers are not doing the right thing. The specifics of the invocation haven't been announced yet, but I suspect one or more companies started misbehaving, and that resulted in invoking the act.
> We should have a mandate for masks for everyone (since we don’t know who is a carrier or not) and government should contract manufacturers to ramp production ASAP to meet the demand.
Absolutely, and this is true for all countries. Personal prophylaxis and distancing will have to become a natural part of our life if we want to get out of this before the eventual remedy happens. But the masks do not exist yet.
If people are collectively idiots, then telling 'white' lies like this only throws fuel on the fire by eroding what little trust people have in genuine authorities/experts. Without trust in those authorities/experts, the 'idiot' collective masses will behave even stupider.
It's my impression that at this point in time, eroding trust in a targeted way is very easy, and there's plenty of people doing it, out of partisanship, greed, or even plain stupidity. The collective "we" have allowed trust in genuine experts to be low and brittle.
So, it makes sense for experts to put little value in trying to preserve it, when trying to balance the value of other courses of action. It sucks, but in their shoes I would do the same.
> I personally hate being told something that is patently false, but I totally understand that, collectively, we need to be lied to for our own protection, because collectively we become a bunch of idiots.
Yep, I understand this. I've also noticed recent emphasis on the danger of the virus to young people (like this somewhat misleading NYT article [1], although I just noticed that they recently updated it), I suspect because they want young people to stay home.
Yes, there are also over 300k confirmed cases of coronavirus worldwide. I'm not suggesting that the young should not worry (indeed, it's something like 10x deadlier than the flu), but suggestions that young people are disproportionately in danger (as the original NYT article did) are actively misleading.
No sane medical person would connect three 30-years doctors to the breathing machines ("ventilators") unless they actually had to be connected to them:
That's why it's in the interest of everybody for the hospitals to remain functional and that the current speed of growth gets at least significantly reduced.
> I totally understand that, collectively, we need to be lied to for our own protection, because collectively we become a bunch of idiots.
This is a tall order in the modern informational environment. There are enough honest people out there that the truth will filter out, first to people who think critically and then as a meme to be swallowed uncritically by the masses. Then you just end up further damaging the credibility of official sources at a time when their credibility is important.
People don't work that way. Social status is always more important than truth. For socially suppressed knowledge, individuals can find it out for themselves if they want, but they can't share it or they'll be ostracized for heresy. So most people won't want to even find out when even expressing curiosity is an offence and they'll work to punish those who do share it because that helps them to be accepted by the majority.
Yea this is really frustrating. I bought a box of 10 N-95s in January when I saw what was going on in China and figured they’d be good to have, since I have older people in my family who are in poor health (leukemia, diabetes, heart disease). Now since I’m shopping and cooking for them, I am trying really hard not to get sick so I wear a mask to the stores and I’m getting looks from people like I stole them from a hospital. How about we blame the government for not ramping up production of masks back in January when even I knew this was going to be a problem?
>How about we blame the government for not ramping up production of masks back in January
or not having a strategic reserve of masks, gloves and suits in a giant warehouse somewhere. You could rotate the stock though the marketplace during safe times so it would cost little. Probably less than the CDCs $110 million dollar visitors center.
What kind of pandemic was the government preparing for? One that did not need n95 masks and disposable gloves? One that wouldn't see a shortage of PPE?
> The Department of Health and Human Services said last week that the stockpile has about 12 million N95 respirators and 30 million surgical masks —a scant 1 percent of the estimated 3.5 billion masks the nation would need in a severe pandemic. Another 5 million N95 masks in the stockpile are expired.
> What kind of pandemic was the government preparing for? One that did not need n95 masks and disposable gloves? One that wouldn't see a shortage of PPE?
Some "bioterrorism" spectacle that would be localized to a small area, requiring only a small supply sold by a politically-connected middleman, who could mark up the price 30x while having no difficulty sourcing the modest quantity from a commercial supplier.
> Now since I’m shopping and cooking for them, I am trying really hard not to get sick so I wear a mask to the stores and I’m getting looks from people like I stole them from a hospital.
I have an N99 (actually FFP3, a pretty much equivalent European standard I gather) from some DIY work a year or so ago; I haven't been out in some time, but when I did I didn't wear it for the same reason.
It will be interesting to see what happens to production, and commercial & residential stockpiles when we do get back to something resembling normality. I suspect there'll be a marked increase in non-Asian* routine mask-wearers on public transport, for example.
(* it was a lot more common among that group anyway, so I'm not so sure in my speculation that it would increase so much.)
This will probably hit us culturally the way SARS hit east Asia in the early aughts. The good news is that we likely won't be caught completely flat footed against a pandemic again.
Unfortunately many authorities are trying to stamp out public mask culture in the west before it even has a chance to properly develop. I think this is penny wise, pound foolish. It's short term thinking that optimizes for the present at the expense of the future.
It's quite possible that people think you are wearing a mask because they think YOU are sick, as that is the mask's primary effect (preventing you from spreading your disease to others)
The primary purpose of a filtering mask [is to protect the wearer][0]. They coincidentally protect the environment, too, [unless of course they have a built-in check valve][1]
that passes unfiltered air out of the mask.
Your first citation calls out a difference between "masks" (which protect the environment) and "respirators" (which protect the western and environment) and are the N95 discussed on this thread. Thanks for helping to clarify the differences.
You did the right thing, don’t let anyone pressure you to feel otherwise. Retail stocks of masks for things like painting or carpentry are not at all related to depriving medical supplies. Also for N95 masks, the filter size is about 3x wider than the size of coronavirus. Meaning it provides _a lot_ of protection. It’s not a way to fully prevent anything, but a door only 3x wide lets in way way way fewer things than not even having a wall or door at all.
I meant 3x. Coronavirus can go through N95 filter size, but just as mention in the link below, that’s still better than not using it. For certain situations, like needing to go out for errands and then be near the elderly, it’s smart to have it and makes sense for individuals to buy the retail stock.
What needs to happen is making mask wearing mandatory for anyone in the public.
If both parties have a mask, even just made at home from a piece of cloth or even a scarf, the risk of one party infecting the other goes way down, even without sophisticated respirators being used.
> It is almost like authorities didn't want anyone to start asking why the public couldn't get masks, as they can in say Taiwan.
It appeared to be very common for citizens to wear masks in eastern Asia long before this pandemic. I'm not the least bit surprised they were more prepared to scale up production.
I really want to hear the back story on this. Who is the distributor? Why did they end up at a Target? I'm betting the distributor tried to sell them to hospitals but the hospitals said they weren't appropriate/certified for medical use so couldn't take them? Not much to go on from a tweet but definitely needs investigating.
“Respirators with exhalation valves can be used in a healthcare setting when it is not important to maintain a sterile field (an example of an acceptable practice would be when taking the temperature or blood pressure of a patient). Respirators with exhalation valves should not be used in situations where a sterile field is required (e.g., during an invasive procedure in an operating or procedure room) because the exhalation valve allows unfiltered exhaled air to escape into the sterile field.”
Interesting. It still seems like these respirators would have been earmarked for industrial use, but I didn't realize they could normally be used in healthcare at all.
There’s this idea thats not even close to correct that we as a country have somehow tracked and accounted for all masks. Someone sent me some N-95 masks like around 9 days ago (which I didn’t ask for) which they got from industrial suppliers. This is a coordination and information problem not a capacity issue so I expect to see more like this.
The US government, given any sense, should be forbidding private sale of these masks until there's enough supply in hospitals and other critical spots. It shouldn't be hard for a mask distributor to find a hospital willing to buy right now.
The action sends a message to the producers of masks too; that they shouldn't bother trying to meet the public's demand for masks by massively scaling up production because the government won't allow those sales. By suppressing perceived demand for masks, the economics of scaling up production become less appealing to manufacturers.
> Health care professionals from the American Hospital Association (AHA), the American Medical Association (AMA), and the American Nurses Association (ANA) sent a joint letter to President Donald Trump on Saturday pleading for more medical supplies amid the COVID-19 pandemic.
> In the letter, the three organizations implored Trump to utilize the Defense Production Act (DPA) to help with the “dwindling supplies” of respirators, surgical masks, and other necessary tools.
That's not all the government is doing though. They are saying things that will convince people in the future, once this pandemic and supply problems are resolved, that they shouldn't bother buying masks to prepare for the next time. They're suppressing demand for masks not only in the present but in the future as well. In doing so, they make mask manufacturers less inclined to scale up production now or ever, since scaling up production now would become a liability for them in the near-future when the medical industry returns to buying the normal number of masks again. Increased long-term public demand for masks would support the long-term increased production of masks and would therefore make mask manufacturers more inclined to make long-term investments in their manufacturing capacity.
Furthermore, increasing long-term public demand for masks would reduce the severity of future respiratory pandemics, since a larger portion of the population would be prepared in the future.
Edit:
> "There are two issues you're mixing together. The government should stop lying [...]"
That's on-message for this entire discussion as far as I'm concerned. The topic for discussion is the CDC's lies. Discussing the distribution of masks without discussing authorities suppressing the demand for masks is myopic. These two issues are not distinct.
It is not clear from the post whether they were seized or purchased by the state. There are (comparatively) plenty of financial resources around, just not a lot of masks.
they were purchased. the government does not just take property. in the end it may be the GSA price, which may not be the same as target was expecting to retail it at.
I don't have time to look right now, but I suspect most states (and the feds) have the ability to repurpose private assets in emergencies, with some constraints.
I hope by seized e means try bought them at market price.
While supportive of strict social distancing measures I do not think any governor or president can suddenly start tossing basic civil rights. The rise of authoritarian language from state leaders is very concerning
Sure. Being compensated still means they were bought. Compelled to sell is fine as an emergency police power and is fine. Being seized is a violation of the amendment against involuntary seizure without due process of law.
Yes they have the power to compel a sale but the government has to pay. And the defense production act is not relevant to governors. Governors have sovereign executive power in their state including ordinary police power. The federal government does not ordinarily have that power which is why they need an act of congress.
It is available to be invoked but it is better that we dont have to use it to compel manufacturers and can instead ask nicely. Currently all manufacturers are basically complying without compulsion.
No government did this, even when months ago China was shutting down it's factories and locking down a hundred million people zero preparation was done by all of our politicians. My country ran out of masks two weeks ago and people are just wearing makeshift masks
Pretty much. We're seeing the result of institutional decay at every level.
"In the middle of the 20th century, a cadre of credentialed experts was created to replace citizens. This was a mistake. The selection mechanism for entry into this cadre selects against bravery and original thinking. Experts should be consulted, but what use is an expert unwilling to consult on a grand vision? The American system of the 2020s through the city, county, state, and up to the federal level has been staffed with people who know how to speak and make themselves appear blameless, but not how to act."
- The CDC (and the US Federal Government in particular) has been understaffed and underfunded for the entire duration of the Trump Administration; to expect the agency that's been gutted for 3 years to rise up to responding effectively to a pandemic seems a bit much. The CDC is not the Center for Pandemic Control; 99% of the time their goal is to optimize tests and 99% of diseases they work with are not pandemics.
- Understanding that the responses to the pandemic by federal agencies would be suboptimal, the pandemic response team was created for this very scenario to provide an "optimal" response to a pandemic. But that too was disbanded by the current administration.
Removing all the ways in which an agency is empowered to tackle a specific problem and then claiming its institutional decay doesn't sound reasonable to me. Federal agencies are hyper-specialized things and deliberately don't have the kind of "leadership" that you're looking for... that power is held by the President, as it should be. Literally any other competent president would have (re-)created the task force and empowered that to lead the response.
Per your first point, you are incorrect. From the CDC About page:
* CDC is the nation’s health protection agency, working 24/7 to protect America from health and safety threats, both foreign and domestic. CDC increases the health security of our nation.*
“Protection” is active, not passive. So yes, they are the center for pandemic control.
And if you don’t like my wording, then check out this page [0] which is the homepage for the Deputy Director for Infectious Diseases (DDID). On that page it states that “he directed CDC’s 2009 H1N1 Pandemic Vaccine Task Force”.
Finally, this funding story has been denied [1] by the CDC itself.
So yes, someone dropped the ball. I’m not mad about that (it’s a complicated environment, etc), as much as I am mad that nobody will own up to it. That lack of responsibility is why I hate politics and Washington crap in general.
I've posted this here before, so sorry about that, but in this case I think it's just so important that I belive it's justified:
The messaging around masks has been so aggravating to me that I got together with a couple of colleagues to write a detailed, scientific mini-review / commentary:
The benefit of widespread mask usage by the general population is source control [0]. This works even if the person wearing the masks makes mistakes such as touching their face more while wearing the mask.
Also, it should be obvious that there is no downside to wide-spread mask usage by the general population. The countries that have so far the most control over the virus' spread are the ones where wearing masks is normal and often done to protect others when sick.
Importantly, if the goal is source control, then all sorts of makeshift mask designs can work. People in Japan and other countries are already getting really creative [2,3].
Of course, the problem that medical personnel might face even more shortages if everybody starts wearing medical grade masks is real and must be taken seriously. But that's not the only option we have.
There is a resolution to the paradox. Masks do work (especially when worn correctly), but the net-optimal place to put them to work is keeping medical personnel up and functional.
Have spare masks? We are trying to get them to the people who need them most: https://findthemasks.com/
We are presently listing hospitals accepting small-scale donations in 28 states, growing fast.
That's not a resolution because the claim is that they're useless ("not effective"), which is not the same as there existing a better use. They could have communicated the truth, instead they chose to lie, which erodes trust.
If they’d said something like “they’re effective but it’s better for all of us if these people get them instead of you” would that have been effective?
They could have avoided making any direct comment on effectiveness and simply stated that access by medical personnel needs to be prioritized since they're the most exposed group.
TP hoarders will think: So if access to them is prioritized, they are obviously very effective, and if there is a need to prioritize, I should keep mine/get more, because I won't be able to get them later.
Except that wasn't the actual message coming from the Surgeon General. The original message appears to intentionally obscure the fact that not only does the US not have enough masks for our civilians, we also don't have enough masks for our health care professionals.
In emergency situations, it's possible misleading the public might be somewhat necessary to reach optimal health outcomes. There is substantial literature on this question with regards to climate change messaging.
The government already misleads the public when it exaggerates things like the actual threat of terrorism to the average American, at least this time it is lying with some sort of societal good in mind.
Even if we grant the premise, this is just such a dumb lie. It's universally obvious that masks work; you can look at pictures of everyone in other countries wearing masks, and the 1 second thought of "the virus has a hard time going through the mask" is substantially correct. How's anyone who realized that they lied about masks supposed to trust their other public health recommendations?
Perhaps, but it also pours gasoline on the flame of skepticism, once the cat is out of the bag and there's proof that they have lied. I.e. those decisions don't exist in a vacuum, they require (and burn) trust built in the past and decrease trust in the future. At some point it ceases to work and only makes things worse.
Agreed, I think that managing trust is important. At the same time, choices have to be made about what information to emphasize and what to not emphasize, this is inherent to communication.
I think our government's decision to emphasize to the public that masks are not completely protective and that washing your hands is a more effective intervention is probably a good one, even if it neglects the fact that masks are more helpful than not.
China has ramped their face mask production to 200 million a DAY. And
CDC’s continued insistence that face masks don’t work is disingenuous at best. Leading way to a global recession at worst.
Had they changed their guidelines to saying that face masks can help inhibit spread at the very least, especially from asymptomatic carriers who are wearing masks, US gov could have contracted mask manufacturers to with millions of dollars worth of mask orders. Spurring then to produce masks, eliminating this shortage of masks.
Instead, gov plan has no mask protocol, so the only other option is a global shutdown of “non-essential businesses”. Causing an essential shutdown of the economy. The cost of which they have obviously not calculated.
I haven’t seen any real results on whether bare virions in the air are infectious, but it certainly doesn’t sound like a major mechanism of COVID-19 infection. Certainly, when coughing, a good deal of the expelled material is visible and fairly large. And wet.
ISTM a moderately tightly woven or knit hydrophilic mask (e.g. cotton) could be quite effective. Knits could have the added benefit that droplets would need to take a twisty path to get through. And there is plenty of such material around.
This shouldn’t be that hard to study in a lab. Find a sick person, have them cough through different masks, and measure viral concentrations on nearby surfaces.
And some data back from SARS: "Always wearing a mask when going out was associated with a 70% reduction in risk compared with never wearing a mask. Wearing a mask intermittently was associated with a smaller yet significant reduction in risk."
I saw a lot of people sanctimoniously talking about fit tests in normal healthcare settings as if an imperfect fit dropped effectiveness immediately down to 0% from 100%.
Yes the truth is masks help, but officials decided to lie about this to prevent panic over lack of masks. But this is damaging not only to official credibility but also to the response. A big demand for masks in January could have forced new supply chains to develop in the west. That would have averted some of the current disaster happening where hospitals can't get masks.
I think the thing is that most people will naturally treat things qualitatively. A mask either protects you or it doesn't. A substance is either a poison or it isn't. Etc.
Something does not add up about the advice. Specially given that Eastern authorities encourage the use of makes by the general public. Which part of the World is better handling this pandemic?
If we consider a place like South Korea, or Singapore, the executive actions contrast wildly with the executive actions that our city, state, and federal governments have taken.
If I'm not mistaken, in Singapore they even went so far as to distribute packs of masks to each and every family. I don't ask for that level of efficiency, but it does illustrate an example of effective executive action during times like these.
Well, why the crap not? Why is the west so unbelievably bad at handling this epidemic? Why aren't we able to produce our own masks? These things are essential and it was all off-shored to China. Now the west is screwed while life goes on in Asia.
Actually, we do produce masks. Right here in the US.
We just didn't order up enough in the ramp up to prepare for the surge the way the government did in Singapore.
As to the question of competence, well, I guess maybe I should demand the eastern level of competence out of my leaders. But what good does it do to demand something that you know from the outset your leaders are not capable of? We have the leaders we have. I can't change that right now. The only thing we can do collectively is to try to get the best we can out of them, realizing that it's very likely their best ain't gonna be anywhere near asia level efficiency.
Maybe one of the good things to come out of this crisis will be a demand for higher quality stewards. Maybe we'll get much higher quality candidates at election time? But in all honesty, I kind of doubt it.
There was a paper that went by my Twitter feed yesterday about how dish towels tended to do better on the particulates the researchers were testing on than a t-shirt (or piece of silk, or double layer cotton shirt, or...). I agree about them being better than nothing and it'll be fairly dependent on aerosol size but you should probably prefer thicker clothes.
Dish towels and vacuum bags do a better job of filtering, but make breathing quite difficult. A simple cotton t-shirt material is fine. And there's no sign that double layers help; and they make it harder to breath as well.
Masks work, masks are low impact on daily living, masks are used successfully overseas by countries that didn't lock down their society (tawain / Singapore etc) - huge empahsis on masks including govt run websites with live maps showing where to get them, masks in all post offices for distribution etc and BIG production increases.
I was wondering the same. I'm by no means professional but it seems to be better than nothing, especially for people who sneeze.
In China, it's pretty much contained now, and everyone wears masks on the street -- The thing is, there are 1.3 billion people, of course there are a lot of people couldn't buy or afford surgical masks, let alone N95 masks.
It turns out people wear regular masks, or even they don't have any mask they sew their own mask.
Also, most surgical and N95 masks are disposable, in China, people cover their hand sewed mask outside, covering the disposable masks inside and try to reuse them, and disposes the hand-sews masks. This hack, of course, have potential risks, but it might help for people who are running out of masks.
> In China ... everyone wears masks on the street ... there are a lot of people couldn't buy or afford surgical masks, let alone N95 masks.
Sorry to nitpick, but it's N95 respirators not masks. There's be a lot of terminology confusion on this topic, and I think it's making communication significantly more difficult on this topic.
Agreed; I believe a scarf around your face will have some benefit. The CDC’s current guidance is about “respirators”, and maybe they’re not saying anything at all about plain masks or scarves, but studies posted here on HN in the last 2 days have shown some positive effectiveness for any kind of mask at all. I’ve heard first hand from a friend in Shenzhen China - where they are now back at work - that they are certain masks are effective, and the main vector is coughing and sneezing. If nothing else at all, wearing a mask can be a very helpful reminder to not touch your face.
To your last point, I would worry about that. If you are not used to it, you might want to re-adjust it quite often, and you have to take it off at some point. It is really hard to not touch your face. I probably touched it twice writing this.
Of course you take it off when you get home... so? Yes, it is hard not to touch your face, which is why having a mask on it helps you remember not to... just try it. You have to consciously reach under your mask to achieve skin to skin contact. You can easily scratch your face through your mask without touching your face. Touching your mask is not the same thing as touching your face.
I’m rather confused about this push back. Of course wearing a mask doesn’t guarantee you can’t get infected, but it’s better than not wearing one. There’s a bunch of evidence of this, in studies, and in China right now. What is there to worry about? If you’re really worried, then don’t go out.
My thought as well. The repeated consensus from gov & medical here in France seems to be that they are not effective at protecting you and that's pretty much all that they say.
YES, we get it, but what about protecting others from your cough since most people don't even know they're contagious. Even a 20% decrease from a crappy solution is interesting when dealing with exponential curves.
If the virus is mainly spread by coughing and sneezing, wouldn’t mandating absolutely everyone to wear a regular mask that covers their own cough be enough? Better than all these quarantine measures?
If you are caught without a mask you get fined.
How else can people get the virus? Perhaps people shed the virus through their skin? Or touch their face and get it on their hands? So people can wash their hands before touching their face. Also people can get it in their private homes. But those groups don’t mix all the time.
So I am just wondering... N95 masks are for the person who doesn’t want to get the virus. But what about everyone else?
I understand that you could wear the mask crooked and there are problems with application. But mass producing N95 masks and giving them out and MANDATING everyone wearing them like women in Saudi Arabia seems like a better policy.
The standard argument is that a mask may give you a false sense of safety which results in subtle behavioral changes that are a net-negative. Additionally if the mask inhibits breathing you might take deeper breaths which is also a net-negative.
That standard argument is a myth simply used to shape opinion in the context of a shortage of masks, to redirect the existing one to health care workers.
In countries where the epidemic is controlled, pretty much everybody wear masks, including handcrafted one in case of shortage. The goal is not to prevent from being infected, but to prevent infecting other, by limiting the amount of saliva you spread everywhere. Especially since tons of carriers are asymptomatic, or starting to be contagious before becoming symptomatic. And even a poor mask in front of your mouth is better than nothing, at least if everybody wears one, and if you don't become careless on other measures (distancing, washing the hands, etc.)
So there is an availability and potentially a cultural problem, but that can and should be fixed. Because this will be far less costly than infinite lockdowns.
Agreed. The US surgeon general lied to the population about the efficacy of masks to try to preserve them for healthcare workers. It would have been better to ask people to preserve N95 for healthcare workers and instead improvise their own. Any reduction in droplet transmission is going to drop the R0 of this and help flatten the curve.
Improvised masks commonly provide little protection, but obstruct breathing so people suck in more air with more force, increasing their risk of exposure.
Unless you have a study that backs this up, this is just baseless speculation. I agree with the other posters, I am incredibly frustrated with the CDC for misleading about the efficacy of surgical masks with statements like "the virus particles are smaller than the holes in the mask" - that may be true, but all the studies I could find show that masks reduce flu transmission by 70-80%.
>> It would have been better to ask people to preserve N95 for healthcare workers and instead improvise their own. Any reduction in droplet transmission is going to drop the R0 of this and help flatten the curve.
> Improvised masks commonly provide little protection, but obstruct breathing so people suck in more air with more force, increasing their risk of exposure.
The point of an improvised mask should not be to protect the wearer, but to protect the community from the wearer.
For reference, this is the recently released guide on mask usage by Chinese National Health and Medical Commission: https://zhuanlan.zhihu.com/p/114129365
Cat meme because it was reposted to Chinese Quora. Obviously consider that Asian countries have no mask shortage due to existing cultural practices. Masks should be prioritized to prevent collapse of medical capacity when there is shortage - the policy suggestion most western countries are seeing. The TL;DR of the guide: the only scenario not to wear (normal surgical) mask is when you're alone. Surgical masks for almost every other situation, N95+ for high risk situations. On efficacy for public health, The microbiologist Yuen Kwok-yung, from HK who was a key figure in SARS and one of the expert teams on Covid response:
>Given this novel coronavirus is so "cunning", with probably many infected but asymptomatic people moving around in communities, how should ordinary citizens protect themselves?
>We can only rely on telling everyone to wear a mask, wash their hands frequently, use alcoholic sanitiser. I had called for everyone to wear a mask when I was in Beijing, but many people disagreed, saying that the World Health Organisation (WHO) said healthy people don't need to wear masks unless they go to crowded places. Nevertheless, if people wear masks only when they feel sick, then the eight infected people on the Diamond Princess would have transmitted it to others because they were not feeling uncomfortable. Wear a mask to protect not only yourself but also others, because if you are infected but asymptomatic, you could still stop the spread by wearing a mask.
>In our experiments previously, we found 100 million virus strands in just one milliliter of a patient's saliva. Therefore, scenarios with the potential for exchanging saliva are generally quite dangerous. The temporary success of virus control in Hong Kong this time is not only due to population controls, but also contributed by the early advocacy for mask-wearing, hand-washing, and social distancing. Otherwise, with such a dense population in Hong Kong, the epidemic would very likely have spread the same way as in Italy or Daegu in South Korea.
(1) Home and outdoor, no people gathered, well ventilated. It is not recommended to wear a mask.
(2) Being in a crowded place, such as office, shopping, restaurant, conference room, workshop, etc .; or taking a box elevator or public transportation. In low- and medium-risk areas, it is recommended that you wear spare masks (disposable medical masks or medical surgical masks) with you, and wear them when in close contact with other people (less than or equal to 1 meter). In high-risk areas, disposable medical masks are recommended.
(3) For those with cold symptoms such as coughing or sneezing. It is recommended to wear disposable medical or surgical masks.
(4) For those who live together with those who are separated from home and discharged from rehabilitation. It is recommended to wear disposable medical or surgical masks.
Personnel in specific places
(1) It is located in densely populated hospitals, bus stations, railway stations, subway stations, airports, supermarkets, restaurants, public transportation, and community and unit import and export places. In medium and low risk areas, it is recommended that workers wear disposable medical masks or surgical surgical masks. In high-risk areas, it is recommended that workers wear medical surgical masks or protective masks that comply with KN95 / N95 and above.
(2) In prisons, nursing homes, welfare homes, mental health medical institutions, school classrooms, construction site dormitories and other densely populated places. In medium and low-risk areas, it is recommended that you always wear spare masks (disposable medical masks or surgical surgical masks) with you daily, and wear masks when people gather or come into close contact with one another (less than or equal to 1 meter). In high-risk areas, it is recommended that workers wear medical surgical masks or protective masks that comply with KN95 / N95 and above; other personnel wear disposable medical masks.
Key personnel
Suspected cases, confirmed cases, and asymptomatic infections of new coronavirus pneumonia; close contacts of new coronavirus pneumonia; immigrants (from entry to end of quarantine). It is recommended to wear medical surgical masks or protective masks without exhalation valve that conform to KN95 / N95 and above.
Occupational exposure
(1) Medical personnel such as general outpatient clinics and wards; emergency medical personnel in medical institutions in low-risk areas; administrative personnel, police, security, cleaning, etc. engaged in epidemic prevention and control. Medical surgical masks are recommended.
(2) Personnel working in the ward and ICU of patients diagnosed with a new type of coronavirus pneumonia, suspected case patients; medical staff at designated medical institutions for fever clinics; medical staff in emergency departments of medical institutions in middle and high risk areas; epidemiological investigations and experiments Room testing, environmental disinfection personnel; transfer of confirmed and suspected cases. Medical protective masks are recommended.
(3) Operators engaged in the collection of respiratory specimens; staff who perform tracheotomy, tracheal intubation, bronchoscopy, sputum suction, cardiopulmonary resuscitation, or lung transplantation, pathological anatomy in patients with new-type coronavirus pneumonia. Suggestion: hood-type (or full-type) powered air-supply filter respirator, or half-plane power-supply air-filter respirator with goggles or full screen; P100 anti-particulate filter should be used for both types of respiratory protection Elements and filter elements should not be reused. Use protective equipment after disinfection.
Masks work by trapping flu particles.
The 95 in an N95 mask is shorthand for "this masks traps 95% of particles of size .3 microns.
There are also N99 and N100.
N100 trap 99.7%. N100 when it is used in an air filter is called HEPA which I believe stands for High Efficiency Particle Attenuator or Arresting.
There is also a level above that found mostly in Europe called ULPA which pushes the decimal out further to 99.9997% . All of these aarea measure of the masks ability to trap particles of 0.3 except ULPA which is a measure of trapping particle 0.17
Masks are matted fibers designed to trap particles on their fibers. They do this using 3 mechanisms which all masks share- diffusion, impaction and inertial impaction.
Diffusion happens when a particle is so small it is in Brownian (random) motion. These particles are trapped because they constantly change direction randomly as they pass through the mask and eventually run out of luck trying to dodge fibers. Such particles are less than 0.03 microns in size. (I should inject here that even though virus are smaller than this, there's more to the story as detailed below).
Inertial impaction happens when a particle is larger than .03 and owing to its size and momentum cannot change its direction of travel fast enough to stop itself running into a fiber.
Impaction happens when a particle comes within 1/2 of its radius of a fiber and touches it, becoming trapped. This is the most difficult size of particle to capture (as it happens) and that's why its the reference particle size for safety masks.
In the above I acted as though the particles were "trying" to avoid being trapped, but of course that's just a stub for the underlying physics off motion and magnetic attraction/repulsion which underlie these facts.
If you want to DIY some sort of mask to reduce your exposure, you have to consider that the weave of most cloth is far far wider than .03 and anyway not in layers (a cloth like yarn is the exception to the second property).
Just guessing but rags scarves etc lack the required fiber density to function as safety masks. It is possible that the virions would sail through them even under Brownian motion. But that is not really how virions are transmitted- they are transmitted mixed in with saliva particles which are hugely larger than the virions themselves. The size of a particle of saliva in a sneeze was examined here- tldr: a bimodal distribution of sneeze particle size all over 50 micrometers.
So all in all we can say this-any mask covering is better than no mask because it's an odds game with virus particles and saliva.
The less able you are to breath through it, the better it functions as a barrier.
Ordinary cloth is just not woven tightly enough to substitute for a p95 mask.
If you had to choose between multiple layers of x number of fibers and a tighter weave of the same fibers, it might be better to go for a tighter weave because even though individual virions would travel under Brownian motion, that's not how a spray of sneeze which is the transport mechanism of the virus is going to travel.
Some sneeze particles containing virions have a particle size of 5 microns and will stay aloft in a still room for a long, long, long time. If someone sneezes and three minutes later you walk through where they were, you could very well become the unknowing, unwilling next host of the virus.
That last - horrifying - fact is one of the the reasons why they're telling people to maintain social distancing and just stay home.
It's not all that confusing. The science is pretty clear. The best use of masks on people in public is on the sick themselves. You can't use the standards and practices in something like a TB hospital for medical personnel in public spaces. Not only is it an inefficient use of resources, but the efficacy is in question.
You cannot expect the general population to adhere to the standards of a TB hospital. It cannot be done, even if it was a good idea. For example, standard practice is that a mask is meant to be worn for only 8 hours and that is under the assumption that you have no reason to believe you were exposed. If the mask becomes wet, damp, or if you have any reason to believe you've been exposed you're supposed to immediately doff it carefully and dispose of it. Typically PPE is used only once per exposure, or is reused for exposure to one patient at a time.
There are so many variables at play here. From the efficacy of the masks themselves, the best allocation of resources, the different varieties of masks, the techniques for proper fitting, the decontamination processes, other PPE. Does this mean masks are not useful? No. And you won't find many experts making this claim. It's clear that masks help.
Think critically about this. It is not as simple as "masks good" or "surgeon general lied." There are manifold hysterics going around -- please don't contribute to it.
Metagenomics would solve these issues. Of course we have these problems when a new disease comes along if we have to invent new diagnostics for it. Metagenomics isn’t new, you just sequence the everything and look to see what DNA/RNA is in the environment. That’s orders of magnitude more data because it doesn’t require labels, you don’t need to know in advance what you’re looking for...
The devices to do this are getting cheaper faster than Moore’s law. Just takes the will to set up the programs
In late January my wife and daughter visited Disneyland, and there were a handful of COVID-19 cases reported in SoCal around the same time. On the Sunday they were due to fly back, my daughter came down with a very strong cough (she said it was even "hurting her throat") and a high fever of around 102F. We had been following the outbreak in China and my wife called the CDC to inquire about getting her tested for COVID-19.
They said they had no ability to get her tested, that we should not be concerned at all that it might actually be COVID-19, and she should visit a clinic. The clinic said it was probably just the flu, and told her to go ahead and fly back but to wear a mask.
This was absolutely criminal incompetence on the CDC's part.
The actual title is:
How the CDC’s Restrictive Testing Guidelines Hid the Coronavirus Epidemic
This is very different from guidelines in general. Encouraging people to avoid large crowds, wash their hands and wipe surfaces, and possibly self-quarantine could have made a huge impact earlier on.
Instead, people kept going to bars, concerts, and traveling. A lot could have been done, and testing is only part of the story.
My colleagues are out of PPE and now using scarves because we are so under supplied. CDC guidelines were just changed to allow staff to be exposed to COVID patients without properly protecting themselves.
I was talking with some physicians and providers when I said that I think this will be the Chernobyl like moment of our era: where the truth is hidden from people to prevent a panic paradoxically exacerbating the current crisis. Shockingly, almost all agreed with me.
The common complications, of those initially hospitalized(note this limits our extrapolation for population), that were observed in Wuhan were ARDS, acute cardiac injury 7.2%, acute kidney injury 3.6% [1]. This is most likely analogous to having a mild heart attack(we need to read the EKG and labs here to elucidate the actual prognosis), which is still concerning because long term prognosis is usually poor. Acute kidney injury usually progresses to chronic kidney injury.
On top of both of these you're more than correct that lung function will likely decrease. This virus kills lung tissues and although we have cells that are there to heal lungs, SARS-CoV-2 tissue tropism is highest for these cells (ACE2 receptors on type II pneumocytes).
Dr. Facui is one of the most respected scientists in the medical field. He's either in the top ten or right around the top ten of the most referenced. He is the reason why HIV has killed only ~50 million people. I'm building his credibility because he has stated that he hopes we're over reacting to this [2-3].
Chernobyl was projected to kill millions. The top epidemiologists in the world projected in the most realistic scenarios that the death toll would have been in the millions prior to the quarantines. Both could have been prevented if people knew the truth well in advance of the crisis.
Call it hyperbole, but the Spanish Flu killed millions because the public was not told the truth soon enough. We were likewise told this was nothing to worry about for months, and now we have ~30%-50% of the US quarantined.
Don't you think it's more likely that the Spanish flu was so widespread because of the unhygienic conditions and stressed infrastructure caused by World War 1?
Not at all. Good sanitation is going to prevent mainly oral-fecal spread of disease, but H1N1 (Swine flu is the most recent H1N1 pandemic) is droplet/airborne spread. Hand washing and physical distancing are key here.
If you're asking about hand washing practices in that era and if that would have prevented the spread, absolutely. Hand washing attenuated SARS spread during the 2002 epidemic by roughly ~50% [1]. I am not an expert in history so I cannot speak to hand hygeine practices during that era. What current research is suggesting is that H1N1 spread was exacerbated by a lack of knowledge to the public [2]. Time and time again public health is predicated on the right knowledge given as quickly as possible; this is the most important key to almost every single disease spread[3].
because the public was not told the truth soon enough
Nobody knew the truth (as the "Spanish" moniker makes obvious). Germ theory itself was new, and viruses were unknown. In fact, a substantial effort to make a vaccine to combat the suspect bacteria resulted in actual deployment to thousands despite the fact that they had misidentified a bacterium as the culprit.
This whole corona virus episode has definitely shown one thing. US, under the current govt can’t execute. Despite claims Like “world best”, “most powerful in the world” and whatever else our leaders proclaim it’s all baseless “marketing”. as they say past performance is not a indicator of future performance in the same way we did quite well from 40s/50s onwards for a certain time and build an image based on substance what we had at the time but is now just gone. It’s all a house of cards run on decrepit systems.
CDC has there shortcomings, no doubt but let’s not forget who’s truly to blame for the mess we’re in now. The trump administration’s disbandment of federal institutions created to combat this and the ongoing denial of a serious problem have led to a collapsing economy and isolation of millions. Good article here for sure but let’s not pass the blame to the CDC. We know who to blame...
Evidence? CDC has more funding than ever. And it's a myth trump got rid of the pandemic team at NSC. They just renamed it the bioterrorism team after people left.
Still according to factcheck.org, with links to contemporaneous news articles indicates that all trump admin budgets are higher than the last obama one (fy17).
Doing some more analysis it seem that the figures you posted include emergency funding the cdc received for things like zika. These are not part of the standard budget. For example in fy16, they include retained funds for swine flu which expired. If you remove these you as the trends reported in the news.
In both links the Trump administration tried to cut the funding but Congress funded it anyway. Can't say that instills confidence in health leadership.
That said, calling the situation a hoax was beyond redemption.
Read the politifact. Trump said the accusations he hasn't responded are a hoax like the impeachment accusations. He never said covid was a hoax. Not sure why everyone keeps saying this. Its quite clear from his speech.
In the same speech he compared the projected fatalities to that of the common flu and said the press was in "hysteria mode." The message was very clearly from Trump. There's nothing to worry about.
He downplayed the threat and called the alarm bells a political hoax. That is the same thing as calling the threat a hoax even if he never denied the existence of the virus. A week later it was a national emergency.
> Morrison objected to claims that the office was “dissolved,” writing in the Post on March 16 that the administration “create[d] the counterproliferation and biodefense directorate, which was the result of consolidating three directorates into one, given the obvious overlap between arms control and nonproliferation, weapons of mass destruction terrorism, and global health and biodefense. It is this reorganization that critics have misconstrued or intentionally misrepresented.”
Why on earth would anyone believe a Trump Appointee on what happened. The administration has proven themselves time and time again to lie through their teeth. And it sure seems to me that Arms Control, Weapons of Mass Destruction don't have that much in common with Global Health. And if it did, where is that agency right now during this crisis?
This thought might comfort you, but if the only lesson we learn from this is “because Trump”, the next pandemic will be just as bad. Our regulatory agencies, our culture, our economic systems, all deserve consideration in the post mortem.
One of the problems with the hyperpartisanship in America is that it prevents people from acknowledging leadership problems that both parties share. Though I think that Trump has done an incredibly poor job of handling this crisis, there's little evidence that other leaders - in Congress, at the state level, in the media, etc. - have done any better. Of course all our leaders will want to blame other people right now - failure is an orphan, as the saying goes.
I just did a search for news articles from the end of January to the end of February, and only found articles like this one[1], where politicians are criticizing the Trump administration's communication, but aren't callng for stronger efforts or mass mobilization (and the article has a quote from Pelosi saying she has confidence in how the CDC is handling things). Congress wasn't passing legislation to fight the pandemic as things were heating up, and governors don't seem to have made effective plans. The media didn't consider it to be a major disaster until recently (it didn't get brought up in the presidential debates until a couple weeks ago, IIRC). Issues like our lack of emergency stores for things like masks and our lack of an ability to manufacture them here is an issue that goes back for years, as is the poor safety net that leaves Americans so vulnerable in times like this.
Hopefully this crisis will encourage people to look at the poor leadership America has had across the board. Simply getting rid of Trump and calling it a day is just rearranging deck chairs on the Titanic.
This is a failure of the executive branch. Congress did its job long ago. The executive branch already had the legal means it needed but the administration chose to abdicate its responsibility.
Trump cancelled flights in January and was called xenophobic by the minority leader (who cowardly deleted the tweet.) There is plenty of blame to go around. If you actually want to prevent this from happening again, problems need to be corrected beyond the hypothesis of “we elected a bad leader.”
Cancelling flights is not even remotely courageous or impactful, given that the virus was already spreading in WA at that time. After January, the Trump administration did essentially nothing productive to prepare for the coming storm and squandered the following critical 6 weeks claiming it was no worse than the seasonal flu.
There is plenty of blame to go around but it concentrates at the top.
The fact that you leap from "Trump should have done more" to "what Trump did was not impactful" shows your bias. Cancelling flights was impactful, but clearly insufficient. You're the one who is off-balance here, not me. There were systematic failures to recognize the threat from leaders and citizens alike. Regulatory structures that have been in place for decades have shown their cracks in an emergency. The CDC/FDA dumped tons of red tape on the testing process, and 'fixed' the problem by taking themselves out of the loop. The testing debacle was well underway during the timeline you mention - what does that tell you? If it only tells you "Trump fucked it up", you're not paying attention. It may be a contributing factor, but we have some real, serious problems beyond who is at the top of the executive branch. Similar weaknesses are about to be exposed in the clinical trial testing process, due to the degree to which we have culturally landed on p-values and statistical power needed to lead to action - there's a chance to correct that now, but if we're focused on Trump, and only Trump, we will fail to do so pre-emptively and it will cost more lives.
I have been preparing for this since early January, have you? If not, why not? If not, you fell into the trap almost everyone else did to fail to recognize the threat and the exponential nature of the threat. So stop throwing stones from within your glass house, and look forward. Critique the actions of leaders who are behind the curve today, not those who were behind it yesterday. The finger pointing backwards can happen later: for now, we should focus on course correction and survival.
Also, I did some more research, and it sounds like the tweet I was referencing above was in fact misinformation. So I stand corrected on that one! However, it was certainly the case that at the time flights were being called to be cancelled from China, there were accusations of xenophobia being through around.
As I said, there is plenty of blame to go around, but I am particularly incensed at a specific person who had the power to do more but essentially did nothing. In times of crisis, the quality of leadership matters tremendously. Trying to deflect by saying “the other side would have been the same” or “whatabout all these other people that failed” simply demonstrates the bias that you accuse me of.
Do you have evidence that other politicians would have handled things significantly differently? As I said, the articles I found from the beginning of the crisis don't demonstrate that. Have you found any articles from, say, the beginning of February where politicians are calling for a much more robust response? The legislative branch certainly has the ability to act when they don't think the executive branch is up to the task (they actually were embroiled with a political battle with Trump at the start of this, but it was about impeachment).
Getting rid of Trump and replacing him with someone who would have handled this much better is great. Replacing Trump with someone who would have handled things about as well, keeping all the other political leaders who dropped the ball on this, and not changing the deep structural issues that have made things worse, will do little to help.
State leadership stepped up while conservative media was echoing the president's narrative that that response was a liberal hoax. There's a stark difference between the standard response and how the president acted.
From what I gather, the CDC is also largely sweeping the Hepatitis issue under the rug (which is something of a quiet epidemic, but certainly nothing on the scale of covid19).
It disproportionately impacts the homeless. The problem appears to have started in San Diego and spread outward from there.
I'm aware of the issue because a reporter from San Diego contacted me and interviewed me via email in September 2017 because I run the San Diego Homeless Survival Guide.* Another reporter contacted me when it reached Los Angeles.
I received an email last September from something I'm subscribed to indicating it had reached Washington state, though my county was not listed.
On a per capita basis, the small town I live in has a worse homeless problem than the big cities that routinely make the news for it. If I had any real power, I would be trying to come up with the means to do a free hygiene event for the homeless and give away hand sanitizer and free haircuts and Hepatitis vaccines, something I had on my mind before covid19 became a thing.
I've seen relatively little in the press about it. I have seen at least one article about the resurgence of "Medieval diseases."
To my mind, our homeless policies are actively creating a health hazard for the entire nation. CDC policy looks to me like part of the problem. They seem to be sitting on the data about the spread of hepatitis and intentionally not making an effort to publicize it.
I imagine it will get swept under the rug entirely in the face of covid19. This seems to me like a good means to compound our problems.
Oh, data, that pesky thing. I go here, and observe rate of change (log) graphs. I ignore linear body counts, which all the headlines scream:
https://www.worldometers.info/coronavirus/
Italy is flattening and exponential growth becomes exponential decay.
Italy new cases did flatten to 3500-4000 per day for a few days this past week, but they have since resumed increasing on a daily basis. So I don't think they are out of the woods yet. It may not be exponential, but it is very much super-linear
Well, "other countries" also did the same. Spain, for example, seems to be the 3rd country with most infected and I got pneumonia about 2 weeks ago. Called the agencies here but they still didn't want to test me, even with pneumonia! Still got a cough since then and they still won't test me.
So, the US is not alone. And it does make a bit sense, I didn't require hospitalization, so makes sense they want to save the resources. But I feel like the article author could have done some better research.