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It should have been, but strangely even public health officials were very recently advocating strongly against masks unless you had symptoms. No one has ever ab

It should have been, but strangely even public health officials were very recently advocating strongly against masks unless you had symptoms. No one has ever able to explain to me why symptoms were relevant in any way given that many or most carriers are asymptomatic. Even the WHO continues to advise against wearing masks for "healthy" people (i.e., presumed asymptomatic carriers).

rapind 6y ago
Careful you don't contradict the WHO or you might get banned from the internet by Google...
macintux 6y ago
To me, completely untrained in medicine, their guidance seems much more nuanced than you suggest. https://apps.who.int/iris/rest/bitstreams/1274280/retrieve https://apps.who.int/iris/rest/bitstreams/1274280/retrieve (pdf)
- bobbydroptables 6y ago
  It doesn't seem very nuanced to me: > However, there is currently no evidence that wearing a mask (whether medical or other types) by healthy persons in the wider community setting, including universal community masking, can prevent them from infection with respiratory viruses, including COVID-19. There is plenty of evidence that masks help. It could be argued that some is contradictory but it's not "no evidence". I guess you could argue they are correct in the asinine point that it doesn't "prevent them from infection" in every case. Ignoring that I'm not sure that makes sense grammatically, are they just trying to say that no masks provide complete protection? It's true that no single method or equipment provides complete protection. It's a layered network of protections that we need to use to lower the transmission rate. Masks are a very important layer in that system, along with hand washing, quarantines, goggles and contact tracing. Hand washing doesn't help you either if an infected person coughs into your open mouth.
  - macintux 6y ago
    The argument to this point in the thread was about preventing transmission from the mask-wearer, which is where the more nuanced take is.
    - bobbydroptables 6y ago
      The asymptomatic point goes to both directions. I don't know who I need protection from as an uninfected person and I don't know when I need to wear a mask to protect others as a potential asymptomatic carrier. Which more nuanced text are you referring to?
      - macintux 6y ago
        In addition to these factors, potential advantages of the use of mask by healthy people in the community setting include reducing potential exposure risk from infected person during the “pre-symptomatic” period and stigmatization of individuals wearing mask for source control. However, the following potential risks should be carefully taken into account in any decision-making process: • self-contamination that can occur by touching and reusing contaminated mask • depending on type of mask used, potential breathing difficulties • false sense of security, leading to potentially less adherence to other preventive measures such as physical distancing and hand hygiene • diversion of mask supplies and consequent shortage of mask for health care workers • diversion of resources from effective public health measures, such as hand hygiene Whatever approach is taken, it is important to develop a strong communication strategy to explain to the population the circumstances, criteria, and reasons for decisions. The population should receive clear instructions on what masks to wear, when and how (see mask management section), and on the importance of continuing to strictly follow all other IPC measures (e.g., hand hygiene, physical distancing, and others).
- ggrrhh_ta 6y ago
  That's at least the fourth version, look for the archived recommendations in January, February and March, the April one is the first one to touch upon all the aspects directly and more honestly.
  - macintux 6y ago
    Ok, but the key word in the parent was “still”. That pdf dates back to early April. (Sorry, “continues”.)
specialist 6y ago
Inertia. I recently changed my position to "surgical masks for everyone, N95 respirators for people at risk." I'm immunosuppressed. Transplant when I was a kid. For 30+ years, I had it pounded into my head that surgical masks will not protect me. Especially if I share a space with others for longer than 30 minutes. Because exhaled water vapor saturates the mask and then air comes around the sides. This is still true. What's new is understanding that surgical masks protects everyone else from me. I think it's called "source prevention". IIRC, infected people wearing masks cuts risk of transmission by 70%. And because people can be asymptomatic for up to 14 days, that means everyone should be wearing masks. Just in case. WHO, CDC, others were not "wrong". Just out of date. It takes longer than instantaneous transmission for best available science to percolate out. Especially in a noisy environment. Sure, we westerners could have been more proactive about adopting practices from societies who'd already adapted. But the hard data is still very fresh. Further, none of the advice, messaging was making a distinction between masks and respirators AND many people hoarded respirators AND healthcare workers haven't gotten the N95 PPE they need. Of all the things which went sideways, the suboptimal advice on masks, now since revised, isn't even in the top 10. Dwelling on it while we're still not taking the steps to end social distancing seems premature. There will be plenty of time to apportion blame later.
- bobbydroptables 6y ago
  >Transplant when I was a kid. For 30+ years, I had it pounded into my head that surgical masks will not protect me. Especially if I share a space with others for longer than 30 minutes. Because exhaled water vapor saturates the mask and then air comes around the sides. This is not exactly right. It is correct that no mask (not even an N95) provides complete protection. But surgical masks do provide significant protection. As an immunocompromised individual, I want the best protection money can buy of course. But this is different than saying that surgical masks don't protect you, which is incorrect. >WHO, CDC, others were not "wrong". Just out of date. It takes longer than instantaneous transmission for best available science to percolate out. Especially in a noisy environment. Well, they were wrong. Masks protect in both directions, obviously. I can point you to the science on this if you're in doubt. But a simple way to think about it is why do doctors wear surgical masks in the Covid ward when N95's are unavailable? The answer is simple some filtration is better than no filtration. >But the hard data is still very fresh. It's not. Most of what we know about masks came from research in the early 2000's after SARS. >Further, none of the advice, messaging was making a distinction between masks and respirators AND many people hoarded respirators AND healthcare workers haven't gotten the N95 PPE they need. Another common misconception. Hoarding had basically nil effect on this. I understand that governments have tried to blame hoarders for their own failure to stockpile before this happened, but it's not actually based in reality. Average people started buy masks at a higher pace in January and February which pretty much instantly cleared out any store inventory. By the way, this store inventory has basically nil impact on the availability of respirators for the millions of healthcare workers in the country. Before regular stores could be refreshed, hospitals and governments commandeered the supply chains for all quality respirators. A normal person buying a surgical mask these days has zero effect on the ability of hospital staff to get them. >Of all the things which went sideways, the suboptimal advice on masks, now since revised, isn't even in the top 10. Dwelling on it while we're still not taking the steps to end social distancing seems premature. There will be plenty of time to apportion blame later. What else is in your top 10. The lies about masks are very close to the top for me. The only thing worse would be the WHO loudly proclaiming there was no evidence of human to human spread when we all knew (including the WHO) that human to human spread was likely happening by then. The WHO had already briefed world leaders on that. Why didn't they tell the public?
rtkwe 6y ago
A lot of the early don't wear masks was a lot more about preserving supply for people like hospital and other critical personnel that needed to continue working and had no way to avoid or distance from infected people. There's no real way I can think of to say 'yes masks are effective but you shouldn't get them because we need them for doctors' that doesn't wind up with more people buying masks and deeper shortages early.
- bobbydroptables 6y ago
  Problem with this idea was twofold: 1. It completely misunderstands the supply chain. By the time this message was out there, masks were already mostly sold out in retail places. Even a slight increase in demand will cause that because of JIT manufacturing. Anyway, by that time the healthcare system and the government had already taken over the supply chain for all new masks. And obviously hospitals don't buy masks from Home Depot 2. In fighting any emergent public health crisis, the number one thing you need is the public's trust. Why destroy it for essentially no gain.

rapind 6y ago

Careful you don't contradict the WHO or you might get banned from the internet by Google...

macintux 6y ago

To me, completely untrained in medicine, their guidance seems much more nuanced than you suggest. https://apps.who.int/iris/rest/bitstreams/1274280/retrieve https://apps.who.int/iris/rest/bitstreams/1274280/retrieve (pdf)

bobbydroptables 6y ago
It doesn't seem very nuanced to me: > However, there is currently no evidence that wearing a mask (whether medical or other types) by healthy persons in the wider community setting, including universal community masking, can prevent them from infection with respiratory viruses, including COVID-19. There is plenty of evidence that masks help. It could be argued that some is contradictory but it's not "no evidence". I guess you could argue they are correct in the asinine point that it doesn't "prevent them from infection" in every case. Ignoring that I'm not sure that makes sense grammatically, are they just trying to say that no masks provide complete protection? It's true that no single method or equipment provides complete protection. It's a layered network of protections that we need to use to lower the transmission rate. Masks are a very important layer in that system, along with hand washing, quarantines, goggles and contact tracing. Hand washing doesn't help you either if an infected person coughs into your open mouth.
- macintux 6y ago
  The argument to this point in the thread was about preventing transmission from the mask-wearer, which is where the more nuanced take is.
  - bobbydroptables 6y ago
    The asymptomatic point goes to both directions. I don't know who I need protection from as an uninfected person and I don't know when I need to wear a mask to protect others as a potential asymptomatic carrier. Which more nuanced text are you referring to?
    - macintux 6y ago
      In addition to these factors, potential advantages of the use of mask by healthy people in the community setting include reducing potential exposure risk from infected person during the “pre-symptomatic” period and stigmatization of individuals wearing mask for source control. However, the following potential risks should be carefully taken into account in any decision-making process: • self-contamination that can occur by touching and reusing contaminated mask • depending on type of mask used, potential breathing difficulties • false sense of security, leading to potentially less adherence to other preventive measures such as physical distancing and hand hygiene • diversion of mask supplies and consequent shortage of mask for health care workers • diversion of resources from effective public health measures, such as hand hygiene Whatever approach is taken, it is important to develop a strong communication strategy to explain to the population the circumstances, criteria, and reasons for decisions. The population should receive clear instructions on what masks to wear, when and how (see mask management section), and on the importance of continuing to strictly follow all other IPC measures (e.g., hand hygiene, physical distancing, and others).
ggrrhh_ta 6y ago
That's at least the fourth version, look for the archived recommendations in January, February and March, the April one is the first one to touch upon all the aspects directly and more honestly.
- macintux 6y ago
  Ok, but the key word in the parent was “still”. That pdf dates back to early April. (Sorry, “continues”.)

specialist 6y ago

Inertia. I recently changed my position to "surgical masks for everyone, N95 respirators for people at risk." I'm immunosuppressed. Transplant when I was a kid. For 30+ years, I had it pounded into my head that surgical masks will not protect me. Especially if I share a space with others for longer than 30 minutes. Because exhaled water vapor saturates the mask and then air comes around the sides. This is still true. What's new is understanding that surgical masks protects everyone else from me. I think it's called "source prevention". IIRC, infected people wearing masks cuts risk of transmission by 70%. And because people can be asymptomatic for up to 14 days, that means everyone should be wearing masks. Just in case. WHO, CDC, others were not "wrong". Just out of date. It takes longer than instantaneous transmission for best available science to percolate out. Especially in a noisy environment. Sure, we westerners could have been more proactive about adopting practices from societies who'd already adapted. But the hard data is still very fresh. Further, none of the advice, messaging was making a distinction between masks and respirators AND many people hoarded respirators AND healthcare workers haven't gotten the N95 PPE they need. Of all the things which went sideways, the suboptimal advice on masks, now since revised, isn't even in the top 10. Dwelling on it while we're still not taking the steps to end social distancing seems premature. There will be plenty of time to apportion blame later.

bobbydroptables 6y ago
>Transplant when I was a kid. For 30+ years, I had it pounded into my head that surgical masks will not protect me. Especially if I share a space with others for longer than 30 minutes. Because exhaled water vapor saturates the mask and then air comes around the sides. This is not exactly right. It is correct that no mask (not even an N95) provides complete protection. But surgical masks do provide significant protection. As an immunocompromised individual, I want the best protection money can buy of course. But this is different than saying that surgical masks don't protect you, which is incorrect. >WHO, CDC, others were not "wrong". Just out of date. It takes longer than instantaneous transmission for best available science to percolate out. Especially in a noisy environment. Well, they were wrong. Masks protect in both directions, obviously. I can point you to the science on this if you're in doubt. But a simple way to think about it is why do doctors wear surgical masks in the Covid ward when N95's are unavailable? The answer is simple some filtration is better than no filtration. >But the hard data is still very fresh. It's not. Most of what we know about masks came from research in the early 2000's after SARS. >Further, none of the advice, messaging was making a distinction between masks and respirators AND many people hoarded respirators AND healthcare workers haven't gotten the N95 PPE they need. Another common misconception. Hoarding had basically nil effect on this. I understand that governments have tried to blame hoarders for their own failure to stockpile before this happened, but it's not actually based in reality. Average people started buy masks at a higher pace in January and February which pretty much instantly cleared out any store inventory. By the way, this store inventory has basically nil impact on the availability of respirators for the millions of healthcare workers in the country. Before regular stores could be refreshed, hospitals and governments commandeered the supply chains for all quality respirators. A normal person buying a surgical mask these days has zero effect on the ability of hospital staff to get them. >Of all the things which went sideways, the suboptimal advice on masks, now since revised, isn't even in the top 10. Dwelling on it while we're still not taking the steps to end social distancing seems premature. There will be plenty of time to apportion blame later. What else is in your top 10. The lies about masks are very close to the top for me. The only thing worse would be the WHO loudly proclaiming there was no evidence of human to human spread when we all knew (including the WHO) that human to human spread was likely happening by then. The WHO had already briefed world leaders on that. Why didn't they tell the public?

rtkwe 6y ago

A lot of the early don't wear masks was a lot more about preserving supply for people like hospital and other critical personnel that needed to continue working and had no way to avoid or distance from infected people. There's no real way I can think of to say 'yes masks are effective but you shouldn't get them because we need them for doctors' that doesn't wind up with more people buying masks and deeper shortages early.

bobbydroptables 6y ago
Problem with this idea was twofold: 1. It completely misunderstands the supply chain. By the time this message was out there, masks were already mostly sold out in retail places. Even a slight increase in demand will cause that because of JIT manufacturing. Anyway, by that time the healthcare system and the government had already taken over the supply chain for all new masks. And obviously hospitals don't buy masks from Home Depot 2. In fighting any emergent public health crisis, the number one thing you need is the public's trust. Why destroy it for essentially no gain.