6 ms·

.NET Rocks did a great Geek Out podcast on that which explained it in layman's terms - https://www.dotnetrocks.com/?show=1720 https://www.dotnetrocks.com/?show=

.NET Rocks did a great Geek Out podcast on that which explained it in layman's terms - https://www.dotnetrocks.com/?show=1720 https://www.dotnetrocks.com/?show=1720 If I recall, the CDC was recommending treatment that worked against past similar viruses. This one turned out to be spread in a completely different way than typical.

wutbrodo 5y ago
This excuse doesn't make any sense. Their messaging at the time was "masks aren't effective, plus we need them for healthcare workers to care for pandemic patients". If they're not effective, why would healthcare workers need them? Higher viral loads put you at higher risk, but the messaging decidedly wasn't that masks are only protective at high viral loads. Let alone the incredibly basic prior on respiratory diseases' vector being limited by _covering up the sources of spread_. The initial recommendation, the flip-flop, and attempts to explain it away have been universally incoherent, because the real reason is that the CDC and FDA combine the worst of the federal government's bureaucratic inefficiency with medical culture's innumeracy and blind status quo bias. Leaving aside the failures of pandemic preparedness stretching back multiple administrations (the PPE stockpile had been depleted since 2013, and I don't need to describe the trump admin's failures..), it would have been trivial to do what we eventually did, and what many other countries did: recommend face coverings of any sort, and encourage people to save n95s for medical personnel. The insane route we ended up taking had people hoarding n95s anyway and deeply poisoned the well of trust in public health authorities in general and masks in particular (helped along by our president).
- caddemon 5y ago
  They also at one point early on said that wearing a mask if you have COVID can prevent you from spreading it, it just won't protect you from getting it at all. This was simultaneous with the recommendation that laymen not wear masks, but also with the recommendation that everyone should behave as if they have COVID because of asymptomatic spread. The messaging not only raised red flags based on both Asian SARS experience and just using common sense, it was also internally contradictory.
- ff317 5y ago
  > masks aren't effective, plus we need them for healthcare workers to care for pandemic patients I noted this at the time as well, but I read it (perhaps between the lines a bit) as more like: masks probably help, but if you all go panic-buy masks like you do TP, there will be none left for healthcare workers, who need them more than you do.
  - wutbrodo 5y ago
    That's possible, but the route we went with got us the worst of both worlds. There were gov'ts that simply told the entire country to use scarves or sew string to cloth and put it over their mouth. Lying about the efficacy of all masks to preserve a specific kind is just about the stupidest approach to the problem I can imagine. Note that even if your theory is correct, it also means that public health authorities have been continually lying to us after their mask flip-flop, with the Surgeon General claiming in April that it's because they didn't know asymptomatic transmission was possible. This is, of course, horseshit, as there were Chinese reports of asymptomatic transmission as early as January. The only theory which fits all the evidence is the one I laid out: asymptomatic transmission did not have a solid, high-quality study behind it yet, and medical culture has serious problems doing anything but rounding priors and weak evidence down to "zero evidence" instead of doing the difficult work of choosing the best option under uncertainty. It's ludicrous to claim that telling people to put scarves over their face would deplete , and that this cost-benefit suddenly flipped the moment the level of evidence for mask efficacy rose from "no-brainer if you're capable of modeling uncertainty" to "has a specific high-quality study supporting it in narrow conditions".
    - ummonk 5y ago
      "The only theory which fits all the evidence is the one I laid out: asymptomatic transmission did not have a solid, high-quality study behind it yet, and medical culture has serious problems doing anything but rounding priors and weak evidence down to "zero evidence" instead of doing the difficult work of choosing the best option under uncertainty." Yup. See also how long it took before the medical community came around to accepting that it's an airborne virus, despite very early evidence from China and South Korea to that effect.
- DanBC 5y ago
  > Their messaging at the time was "masks aren't effective, plus we need them for healthcare workers to care for pandemic patients". If they're not effective, why would healthcare workers need them? Isn't it simple statistics? If you're on a ward with 10 people who are ill and coughing at you you'll need a mask. If you're walking about in the street, not getting closer than 2m to anyone, and not spending much time in close proximity to anyone, the mask isn't doing much.
  - wutbrodo 5y ago
    > Isn't it simple statistics? If you're on a ward with 10 people who are ill and coughing at you you'll need a mask. I addressed this in my comment: > Higher viral loads [and longer exposure] put you at higher risk, but the messaging decidedly wasn't that masks are only protective at high viral loads. Let alone the incredibly basic prior on respiratory diseases' vector being limited by _covering up the sources of spread_. "Medical workers need masks more because they have more exposure" is not the same thing as "masks don't work for the general public", and brazenly and badly lying to the public has costs that have been demonstrable throughout the pandemic (helped along by our dear insane President over the course of the pandemic). > If you're walking about in the street, not getting closer than 2m to anyone, and not spending much time in close proximity to anyone, the mask isn't doing much. This is a general-purpose argument which explains away the existence of community spread, which we know was happening (33m US cases later...). Especially given what we now know about air vs surface transmission, people were clearly spreading it to each other last spring in ways that masks would have mitigated. Knowing what we now know about the difficulty of outdoor spread, people by definition were not universally adhering to what you're describing. Leaving aside the non-compliant (some portion of whom would have worn masks despite violating indoor gathering guidelines), many people were unable to avoid this: nursing homes, grocery stores, meatpacking plants, and all manner of essential workers[1] were clearly enough to drive robust spread. [1] Here's a list of just how expansive the "essential worker" category was in NYS: https://www.lawandtheworkplace.com/2020/03/new-york-state-mandates-that-non-essential-workers-must-stay-home/#:~:text=New%20York%20State%20Mandates%20That%20Non%2DEssential%20Workers%20Must%20Stay%20Home,-By%20Arielle%20E&text=Beginning%20Sunday%2C%20March%2022%2C%202020,utilize%20an%20in%2Dperson%20workforce https://www.lawandtheworkplace.com/2020/03/new-york-state-ma.... (Note that I don't mean that as a criticism, just a note that your postulated world of 100% of people never coming within 2m of anyone, including outside, is not reflective of reality)
- mcguire 5y ago
  1. Convincing the public to wear effective masks, correctly and consistently was known to be very difficult. Still is. 2. Most epidemiologists it the US, at least, believed that corona- and similar viruses were transmitted by larger droplets generated by coughing or sneezing. These droplets would not remain airborne long, resulting in the advice for social distancing and surface cleaning. The "flip-flop" occurred very shortly after it was demonstrated that they were transmitted by aerosol particles. 3. This event primarily demonstrates the difficulty of communicating science---a "this is the best advice we can give now based on our limited understanding" is treated as permanent, universal truth by the general public; any later changes in that advice is "insane" and "deeply poisons the well" of trust.
  - Izkata 5y ago
    > 2. Most epidemiologists it the US, at least, believed that corona- and similar viruses were transmitted by larger droplets generated by coughing or sneezing. These droplets would not remain airborne long, resulting in the advice for social distancing and surface cleaning. The "flip-flop" occurred very shortly after it was demonstrated that they were transmitted by aerosol particles. That makes even less sense, masks only stop the heavier droplets. The virus is small enough to go right through cloth masks when aerosols, or get carried out the sides of surgical marks by your breath. But I remember the aerosol realization happening around summer/fall last year, way after the mask flip-flop anyway.
    - mcguire 5y ago
      Masks are the only thing that might stop aerosols, which remain airborne for a long period of time.
      - Izkata 5y ago
        How? As aerosols you need an N95 mask to actually filter them out: * The virus is small enough that they go right through regular cloth masks; the theory on these was that the cloth masks would catch the too-large-to-pass-through droplets and the virus would get stuck inside the droplet. * Aerosols are as light as and easily carried by the air, which is why they hang in the air for a long period. Because they're so easily carried by the air, any mask that your breath can escape the sides of, such as a surgical mask, will carry the aerosolized virus out the sides without catching it. It's the same phenomena that stops butterflies from hitting car windows [0]. The larger droplets are like the denser bugs that aren't carried safely away by the air, those will get caught by these masks. Really, ventilation is the best way to deal with aerosols. Open a window and get them out of the room entirely. [0] https://physics.stackexchange.com/questions/631854/how-can-a-butterfly-dodge-the-windshield-of-a-fast-moving-car https://physics.stackexchange.com/questions/631854/how-can-a...
caddemon 5y ago
My understanding is that it is not atypical for SARS though? I thought that was the main reason Asia was big on masks, which should have suggested that we ought to at least consider masks. My guess is it was some combination of uncertainty about effectiveness in the general public and wanting masks to be available for healthcare workers, so they ran with the messaging they did. IMO if they didn't want to make a statement that could lead to hoarding in the early days they should have just said nothing about masks until production was ramped up. Masks are such a minimally invasive preventative measure that given uncertainty about their effectiveness you would normally err on the side of encouraging.
- mcguire 5y ago
  The other downside of such statements is excessive belief: "wearing medical-grade masks correctly might help" is understood as "wearing anything over your face will provide perfect protection".
  - caddemon 5y ago
    Can you point to any countries that encouraged mask use where that ended up being the general sentiment? It's not like encouraging mask use means restrictions on shopping, dining, etc. wouldn't also exist. Besides, you could make the same argument for something like wearing a helmet while bike riding. I'm sure there are situations where false peace of mind is a problem, but I don't see why we should assume mask wearing would be one of them. At the time they were obviously operating with limited information, but it's crazy to me that people continue to defend the early pandemic mask messaging. They screwed up, it happens, but it should be acknowledged and there should be a post mortem.
    - mcguire 5y ago
      Most "N95" masks that are generally available (i.e. those from Home Depot) have the rubber flapper valves for exhalation. Think they do anything much useful medically? How many people have you seen wearing clear plastic face shields or bandannas tied around their face like Ol' West banditos, with the bottom open? How about with the mask pulled down below their nose? (Disclaimer: I did that the other day; I was at the optometrist and my breath was fogging up the lens thingy.) The early pandemic mask messaging was wrong. A postmortem might very well find that they made the best recommendations they could based on what they knew.[1] Unless you've already decided that they screwed up because they're lying idiots. [1] See https://news.ycombinator.com/item?id=26138301 https://news.ycombinator.com/item?id=26138301: "(I note that there was a meeting of epidemiologists in March, 2020, where famously, no one wore masks. How far are you willing to to go to lie?)"
ummonk 5y ago
That's not true. Masks have worked against other viruses too - it's just something the western epidemiological community has always been slow to adopt, despite empirical evidence.

wutbrodo 5y ago

This excuse doesn't make any sense. Their messaging at the time was "masks aren't effective, plus we need them for healthcare workers to care for pandemic patients". If they're not effective, why would healthcare workers need them? Higher viral loads put you at higher risk, but the messaging decidedly wasn't that masks are only protective at high viral loads. Let alone the incredibly basic prior on respiratory diseases' vector being limited by _covering up the sources of spread_. The initial recommendation, the flip-flop, and attempts to explain it away have been universally incoherent, because the real reason is that the CDC and FDA combine the worst of the federal government's bureaucratic inefficiency with medical culture's innumeracy and blind status quo bias. Leaving aside the failures of pandemic preparedness stretching back multiple administrations (the PPE stockpile had been depleted since 2013, and I don't need to describe the trump admin's failures..), it would have been trivial to do what we eventually did, and what many other countries did: recommend face coverings of any sort, and encourage people to save n95s for medical personnel. The insane route we ended up taking had people hoarding n95s anyway and deeply poisoned the well of trust in public health authorities in general and masks in particular (helped along by our president).

caddemon 5y ago
They also at one point early on said that wearing a mask if you have COVID can prevent you from spreading it, it just won't protect you from getting it at all. This was simultaneous with the recommendation that laymen not wear masks, but also with the recommendation that everyone should behave as if they have COVID because of asymptomatic spread. The messaging not only raised red flags based on both Asian SARS experience and just using common sense, it was also internally contradictory.
ff317 5y ago
> masks aren't effective, plus we need them for healthcare workers to care for pandemic patients I noted this at the time as well, but I read it (perhaps between the lines a bit) as more like: masks probably help, but if you all go panic-buy masks like you do TP, there will be none left for healthcare workers, who need them more than you do.
- wutbrodo 5y ago
  That's possible, but the route we went with got us the worst of both worlds. There were gov'ts that simply told the entire country to use scarves or sew string to cloth and put it over their mouth. Lying about the efficacy of all masks to preserve a specific kind is just about the stupidest approach to the problem I can imagine. Note that even if your theory is correct, it also means that public health authorities have been continually lying to us after their mask flip-flop, with the Surgeon General claiming in April that it's because they didn't know asymptomatic transmission was possible. This is, of course, horseshit, as there were Chinese reports of asymptomatic transmission as early as January. The only theory which fits all the evidence is the one I laid out: asymptomatic transmission did not have a solid, high-quality study behind it yet, and medical culture has serious problems doing anything but rounding priors and weak evidence down to "zero evidence" instead of doing the difficult work of choosing the best option under uncertainty. It's ludicrous to claim that telling people to put scarves over their face would deplete , and that this cost-benefit suddenly flipped the moment the level of evidence for mask efficacy rose from "no-brainer if you're capable of modeling uncertainty" to "has a specific high-quality study supporting it in narrow conditions".
  - ummonk 5y ago
    "The only theory which fits all the evidence is the one I laid out: asymptomatic transmission did not have a solid, high-quality study behind it yet, and medical culture has serious problems doing anything but rounding priors and weak evidence down to "zero evidence" instead of doing the difficult work of choosing the best option under uncertainty." Yup. See also how long it took before the medical community came around to accepting that it's an airborne virus, despite very early evidence from China and South Korea to that effect.
DanBC 5y ago
> Their messaging at the time was "masks aren't effective, plus we need them for healthcare workers to care for pandemic patients". If they're not effective, why would healthcare workers need them? Isn't it simple statistics? If you're on a ward with 10 people who are ill and coughing at you you'll need a mask. If you're walking about in the street, not getting closer than 2m to anyone, and not spending much time in close proximity to anyone, the mask isn't doing much.
- wutbrodo 5y ago
  > Isn't it simple statistics? If you're on a ward with 10 people who are ill and coughing at you you'll need a mask. I addressed this in my comment: > Higher viral loads [and longer exposure] put you at higher risk, but the messaging decidedly wasn't that masks are only protective at high viral loads. Let alone the incredibly basic prior on respiratory diseases' vector being limited by _covering up the sources of spread_. "Medical workers need masks more because they have more exposure" is not the same thing as "masks don't work for the general public", and brazenly and badly lying to the public has costs that have been demonstrable throughout the pandemic (helped along by our dear insane President over the course of the pandemic). > If you're walking about in the street, not getting closer than 2m to anyone, and not spending much time in close proximity to anyone, the mask isn't doing much. This is a general-purpose argument which explains away the existence of community spread, which we know was happening (33m US cases later...). Especially given what we now know about air vs surface transmission, people were clearly spreading it to each other last spring in ways that masks would have mitigated. Knowing what we now know about the difficulty of outdoor spread, people by definition were not universally adhering to what you're describing. Leaving aside the non-compliant (some portion of whom would have worn masks despite violating indoor gathering guidelines), many people were unable to avoid this: nursing homes, grocery stores, meatpacking plants, and all manner of essential workers[1] were clearly enough to drive robust spread. [1] Here's a list of just how expansive the "essential worker" category was in NYS: https://www.lawandtheworkplace.com/2020/03/new-york-state-mandates-that-non-essential-workers-must-stay-home/#:~:text=New%20York%20State%20Mandates%20That%20Non%2DEssential%20Workers%20Must%20Stay%20Home,-By%20Arielle%20E&text=Beginning%20Sunday%2C%20March%2022%2C%202020,utilize%20an%20in%2Dperson%20workforce https://www.lawandtheworkplace.com/2020/03/new-york-state-ma.... (Note that I don't mean that as a criticism, just a note that your postulated world of 100% of people never coming within 2m of anyone, including outside, is not reflective of reality)
mcguire 5y ago
1. Convincing the public to wear effective masks, correctly and consistently was known to be very difficult. Still is. 2. Most epidemiologists it the US, at least, believed that corona- and similar viruses were transmitted by larger droplets generated by coughing or sneezing. These droplets would not remain airborne long, resulting in the advice for social distancing and surface cleaning. The "flip-flop" occurred very shortly after it was demonstrated that they were transmitted by aerosol particles. 3. This event primarily demonstrates the difficulty of communicating science---a "this is the best advice we can give now based on our limited understanding" is treated as permanent, universal truth by the general public; any later changes in that advice is "insane" and "deeply poisons the well" of trust.
- Izkata 5y ago
  > 2. Most epidemiologists it the US, at least, believed that corona- and similar viruses were transmitted by larger droplets generated by coughing or sneezing. These droplets would not remain airborne long, resulting in the advice for social distancing and surface cleaning. The "flip-flop" occurred very shortly after it was demonstrated that they were transmitted by aerosol particles. That makes even less sense, masks only stop the heavier droplets. The virus is small enough to go right through cloth masks when aerosols, or get carried out the sides of surgical marks by your breath. But I remember the aerosol realization happening around summer/fall last year, way after the mask flip-flop anyway.
  - mcguire 5y ago
    Masks are the only thing that might stop aerosols, which remain airborne for a long period of time.
    - Izkata 5y ago
      How? As aerosols you need an N95 mask to actually filter them out: * The virus is small enough that they go right through regular cloth masks; the theory on these was that the cloth masks would catch the too-large-to-pass-through droplets and the virus would get stuck inside the droplet. * Aerosols are as light as and easily carried by the air, which is why they hang in the air for a long period. Because they're so easily carried by the air, any mask that your breath can escape the sides of, such as a surgical mask, will carry the aerosolized virus out the sides without catching it. It's the same phenomena that stops butterflies from hitting car windows [0]. The larger droplets are like the denser bugs that aren't carried safely away by the air, those will get caught by these masks. Really, ventilation is the best way to deal with aerosols. Open a window and get them out of the room entirely. [0] https://physics.stackexchange.com/questions/631854/how-can-a-butterfly-dodge-the-windshield-of-a-fast-moving-car https://physics.stackexchange.com/questions/631854/how-can-a...

caddemon 5y ago

My understanding is that it is not atypical for SARS though? I thought that was the main reason Asia was big on masks, which should have suggested that we ought to at least consider masks. My guess is it was some combination of uncertainty about effectiveness in the general public and wanting masks to be available for healthcare workers, so they ran with the messaging they did. IMO if they didn't want to make a statement that could lead to hoarding in the early days they should have just said nothing about masks until production was ramped up. Masks are such a minimally invasive preventative measure that given uncertainty about their effectiveness you would normally err on the side of encouraging.

mcguire 5y ago
The other downside of such statements is excessive belief: "wearing medical-grade masks correctly might help" is understood as "wearing anything over your face will provide perfect protection".
- caddemon 5y ago
  Can you point to any countries that encouraged mask use where that ended up being the general sentiment? It's not like encouraging mask use means restrictions on shopping, dining, etc. wouldn't also exist. Besides, you could make the same argument for something like wearing a helmet while bike riding. I'm sure there are situations where false peace of mind is a problem, but I don't see why we should assume mask wearing would be one of them. At the time they were obviously operating with limited information, but it's crazy to me that people continue to defend the early pandemic mask messaging. They screwed up, it happens, but it should be acknowledged and there should be a post mortem.
  - mcguire 5y ago
    Most "N95" masks that are generally available (i.e. those from Home Depot) have the rubber flapper valves for exhalation. Think they do anything much useful medically? How many people have you seen wearing clear plastic face shields or bandannas tied around their face like Ol' West banditos, with the bottom open? How about with the mask pulled down below their nose? (Disclaimer: I did that the other day; I was at the optometrist and my breath was fogging up the lens thingy.) The early pandemic mask messaging was wrong. A postmortem might very well find that they made the best recommendations they could based on what they knew.[1] Unless you've already decided that they screwed up because they're lying idiots. [1] See https://news.ycombinator.com/item?id=26138301 https://news.ycombinator.com/item?id=26138301: "(I note that there was a meeting of epidemiologists in March, 2020, where famously, no one wore masks. How far are you willing to to go to lie?)"

ummonk 5y ago

That's not true. Masks have worked against other viruses too - it's just something the western epidemiological community has always been slow to adopt, despite empirical evidence.