6 ms·

The masks issue is different because we have very little actual evidence that masks in the hands of the general public have a substantial effect. The best evide

by timr 5y ago

The masks issue is different because we have very little actual evidence that masks in the hands of the general public have a substantial effect. The best evidence out there suggests a small impact (~11%) for surgical masks in an unvaccinated population, and none for cloth masks [1] The evidence quality is roughly as poor as that for ivermectin, vitamin D, etc., except that it has become a wildly political issue, fraught with propaganda to the point that most people will vehemently insist that the evidence quality is higher than it is. It is therefore deeply ironic that Slate is arguing about risk compensation, while using NPIs as an example of the kind of safety behavior being deterred by discussions of risk compensation. Did any of those NPIs do anything at all? We never did proper randomized studies, so we really have no idea. This feels like so much more propaganda: one side said that risk compensation is a thing, so now we must attack the notion, to ensure that $MY_PREFERRED_INTERVENTION is properly imposed on society. But nobody much cares if the intervention works... [1] https://vinayprasadmdmph.substack.com/p/do-masks-reduce-risk-of-covid19-by https://vinayprasadmdmph.substack.com/p/do-masks-reduce-risk...

Ensorceled 5y ago
The masks are secondary to the issue of refusing to acknowledge the high probability of airborne transmission. People were washing their hands, using hand sanitizer, opening doors with crazy key-chains, basically not touching anything, wearing gloves, fist and elbow bumping ... when they really needed to not be breathing each others air.
- timr 5y ago
  Yeah, that was definitely part of it too. It was plausible for a minute there that surface transmission was real, but then it took way too long for the CDC and the WHO to admit it. So now, even today, I see people wearing dirty rubber gloves in the grocery store (sigh). There's simply no part of this pandemic that makes "the experts" look good, and it has utterly destroyed any remaining faith that I had in journalism. Now we merely have competing ideological factions, and their preferred sources of propaganda.
  - maxerickson 5y ago
    Yeah, it's totally the fault of the CDC that people continue to do things that don't make sense. Totally a top down problem, all they had to do was get the messaging right and no one would have done anything wildly incoherent for the entire pandemic.
    - Ensorceled 5y ago
      No one is asserting that the CDC/Health Canada mis-steps are the lone cause of the disastrous response to COVID.
      - maxerickson 5y ago
        So now, even today, I see people wearing dirty rubber gloves in the grocery store (sigh). That sentence is about CDC messaging. There would be people wearing dirty rubber gloves in grocery stores if they did it perfect.
        Ensorceled 5y ago
        Again, NO ONE is asserting that the CDC messaging is causing all the problems. But it was, and id, certainly contributing to it.
        timr 5y ago
        If the CDC and the WHO and "the experts" hadn't spent months flooding the airwaves with the message that people should be scared of fomites, while ignoring aerosols? I think that might have played a role, yes.
  - geoduck14 5y ago
    >So now, even today, I see people wearing dirty rubber gloves in the grocery store (sigh). A month ago, I was judgemental towards a couple who were "overly protective" about the virus. It turns out they did REALLY risky stuff, and they were "overly protective" to protect me. Maybe the people in the grocery store with gloves have open wounds and don't want to spread infected blood around.
mikeyouse 5y ago
Vinay does a big disservice to that 53% number and is in my opinion, extraordinarily dishonest about the 10% number. He says; > Interestingly, in the only published cluster RCT to date during COVID19, surgical masks had an 11% risk reduction and cloth masks had no effect at all on the primary endpoint of symptom driven lab positive result The actual study showed that with intervention, the scientists increased the rate of mask wearing from 13% to 42% -- and that 29/100 person uptake was enough to reduce Covid seropresence by 11% in the community. That's a huge effect! Fewer than half of the people in the villages were wearing masks and symptomatic Covid saw >10% reduction compared to villages without extra mask wearing. It's abundantly clear that the effect would be far greater with universal masking so to say "mask wearing only leads to a 10% reduction" omits a massive part of the story. https://www.poverty-action.org/sites/default/files/publications/Mask_RCT____Symptomatic_Seropositivity_083121.pdf https://www.poverty-action.org/sites/default/files/publicati... To quote the authors who tried in vain to prevent people like Vinay from mangling their research: > Our results should not be taken to imply that masks can prevent only 10% of COVID-19 cases, let alone 10% of COVID-19 mortality. Our intervention induced 29 more people out of every 100 to wear masks, with 42% of people wearing masks in total. The total impact with near universal masking–perhaps achievable with alternative strategies or stricter enforcement–may be several times larger than our 10% estimate. Additionally, the intervention reduced symptomatic seroprevalence more when surgical masks were used, and even more for the highest-risk individuals in our sample (23% for ages 50-60 and 35% for ages 60+). These numbers likely give a better sense of the impact of our intervention on severe morbidity and mortality, since most of the disease burden is borne by the elderly. Where achievable, universal mask adoption is likely to have still larger impacts.
- timr 5y ago
  > The actual study showed that with intervention, the scientists increased the rate of mask wearing from 13% to 42% -- and that 29/100 person uptake was enough to reduce Covid seropresence by 11% in the community. That's a huge effect! No, it isn't. Because he's being generous: the 11% difference was on a baseline seroprevalence of 0.76%. So you have a study where cloth masks were shown to be completely ineffective, and the total absolute effect size of the surgical mask arm was .08% (edit: 0.09% per the numbers in the paper). In other words: you'd have to get 1300 people to wear masks to prevent one seropositive (in case you're wondering, the confidence interval on that value overlaps zero.) No matter how you spin it, this is a small, small effect. And this is in a completely unvaccinated population -- the best possible scenario for masks. Even if we accept the argument that "several times more" people would be protected if we lived in a fictional, ideal universe where everyone wore surgical masks (newsflash: we don't), we're still only talking about a total effect size of a fraction of a percent. Oh and by the way, it's particularly hilarious that the paragraph you quoted says the following: > Additionally, the intervention reduced symptomatic seroprevalence more when surgical masks were used That has to go in my top-five lifetime examples of weasel-wording for reframing negative experimental outcomes. Cloth masks showed no effect. Saying that surgical masks reduced prevalence "more" is like saying that together, Ootani Shohei and I hit 46 home runs last year. But yeah, he hit more.
dendriti 5y ago
if you are getting your medical information from a substack page, I don't think anything anyone here will convince you otherwise... pointing out elsewhere in the thread that when the CDC fucked up, they ultimately admitted it and changed recommendations, does not support your argument.
- timr 5y ago
  The "substack page" is written by a doctor and professor at UCSF who specializes in clinical trials, evidence-based medicine and medical reversals.
  - CamperBob2 5y ago
    If this pandemic has proven anything at all, it's that incompetent and/or corrupt doctors are a dime a dozen. Pick any intervention, no matter how counterproductive, implausible, or just plain stupid, and you can probably find a fully-accredited MD somewhere who's evangelizing it from the rooftops. Medical doctors are not scientists, or even engineers. They are more like highly-skilled technicians. NTTAWWT, but the MD degree by itself shouldn't bring individual doctors anywhere as much social and scientific credibility as it does. For most Americans, the best source of information on COVID has been, and remains, their public health authorities.
    - zpeti 5y ago
      > If this pandemic has proven anything at all, it's that incompetent and/or corrupt doctors are a dime a dozen. Not sure which side of the argument you are on, but it's funny, did you see how the death count for vaccinated people on the 22,000 pfizer study has been corrected from 17 to 24 people? And the FDA has asked for 76 years to ongoingly release the safety data on the vaccine? I'm vaccinated, but I'm super angry and worried about wtf is going on here. What's certain is, yes: If this pandemic has proven anything, it's that there are incompetent and corrupt people EVERYWHERE on ALL SIDES.
      - CamperBob2 5y ago
neilwilson 5y ago
On a fundamental level the recommendation is the wrong way around as a matter of basic physics. Filters work better under suction than pressure - because they are less likely to leak. So why have a nonsensical system where everybody has to wear a mask properly all the time and change it regularly in the correct manner just to have any material effect, when an individual that is worried could just wear a better one that filters inbound properly and everybody gets to do what they want. What's interesting about this is the psychology of why intelligent people have swallowed this. Do they believe the mask is filtering inbound when it isn't? Or is it entirely political - signalling membership of a group to others. Or is it that the perennially worried believe they should have the right to tell others what they can and can't do, when there is a perfectly reasonably 'live and let live' option available. Why choose a position that divides society when there is one that brings people together?
- FeepingCreature 5y ago
  I've always heard it as masks being more to protect others during the time where you're infectious but largely asymptomatic. At any rate, you can't prove you're uninfected easily - but masks are trivial to validate.
  - neilwilson 5y ago
    Why do you need to 'protect others' if their mask works inbound? You have no idea whether you are 'protecting others' or just creating plastic waste for no good reason. Clearly masks are not trivial to validate given that there is no evidence they have any positive effect whatsoever in the real world. No deflection in rates can be seen from NPIs and the process leaks like crazy. It's entirely a backward belief. Believing you are 'protecting others', yet doing nothing to protect yourself against the almost certain risk that other people won't be 'protecting others'. None of it makes any sense in any logical analysis.
    - FeepingCreature 5y ago
      > Why do you need to 'protect others' if their mask works inbound? Huh? You need to protect others because masks (mostly) don't work inbound, that's what I'm saying. (But do work outbound.) > Clearly masks are not trivial to validate given that there is no evidence they have any positive effect Sorry, restate: the presence of masks is trivial to validate.
clairity 5y ago
it's dismaying to see a reasoned (if countervailing) position being so reflexively suppressed, and maddening to witness the mass hysteria still buttressing ineffective mandated interventions like public masking. the only places outside of healthcare settings where masking plausibly makes any difference for ordinary folks is at home (amongst friends/family) and in crowded indoor social gatherings (club, house party, etc.). a modicum of physical distancing is all that's need in most public places to minimize tranmission risk about as much as is possible. combine that with masking public-facing workers (like cashiers), and we've maxed out the potential of masking as an intervention. everything else is theater.
jacquesm 5y ago
11% (just adopting the number from your comment, no idea if that is the real figure) is huge. It would turn a spread 1.05 into one of 0.94 assuming that number has a direct impact like that. That's the difference between 'out of control' and 'decreasing to the point where we can start doing contact tracing'. That's exactly what is wrong with all these discussions, the cost of wearing a mask is negligible compared the potential cost of not wearing a mask: so wear a mask. It doesn't matter if it is proven to help yet or not, the fact that it may help and won't harm is the only thing that matters when deciding whether or not you should wear one. As for the rest of your comment, the evidence quality for Ivermectin is substantially lower than that, so low that it drowns in the noise and is essentially a complete wash, and there are substantial downsides to using it in quantity.
- timr 5y ago
  > 11% (just adopting the number from your comment, no idea if that is the real figure) is huge. It would turn a spread 1.05 into one of 0.94 assuming that number has a direct impact like that. No, because that's not what the 11% number was measuring. You can't just take an 11% relative reduction in population seroprevalence at a given time, and then blindly multiply the virus R0 by that factor. They observed a drop in symptomatic seroprevalence that corresponded to about 1 case for for every 1300 people who wore a mask. That is nowhere near an 11% drop in R0 (which you'll recall is an exponent). > That's exactly what is wrong with all these discussions, the cost of wearing a mask is negligible compared the potential cost of not wearing a mask: How do you know? Have you measured it? No, of course you haven't. You're just asserting things. > so wear a mask. It doesn't matter if it is proven to help yet or not, the fact that it may help and won't harm is the only thing that matters when deciding whether or not you should wear one. Fine. You should take Ivermectin, then. And vitamin D. And flush your sinuses daily with a neti pot. And get your chakra aligned. It's essentially the same argument. Can't hurt, might help! By your logic, it all must be done. ...or do you just pick-and-choose which unsupported interventions you prefer to believe in? (for the record: I do not believe you should take Ivermectin. But it is the same argument.) > the evidence quality for Ivermectin is substantially lower than that, It really isn't. Just like mask studies, there are a few weakly suggestive good ones, and a few bad ones that make ridiculous claims, and a whole lot of nonsense in between. > there are substantial downsides to using it in quantity. No, not really. It's a pretty common, safe drug. We probably know more about the downsides of Ivermectin than we do about the downsides of (say) masking young children in school.
twic 5y ago
Striking that the only reply in this thread which refers to actual data is the one which is downvoted. More than a political issue, for many, mask-wearing has taken on something like religious significance.
- duckmysick 5y ago
  Does it? It's a link to a Substack article with some numbers, but no actual data. Not even the links or names of the papers and articles. At first I thought it was a stylistic choice, but the author does link his own whitepaper from the Cato institute. There's also a thought experiment, which is convenient, since the outcome is open to everyone's interpretation. But it's not actual data.

by timr 5y ago

Ensorceled 5y ago

The masks are secondary to the issue of refusing to acknowledge the high probability of airborne transmission. People were washing their hands, using hand sanitizer, opening doors with crazy key-chains, basically not touching anything, wearing gloves, fist and elbow bumping ... when they really needed to not be breathing each others air.

timr 5y ago
Yeah, that was definitely part of it too. It was plausible for a minute there that surface transmission was real, but then it took way too long for the CDC and the WHO to admit it. So now, even today, I see people wearing dirty rubber gloves in the grocery store (sigh). There's simply no part of this pandemic that makes "the experts" look good, and it has utterly destroyed any remaining faith that I had in journalism. Now we merely have competing ideological factions, and their preferred sources of propaganda.
- maxerickson 5y ago
  Yeah, it's totally the fault of the CDC that people continue to do things that don't make sense. Totally a top down problem, all they had to do was get the messaging right and no one would have done anything wildly incoherent for the entire pandemic.
  - Ensorceled 5y ago
    No one is asserting that the CDC/Health Canada mis-steps are the lone cause of the disastrous response to COVID.
    - maxerickson 5y ago
      So now, even today, I see people wearing dirty rubber gloves in the grocery store (sigh). That sentence is about CDC messaging. There would be people wearing dirty rubber gloves in grocery stores if they did it perfect.
      - Ensorceled 5y ago
        Again, NO ONE is asserting that the CDC messaging is causing all the problems. But it was, and id, certainly contributing to it.
      - timr 5y ago
        If the CDC and the WHO and "the experts" hadn't spent months flooding the airwaves with the message that people should be scared of fomites, while ignoring aerosols? I think that might have played a role, yes.
- geoduck14 5y ago
  >So now, even today, I see people wearing dirty rubber gloves in the grocery store (sigh). A month ago, I was judgemental towards a couple who were "overly protective" about the virus. It turns out they did REALLY risky stuff, and they were "overly protective" to protect me. Maybe the people in the grocery store with gloves have open wounds and don't want to spread infected blood around.

mikeyouse 5y ago

Vinay does a big disservice to that 53% number and is in my opinion, extraordinarily dishonest about the 10% number. He says; > Interestingly, in the only published cluster RCT to date during COVID19, surgical masks had an 11% risk reduction and cloth masks had no effect at all on the primary endpoint of symptom driven lab positive result The actual study showed that with intervention, the scientists increased the rate of mask wearing from 13% to 42% -- and that 29/100 person uptake was enough to reduce Covid seropresence by 11% in the community. That's a huge effect! Fewer than half of the people in the villages were wearing masks and symptomatic Covid saw >10% reduction compared to villages without extra mask wearing. It's abundantly clear that the effect would be far greater with universal masking so to say "mask wearing only leads to a 10% reduction" omits a massive part of the story. https://www.poverty-action.org/sites/default/files/publications/Mask_RCT____Symptomatic_Seropositivity_083121.pdf https://www.poverty-action.org/sites/default/files/publicati... To quote the authors who tried in vain to prevent people like Vinay from mangling their research: > Our results should not be taken to imply that masks can prevent only 10% of COVID-19 cases, let alone 10% of COVID-19 mortality. Our intervention induced 29 more people out of every 100 to wear masks, with 42% of people wearing masks in total. The total impact with near universal masking–perhaps achievable with alternative strategies or stricter enforcement–may be several times larger than our 10% estimate. Additionally, the intervention reduced symptomatic seroprevalence more when surgical masks were used, and even more for the highest-risk individuals in our sample (23% for ages 50-60 and 35% for ages 60+). These numbers likely give a better sense of the impact of our intervention on severe morbidity and mortality, since most of the disease burden is borne by the elderly. Where achievable, universal mask adoption is likely to have still larger impacts.

timr 5y ago
> The actual study showed that with intervention, the scientists increased the rate of mask wearing from 13% to 42% -- and that 29/100 person uptake was enough to reduce Covid seropresence by 11% in the community. That's a huge effect! No, it isn't. Because he's being generous: the 11% difference was on a baseline seroprevalence of 0.76%. So you have a study where cloth masks were shown to be completely ineffective, and the total absolute effect size of the surgical mask arm was .08% (edit: 0.09% per the numbers in the paper). In other words: you'd have to get 1300 people to wear masks to prevent one seropositive (in case you're wondering, the confidence interval on that value overlaps zero.) No matter how you spin it, this is a small, small effect. And this is in a completely unvaccinated population -- the best possible scenario for masks. Even if we accept the argument that "several times more" people would be protected if we lived in a fictional, ideal universe where everyone wore surgical masks (newsflash: we don't), we're still only talking about a total effect size of a fraction of a percent. Oh and by the way, it's particularly hilarious that the paragraph you quoted says the following: > Additionally, the intervention reduced symptomatic seroprevalence more when surgical masks were used That has to go in my top-five lifetime examples of weasel-wording for reframing negative experimental outcomes. Cloth masks showed no effect. Saying that surgical masks reduced prevalence "more" is like saying that together, Ootani Shohei and I hit 46 home runs last year. But yeah, he hit more.

dendriti 5y ago

if you are getting your medical information from a substack page, I don't think anything anyone here will convince you otherwise... pointing out elsewhere in the thread that when the CDC fucked up, they ultimately admitted it and changed recommendations, does not support your argument.

timr 5y ago
The "substack page" is written by a doctor and professor at UCSF who specializes in clinical trials, evidence-based medicine and medical reversals.
- CamperBob2 5y ago
  If this pandemic has proven anything at all, it's that incompetent and/or corrupt doctors are a dime a dozen. Pick any intervention, no matter how counterproductive, implausible, or just plain stupid, and you can probably find a fully-accredited MD somewhere who's evangelizing it from the rooftops. Medical doctors are not scientists, or even engineers. They are more like highly-skilled technicians. NTTAWWT, but the MD degree by itself shouldn't bring individual doctors anywhere as much social and scientific credibility as it does. For most Americans, the best source of information on COVID has been, and remains, their public health authorities.
  - zpeti 5y ago
    > If this pandemic has proven anything at all, it's that incompetent and/or corrupt doctors are a dime a dozen. Not sure which side of the argument you are on, but it's funny, did you see how the death count for vaccinated people on the 22,000 pfizer study has been corrected from 17 to 24 people? And the FDA has asked for 76 years to ongoingly release the safety data on the vaccine? I'm vaccinated, but I'm super angry and worried about wtf is going on here. What's certain is, yes: If this pandemic has proven anything, it's that there are incompetent and corrupt people EVERYWHERE on ALL SIDES.
    - CamperBob2 5y ago

neilwilson 5y ago

On a fundamental level the recommendation is the wrong way around as a matter of basic physics. Filters work better under suction than pressure - because they are less likely to leak. So why have a nonsensical system where everybody has to wear a mask properly all the time and change it regularly in the correct manner just to have any material effect, when an individual that is worried could just wear a better one that filters inbound properly and everybody gets to do what they want. What's interesting about this is the psychology of why intelligent people have swallowed this. Do they believe the mask is filtering inbound when it isn't? Or is it entirely political - signalling membership of a group to others. Or is it that the perennially worried believe they should have the right to tell others what they can and can't do, when there is a perfectly reasonably 'live and let live' option available. Why choose a position that divides society when there is one that brings people together?

FeepingCreature 5y ago
I've always heard it as masks being more to protect others during the time where you're infectious but largely asymptomatic. At any rate, you can't prove you're uninfected easily - but masks are trivial to validate.
- neilwilson 5y ago
  Why do you need to 'protect others' if their mask works inbound? You have no idea whether you are 'protecting others' or just creating plastic waste for no good reason. Clearly masks are not trivial to validate given that there is no evidence they have any positive effect whatsoever in the real world. No deflection in rates can be seen from NPIs and the process leaks like crazy. It's entirely a backward belief. Believing you are 'protecting others', yet doing nothing to protect yourself against the almost certain risk that other people won't be 'protecting others'. None of it makes any sense in any logical analysis.
  - FeepingCreature 5y ago
    > Why do you need to 'protect others' if their mask works inbound? Huh? You need to protect others because masks (mostly) don't work inbound, that's what I'm saying. (But do work outbound.) > Clearly masks are not trivial to validate given that there is no evidence they have any positive effect Sorry, restate: the presence of masks is trivial to validate.

clairity 5y ago

it's dismaying to see a reasoned (if countervailing) position being so reflexively suppressed, and maddening to witness the mass hysteria still buttressing ineffective mandated interventions like public masking. the only places outside of healthcare settings where masking plausibly makes any difference for ordinary folks is at home (amongst friends/family) and in crowded indoor social gatherings (club, house party, etc.). a modicum of physical distancing is all that's need in most public places to minimize tranmission risk about as much as is possible. combine that with masking public-facing workers (like cashiers), and we've maxed out the potential of masking as an intervention. everything else is theater.

jacquesm 5y ago

11% (just adopting the number from your comment, no idea if that is the real figure) is huge. It would turn a spread 1.05 into one of 0.94 assuming that number has a direct impact like that. That's the difference between 'out of control' and 'decreasing to the point where we can start doing contact tracing'. That's exactly what is wrong with all these discussions, the cost of wearing a mask is negligible compared the potential cost of not wearing a mask: so wear a mask. It doesn't matter if it is proven to help yet or not, the fact that it may help and won't harm is the only thing that matters when deciding whether or not you should wear one. As for the rest of your comment, the evidence quality for Ivermectin is substantially lower than that, so low that it drowns in the noise and is essentially a complete wash, and there are substantial downsides to using it in quantity.

timr 5y ago
> 11% (just adopting the number from your comment, no idea if that is the real figure) is huge. It would turn a spread 1.05 into one of 0.94 assuming that number has a direct impact like that. No, because that's not what the 11% number was measuring. You can't just take an 11% relative reduction in population seroprevalence at a given time, and then blindly multiply the virus R0 by that factor. They observed a drop in symptomatic seroprevalence that corresponded to about 1 case for for every 1300 people who wore a mask. That is nowhere near an 11% drop in R0 (which you'll recall is an exponent). > That's exactly what is wrong with all these discussions, the cost of wearing a mask is negligible compared the potential cost of not wearing a mask: How do you know? Have you measured it? No, of course you haven't. You're just asserting things. > so wear a mask. It doesn't matter if it is proven to help yet or not, the fact that it may help and won't harm is the only thing that matters when deciding whether or not you should wear one. Fine. You should take Ivermectin, then. And vitamin D. And flush your sinuses daily with a neti pot. And get your chakra aligned. It's essentially the same argument. Can't hurt, might help! By your logic, it all must be done. ...or do you just pick-and-choose which unsupported interventions you prefer to believe in? (for the record: I do not believe you should take Ivermectin. But it is the same argument.) > the evidence quality for Ivermectin is substantially lower than that, It really isn't. Just like mask studies, there are a few weakly suggestive good ones, and a few bad ones that make ridiculous claims, and a whole lot of nonsense in between. > there are substantial downsides to using it in quantity. No, not really. It's a pretty common, safe drug. We probably know more about the downsides of Ivermectin than we do about the downsides of (say) masking young children in school.

twic 5y ago

Striking that the only reply in this thread which refers to actual data is the one which is downvoted. More than a political issue, for many, mask-wearing has taken on something like religious significance.

duckmysick 5y ago
Does it? It's a link to a Substack article with some numbers, but no actual data. Not even the links or names of the papers and articles. At first I thought it was a stylistic choice, but the author does link his own whitepaper from the Cato institute. There's also a thought experiment, which is convenient, since the outcome is open to everyone's interpretation. But it's not actual data.