The world was told by the public health apparatus, up to and including the U.S. Surgeon General, that masks were not effective. The circle was then squared by telling people to wear "face coverings" and, well, here we are.
I would have hoped that in our current age of misinformation, that sources people trusted would not actively lie, but there you go.
> I would have hoped that in our current age of misinformation, that sources people trusted would not actively lie, but there you go.
Find a meta-analysis of mask wearing to prevent infection that was published at the time. Or find some RCTs of mask wearing to prevent infection. There are lots of papers looking at infection control - it's an important part of healthcare. Have a look at how they describe the quality of evidence.
> Transmission of viruses was lower with physical distancing of 1 m or more, compared with a distance of less than 1 m (n=10 736, pooled adjusted odds ratio [aOR] 0·18, 95% CI 0·09 to 0·38; risk difference [RD] −10·2%, 95% CI −11·5 to −7·5; moderate certainty); protection was increased as distance was lengthened (change in relative risk [RR] 2·02 per m; pinteraction=0·041; moderate certainty).
Face masks only achieve "low certainty"
> Face mask use could result in a large reduction in risk of infection (n=2647; aOR 0·15, 95% CI 0·07 to 0·34, RD −14·3%, −15·9 to −10·7; low certainty), with stronger associations with N95 or similar respirators compared with disposable surgical masks or similar (eg, reusable 12–16-layer cotton masks; pinteraction=0·090; posterior probability >95%, low certainty). Eye protection also was associated with less infection (n=3713; aOR 0·22, 95% CI 0·12 to 0·39, RD −10·6%, 95% CI −12·5 to −7·7; low certainty). Unadjusted studies and subgroup and sensitivity analyses showed similar findings.
This is disingenuous. The study you cite has a large effect size with low certainty ("Face mask use could result in a large reduction in risk of infection"). Best available data was that they probably help a lot, but we don't know yet, based on data from COVID19.
At the time COVID19 broke out, we had a ton of data from flu viruses and masks. That data clearly showed masks reduced viral loads a lot.
Was it perfect data? No data is perfect, especially 3 months into a new infection. But when the anti-mask recommendations came out, they were lying.
Studies range in effect sizes, but all the ones I read in March 2020 showed significant reductions in flu infection rates with masks. There were nice studies on cloth versus surgical versus N95 at the time too (summary: surgical and N95 were similar in performance, and much better than cloth, when used without full hazmat).
We know a lot more, specific to COVID, today. But that was best available evidence in March.
If it was so well established that mask wearing's effectiveness has low certainty, then the following tweet from the US Surgeon General was definitely a lie:
"Seriously people – STOP BUYING MASKS! They are NOT effective in preventing general public from catching #Coronavirus, but if healthcare providers can’t get them to care for sick patients, it puts them and our communities at risk!"
Effectiveness doesn't just mean "can this mask trap particles?" -- because it's clear that FFP3 masks can do this. Effectiveness also means "In a particular situation with a thousand people, how many if them will be infected if none of them wear a mask, vs if all of them wear a mask?"
Healthcare professionals have to shave facial hair; they use good quality masks that are tested for conformity; they have sessions where their masks are fitted for them; they have training about how to put on, take off, and wear the mask; they have support to help them put on PPE; and they use the mask as part of a bundle of PPE that includes gowns, gloves, hand-sanitising, and eye protection.
In a healthcare situation we see that this package of measures does reduce infection. (And then we struggle to understand what's doing what because it's all a big confounded mess)
But for the public, going about day to day activity, it was really hard to see that masks would do much good.
And it's hard to do that even today: people in this thread are saying that it's obvious cloth masks do nothing but p95s are super effective. No-one can post any good quality evidence for that. All we get a some pretty rough studies that are trying to disentangle a bunch of measures to see which had most effect.
* Cloth masks reduce viral loads by somewhere around 30-70%.
* High-quality masks reduce them by e.g. 70-95% depending on how they're fitted.
* We know risk of infection (and severity) is related to viral load, but we don't quite know how.
* We have a lot of well-documented evidence from Asia about reduced infections when high-quality masks are used consistently (e.g. buses in China, hospitals in Singapore, etc.).
* We know masks significantly reduce R0, but we don't know by how much; error bars are huge, and dependent on a slew of other variables.
The key difference between public health settings and hospital settings is opportunities to be infected. As a doctor, I might have 10 opportunities per day, and if I don't have properly-fitted PPE one of those times, and I'm susceptible, I'll catch COVID19. This means half-measures do very little.
In a public health setting, it's a numbers game:
* Personal: If I have 1 opportunity per 2 weeks to be infected, and I reduce odds by 50%, I'm half as likely to catch COVID personally.
* Public health: If I reduce infection odds by 50%, R0 is cut in half. That's huge. Our exponent is very different.
So cloth masks are definitely worth the $2, but won't stop you from catching COVID if you take other risks. If everyone wore N95 or even surgical or nanofiber masks, COVID would probably be gone pretty quickly.
> If everyone wears N95 masks, the virus basically doesn't seem to spread.
I don't know about elsewhere, but at least here in Germany, it would be literally illegal for an employer to require their staff to wear N95 masks at all times. Worker protection laws mandate 30 minutes of break time without a mask for each 90 minutes worked with a mask on.
Agree of all the stupidity in this pandemic, the false equivalence implied by leadership between n95s and cloth masks has probably killed the most people counterfactually. Particularly if you assume it has led to a false sense of safety by cloth-wearers, leading them to take risky behavior like going indoors they would have avoided otherwise if their cheap masks were explained to be insufficient protection.
I tend to agree with you on this. I've got some anecdata and commentary. So obviously I'm not the CDC or a doctor so don't decide anything based on my story here.
My wife works in the hospital and employees are only given one mask a month or so and must use the hospital provided equipment. For staff that are not in the covid units, incidents of transmission and overall infection rates have been very low. For those in the covid units themselves, the infection rates are 60-70%. The PPE situation is still quite poor, gowns and face shields are being reused where in ordinary times they would be disposable.
For ordinary people without regular contact with the infected and who take reasonable precautions (modeled in my anecdata by the staff outside the covid units) I believe that the masks combined with frequent hand washing are probably pretty effective. If you're in suboptimal circumstances and in constant contact with the infected I don't know. It's hard to tell with all of the PPE reuse.
The story being told is that the cloth masks reduce spread from you to others but do not overtly protect you. I can see circumstances where improper doffing techniques could cause these to be counterproductive but overall I tend to believe this. Properly fitted N95 masks have similar protection of others but also protect you from some, but probably not all exposures.
> My wife works in the hospital and employees are only given one mask a month or so and must use the hospital provided equipment.
Really? I mean really?
N95 masks are not reusable. They have an electrostatic layer that degrades after hours of moisture from breath.
In hospitals in Asia, where this is done right, infection rates have been close to zero.
US companies have a glut of N95 mask stock right now because no one will buy them due to cheaper alternatives. In addition, tons of places produce tested N95-equivalent masks which have not gone through certification procedures.
I believe the issue is two-fold. The Hospitals have contracts etc with GPOs that often require the hospital to make most if not all of their purchases (PPE and Drugs, there is some discussion about GPOs being partially to blame for drugs shortages). If those organizations are unable to source, or unwilling to source PPE (speculation - due to market value being over contract value?) then the hospitals receive a restricted supply e.g. a shortage.
The second axis is that this is not a situation that is generally known and hospital staff are generally underrepresented politically. To whom is the Nurse Assistant or LPN to complain to about their company practices? If you complain, you risk termination etc. Given that most took the vaccine the issue is partially mooted but still remains.
1) The vaccine doesn't prevent you from catching COVID19; it prevents symptoms. Your body fights it off. We know nothing about how it impacts long COVID or spread. I mean, we know it reduces them, but is it a 10% effect? 90%? If hospital staff are spreading COVID to patients, we've got a problem.
2) Vaccinated people in contact with non-vaccinated is how you get vaccine-resistant mutations.
We need vaccines and proper masks, especially in hospitals.
If there's an issue like that, it seems like an anonymous complaint might help. Letters to newspapers, regulators, and hospital leadership, all cc:ed so they know others have received them, outlining that:
- Proper masks are available: links to US plants having overstock, new technologies (e.g. Korean nanofiber)
- Used N95 masks don't work
- Reuse of N95 at the institution
That puts a lot of pressure on leadership to address the issue. Enforcement actions usually go nowhere if an issue was already resolved by the time the agency gets there, and it's a lot cheaper to deal with early rather than late.
1. I haven't seen that idea claimed anywhere. 'Most','very many'???
2. There was a great shortage of N95s for hospitals for a long time. (Let alone 'nursing'-home death-traps, where 33% of US deaths - 179,000 - have occurred. [0]) Sterilization methods took months to emerge.
3. Consider how dense viruses get in IC units, compared to retail locations.
I saw an article the other day saying they'd given the FFP3 (out N95 equivalent) masks to the nurses in the ICU where patients are on ventilators, but the nurses dealing with the less sick patients just had surgical masks. Unfortunately, the less sick ones were up and about, coughing everywhere, not connected to machines to regulate their breathing and so those coughs are going into the air. Sadly lots of NHS staff have died.
If everyone wore masks with proper filters, we might be done by now.
The world seems too dumb to notice the difference between a piece of cloth and a proper filter.
If everyone wears N95 masks, the virus basically doesn't seem to spread.