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Last year, more people in San Francisco died of overdoses than of Covid-19 (economist.com)
129 points by rblion on May 19, 2021 | hide | past | favorite | 166 comments


I live here and to anyone who doesn’t know san francisco this might help explain why I am not surprised (and probably anyone living here isn’t as well):

- Everybody wears a mask here. Everyone. Even vaccinated people and children. It’s taken extremely seriously. And I’m not even talking about social distancing. Everything has been closed since the beginning of the virus and indoor dining is merely re-opening.

- san francisco has the largest homeless population I’ve seen in the world (and I’ve traveled and lived in a bit everywhere in the world including many poor countries). On top of that, drug is hitting homeless people hard. It’s extremely common to see someone shooting themselves with a syringe here.


I don’t know what’s going on here either with masks.

30-50 year old adults outside, alone, in direct sunlight, exercising, dozens of feet away from anyone else are still wearing masks. No doubt they’re fully vaccinated by now as well.

And multiple times a day you see people driving alone in cars wearing masks.

Just the other week, we overheard a young girl commenting on a woman not wearing a mask, “she’s a bad person, isn’t she mommy?” “No, she’s not a bad person, just inconsiderate”, the mother replied. This was in response to a fully vaccinated adult walking in a state park alone, in broad daylight, 3-4x father away than social distancing guidelines require.

I’m glad we took COVID seriously here earlier and longer than most states, but now that several states are reporting 0 deaths and vaccination rates are climbing the fear of an explosion of cases should hopefully be subsiding.

In the beginning comparing mental health to a potentially uncontrolled global pandemic I think was a serious misunderstanding of how exponential growth works, but now that the pandemic is getting under control it makes sense to weigh mental health more heavily.


This is what you get when things like mask wearing start to become more of a social display than a rational decision. Most of the actual evidence shows outdoor infection to be close to zero, unless you’re close up at a concert or bus stop.

But now mask wearing is some sort of way of displaying that you are a good person. It’s also a way for frustrated people who want to control others and be outraged to be able to vent their frustration at other people, in a socially acceptable way.

It’s not good. And I say this as someone who’s worn a mask for a year now. I’m not against them. But they’re not being worn for rational reasons any more.


How do you tell from the outside it's not for rational reasons?

I don't see how wearing a mask is irrational just because it may not be critically necessary. It doesn't measurably inconvenience me to keep my mask on, and I don't have to think about when I do need to put it on, so even a marginal safety benefit may be worth it.


> How do you tell from the outside it's not for rational reasons?

Look at the data.

However, I agree with you, whoever wants to wear a mask can. Just don’t expect others to wear one too. Your own paranoia does not mean you get to tell others what to do.


> Look at the data.

The way that the death rate in SF is very low comparatively suggests that overshooting with social policy has been very effective.

Those "performative displays of mask wearing in public when it isn't really necessary" actually worked.

Wearing masks when you don't have to produced social pressure towards wearing masks all the time and when it was more necessary and that turns out to have saved lives.

They should start unwinding that now, but it'll take a few months.

For all the people who fixate on the fact that "its not necessary" -- yes, it was, because humans aren't rational like you think they should be. Yep, we're often just "sheep" and "follow the herd", but the "irrational" policies in SF saved lives.

Looking at the graphs of the SF metro area they did about as good as Seattle metro did even though SF is more densely packed. They were way better than Dallas and saved a lot of lives compared to LA.


> They should start unwinding that now, but it'll take a few months.

How do you determine when the right point to start unwinding it is? Just glancing at random new-cases-in-SF graphs on google, we're somewhat better off than 1 year ago, but not like by an order of magnitude. Based on that, I think I'll want to keep wearing a mask and avoid people who aren't wearing masks where not too troublesome, for now.


SF is down to 3.9 new cases per 100,000 per day from a peak of 53.9, it is already going to be silly to be wearing masks while walking around in public away from crowds. You were never going to catch coronavirus from walking past someone who had it (which is one reason why the protests were not significant sources of spread). I seriously doubt that masks outside in SF serve any purpose right now in SF.

And the rate is still declining, at some point it'll be under 1 in 100,000 which would be 3,300 cases per day across the united states. I doubt we can achieve a lot better than that given that there's 883 million outpatient visits per year (CDC stats) with 1% of them for influenza like illness in the summertime which is a 24,000/day minimum rate. Having 10% of that background be coronavirus is probably the lowest it'll go.

There's always going to be some level of coronavirus spread, but if you're vaccinated and the level of spread is where its at now in SF then you need to be more worried about getting T-boned by an Escalade (particularly the way people blow red lights in SF).

So the people in this thread are correct. The time to unwind is pretty much now. At the same time they're unreasonable to expect everyone to just instantly drop everything because they're failing to account for the way people behave (and particularly when the strategy has been successful for the past ~15 months).


And here's a good graph:

https://covidactnow.org/share/36630/?redirectTo=%2Fus%2Fmetr...

(think you may need to scroll up)

That compares SF to Orlando, Miami and LA. And SF includes Oakland in that graph (SF County's numbers are slightly lower).

That is for all the "then how do you explain how Florida did so much better?" people. Florida-vs-California looks better because SF is actually a bit of an island in this case.


That graph makes it look like Miami, Orlando and San Francisco are all about the same. Which is kind of the point, that masks maybe didn't really help.


The alleged paranoia is not one unless herd immunity is verified, and effective against upcoming variants from abroad.

Precautionary principle gives it a few months of wait time after that research, to ensure it's valid and repeated.


That would make sense if masks protected me, but that’s not how they work. Masks are not protective of the wearer, they protect the wearer from spreading to others.

The research is months old on this. It seems pretty valid to me, and to public health agencies issuing guidance.

Also from basic logical principles, if vaccinated then masks don’t do much of anything.

I don’t think you owe anyone your rationale for why you wear a mask, but it’s irrational to expect others to wear masks when they are past the point of usefulness. Or to hold negative opinions of people who don’t wear masks.

If anything, wearing masks using faulty logic is something that should be avoided. As trying to avoid all illogical things.


Trying to avoid illogical things isn't in itself logical. Not accounting for people acting irrationally isn't rational.

Your argument from logical principle presupposes that vaccinated people wearing masks is 100% useless. I don't think that's right, eg. wearing a mask isn't 100% useless for protecting yourself, vaccination doesn't provide 100% certainty that you aren't carrying/spreading the virus, and even wearing masks purely performatively may induce unvaccinated people to wear masks. You may be correct in discounting that because of statistical arguments and low probabilities, but at that point you are making some sort of risk/benefit judgement call and not a purely logic-driven conclusion.


Good point, I’m not arguing that something is 100% useless. Just that there is not high enough marginal utility to be worthwhile.

Vaccines aren’t 100% effective, so obviously a mask worn by someone who is vaccinated but infected will reduce their ability to infect others.

I think you’re right that I’m arguing about a risk/benefit calculus and that the specific result is that the benefits of masks+vaccines are not high enough to outweigh the costs.

But I think this is driven from the logical basis of how masks work, how vaccines work, public health interventions work, etc.

Many people misunderstand masks and they they are protective for the wearer. Or they think masks give greater protection, etc.


Covid is not the only thing masks help to prevent /contain.

Most people wear a mask in SF because they want to, not because they have to. You are free to not were them if you like, no one is going to stop you .

I wear it and then forget about it, it is lot more hassle to remember to remove in some contexts sometimes that means wearing while driving alone. It doesn't bother me, not sure why people get winded about it.


Tip: All the people engaging in ad hominem based arguments against people wearings masks are under the thrall of normalcy bias. What annoys them about people wearing masks is it's hard in their face that other people don't believe things are normal.


I think they're also a bit under the thrall of being a bit on the spectrum and expecting everyone in the world to be terminally online and to behave like Spock all the time.

(And I pretty much am all those things, but I don't expect everyone else in the world to be)


I had people on here saying some pretty nasty things to me for suggesting that while social distancing is good, having a mask on when outside and more than 6 ft apart is unnecessary.

I wonder if they realize how they're proving all the "virtue signaling" critics right.


I don't think virtue signalling explains the phenomenon fully. There seems to be another large group: people who are just over-cautious and not willing to take any amount of risk.

I have several friends/family members who struggle with anxiety and COVID has been overwhelming for them. One of them (fully vaccinated) said they know the chance of infection after vaccination is less than 0.1%, but it's not a risk they're willing to take. I know their viewpoint isn't rational, but I empathize with it much more than the virtue signalers.


Or they just look at the risk-to-effort ratio. We're talking about wearing a mask here not some tough commitment. I'd wear a mask for 0.1%. I also look both ways before crossing a one way street. I'm not going to force someone else to do it, but I'll take 0.1% for free.


Maybe you don’t see the social and communication value of seeing someone’s face, I do.

Maybe you don’t live somewhere where the temperature is 30 degree Celsius plus often, at which point wearing a mask is a very different UX to colder weather.


My summer was 40C. It's ok if you find it uncomfortable. Not everyone does.

From communication point of view, I do care and want to normalise wearing masks whenever you want. I'm totally using one when I need to go shopping and not feeling great.


Masks are not created equally. proper N95s are an order of magnitude more effective than cloth at protecting yourself.

Putting on a cloth mask outdoors is like wearing a helmet while driving on the highway.


What percent has society gotten worse from the lost trust due to less communication information from masks?

What percent have mental health issues increased due to less oxytocin from less hugs?

What percent has society gotten worse from people being suspicious of others that perhaps they are infected?

That 0.1% you speak of might have much bigger indirect costs, that you aren’t considering, but others might.


Part of the question is just how effective are masks? Is wearing a mask while vaccinated better than not wearing one? As for me, being hard of hearing, I hope people will stop wearing masks sooner than later


This is also assuming masks actually prevent spread - data on that isn't clear.


To me, putting on a mask is like putting on your seat belt. Maybe it protects you from a low probability event, maybe not, but it's close to zero effort, zero cost, so why not?


I agree, but as an indirect consequence it’s allowed highly paranoid people to be able to blame and outrage vent at others. Which isn’t exactly healthy.


If you see it up close and personal the devastation that COVID can bring , you would probably also be over-cautions too.


It's also just a damn mask. Not like they are waking you up at night or kicking you in the shin.


It's not virtue signaling, just poor risk assessment.


Why 'poor'? Have you factored in everything going on that person's life? Do you know if they have a friend or relative who might be at higher risk? What if they have a young kid and they don't want to risk it? What if they just consider wearing a mask a mild inconvenience when compared to - say - the risk of being intubated?

I honestly can't understand this whole obsession with shaming people for wearing masks. Who gives two shits if someone else is wearing a mask? How does it affect you?


Why would I mind if people wore masks outside? They don't bother anyone.


Then you shouldn't use qualifiers such as 'poor' to describe their risk assessment. Don't give the idiots pushing anti-masking rhetoric in this forum more wind than they deserve by propagating their memes.


Nah, trust me, by treating it as a religious war you are a far bigger problem. Their identities as anti maskers are built in large part in opposition to people like you.

It's a little like how Republicans have a tendency to define themselves as in opposition to Democrats.


It makes it harder for me to communicate. If you want to wear a mask, that is fine, it is your perogative. But people should be aware of the risks, and I don't think most people do. Many people wear masks because they were told too, despite the fact that the people who said that know that masks aren't necessarily effective.


Some people get so comfortable with a mask, that it's more trouble temporarily removing it, than to just keep wearing it for the whole trip, even when outdoors or in their car.

A respirator mask also filters out pollen, and particulate pollution and fine dust from traffic. Some people used these even before pandemic, when outside in polluted areas. And if you really hate the feeling of insects flying in your mouth when bicycling, a mask prevents that, too.


I have had some of the best breathing of my life lately. Being able to wear a mask in public without the police going after you or people looking at you funny is such a wonderful thing. Cedar fever is a real pain.


I don't know if it's a social display.

Some people might simply feel safer by using, even if it's not necessary (yes, perhaps not "rational" but not just as a statement).


Agreed. It is socially cool in areas to either wear or not wear a mask and society is too prone to judging someone for having it on/of.

Case in point is being in a Lowe's garden center, outdoors, 24 feet away from a guy. He still decides to yell at me to put my mask on even though he was the closest person to me and it was only him and me outside.

I don't mind wearing it either, it is a fashion accessory as my wife makes custom ones and we have a vinyl cutter to express our nerdy side. But, I won't be wearing one just for the sake of social posturing.


Opinions about masks are like assholes. Everybody has one. How do I know? Because they _will_ tell you what they think about it, whoever it is.

There is no safe space on any social media that when the pandemic is mentioned in any way, the discussion devolves into whether masks help or not.

I've heard so much mask discussion since the beginning of the pandemic it's much easier for me to tell someone to wear one and just, pardon the French, STFU about it.


And then it becomes easier for someone to ignore you, and not wear a mask when it might help.

Like it or not there will always be shades of grey and discussion and nuance. Trying to ignore that is how you get extremism and identity politics. If you're tired of talking about something - don't talk about it. But oversimplifying and becoming absolutist is dangerous.


Mind, I'm not trying to silence discussions around masks. I personally don't want to hear it every single time there's a chance for someone to just throw a "fucking masks, am I right?" in a discussion and it devolving into a mass of useless, uninformed and generally uninteresting opinions, and that's when actual extremism and identity politics start to show itself (us vs them, woke vs the sheeple, freedom vs muzzled), thankfully not on this forum.

OP mentioned masks and homeless. This sub-thread has 5 comments about homelessness in San Francisco, and 69 comments about masks, and it's far more interesting trying to understand the homelessness situation in SF, which is absolutely bonkers IMO, than the same old hot air talk.

First we had the COVID experts and/or denialists, now we have the mask sceptics. I really can do without that.


I hear ya - it is indeed tiresome. Just as a general thing though, the conversations we have need to move away from 'telling [them] to just do [x]'.

In Britain, a lot of my friends got upset about Brexit and Election Results and said things like 'we told them not to vote for..., then we told them again to vote for...' - people do not like being told what to do. You gotta win hearts and minds. Sure, a lot of the more vocal ones are a lost cause best left to their own demise - but it's still worth it for most.


> I've heard so much mask discussion since the beginning of the pandemic it's much easier for me to tell someone to wear one and just, pardon the French, STFU about it.

So following your logic that someone has to wear mask and STFU just because you decided so? Sorry to say that but we are not in dystopia yet luckily and you can tell _yourself_ what to do, but STFU about what other people have to.


Freedom of speech doesn't mean I need to hear one's bullshit. The point is that the mask talk is a useless argument everyone jumps into whenever there is the occasion. Everyone has something to say about it.

Do whatever you (not you in particular) want, just quit moaning about it. It's as interesting as discussing political affiliations.


> Freedom of speech doesn't mean I need to hear one's bullshit

As a matter of fact, it is. Not particularly about your hearing of course, but about expressing everything, even things you may consider as BS. You can be wrong, aren't you?

> Do whatever you (not you in particular) want, just quit moaning about it

Couldn't agree more here, but this statement is contradictory to the one you've made before. Glad you changed your mind.


Has there been an empirical study since the danish one?

https://www.acpjournals.org/doi/10.7326/m20-6817


Plenty, although it's very hard to do a fully randomised trial of mask wearing on its own when everyone is also social distancing and hand washing.

I know of no studies which suggest that mask wearing is a health risk, and plenty that suggest it's a health benefit.


alternatively... People just find it easier to leave it on. If I take it off I have to store it in a dirty pocket or carry it.

I'm not frustrated or outraged trying to control others, it's just more convenient.


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Studies from Israel so far have shown vaccinated people almost never infect others. So wearing a mask vaccinated is not about protecting others, at least not according to our current scientific studies


Studies from the UK have shown that people with one shot, after 3 weeks, still infect others, though the rate is 49% lower.


One shot is therefore not sufficient for herd immunity, apparently, as expected. We need also data for all the various vaccines, and for people who recovered from the infection.


> It’s also a way for frustrated people who want to control others and be outraged to be able to vent their frustration at other people, in a socially acceptable way.

You could say the same about people who get offended over others wearing masks in situations where it dont affect them at all.

Like, someone wearing it in car or when exercising alone outside. It does not affect you in any way. Those people dont jump out of their cars to complain about what you wear. They are silently driving somewhere, ignoring you. I cant really think of situation where other people wearing masks affect me.


733 people died yesterday in the U.S. from COVID. On an annualized basis, that would be 267,545 deaths per year. On the other hand, 36,120 people die in car accidents per year.

If you saw someone wearing a seatbelt when they were stopped at a red light, would you make fun of them due to the relative safety of that situation?

If you had a friend that refused to drive after drinking any alcohol at all, would you make fun of him?

Perhaps some people do more to protect themselves and others against COVID than is necessary, but perhaps we should appreciate their conscientiousness by contrast with the very large number of people who took unnecessary risks, downplayed the problem, got infected, infected others, and ultimately led to 33 million people getting sick and 600,000 dying.


AFAIK there still isn't a single documented case of outdoor transmission of the virus, anywhere in the world.


There's been a few cases reported, e.g. here in Germany there was a cluster of cases of a spread among members of extended family that only met outside reported. And for the vast majority of cases, we simply have no data.

Still, everything points to outdoors being massively safer, with the highest remaining risk if you stand still with someone infected for a long time. (And in many places masks have never been required outdoors, or only when in large groups of people)


If outdoors is that safe we shouldn't be having lockdowns and stay at home orders. We should be happy for people to be outdoors doing activities.

Also sports shouldn't have stopped at all having audience


> Officials in Haridwar said that on Monday and Tuesday alone they detected nearly 2,000 infections among festival goers.

https://www.dw.com/en/india-hindu-festival-turns-to-superspr...


A news report with the words "Experts say.." is noise. A case documented in a journal in a trial (e.g. DANMASK-19, or any of the dozens of other trials) is not an unreasonable standard of evidence in order to better determine what the true risk of outdoor transmission is.


How exactly would you confirm - beyond any doubt - that contagion happened outside? Most people live most of their lives inside a building of one sort or another, so it'd be almost impossible to 'document' a case of outside transmission.

The closest thing we have is homeless populations - they spend most of their time exclusively outside - and they still get sick: https://www.sfpublicpress.org/covid-19-cases-spike-among-hom...

So making some big claim about how outdoors transmission is impossible is kind of preposterous.


Even people from remote Amazon tribes in the jungle have got covid.

Also in warmer countries outdoor/indoor is not all that different ventilation wise. It is not like I am magically getting covid if I am standing just inside the door and am suddenly immune standing on the porch.


I can’t find the source, but early days of contact tracing I think there were some outdoor transmissions identified, but it was in the low single digits compared to tens of thousands identified indoors.

If you’re outside and whispering in someone’s ear or accidentally cough in their face, it sounds like transmission is possible from what I’ve heard.

But yeah the risks are super low.


> If you had a friend that refused to drive after drinking any alcohol at all, would you make fun of him?

If he were drinking non-alcoholic beer, yes. This is probably a better comparison to the mask situation going on.


Non-alcoholic beer is still a psychoactive drug due to all the psychoactive flavonoids and especially the heterocyclic aromatic amines present in all boiled mash beverages.


WTF, gtp-3?


Look it up, because it checks out.

”Flavonoids” and ”heterocyclic aromatic amines” are groups of chemicals, which both contain some chemicals that act as MAO-A and MAO-B inhibitors in the human CNS, causing attentional, cognitive, emotional and behavioral changes.


https://www.bevindustry.com/articles/92090-flavonoids-provid...

So non-alcoholic beer could modify behavior like a blackberry smoothie?


Sure, especially if you make a habit out of it and pair it with a stimulant, like nicotine or caffeine, which both are routinely consumed with large amounts of MAOIs (which are found in both tobacco smoke and brewed coffee).

For an especially interesting evening, search ”monoamine oxidase” in the publicized tobacco industry documents: https://www.industrydocuments.ucsf.edu/tobacco/results/#q=%2...


> If you saw someone wearing a seatbelt when they were stopped at a red light, would you make fun of them due to the relative safety of that situation?

There’s a causal relationship between seatbealts and utility in a crash. The fatality rate is lower because of the use of seatbelts.

Wearing a mask while vaccinated is not causal with reduced transmission or death.

I wouldn’t make fun of someone for anything like this, but if I saw the driver of the car next to me with a pillow in their lap with the intent to help during an accident, I would think that they are being silly. I would definitely think they were super silly if they were espousing the benefit of keeping pillows in laps while driving because it makes them feel comfortable, or can’t hurt, or is an easy thing to do.


I'm not sure what your argument is here. Are you claiming that masks are ineffective in general or that vaccines are so effective that further protection is pointless?


I’m claiming, and not just me, that masks are ineffective at adding additional protection for a vaccinated person who wishes to not spread covid.

Masks are quite effective at preventing the spread of COVID. I believe this is shared by public health authorities.

Masks are tool that are good for some things so it depends the particular need.

I’m not arguing either of your claims, but masks+vaccine are unnecessary. This is different from masks being effective or from vaccines requiring no further needed protections.


What evidence is there that masks provide no additional protection for vaccinated people?

Are there special types of virus particles that come from vaccinated people that pass freely through filters? Or is it that when on the face of a vaccinated person, a mask is unable to filter out viruses?


> What evidence is there that masks provide no additional protection for vaccinated people?

The question is what evidence is there that they provide additional protection.

You don’t disprove things, you prove them.

Since there’s lack of evidence of efficacy, so that affects the decision.

This is kind of why I think people are logically waking through available evidence. There’s some material on CDC’s page [0] but I’m not familiar with the field so don’t know all the specific papers and studies and what not.

As a layperson, just reading the CDC site I think it’s that a vaccinated person, almost always, does not produce vaccine particles to spread. Since masks reduce spread of particles from infected people, the principle of the mask would not apply. Since vaccinated means no particles to prevent spreading.

Of course the vaccine isn’t 100% effective, but I assume protective enough that wearing masks produces no additional population protection, or that the benefit does not outweigh the cost.

[0] https://www.cdc.gov/coronavirus/2019-ncov/vaccines/fully-vac...


We know:

a) Masks reduce transmission by physically blocking viruses

b) Vaccinated people can contract COVID by breathing in viruses

c) Vaccinated people can infect others by breathing out viruses

There's no reason to believe that the mechanism in (a) doesn't work for vaccinated people any more than it wouldn't work for people in Vermont or people named Jake, even if there hasn't been a specific study on those subgroups.

Yes, vaccinated people are significantly less likely to be infected and to infect others. That doesn't mean it doesn't happen or that a mask wouldn't reduce that risk further.

Whether or not it's worth the hassle of wearing a mask is a reasonable question, but that's a risk/reward tradeoff question, not a question of whether or not a mask reduces risk, which is what your claim is.


I was one of the first to wear a mask. I made them from tissue paper and staples and rubber bands. I would get weird looks for being the only one in the store that had a mask. 6 months later, when I got masks with valves, I staryed double masking. I never wore a mask in the open though. Just kept my distance from people and that's it. Especially in the state parks, that would make zero sense.


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The numbers are indeed wrong... but in the other direction. Covid deaths counted as pneumonia deaths. Excess death way more than official counts.

Who's gullible here? Everyone sees what they want to see.


> Everyone sees what they want to see

Indeed. I am not sure why your assertion that the numbers are wrong in one direction is any better than someone else saying the opposite. Neither of you believe the data.


Why should anyone mindlessly "believe" the data? Politicians are not infallible, and they are not the most honest people.


I am not saying you should.


> No doubt they’re fully vaccinated by now as well.

Why would you assume that? Statewide, it looks like CA is just shy of 50% vaccinated, and in SF it looks like (eyeballing the by-age graph) around 60% of adults are fully vaccinated (and 30% of kids)[0]. So around 40% of the adults (and 70% of the kids) you run into in SF are not fully vaccinated.

You might think it's not a big deal, and we don't need to wait out the full two weeks past the final dose, but many of us don't think wearing a mask in public for a couple more weeks is a big deal after we've been doing it for a year already. Even if the risk is low, why take that risk just to take the mask off a couple weeks early?

> ... but now that the pandemic is getting under control it makes sense to weigh mental health more heavily.

And that's exactly what the state has done (whether intentionally or otherwise). If people still choose to wear a mask, that's up to them, and we should respect their choices. But I agree that out-loud recriminations directed toward random people who are distancing but maskless, and may even be fully vaccinated is ridiculous and goes too far.

> you see people driving alone in cars wearing masks.

Sometimes I do this by accident, just forgetting to take it off when I get in the car. Maybe that's common?

[0] https://covid19.ca.gov/vaccination-progress-data/


>* around 40% of the adults (and 70% of the kids) you run into in SF are not fully vaccinated*

Vaccination rates are not uniformly distributed across the state. It’s a big, diverse state and SF has a much higher rate relative to the average.


> Sometimes I do this by accident, just forgetting to take it off when I get in the car. Maybe that's common?

I’ve done that. If I plan to make several stops, I might put on my mask at the first stop and then leave it on until I’ve finished my business at the last stop.


Touching the mask could be a potential vector for spreading the infection to surfaces, and could also compromise the seal. It's typically best to fit it well once and not touch it afterwards if possible.

It's kind of related to touching face or eyes in terms of spreading diseases.


>And multiple times a day you see people driving alone in cars wearing masks.

I don't live in SF but I drive alone with a mask (and I'm fully vaccinated!). I generally put it on before leaving the house and keep it on until I get home so I don't risk contaminating the inside when taking it off, putting it back on, taking it off, putting it back on, etc. It's just a zero-effort bonus to mask efficacy and extra peace of mind, IMO.


Agreed. Once you have put the mask on and entered a contamination-risk zone, you need to wait until you have access to hand-washing facilities before you take it off again. Constantly taking it off and putting it on again is a great way to spread the virus all over your face. When I'm out, I carry hand sanitiser for this reason, but even so I don't want to be shifting my mask around and sanitising all the time.


> don't risk contaminating the inside when taking it off, putting it back on

Unless you’re using a respirator (N95, etc) the point of the mask isn’t to prevent you from contracting covid, but from spreading through exhalation. So the concerns about contaminating the mask aren’t very relevant to covid as, since I’m the potential source, the inside of the mask is already contaminated through my breathing and using my hands to put it on.

Lots of people get confused as to the hygiene procedures needed for using masks. One thing that helps me remember is that I’m trying to put a barrier between me and the world, not between the world and me.

When using PPE to prevent self-infection, the protocol is totally different and requires a clean chain that I think is something like: disinfect hands, goggles/eye shield, open respirator, apply without touching inside. Doffing is the reverse.


I do the same, and I usually have hands full / a small child with me, so it's way easier to put the mask on before you go outside.


When the mask enforcement was lowered in Australia I found myself wearing a mask where I didn't have to. It's such a small thing it wasn't worth taking it off while driving for a few minutes alone, or sitting somewhere away from people. I don't find people going further than necessary weird.

> a fully vaccinated adult

Being vaccinated isn't a perfect protection. I'd probably opt to wear a mask anyway if unvaccinated people around were forced to wear one. Wouldn't describe people not doing that as inconsiderate though.


Singapore had an outbreak originating with a fully vaccinated (2 doses) nurse.

Your examples are extreme but I’m not sure how to get people to act sanely. Restrictions are eased in Sydney and everyone just stopped doing anything even in crowded spaces. And we had a case that was traced to a person in quarantine, but we can’t find all the links back to the source.


Not sure why you’re downvoted - your comment about Singapore is correct. In fact, 9 fully vaccinated people were a part of that outbreak.

What that tells you is the vaccine will only protect the vaccinated. Unvaccinated people are still at risk and could be infected by someone vaccinated.

So keeping restrictions in place until everyone has had an opportunity to get vaccinated makes sense.


> but now that the pandemic is getting under control it makes sense to weigh mental health more heavily.

I don't quite understand where is the link between wearing masks and mental health? I lived many years in Singapore, Tokyo, Bangkok, have a Japanese wife and in many of these places wearing a mask is just a sign of being considerate towards others. Coming from the country myself it looks maybe odd at first but this makes sense in dense urban places where you need some rules for how to share this public space.


People who are most averse to wearing them tend to have mental health issues, including paranoia.

https://pubmed.ncbi.nlm.nih.gov/33469574/

Anti-maskers are often also anti-vaxers, and they have issues understanding the difference between a consistent statistical trend and a single emotionally negative event.

https://www.eurekalert.org/pub_releases/2020-04/ttu-pra04092...


> 30-50 year old adults outside, alone, in direct sunlight, exercising, dozens of feet away from anyone else are still wearing masks.

This is how it's been in East Asia and spread has been fairly limited compared to the west.

Mask wearing and not clustering in tight groups here isn't really a mental health issue. It's just a hygiene issue, like washing hands. I think most people here grimace when we see someone walk out of a stall and leave without even wetting their hands.


Many, if not most, people in that age group actually aren't yet fully vaccinated - the general availability was April 14th in SF. 21 days between vaccines plus two weeks of waiting. Plus a few days to find a slot maybe. So a few more days...

I think it's fine to still not wear a mask in the scenario you describe, but...

Fwiw, around here (inner Richmond), there's plenty people without masks. The cafe I can see from my office (if I peek above the screen at least :() has unmasked people eating outside without conflicts for months.

Golden gate park is full of unmasked people lounging around.


I think that the amount of political/social information that people seem to divine from observing maskers/non-maskers, as well as the signal that people think that they are sending by being one or the other, is one of the strangest things I've ever been made aware of.

When I leave my house, I grab a mask, and I wear it basically the whole time I'm out and about. I don't notice it, it's just a non-entity to me. I genuinely barely notice whether other people are wearing masks or not, and therefore obviously don't make any judgements about them.

If I'm walking alone outside during the day with a mask on, I'm not saying "I believe that this outdoor environment poses a legitimate risk to me, and based off of my 99.99+% survival chance from COVID, I'm still terrified that I'm going to catch it from some long distance passerby." When I wear a mask, my thought process is "I don't notice this thing, and if it helps mitigate the chance that I'll get sick or make someone else sick, I'll mostly wear it when I'm not in my home." I'm not constantly putting it on or taking it off based off of my immediate surroundings; I find that to be far more of a nuisance than just wearing it.


> I don’t know what’s going on here either with masks.

I live there too, and I share your feeling big time. Just to give you a little idea of the local mentality with regards to covid: https://www.kqed.org/forum/2010101883465/vaccinated-dont-nee...


Even last year if I was out in the open air I didn't wear a mask only when say queuing for public transport.

And I am an immunosuppressed solid organ transplant patient.


> I don’t know what’s going on here either with masks. And multiple times a day you see people driving alone in cars wearing masks.

I drove car with mask, because I did not bothered to put it down when I entered. That was all there was to it. I always assumed other people are like that too. There is a lot of judgement and reading on people who leave their masks on.

> This was in response to a fully vaccinated adult walking in a state park alone, in broad daylight, 3-4x father away than social distancing guidelines require.

Out of curiosity, how do you know woman was fully vaccinated?

I mean, inconsiderate is quite mild qualification? I dont know why mom thought it is inconsiderate, but it is not like she would go on full on bashing vent or something. Like, I dont find the whole discussion horrifying and I pretty often dont wear mask when I am alone.


I knew the woman walking alone.

People are free to insult each other and name call all they want. I just thought it was odd that the mother name called the woman and that the child was conditioned to do so as well, especially in the scenario where science says there’s a near 0 benefit to staying masked outdoors alone in sunlight while socially distanced.

I find it curious why they thought it was inconsiderate, but didn’t get the chance to ask them.


When I'm going from one shared indoor space to another, I don't remove my mask unless the walk is more than 10 minutes. I suppose the mask doesn't bother me that much and I don't want to touch it too much.

Going for a walk outside - that's another story.


you see people driving alone in cars wearing masks

Off-topic fun fact: in Germany, that is verboten.


In Finland - the police frown upon it because it's gotten a few people out of speeding tickets apparently...


How does that work? Surely license plates, and driver's licenses, suffice for fallback identification methods?


I think it's the case that they need clear conclusive proof of who was driving the car, and some cameras are probably crappy anyway.

Although I think for a lot of people if they were to pull up the driving licence of who the car's registered to, and masked-photo, it'd be pretty obvious - but I'm not sure how the law really works. Maybe for fleet-cars you might have some additional challenges.

Here's the article about it: https://yle.fi/uutiset/osasto/news/face_masks_fool_finlands_...

Edit: I'm British and the standard there is that the car is photographed from the rear and the owner has the legal liability to identify who was driving or face equivalent or worse sanctions. There seem to be both social and technical differences between the two (UK is almost exclusively radar based - and the evidence the police show must have the car crossing painted lines to show the speed. Some privacy concerns about who you might have been pictured in the car 'with'. In Finland they seem to be triggered by inductive coils in the road? I don't know, but I've never ever seen the painted lines)


The newer speed cameras in Finland, like pictured in the article use a tracking radar to detect speed. Older speed cameras (most cameras on the road still) use two induction coils built into the road.


In Germany, only the driver can get fined, not the car owner. However, if the latter cannot tell the authorities who was driving their car at the relevant point in time, they can be forced to start keeping a written log of who's driving their car at any point in time. That's only for the future though, it does not apply retroactively.


So how do we get the rest of the country to do this?


Be irrational?


Why would you want that?


Blindly follow orders, which make no sense?

I do wear a mask at all times when in public, but come on, I'm not going to the forest to walk my dogs with my mask on.

People got too comfortable with not doing any thinking on their own, instead went fully autopilot based on news and government.


People have been wearing masks before it was government guidance. People I'm talking to will keep wearing masks when it stops being government guidance. It sounds like they're doing thinking on their own rather than going autopilot based on news and government.


Obviously what I wrote doesn't apply to 100% of people.


People are weak - and if they see more examples that masks are not necessary, they'll follow. So I'm trying to not wear mask unless absolutely necessary, but it's hard, the pressure is real.

Not to mention kids - masked kids on playgrounds break my heart.


> 30-50 year old adults outside, alone, in direct sunlight, exercising, dozens of feet away from anyone else are still wearing masks. No doubt they’re fully vaccinated by now as well.

It's virtue signalling, I'd say. It means you're one of the good people.


The only people whose mental health I'm really concerned about are those who are obsessed with trying to get rid of masks.

If you are vaccinated and feel comfortable not using a mask, don't wear one. If you don't feel comfortable, then wear one. I literally have yet to hear someone complaining about someone not wearing a mask outside, but all you need to do is read this thread to see tons of comments complaining about people wearing masks.

Let people make their own decisions. They aren't cattle.


Wearing a mask has become another way to identify yourself as the “in group”. Health benefits are a far second to the signaling that you “follow the science” and “are willing to sacrifice for the greater good” - your one of the good people.

My buddy told me his Bay Area company did a story about “the story behind people’s masks”. They literally interviewed people and asked them to share “what their mask represents”.

It’s really bizarre how much people’s egos and identity are wrapped up in it now.

(And that applies to people willing to make a public stand against masks as well - it’s become a core part of who they are).


That’s a sweeping generalization that I doubt you have any data on about why people wear masks.

It sounds like you’re bashing the good kid at school for trying to be good. Maybe it’s OK to try to be good.


Reading the comments here it’s pretty clear I’m not far off the Mark.


I don't know about SF specifically, but according to [1], California is doing about average for the US and is at the world's top 30 (higher is worse) for deaths per million, so I'd guess it's more #2 than #1.

Is SF doing significantly better than the rest of California, in general? Hopefully now enough people are vaccinated that the rates have dropped.


The cases per capita in SF were about 1/10 those in LA at its peak, so the pandemic in california was really focused in socal.


But you’re comparing a city of 800k to a city of 10M.


Oh aha, thanks for that stat, I didn't know.


I had the same suspicion and did the math based on the numbers below.

40,273 cases/1M pop (better than 49 states)

597 deaths/1M pop (better than 48 states)

https://www.worldometers.info/coronavirus/country/us/

https://data.sfgov.org/stories/s/COVID-19-Cases-and-Deaths/d...

https://www.usapopulation.org/san-francisco-population/


I’m not sure why you cite consistent mask usage as the primary reason.

What I imagine to be a more likely cause is that there is a large proportion of SF’s population (esp compared to other cities) that are professionals who have the privilege to be able to work from home without worrying about losing their jobs. Couple that with vast grocery and food delivery services. So staying home is more convenient than most places


Your bubble is showing. SF has massive swaths of people who aren’t in white collar jobs and have been working the entire time. They actually make up a lot of the cases that did happen.


Most people dying from drug overdoses aren't homeless.


Isn't it interesting how our perception of reality is shaped by what we observe daily?


"In the world of phenomena, perception is everything." - some philosopher (cannot google who)


Find it strange the way the US has gone all in for masks while in the UK it's only inside.


To say "Mask mandates are useful b/c we have more drug dead than covid dead" is not logically plausible. The fact that measure have been useful rather shows wishful thinking to me.


I live in San Francisco. I look at pictures of (maskless) people on billboards and have to stop myself from judging them.


Don’t SJ and LA have bigger homeless pop?


For an article that doesn't focus on SF, that's an odd headline, and not a big surprise for anyone who's seen the Civic Center Bart station: https://www.youtube.com/watch?v=5gT5NULvRSk

SF is an oddity because of its homeless problem, open-air drug market, not being too concerned with either, but being incredibly concerned over covid, so this outcome isn't surprising.


Yes but that's a poor people problem, so who cares?

I don't think it's possible for these things to be solved at any level lower than the federal, you can apply some band-aids but ultimately you need a stronger social safety net, which the US seems culturally averse to.


2% of my HS class has died of drug overdoses, and it is the opposite of poor. OK, small sample size, but it's safe to conclude that it's not a "poor people problem."


For 2% to work, you'd need like 50 people in your HS class. Was your HS class really that large? That's insane.


By 'class', he means those who graduated the same year as him (which is often hundreds of people). Not the students crammed into a single classroom.


Thanks. Not too familiar with school system lingo in English.


You must not be from the US. 100+ class sizes are the norm and 1000+ aren't unheard of.


Pretty sure he was being sarcastic, if you read the second part of his comment.


You are absolutely right. SF is just the symptom of a national homeless crisis in the US. As long as the US isn’t willing to help its people, more liberal cities like SF will lay the price.


> more liberal cities like SF will lay the price

This is a tricky problem because housing people isn't free (there is an argument that it saves money on ER bills), housing homeless people in SF is an incredibly inefficient use of money, but at the same time, you don't want cities to be bastions of wealth that outsource their poverty. Action also has to be done at the regional level, or else you'll get a TL situation where homelessness is isolated to one area. Even regional alignment isn't enough, though; the fact that the Bay Area has relatively good homeless services attracts more homeless. Federal housing projects aren't a good answer, either, and least not in the US, because of their history.


> Federal housing projects aren't a good answer, either, and least not in the US, because of their history.

genuinely curious: what is this history that makes it difficult in the US ?


I'd disagree that federal projects are not the answer, but the gp has a point.

Background:

https://ggwash.org/view/78164/how-public-housing-was-destine...

https://ushistoryscene.com/article/public-housing-myth-of-fa...

These matters are quite complicated and very tough to handle with means tests, or piles of one-time cash. Instead we need to acknowledge that the US has created a worsening class of the generationally impoverished. Bear in mind that the federally defined poverty line is deeply flawed, and people living such lives are often severely impoverished.

https://www.economist.com/special-report/2019/09/26/the-offi...

Then we can have a conversation about benefits cliffs, which actively discourage people from even trying to better themselves by withdrawing benefits faster than people can improve their lives and forcing people to dismantle their lives before they even qualify for aid.

https://www.benefitscliff.com/

https://www.forbes.com/sites/jeffreydorfman/2016/10/13/welfa...

The middle class has been hollowed out. This increases economic precarity and the likelihood that any random family will fall out of the middle class and into poverty.

>"It’s difficult to tell if someone’s part of the hollow middle class because they’re still performing all the external markers of middle-classness. Before the pandemic, they were (and largely still are, absent a layoff) buying and leasing cars, purchasing homes, going on vacation, covering their kids’ education and activities. They’re just taking on massive loads of debt to do so."

https://www.vox.com/the-goods/22166381/hollow-middle-class-a...

Federal governments failure to keep the economy equitably rewarding for all participants has exacerbated the above problems.

https://www.oecd.org/economy/decoupling-of-wages-from-produc...

We can also talk about lack of affordable healthcare, the increase of poorly paid bullshit jobs, the decreases in high paying jobs, the war on drugs and externalities thereof, the prison industrial complex, and countless other factors that confound a federal housing project.


They were originally a segregation tool, which is a bad way to start. It was not uncommon for the government to use imminent domain to evict huge groups of black people to build white-only public housing. That continued up until the early 60s.

The American style of public housing is also often large developments with many occupants. As the occupants basically have to be poor to qualify, the concentration of poverty tends to lead to a lot of negative externalities. "The projects" are often notorious for gangs, drugs and crime. My impression is that much of Europe does more interspersed public housing, similar to Section 8 (subsidized rent to a private landlord) except the government owns the homes. The US attempted to make some strides by redeveloping former "projects" into mixed-income developments, but there is no requirement that the new development have at least as many low-income units as the demolished building. As a result, only about 12% of people relocated from those buildings eventually move back into the new building.

Funding has also been a big issue. The housing developments become delapidated because we don't fund them enough to maintain them. That above mentioned redevelopment project was aimed at fixing the most distressed housing projects; sadly the public housing that was targeted was that which would bring the most money to the city, rather than the most damaged housing. Some have levied criticisms that public housing has been intentionally underfunded so that it seems like a debacle to build support for Section 8, which allows private companies to profit from housing the poor.

Also as a result of the lack of funding, public housing is often hard to get. The median time on a waiting list for public housing is 9 months. 25% of people spent at least a year and a half on the wait list. Housing Choice Vouchers (I think that's Section 8) is even worse; the median time on waiting lists is 1.5 years, and 25% of applicants spent at least 3 years on the waiting list. Over 50% of HCV waiting lists are currently closed to new applicants because they're so backlogged. This is often a compounding issue for people with mental health issues or drug addiction. If you are removed from your unit for any reason, you go to the back of the wait-list. I know a social worker who will fight tooth and nail to get someone with a debilitating mental illness housing, only to have them get evicted the next month as a result of their mental illness.

Lastly, because we build these giant complexes, it's trivial to tell whether an address is an a public housing project. They're not well regarded publicly because of aforementioned negative externalities, so anything that requires an address requires you to basically announce that you live in public housing. That invites a lot of discrimination, especially with job applications and finding housing once you're on your feet enough to try to move out. "Im currently or was recently too poor to afford rent" isn't something that most landlords or employers look kindly on, especially since many in the US consider poverty to be a character flaw.

So historically, US public housing has been racist, in poor shape, hard to get and generally unfavorably viewed by the populace causing discrimination. They're often referred to as "housing of last resort" because they're so undesirable that people won't live there unless they have no other choice. It's effectively the tier directly above living in a tent on the street.


It's not even remotely a tricky problem.

It's just a trick, of convincing ourselves it's not our problem when we are the cause.


End local nimbyism laws with a state level mandate to build and reverse prop13. The USA doesn’t have the California homeless problem. Texas and florida don’t have the homeless problem and their weather is also good all year.

California has created this mess and California can solve it.


After the real estate bubble crashed in 2008 policy makers decided to try to reinflate the bubble and at the same time limit the supply of housing to make sure it stayed inflated. They succeeded, prices are higher than the last bubble and we're short a couple million units of housing.

The able bodied people living in tents in major cities the the victims of that success.


Another bubble is on the horizon and this one will be bigger than 2008 in my opinion. There are several vectors converging here.

I'm grateful to have a nice room by the beach in Maui. All I need is wifi and I can get by. Learning how to grow food now too as I save up for a farm.

The real estate market out here is INSANE. Housing shortage too. I got lucky because the people I live with now see potential in me. Wouldn't have happened without lurking on HN for 11 years.


Better drugs would be a good start.

Better drug laws would help that


The war on drugs has indeed claimed many more lives than it has saved. I think we're long overdue for more sensible drug policies that treat addicts with compassion instead of vengeance.


Overdoses aren’t contagious.

We are not really afraid of the current levels of COVID, we are afraid of the potential spread of COVID that can happen so rapidly that hospitals and other critical infrastructure will have to close because everybody is sick.

It’s not even the mortality rate of COVID that has caused a global lockdown.


>Overdoses aren’t contagious.

But they do tend to cluster. Many people overdose because their supply is unusually strong, or they're clean and use what they would've taken at their previous tolerance. Knowing this we can expect more overdoses to happen in black markets, and the recently released (from rehab, prison, hospital, etc).


Political and social conditions that contribute to overdoses and other forms of suicide are contagious - socially and politically.

But they require political and social solutions, and vaccines can't provide those.


> more people in San Francisco died of overdoses than of covid-19

Maybe this is because anti-covid measures were more efficient than anti-overdosing ones? Regarding the obvious question "Should San-Francisco pay more attention to overdosing" - I don't know, looks like much more people are at risk of dying because of covid than because of overdosing.


Is this evidence of the effectiveness of following CDC guidelines, or evidence that opiates are still a bigger problem?


Are prescription opioids still being widely prescribed as a painkiller these days in the US?


Depends on the state. Many (if not most) have declared some sort of war on pain relief. In the worst, effective pain meds are all but impossible to get.

My adult son was recently cycling and sent flying by a jeep. He's in tons of pain but none of the injuries are serious. The ER isn't willing to Rx anything stronger than ibuprofen.

I recent had abdominal surgery. I had to beg just to get Tramadol. I've a friend with crippling arthritis, who'd responsibly taken opioids for years and was cut off after the state passed draconian anti-opioid laws. This is forcing him to consider actually risky drugs just so he can function at minimal levels.

At some point we need to give a crap about the millions who've lost their quality of life due to anti-opioid hysteria.

We are WAY past time to stop conflating typical Rx pain meds with blackmarket fentanyl. The bulk of the pill mill problem was tackled a decade ago. News reporting on opioid overdoses that infers Rxs are the major current driver is patently false.


Anecdotal, but ~a week after my surgery 3 years ago I told my doctor I quit taking my pain meds 2 days post-op as I wasn't in pain anymore and don't like pills. I was initially given a 14 day supply. Upon hearing this he asked me if I needed more or would like a stronger variant.

This was at a higher tier facility that works on professional athletes in the NFL and MLB.


I got out of surgery last year after a deep cut following a fall. It was indeed painful as hell for some weeks afterwards, but I didn’t particularly ask for anything. I honestly just wanted to get out of the hospital and was annoyed they kept me overnight. But I walked out with a prescription for... guess what.


[flagged]


I've been to concerts where there are smoke clouds above the crowds.


Marijuana isn't known to produce lethal overdoses.


I was just joking. It does cause me to eat an outrageous amount of food that I didn't need to eat but ate anyways. :)


Social distancing works then? Seriously, I don’t think anyone doubted that heart disease/car accidents/opioids are more life threatening than covid. It’s just the devil we don’t know.


I think the bigger conversation is the rising number of displaced people in our society who turn to drugs and crime to cope with life.

I grew up in Atlanta and it's getting out of control here too. I have a friend who models in LA, she is telling the same thing PLUS the rise of sex trafficking and Instagram escorts.

I'm 31 and I'm asking the Big Questions again. Something needs to change or the mental health crisis will become a much bigger stressor on society as a whole.




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