I really hope that the sterility issues the fda found in the cdc labs that held up testing[0] aren't indicative of the standards of the BSL 4 facilities handling smallpox, anthrax, etc ...

[0] https://www.nytimes.com/2020/04/18/health/cdc-coronavirus-la...

https://www.reuters.com/article/uk-factcheck-trump-fired-pan...

> It is true that the Trump administration has seen fit to shrink the NSC staff. But the bloat that occurred under the previous administration clearly needed a correction

This seems like a poor call. Shrinking staff and joining divisions together sounds like a easy way to get parts of your product that are unowned and unmaintained. When it comes to protecting against pandemics, I’m not sure the primary goal ought to be saving money.

I would be fascinated to learn more about what the officials in the organization did about COVID.

"The angry Left just can't stop attacking, even in a crisis."

> On March 14, 2020, John Bolton described the changes made to the team as streamlining. He tweeted: “Claims that streamlining NSC structures impaired our nation's bio defense are false. Global health remained a top NSC priority, and its expert team was critical to effectively handling the 2018-19 Africa Ebola crisis. The angry Left just can't stop attacking, even in a crisis.”

Of course the “masks don’t work” was pure, transparent, bullshit from the very beginning. It didn’t even pass the smell test. Now if the argument was “please save masks for healthcare workers first, they’re higher risk” that would be fine. But “they don’t work”? Fuck off.

Edit: I’m referring to the CDC here, not you personally, dear HN commenter.

At least by telling people masks don't work... peer pressure would keep them from buying them?

Here he claims masks (general) do not protect you. But they do protect healthcare workers. It amazes me that he was willing to put two such contradictory claims in the same tweet. It was just such a transparent lie. Given the context and implication, I think it is referring to "medical" grade masks including N95, surgical masks, etc.

Another part of the confusion is that early on (six weeks ago) the assumption was that the virus spread like the flu, i.e. via droplets from coughing and sneezing. Masks alone (without face shields) are of little benefit for droplet-spread disease because they don't protect your eyes. Now we know the virus spreads via aerosols which are generated by talking or even breathing. Cloth masks do indeed help for aerosols by trapping virus particles electrostatically and by increasing humidity, both of which keep the virus out of your respiratory tract. Or so the latest thinking goes.

Hanlon's Razor applies, but this virus is also an insidious bastard that behaves very differently from what public health experts had expected.

First of all, there are very different rationales for healthcare workers and the general public to wear masks. Healthcare workers know they will be exposed, so the protocols must be damn near perfect. The general population does not know if they’ll be exposed, they’re trying to work in aggregate to put a drag on the viruses’ spread; even partially effective mask wearing slows that down. The general population can also practice social distancing, while healthcare workers must spend hours in close personal contact with positive patients by the nature of their jobs, vastly increasing their risk.

Second, this ignores the fact that mass mask usage prevents you from getting someone else sick. This is in fact exactly why surgeons wear surgical masks. Since we’ve known for months that this disease has asymptomatic transmission, the public health rationale for even cloth mask usage was obvious from the very beginning.

Without the rest of the kit, and without careful adherence to correct donning and doffing, there are at best marginal benefits to mask wearing.

There's some concern that those marginal benefits are eliminated if people wearing masks go on to engage in risky behaviours. These behaviours include increased touching of their face (often without immediate handwashing afterwards), reductions in distance between people, increase in frequency of leaving the home, etc etc.

PPE is designed to mitigate a completely different level and type of risk. PPE is designed for medical professionals who by the very nature of their job must spend hours in physical contact with known sick patients. The protocols must be strict because failure means guaranteed infection.

I on the other hand have no obligation to physically touch random strangers, thank god, and don’t have to go interact with known sick people. Instead I’m trying to provide some protection for myself, and trying to work in aggregate to reduce the risk that asymptomatic carriers spread the disease while doing essential activities. “Marginal benefits” in this context is also known as “reducing R0”, which is absolutely a public health goal.

Now all of that is a good argument for saving N95 masks for medical workers and relying on surgical or cloth masks for the general public, especially in the light of PPE shortages. But that is an entirely different argument from “masks don’t work”.

What's the point of wearing the mask then?

If you're wearing a mask to protect against droplets then maybe you'd get marginal benefits. But if your concern is virus carried in the water vapour that people exhale, then an N95 isn't nearly enough to protect you.

90% what?

It makes no sense to claim "90% effective".

90% reduction in numbers of people infected? Of droplets inhaled? Of droplets exhaled?

"Masks work, don't work" are not cogent arguments.

It's the same with plastic gloves. Their usage in ie. grocery stores etc. may not help as much as incorrect usage may work against the intention. Again the argument is that if you get your hands dirty, you know you need to wash your hands and might think twice before touching face. Even washing hands properly require some training.

We've since learned that less extreme measures may be good enough once you have control, testing and tracking.

A lot of the commentary about the matter is disingenuous. Of course they won't filter out all the infectious agents for all healthcare workers forever. It was a matter of risk mitigation, just as much as shelter-in-place is. Getting infected is a numbers game, as is the live-locking of available hospital capacity.

No, that's not true. Maybe the advice was wrong, but it wasn't "pure, transparent, bullshit." It was always clearly stated that N95s worked if worn properly, but there was a lot of debate if surgical masks would offer much protection or not (they're known to be inadequate for certain viruses). Especially early on, people didn't understand much about this virus, such as the particle sizes involved or if asymptomatic transmission was real or not. There were a lot of factors to weigh in the recommendation in an environment of uncertainty.

> Now if the argument was “please save masks for healthcare workers first, they’re higher risk” that would be fine.

They did make that argument:

https://www.marketwatch.com/story/the-cdc-says-americans-don...

> Most people don’t know how to use face masks correctly, and a rush to buy masks could prevent the people who need them most — health care providers — from getting them, said Dr. Amesh Adalja, a scholar at the Center for Health Security at the Johns Hopkins Bloomberg School of Public Health.

> In fact the U.S. surgeon general recently urged the public to “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!,” wrote Surgeon General Jerome Adams on Twitter US:TWTR

> But “they don’t work”? Fuck off.

It's also pretty clear that they were right that tons of people in the general public don't know how to wear masks correctly. I don't go out much, but when I do there's always a bunch of fools wearing N95s improperly (not using both straps, bunching both straps together behind the head, not shaping the noise area to fit the face). I even see people wearing surgical masks improperly (e.g. not covering the nose, not shaping the nose area, not folding out the material to stretch from the nose to under the chin, etc.).

There's also the issue that the general public is unlikely to follow the kinds of rigorous protocols that make N95s effective in a healthcare setting.

1) Wearing masks is a trainable skill. None of us know how to use condoms initially either, yet literally millions of Americans use them effectively yearly.

2) Masks don’t have to be worn with perfect correctness to produce an effect in aggregate. If mask usage was even 30% effective, this would drop R0 by roughly as much, which is a big freaking deal.

The N95 vs surgical mask is a tricky balance to strike; of course N95 should be saved for those at the highest risk, and if you know your mask will be sprayed with virus droplets, extra precautions must be taken. But that’s much more relevant to medical workers, not those of us who want to reduce risk going to the grocery store.

Not really. Do you have a qualitative fit test handy? Because you need to do a fit test with one to figure out if an N95 you chose actually works properly, even if you're wearing it properly. Healthcare workers are tested, and the kits cost $200 or more.

https://www.medline.com/jump/product/x/Z05-PF07344

https://www.3m.com/3M/en_US/company-us/all-3m-products/~/3M-...

> [Surgical] Masks don’t have to be worn with perfect correctness to produce an effect in aggregate. If mask usage was even 30% effective, this would drop R0 by roughly as much, which is a big freaking deal.

I think that's why they ended up changing the recommendation.

The problem is that this isn’t the nuance that the Surgeon General or the CDC originally went with. His argument was literally “You can increase your risk of getting it by wearing a mask if you are not a health care provider”, and “STOP BUYING MASKS”, neither of which distinguishes between N95s, surgical masks, and cloth masks.

Most people don't wash their hands properly either, but we tell people to do it because even washing hands poorly is better than not. Even "fools" wearing masks wrong would help more than not having them at all.

The parent is right: was pure, transparent, bullshit. If they were intending to preserve masks for healthcare workers, then just say that. Telling people they don't work was not just stupid, it was dangerous and almost certainly made the situation worse. Don't lie to people about their health.

Stopping other people from catching something you might have is a fantastic reason to ask everyone to wear a mask during a pandemic. It’s actually probably the main reason you’d want to do so, from a public health perspective, because it helps you prevent asymptomatic thread. The idea that the surgeon general would beg everyone to not wear a mask is utter madness.

However I was replying to a comment that was implying surgeons are using them to protect themselves. That is just wrong. There are enough good arguments for masks, one does not need to make incorrect statements.

https://twitter.com/Surgeon_General/status/12337257852839321...

Additionally, the surgeon general has repeated this claim on live television as recently as a week ago. There is no way he's that incompetent.

Of course do not / do protect are simplifications as the effects are not binary. This is needed for communicating with the public, the meaning was "don't help much" vs "make a significant difference".

If the health authorities always used the precise and caveat-ridden language of medical journal papers in order to ensure each sentence is logically correct when interpreted literally, they wouldn't get any messages through.

The guidance about public usage of masks has changed in a lot of countries because the guidance changed from "no evidence that it protects the public from infection enough to make difference in epidemic spread" to "let's take even the small benefit of reducing spray from the potentially infected mask wearers". It's a sensible change when the mask shortages let up.

No need to fan the flames of lightly assuming malice from health authorities, it's a bad time for that.

I agree with you that right now it's absolutely crucial that organizations like the CDC maintain credibility, which is what makes this such a huge problem. Me calling out the lie is not the problem. The lie is the problem.

https://twitter.com/Surgeon_General/status/12337257852839321...

  the masks do protect the healthcare workers

With respect to protection from SARS coronaviruses, wearing just a mask and no eye protection is like a hockey goalie wearing a helmet but no mask.

An apt comparison -- a damage reduction by 66% using only a fabric mask is massively worse than a damage reduction by 95% using proper PPE and procedures. In fact, it leaves you 7 times more likely to get infected (get hurt by a puck). But if anyone tried to sell the NHL-watching public the line that "helmets don't help", they would be rightfully humiliated in public.

When found, copy-cat masks are destroyed at border control, as they also don't provide the benefits to contain contagion.

I had to stop following the WHO and CDC Facebook pages because the value of information they were posting was so poor, I was IMHO better of not having access to it.

The CDC and prior administrations recognized the problem, but they weren't given the budget to solve it:

https://www.propublica.org/article/us-emergency-medical-stoc...:

> How Tea Party Budget Battles Left the National Emergency Medical Stockpile Unprepared for Coronavirus

> Dire shortages of vital medical equipment in the Strategic National Stockpile that are now hampering the coronavirus response trace back to the budget wars of the Obama years, when congressional Republicans elected on the Tea Party wave forced the White House to accept sweeping cuts to federal spending....

> The stockpile’s mission has steadily expanded as it confronts new public health emergencies. With limited resources, officials in charge of the stockpile tend to focus on buying lifesaving drugs from small biotechnology firms that would, in the absence of a government buyer, have no other market for their products, experts said. Masks and other protective equipment are in normal times widely available and thus may not have been prioritized for purchase, they said.

> “It just was never funded at the level that was needed to purchase new products, to replace expiring products and to invest in what we now know are the really necessary ancillary products,” said Dara Lieberman, director of government relations at the Trust for America’s Health, a nonpartisan public health advocacy and research group.

Similarly, the ventilator problem was recognized in the mid-2000s and a solution was nearly ready by 2013. However a corporate acquisition derailed the project because the new owners thought a low-cost ventilator wouldn't be profitable enough and would compete with their other product lines:

https://www.nytimes.com/2020/03/29/business/coronavirus-us-v...:

> The U.S. Tried to Build a New Fleet of Ventilators. The Mission Failed.

> Thirteen years ago, a group of U.S. public health officials came up with a plan to address what they regarded as one of the medical system’s crucial vulnerabilities: a shortage of ventilators....

> Money was budgeted. A federal contract was signed. Work got underway.

> And then things suddenly veered off course. A multibillion-dollar maker of medical devices bought the small California company that had been hired to design the new machines. The project ultimately produced zero ventilators.

> That failure delayed the development of an affordable ventilator by at least half a decade, depriving hospitals, states and the federal government of the ability to stock up. The federal government started over with another company in 2014, whose ventilator was approved only last year and whose products have not yet been delivered...

> Government officials and executives at rival ventilator companies said they suspected that Covidien had acquired Newport to prevent it from building a cheaper product that would undermine Covidien’s profits from its existing ventilator business....

> In 2014, with no ventilators having been delivered to the government, Covidien executives told officials at the biomedical research agency that they wanted to get out of the contract, according to three former federal officials. The executives complained that it was not sufficiently profitable for the company.

  they weren't given the budget to solve it

The mistake lies in not demanding that each and everybody covers their faces with whatever they have. There is no need to filter the air if the virus is not released.

https://www.google.com/amp/s/www.forbes.com/sites/daviddisal...

  The idea is that they should have been stockpiling them for decades

* Why did the CDC decide to develop their own diagnostic? Was there some issue with the WHO test that they were trying to avoid? Or just internal politics

* What was the core issue with the CDC's tests? (It's possible that I'm not equipped to understand this, but an ELI5 would be great)

(Edit - I have tried to research this, but for #1 it seemed kind of murky and #2 looks like either poor quality control or poor design - https://www.vice.com/en_us/article/y3mkpx/how-the-cdc-botche.... I'm hoping for some clarity on these)

And developed countries wouldn't actually use WHO kits, just the protocol to manufacture their own tests. The WHO distributes kits only to poor countries. Everyone still runs into the same issues ramping up production.

2) You found the article I was about to link actually. Basically, for a PCR test, what you're doing is making a lot of a particular sequence of DNA if it's present. You set up the reaction conditions so that if a particular sequence of DNA is present in your test tube (actually a plate but same difference), that sequence of DNA will make a lot more of itself. If there isn't that sequence of DNA, nothing will happen. You don't get to pick the entire sequence youa re looking for. You basically hae to pick a start region and and end region for the piece of DNA you want to amplify. So if the nucleotide sequence for a coronavirus gene was atcgctatagc, and you are using 3 letter long end regions (in reality you use longer length sequences and regions), you might pick your targets as atc and agc from each end. Therefore, any sequence of dna in your sample with atg and agc will get amplified and you will get a signal telling you that a dna sequence that starts with that first target sequence and ends with that second target sequence is there. If you don't get a signal, that means no coronavirus.

When picking that sequence (known as a primer sequences since it primes the replication reaction), you have to be careful. Lets say that in your body you have a gene that goes gtcatcagctga or something. Inside of that sequence, your primer sequences are present. If you run a test for your desired sequence, you're going to get signal from non-coronavirus DNA.

In order to make sure there are no overlaps in your primers, you, well, this is the part that's hard to believe. You type in your sequences in to a website and hit a button. Hence the following excerpt from the article you found:

“I just put the primers as input into this program and within seconds it tells you there’s problems with it,” Altman said. “It’s freely available. It’s not hard to use at all. It’s one of those things you’d do as a basic quality control check. It seems like they hand-designed these primers and it seems like they didn’t use computer tools to check it.”

So, yeah. Everyone's still having a hard time wrapping their head around it. All it boils down to is that you want to find sequences of dna that are present in coronavirus but not in humans (and also maybe the reverse for some types of controls). It's, I mean. I don't have words for it. Designing primers is like the first thing an undergrad who joins a lab for a research project or internship is taught.

And I had it rough when I was designing primers like 3 years ago. In those ancient times, I had to design the primer by opening a whole new tab and going to a whole new website! (The site is https://www.ncbi.nlm.nih.gov/tools/primer-blast/). So much work. Thankfully the lab I was working in implemented an electronic lab notebook (I think it was benchling?) that had the feature built in. Now i don't have to open another tab.

I'm being flippant but also, common, this is the CDC. The WHO had no problem doing it. Private labs had no problem doing it. It's not something weird about this virus. It's just, i don't know. There must have been deeper issues.

I think I was expecting the error to be somehow more technical or down in the weeds somehow.

Not at all. You are making a fundamental, erroneous assumption: that the actions taken were made in good faith.

This is a political failure. Trump and his administration chose again and again to put politics above public health. Over and over, given a choice, he chose to pander to his base and attack his perceived enemies rather than helping the country. These weren't miscalculations. The miscalculations happened at the state and local levels, but at the federal level there was very much a knowing purpose.