Don’t forget public health officials outright lied and said masks don’t help reduce the spread of the disease, putatively to help conserve masks for medical personnel: https://www.nytimes.com/2020/03/17/opinion/coronavirus-face-...

> When news of a mysterious viral pneumonia linked to a market in Wuhan, China, reached the outside world in early January, one of my first reactions was to order a modest supply of masks. Just a few weeks later, there wasn’t a mask to be bought in stores, or online for a reasonable price — just widespread price gouging. Many health experts, no doubt motivated by the sensible and urgent aim of preserving the remaining masks for health care workers, started telling people that they didn’t need masks or that they wouldn’t know how to wear them.

When I first started doing volunteer health assessments and triage at our local homeless shelter, I inquired if facial hair was an issue with PPE. The organization's initial response was no.

I sent them a link to the CDC guidance[1] that includes this picture regarding facial hair styles that are ok[2].

I don't think the notice at the top of said article is helpful whatsoever saying that this isn't advice for covid-19. A proper fit and seal is important. The picture could also be considered somewhat offensive to some.

[1]: https://blogs.cdc.gov/niosh-science-blog/2017/11/02/noshave/

[2]: https://blogs.cdc.gov/niosh-science-blog/files/2017/11/Facia...

It’s my understanding — which seems to be congruent with the pages you linked? — that facial hair is an impediment to medical-grade respirators that require a tight seal to be effective. With cloth/paper masks that aren’t intended to be PPE for medical workers, though, that’s not actually what we’re going for, though, right? What we’re trying to do is curtail the spread of droplets. Beards and mustaches really won’t materially affect the effectiveness in that case.

In your specific example of volunteer health assessments and triage at a homeless shelter, you probably need real honest-to-goodness PPE, and the organization’s advice was wrong. When I’m going down to the grocery store, though, a cloth mask should be sufficient — and my (admittedly short) beard is not going to keep my mask from blocking droplets from my mouth and nose, assuming it completely covers both of them.

It's an impediment with any mask which can form some kind of seal. A surgical mask will stick to your face when you breathe in, which indicates that it does form an imperfect seal.

If one's beard is creating even more space between the face and mask, it's of course going to make things worse.

Cloth masks aren't trying to form a seal. They have a few roles:

1) They capture a lot of droplets coming out of your mouth. Do you sneeze in your elbow or in someone's face? A face mask does better than an elbow, and for every breath (not just a sneeze). So does a beard for that matter; if your sneeze goes around through a beard, it's catching big droplets too.

2) You know the six-foot-guideline? They effectively increase that distance. A person talking, yelling, sneezing, etc. can carry droplets 15+ feet in a straight line. If we're both wearing masks (or face shields), it's not going in a straight line. Beards disrupt linear airflow too.

3) You can't touch your face.

They don't stop virus aerosol. That's where you need a proper seal.

I'm not actually sure facial hair makes any difference with a cloth mask. Surgical mask would be in between. And an N95 probably becomes a surgical.

What would someone find offensive about the picture?

I guess the toothbrush mustache is verboten.

Possibly the labels under each facial style.

Offensive or hilarious? I love the creativity behind naming each individual style. I don't think any of them are particularly offensive, are they? It's possible I'm missing some references, of course.

Some people have a hitler mustache phobia.

FWIW, I don’t think the majority of the officials intended to lie about this. It wasn’t anything that started this year or anything - they’ve had the same message about masks since as far back as the 2009 H1N1 pandemic.

https://slatestarcodex.com/2020/03/23/face-masks-much-more-t...

> But the CDC has recommended against mask use. I hypothesized that the CDC was intentionally lying to us, trying to trick us into not buying masks so there would be enough for health care workers.

> But that can’t be true, because the CDC and other experts came up with their no-masks policy years ago, long before there was any supply shortage. For example, during the 2009 swine flu pandemic, their website offered the following table:

> [table in link]

> And during the 2015 MERS epidemic, NPR said South Koreans were wrong to wear masks:

> “[ . . . ] Masks can be helpful for protecting health workers from a variety of infectious diseases, including MERS… But either type of mask is less likely to do much good for the average person on the street…Wearing a mask might make people feel better. After all, MERS has killed about a third of the people known to be infected. But there are no good studies looking at how well these masks prevent MERS transmission out in the community, says Geeta Sood, an infectious disease specialist at Johns Hopkins University. “On the street or the subway, for MERS specifically, they’re probably not effective,” she says. One problem is that the masks are loose fitting, and a lot of tiny airborne particles can get in around the sides of the masks.”

> So if studies generally suggest masks are effective, and the CDC wasn’t deliberately lying to us, why are they recommending against mask use?

I think you’re right. I don’t understand the general tendency of assuming malice when a combination of uncertainty about the virus, poor supply chains, and not-very-good underlying data would do just as well.

It’s also unclear what “masks” meant in the initial phases. An N95 respirator? A surgical mask? A homemade cloth mask? Each of these has different uses and effects. I seriously doubt most people knew the difference in early March, I only had a vague notion. The surgeon general likely is thinking of respirators, because all MDs in hospitals get fitted for it. They know how hard it is to put it on and take it off safely, and know how critical it is for it to be a good tight fit. None of those things are going to be true for most people in early March 2020. If that’s your frame of reference, then it makes total sense that you’d recommend people not buy masks.

Everyone going out and buying N95s when they’re not particularly useful to most people unless in a close confined space is a bad thing. It doesn’t actually save many lives, but does make it harder for people who need it (docs/nurses in close confined spaces, particularly with patients on respirators that aerosolize the virus).

People wearing surgical or cloth masks may help some, probably mostly in enclosed spaces and mostly for exhalation rather than preventing you from inhaling a virus from someone else.

Even then, it’s my understanding that the data isn’t awesome here. Many of the papers I’ve seen are under fairly odd scenarios (for example an airplane, lots of the same air, recycled all over, for hours, where the paper showed positive mask benefit). We don’t have much for bandanas, or masks that were washed 3 weeks ago, or masks that are tighter, masks that are looser. I’d wager it helps, a little, especially indoors.

In other words, this shit is complicated, why assume lying when instead we could just say, “it’s complicated, they didn’t get it 100% right.”

I'd be much more OK with this explanation about how complicated it is and how hard it is to get it right if on any disagreement with the same experts one wouldn't get yelled at as "science denier" and accused in willing to murder millions of people by his stupidity. I mean I get it, there's a complex question whether masks help (depends on which mask, in which circumstance, how long is the contact, how skilled you are in wearing masks, etc.) But isn't that why we are paying the CDC guys - to have clear guidelines about such stuff?

OK, let's say CDC guys screwed up and got caught with their pants down (oh man did they...) and now we have no clear guidelines about it. Then come down from the ivory tower and tell us what you have and let us decide without politicians yelling at us and jerking it around - one day you are an idiot murderer because you're wearing mask, next day you're an idiot murderer because you don't. It just breeds contempt for the whole setup.

I completely agree that the rhetoric around “Science!” has gotten increasingly more toxic. I say this as a trained scientist, we really do at bad job of communicating. This is made worse by a media and a general public that isn’t used to thinking in scientific terms.

By that I mean we spend so much time as scientists living with and making decisions about which course of action to take in the context of uncertain data. Other fields obviously do too, but for a bench scientist, every day is is a constant tradeoff on which data you buy, what experiments will you run to confirm/exclude it, and what’s the downside of that decision. The best rarely speak in full certainty, they talk about probabilities.

Contrast to public messaging or journalism which is, “do this, not that.” This has led to people holding “science” as an identity, a talisman of righteousness. That’s not how science works, but people want to feel better by judging people so here we are.

I personally would have preferred a short, coherent statement on what we know for sure and what we don’t, how confident we are about the same, and to treat people as adults.

The problem with summing up a multi-dimensional tradeoff as simplistic negative advice is that it creates FUD that sticks with us indefinitely. Instead of acknowledging the goal we needed to work towards and getting everyone onto the same page, we end up arguing over a trivial issue as the nonsensical advice continue to echo. The biggest benefit to everyone wearing masks would be that we could finally stop talking about masks.

Remember spending a few weeks agonizing over how to ramp up ventilator production, rather than focusing on masks? And then finally coming around to masks could be useful, with everyone championing DIY cloth masks? We're four months into this thing and most everyone is still proudly wearing those ersatz face-rags, even spending effort to "improve" them as as fashion accessories. Meanwhile a proper N95 costs around $3 to produce and distribute - I thought we were supposed to be an industrialized society!

This isn't complicated at all, it's only been made to look so by governments and organizations caught with their pants down.

Not wearing a mask offers zero protection from an illness which is mainly transmitted through droplets and aerosols.

Wearing a mask offers some protection, ranging from little to very good depending on the type of mask. In the mean time we know that surgical masks offer pretty good protection in particular, but there were studies about SARS, MERS and influenza going back years showing that both FFP2/N95+ and surgical masks do help. We even have studies comparing incorrect, partly incorrect vs correct usage.

The conclusion is inescapable: even if people on average wear masks incorrectly and even if the masks they wear aren't even close to 95% effective, they reduce the rate of transmission. Why on Earth would you not want to reduce the rate of transmission even if by a few percent?

You are assuming that people’s behaviors are identical when wearing and not wearing masks.

This is what we do not know (still).

There are plenty of results in life science far more counterintuitive than the hypothesis, “people are less strict about social distancing when wearing masks.”

There are countries - including in the EU - which made masks mandatory or highly recommended them. If "we" do not know how people behave when wearing masks, we could simply ask them.

Although we don't strictly need to ask them, since the head of the Chinese CDC said more than a month ago that using masks is essential and that he doesn't understand why Europe doesn't do it. KCDC specialists said much of the same thing, although I don't know if they expressed concern at Europe's lax attitude toward masks.

And finally here's a couple of anecdotes:

* people in supermarkets seem a bit more careful now, since the masks have been introduced. But keeping 1.5-2m distance at all times is hard and this is certainly not always respected. That's the whole point of why one needs masks instead of relying on distancing - distancing doesn't always work, but having a mask on is pretty simple. And even if the wearer screws up, at least they don't easily infect the others.

* before the mandatory mask thing people generally got out of my way when they saw me with my mask on.

I think on balance you’re right masks probably don’t hurt, and this is a change from my initial views. I don’t think they’re quite as magical as people seem to think. For example if you wear glasses you’ll notice how easy it is to have them fog up with a mask that doesn’t fit well. Those are your droplets shooting vertically into the air. We don’t know how reused masks perform either esp. when they get dirty. Still, probably helps overall.

Where it does cause harm is early on if everyone gets N95s and the docs can’t get enough (which absolutely happened) then that actually kills more people (docs, nurses, and the people they would have saved).

The right message in retrospect should have been, “don’t go buy masks, save those for people who need the highest performance, but wear a cloth mask when indoors. Wash it frequently.” We screwed up, but it’s not malice and it is complicated.

There was definitely no malice or intent to mislead by health authorities in this regard and the claim that there was has always struck me as a bizarre result of selective reporting.

You can go back a few months and the WHO went on record plenty of times regarding a couple of points

- Health workers really need good PPE and there is a shortage

- When infected people wear a mask, it reduces transmission

- The benefits of a non-infected person wearing a mask are not super well understood/studied and this topic doesn't really come up much because our main audience is healthcare professionals

So they said at one point, focus on getting the masks to health care workers, and then as mask supply increased they said the infected should wear them too, and now that cloth/paper masks are easy to obtain they say everyone should wear them.

It was always a question of supply and availability, there was no conspiracy.

If you looked beyond the headlines and looked at the context it was pretty clear.

The recommendation against masks was probably a knee-jerk reaction. Or maybe a bureaucratic "we know better than you" reaction

At the same time the amount of people that think that have the mask below the nose or just at the chin or mishandling it because it feels "uncomfortable" to them is astounding. I'm not sure but I believe an intubation is more uncomfortable (and yes these are predominantly people at risk ages)

This is so very, very annoying. I saw my parents-in-law yesterday, and both of them were wearing masks incorrectly.

It's just so pointless to go to the bother of getting a mask and then wear it in such a way that you get no benefits from it.

Who says it's lying? Modern Western world has never had a pandemic in the current globally connected world.

Recommendations try to take everything in to account.

It's easy now to say: just wear masks. But then, there was even a global shortage of masks for health professionals.

The UK did a study a few years ago on the most important threat. The #1 spot (on importance) was a pandemic and would have way more impact than the #2 threat. The report suggested various things, including e.g. masks, etc. The report was ignored.

In US there's been many warnings to subsidize a strategic PPE supply and production. This was ignored. Early on (COVID-19) a US mask producer asked officials to provide money to expand production. This was ignored.

It wasn't just easy to predict, it was predicted various times.

A comet will hit the earth is also easy to predict.

But we won't build something now against it because it's a long time ago.

The problem with falsehoods is that by making and perpetuating them, you are undermining your own credibility. Yes, there are some who will think that maybe it was better to be lied to, but most will remember the fact that they were lied to. And some of those will believe that they were lied to because their life was discounted.

The problem with lying is that your intent doesn’t matter, you still lied, and in a society that is built on gradations of trust, you’re trading against your own credibility every time you lie. You don’t get a discount on the price of your lie simply because you were acting in a paternalistic manner, in fact, Officers and employees of the government taking a paternalistic position makes their lie worse and increases the cost to their own credibility in the long run.

It's a trust problem more than anything else. If I trust the medical professionals, I may accept them lying for our own societal good.

However, lots of people don't trust (various types of) "authority". And for them, the lie is further proof of their prior lack of trust.

It's a hard problem, which has been made a lot worse by the politicising of masks, in particular.

My own prior is that Asian people have been wearing masks for many years, and I am inclined to believe that masks are (somewhat) useful. However, there's been so little research on mask-wearing by the general populace that I am deeply uncertain about those benefits.

I don't disagree, but I feel like you're understating it. The reason people don't trust "authority" is because they can't always tell when they're trustworthy, and the more disconnected from their "authority" figures they are, the less they are able to figure it out. So when public health officials, the same public health officials that told us to stay home, close our shops, give up our incomes and livelihoods and stability contradict themselves, they lose trust, and let's be honest, rightfully so.

It is one thing for us as laymen to discuss the efficacy of masks, staying at home, shutting down the economy, not partaking in the activities we used to enjoy and so on. It is an entirely different thing for a person in some kind of authority, like "public health", where your primary domain of expertise is communicable diseases to step out of their lane (which is communicable diseases) and say despite the supposedly high risk of death and bodily destruction that an apolitical virus with neither vices nor virtues nor policy positions can wreck, it is entirely okay to go out and protest something, but only if it is something that "we in authority" currently agree is worth protesting. This is, by the way, not long after the 9th Circuit said allowing Churches to reopen (even with limitations) would make the Constitution into a suicide pact.

People don't trust authority because authority doesn't want to stay in its own lane. Take Anthony Fauci, he has done a remarkable job staying out of the fray as much as possible and simply acting as an advisor to the President and to the people, and people trusted him even when they wanted to imagine their own politics on him. As a civil servant, absolute standout guy, and he's now considered one of the most trusted medical professionals in the country because he stays in his lane, meaning he allows his politics to take a backseat (not even the backseat, it's back in the trunk) to his job and Office (Director of the National Institute of Allergy and Infectious Diseases).

Forgive me, I went on a small rant, but to conclude, when you have lying in the first instance and not staying in your lane in the second, one of the effects is going to be a loss of credibility, and that's both just and understandable. Choices have consequences, and that includes lying, and that includes using your unelected Office for activist purposes. Even when you're right about something, up to and including the efficacy of masks, you've already lost credibility, and in the case of masks, you've already directly contradicted yourself. (I mean "you" as in public health officials recently, not you specifically my fellow HN).

We indeed live in an era where all things are binary.

But what is a thinking person supposed to think when the Surgeon General is saying don’t wear masks in a pandemic caused by airborne viri?

In urban (educated) zones likely to be hotbeds for outbreaks, could the state not do a little nuance and say “hospitals need the N95s and you need a bandana”

Everybody has got a bandana, but if I were to start walking into stores with one before sanctioned, someone would be calling 911. In the meantime, how many weeks go by at R 3...

Hopefully this doesn't come across as pedantic but airborne transmission of COVID-19 is rare. Not ruled out completely but not the main way it is spread. In the initial Chinese study of 75K they said there was zero airborne transmission, I think they've found some exceptions since but it's not a common thing.

The WHO actually has a definition for this, when the droplets carrying the disease are <5μm they spread further and drift around for longer and that's when they start calling it airborne instead of droplets, COVID-19 is not in this category.

It's still good to wear a mask, I've lost count of the number of times over the years that some excited extrovert straight up spit in my face because they were worked up about something. lol.

https://www.who.int/news-room/commentaries/detail/modes-of-t...

If your source that airborne transmission is rare is the WHO, then all you have is a worthless source.

Recently I've read an interview with Drosten (the German virologist which came up with one of the Coronavirus tests) say that they're starting to see airborne transmission as an important transmission factor, maybe not a strong as droplets but comparable. This is especially the case in poorly ventilated spaces.

Key words: starting to see. Using that now is 20/20 hindsight.

Well, at least in the west we're starting to see it now, but we're late to the party compared to Asian countries.

We already knew for instance that SARS is transmitted through aerosols. Then a new thing comes up which is related to the above and is basically named SARS-2 and we forget about the aerosols and instead think we should wash our hands a lot. Words can't express how stupid this is.

I don't suppose you have links to any pre-prints or papers (hell even blog posts I guess) around this?

I don't have much, but maybe this contains a hint on the effects of mask usage on the German death growthrate. https://www.facebook.com/photo.php?fbid=10157238440973015 (Masks about 25.4 - the effect should be visible around the middle of May)

After looking closely I found a small move into the wrong direction (maybe caused by something else?!??)

This is a pretty nice and very recent summary: https://science.sciencemag.org/content/early/2020/06/02/scie...

There have been studies which have found that the virus can aerosolize, but it hasn't been established that infectious spread occurs this way. For example, it could be that viral concentrations in an aerosolized form aren't enough to cause an infection (or maybe they can get there, in prolonged close quarters, but by then you're being exposed multiple ways, so it doesn't matter or can't be determined). Either way it seems that the protocol for preventing transmission probably won't change much; the current protocols (including ubiquitous mask usage) have been enough for Korea, Taiwan etc. to control the spread.

It cannot be established without exposing healthy people to the virus, so it must be assumed.

I think it can change something: currently masks are seen as a necessary evil in stores and public transport. They could and should become ubiquitous.

As far as I have seen, currently people don't use masks for close contact talking situations (family, friends, work, chatting...).

With mask usage in Germany I see only negative trends in the growthrate of both case and death. I think to make them work something has to be changed.

There is a good chance that it now only works as a reverse placebo - it makes people feel confident and pushes them into more risky behaviour - most likely net negative.

Jena's claiming that they made a difference for them. We'll see what happens in Berlin and Munich after the protests...

> could the state not do a little nuance and say “hospitals need the N95s and you need a bandana”

No. Not in 2020. Not with the vast majority of the population. Nuance is dead.

Rumors of its death have been greatly exaggerated.

There seems to be a trend to paint people as imbeciles who can't tie their own shoelaces without somebody standing over them, and then on investigation it turns out not to be true.

There was a story a while back about a couple who drank fish tank cleaner (containing chloroquine) after Trump touted chloroquine against the coronavirus. Come to find out the couple were not fans of Trump but were having marital difficulties, so now you've got to weigh the possibility that these two were stupid enough to drink poison against the possibility that the woman discovered a way to intentionally poison her husband and pin it on Trump:

https://nypost.com/2020/04/29/homicide-cops-investigate-deat...

More often than not, when you see someone doing something apparently colossally stupid, it's because you don't know the whole story rather than because they're actually that stupid. People understand nuance plenty when it's important to them.

Wait, you read a NY Post article with rumors about a married couple having marriage difficulties, and you believe you've uncovered the "whole story" that other people are somehow blind to but you can see?

Do you want the same story from a dozen different sources? This is actually a good example of the differences between partisan sources. The New York Post article says this:

> Mesa City police declined to comment on the investigation but told the paper that the probe was “normal protocol” for non-natural deaths and noted that the case has not been ruled a homicide “at this time.”

In left-leaning publications they omit "at this time" and make that the headline.

But the interesting thing about the story isn't the police determination. That hasn't been made yet, so it tells us nothing, and anyway the police would have to prove it beyond a reasonable doubt. The whole point is using that excuse creates a lot of reasonable doubt even if it was completely intentional.

The value of the story is that it gives us some new evidence. The narrative that somebody recklessly drank fish tank cleaner after a Trump recommendation loses credibility when you learn that the person was anti-Trump and thereby not inclined to unthinkingly believe whatever he says, up to and including drinking something with a label on it that says poison. Meanwhile a plausible alternative explanation exists.

I can't speak for anyone but myself, however I now no faith in anything that the WHO, US surgeon general and to some limited extend the CDC and RKI say, because of the way they lied or hid the truth in the past.

I have much more faith in the KCDC for example and otherwise I want to see studies.

And anyway, people are unfairly accused of hoarding masks. It turns out that in the US, Australia, Germany (and probably other countries) China was buying up all the masks.

Who do you trust instead? Seriously asking, because dismissing somethig is always the easy part.

Regarding the masks, I went deepy down that rabbit hole in February and March. Most production happens in China. China didn't produce anything, needed what was there for themselves and had closed down a lot cities and ports and such. At the same time, demand increased by orders of magnitude around the world. hence the shortage. China didn't buy masks en mass from other countries, they didn't need to. A ,ot of fraud happened as soon as production resumed. No, people who, with a financial interest, tried to help sort out the shortage once the German government failed to do so, are sitting on tons of masks they bought in good faith for 5 - 10 times the normal price. Currently prces are down to roughly 2x the pre-Covid-19 prices. See the problem? People hoarding made the issue even worse.

Hordng mass during that period for retail sales or your own use, thus preventing PPE from getting to medical care professionals, is the deffinition of hoarding.

All of your mentioned institutions are publishing or using studies. Go look them up. But maybe accept that the people behind them know more about the subject than you do.

I did say I trust the KCDC, didn't I? And also the CDC and RKI can obviously do some good work, but they completely failed to set the story straight on masks and aerosol transmission while over-emphasizing the fomite transmission and hand washing. So at least on those topics they've lost credibility.

I don't know if China needed the masks, or if they needed to weld people in their apartments, but apparently they did that anyway. See for example the article "Billions of face masks sent to China during Australian bushfire crisis". This was happening around February.

Spiegel published an article in which a distributor of protection equipment got orders for months of inventory within a day from various Chinese customers. They also claimed that all the other distributors which they knew had a similar situation on their hands. In fact they got so many orders that they alerted the ministry of health about an upcoming bottleneck in procuring PPE.

Then there's the US: "U.S. exported millions in masks and ventilators ahead of the coronavirus crisis". $17.5 millions worth of masks exported during January and February.

And this is in addition to the hundreds of thousands in PPE they received as donations from all over the world.

The average Joe buying a 10 or 20 pack for himself & family is first of all not hoarding, as this is a very small quantity and secondly didn't cause the shortage.

One average Joe, no. Thousands of them? Yes, that's harding. And a problem. China got a lot donations, they also were the first to donate to Italy. The mask situation was a mess.

The proble I have is, that now people accuse every institute or offical body of lying. Because they got, in people's minds, the mask thing wrong. Why can't we just accept that even experts can be wrong? Starting to accuse others of lying is the first step towards conspiracy theories, IMHO, as it only leaves black and white. And what is it that the WHO and co. have to be right 100% right from the start and everybody else is just asking questions?

If we take Australia's case of billions of masks (let's say 2 billion, conservatively), and assume that each average Joe bought let's say 20, the actions of the Chinese government are equal to *one hundred million average Joes", not thousands of them. For one country.

It's mighty noble to donate to Italy after they confiscated all the inland mask production and bought tons of masks from everywhere else. And then they also pressured European politicians to prasise the communist party when receiving said donations.

Not every institute, just the WHO and to some limited extent a few others. Stop setting up this straw man, because that's clearly not the case for me and I listed some organizations which I do trust - because they've proven that they're competent.

Experts can be wrong, sure they can. But if their literal job is to protect us from such pandemic situations and they fuck up, they deserve some criticism.

If they persist in not recommending masks when already most countries are recommending them, like the WHO did until 1-2 weeks ago, they are uselessly incompetent and should be ignored.

I don't think _every post_ whining about the lies of the health authorities has a libertarian "fuck everyone else" subtext.

It seems to me that the original misinformation on this subject has caused a continued belief that masks are not helpful in reducing transmission. Initial public health recommendations cannot easily be walked back. Once the meme is sufficiently embedded, it's nearly impossible to dislodge.

How do you know it was a lie? What evidence do you have?

There seems a fairly trivial explanation: they were talking about the effectiveness of a mask in protecting you from what you breathe in, not the communal action of everyone wearing a mask to protect other people from what you breathe out.

Surgical masks offer some limited protection for the wearer (20-80 AFAIK according to some study). Respirators offer good to very good protection for the wearer.

For a long time I was under the impression that surgical masks don't really help the wearer. There are some studies showing comparable effects to an N95, but I was assuming incorrect N95 usage and I was incorrectly dismissing the benefit of even low double-digit protection.

The thing that convinced me to take a closer look was an interview with the German infection specialist Peter Walger, which said that:

* all masks protect the wearer to a certain degree

* medical grade surgical masks clearly offer partial protection. This was a grave error, which made personnel also in clinical practice not trust the masks and wear them for protection.

It doesn’t matter, the advice was for the whole population not to go buy masks.

That is simply not true and an awful accusation.

The last Sars or Coronavirus illnesses differed from this one, as in those cases asymptomatic people were not spreading the virus very much.

So the (reasonable) assumption was that people mostly know when they are contagious and stay at home.

In that scenario "community masks" (everything below FPP-2) don't matter much.

When researchers found that Covid-19 is different (and that has to do with the massively higher virus load in the throat, where former similar diseases built most of the virus load in the lungs), the stance changed.

That is a good thing! Learn new information, adapt your response.

What's fueling conspiracy theories now is that the messaging back then centered on "we need to preserve masks for the medical community", which was a smaller component of the motivation, sure, but got mostly conflated with the real argument. I think that is because it was much easier to explain to the public and to journalists.

In hindsight that was a mistake. But the conspiracy theories that health officials just flip-flopped for no reason is wrong, and it's damaging the fabric of society even more.

It is actually true. The surgeon general literally said:

"Seriously people- STOP BUYING MASKS! They are NOT effective in preventing general public from catching #Coronavirus"

Did you read my comment at all?

"which was a smaller component of the motivation, sure, but got mostly conflated with the real argument. I think that is because it was much easier to explain to the public and to journalists."

They still lied, which was the original point. Even if they lied for what they believed to be good reasons.

No, they didn't. They reasonably believed masks to be useless (at least compared to the burden of having everyone wear masks).

They simplified (and arguably over-simplified) the public communication.

Insisting that they lied is uncharitable at best, and a hallmark of all sorts of conspiracy theories right now.

When wearing mask in public you're not protecting yourself - that's ineffective - you're protecting others from your own cough/talking droplets - that's effective.

Exactly. Why do you think you disagree with me there?

The point is that when almost all contagious people stay at home, we don't need community masks. We only need them because contagious people are asymptomatic (that's new!), tehrefore don't know about their status and therefore go out in public.

Almost all contagious people never stay at home. Based on my experience, people with colds come to work and go about their business.

That is anecdata. Maybe valid for, say, January. Starting Febuary, that changed. Again anecdata, but In Germany you got up to 2 weeks of sick eave for potential COVID-19 symptoms without seeing a doctor.

I must be unlucky because my colleagues almost always come to work sneezing for a few days until (if!) they take sick days. This was right before the pandemic, when the situation was getting hot in China but not yet in Europe.

Exactly my point, before we were aware it is going to be the same in Europe. After, not so much.

> “we need to preserve masks for the medical community”

To be fair, I remember looking it up on the CDC website when this all started, and they explicitly stated any masks are not necessary (or useful) unless you are caring for a sick patient.

That's exactly what I wrote: the working assumption was that you wouldn't be contagious (because then you'd be staying at home yourself). That turned out to be wrong. Later.

Given that this assumption doesn't work with something as banal and common place as the flu... why would it apply to a new respiratory virus, especially since people were anyways coming down with colds and the flu and had no clue what they had.

"So the (reasonable) assumption was that people mostly know when they are contagious and stay at home."

Too bad this pandemic overlapped with the flu season and with a period of time where many people had colds, thereby rendering the above assumption null and void.

In other words, the number of black lives that may be lost during these protests from the virus alone is worth sacrificing because #blacklivesmatter. Meanwhile, anti-lockdown protests, which were much smaller, are nothing but a bunch of wreckless people protesting to be able to get haircuts. Nothing to do with all the other losses and risks that myopic, upper middle class "experts" can't seem to comprehend. Unemployed black people also don't matter, I guess.

I mean, really. How can people not see the writing on the wall? All of this is political finagling. Black protestors are merely convenient instruments. The political opportunists pushing this bland disingenuous crap don't care about George Floyd in the least.

The CDC revised their risk estimates towards the end of last month.

"The fifth scenario is the CDC's "current best estimate about viral transmission and disease severity in the United States." In that scenario, the agency described its estimate that 0.4% of people who feel sick with Covid-19 will die.

For people age 65 and older, the CDC puts that number at 1.3%. For people 49 and under, the agency estimated that 0.05% of symptomatic people will die."

https://www.cnn.com/2020/05/22/health/cdc-coronavirus-estima...

Those CDC numbers are really weird btw. 0.4% of symptomatic cases is like a 0.2-0.3% IFR.

0.3% of the New York City population has already died of corona-virus. So assuming everyone in New York was infected that gives us an IFR of .3%. But if a more realistic 20% of the population was infected then the IFR could be as high as 1.5%.

I tried going through all the most recent research and almost all of it came up with an IFR in the 0.5-1.2% range. And the few that had a lower rate were looking at anti-body tests in places with very low base rates.

Maybe the 20% of the population was more susceptible? It seems that the outbreak was concentrated in long-term care facilities, healthcare workers (who received a larger viral load than average), and the poor (who tend to have more pre-existing conditions). If the 20% is not randomly distributed the math can still work out.

The math could work out, but if that was true then that means if NYC got 5 times as many infections the number of fatalities would barely change.

I would find that hard to believe and I also doubt they would have enough data to validate that type of hypothesis. We're still guessing at the number of people infected, not to mention how old are they, what pre-existing conditions did they have, how do those pre-existing condition affect Covid-19 mortality in different age groups, what viral load did they receive, etc..

Fair points! You could probably make an estimate with a stratified approach but if 0.3% have already died there’s no wiggle room for additional deaths.

Influenza and pneumonia deaths by influenza season and age United States, 2008–2015: https://www.cdc.gov/nchs/data/health_policy/influenza-and-pn...

Sorry, I don't see the connection.

An interesting question is this: which 20% got it? A representative sample, or a localized group with unusual risk characteristics, like retirement homes or prisons?

Even if you do not die, you might have a very unpleasant experience with lasting consequences.

Perhaps a better way to frame it would be - 2% (?) of patients have serious life-changing consequences. Those under 49 tend to survive them.

The problem for me is we don't have any way at this time of knowing at an individual level what the consequences are likely to be. I might have no symptoms if I get sick but I may transmit it my son (type 1 diabetic) who might die. Or maybe he'd be fine and I might die, etc. There's just no way to gauge what one's reaction might be to getting the coronavirus.

A local, healthy 8 year old girl started having symptoms last week Thursday and died the following Tuesday.

I don't expect my family's lockdown to end before well into next year at the earliest. The odds are against dying or long term complications for younger people, but is going out to dinner, a bar, sporting or music event worth the risk? Not for me. Stay safe folks.

That's really unfortunate with that young girl.

So far it looks like these are the absolute exception, but it does sadly happen that young healthy people and kids too get seriously sick and sometimes even die.

The German pediatric association publishes some (incomplete) stats about the disease in children (https://dgpi.de/covid-19-survey-update-kw22/) and there were so far 159 hospitalizations, with 21 of those in intensive care. 140 kids were released, 1 died. ~9600 <19yos registered as sick with COVID.

Key word: Incomplete. As was Drostens study about the virus concentration in children. The German Fox News wannabe BILD tried to kill him for it. Incomplete studies and data is the norm right now. I am happy to not have to make decissions about life and death based on this. Someone has, so. And erring on the side of caution isn't necessarily a bad thing.

The DGPI data is not a study, but rather they collect data from children's clinics and it is incomplete in the sense that not all clinics deliver information to them. If anything there could be more hospitalizations and deaths, but that seems rather unlikely.

In any case I agree that the topic COVID and children is particularly sensitive and still blurry right now.

There’s the risk of death and injury, which is an interesting discussion, and then there’s the fear. With cases beginning to rise rapidly in multiple states again, I expect the latter to have a more dominant effect on our behavior

> serious life-changing consequences

This is a much more interesting data point.

Death tends to have very few ongoing life-altering consequences, and in and of itself has a very low R0.

The CDC estimate (IFR 0.26%, S-IFR 0.4%) is heavily criticized because it ignores, thus predates, the 3 largest and most reliable serosurveys which all indicate an IFR of ~1% (S-IFR ~1.54%, assuming 35% of cases are asymptomatic):

1.0% in Brazil based on 25,025 samples https://twitter.com/GidMK/status/1267670267624476672

1.14% in Spain based on 60,897 samples https://twitter.com/zorinaq/status/1265405628853305345

0.92% in NYC and 0.84% in New York State based on 15,101 samples https://twitter.com/GidMK/status/1267669314657611777

Also YYG, the guy who runs https://covid19-projections.com/ (a model that has consistently produced the most accurate forecasts) reported his model found that a ~1% IFR gave the best fit: https://mobile.twitter.com/youyanggu/status/1256051255253757...

Note: S-IFR is the fatality of symptomatic cases only. IFR is the fatality of all cases (asymptomatic and symptomatic)

The wider NY state has an IFR of 0.5%. The IFR should also be very sensitive to the demographics of the infection. Both the UK and NY State had a policy of sending recovering (but potentially contagious) older covid patients back to nursing homes and it would have exacerbated the mortality rate vs regions that did a better job at protecting the elderly.

I am also starting to hear some noise that there might be cross immunity between this virus and previous coronavirus. In a recent video Prof Raoult was suggesting it might explain the low infection rate of people under 20 [1]. I am not qualified to tell whether the theory has any leg but it may be that we underestimate the spread of the virus when looking at a specific antibody.

[1] https://www.youtube.com/watch?time_continue=734&v=zUbiYhknaK... (in french)

NY State does not have an IFR of 0.5%. You are probably quoting Cuomo's press briefing https://www.ny1.com/nyc/all-boroughs/news/2020/04/23/governo... which claims 0.5% based on this math:

15740 deaths ÷ 2700000 infected = 0.58% (they round to 0.5%)

However they note that the official state death count (15740 deaths) «only indicates deaths that happened in a hospital or a nursing home, and does not include coronavirus-related deaths that occurred in a home, which means the official death count is likely higher than that official number»

The true number of deaths, including home deaths, is 20759 as of the date of Cuomo's press briefing, April 24 (source: https://raw.githubusercontent.com/nytimes/covid-19-data/mast...)

Furthermore, all the figures quoted by Cuomo were provisional, mid-study. The serosurvey actually completed on April 28 and was published here: https://www.medrxiv.org/content/10.1101/2020.05.25.20113050v... The final figures as of this date were:

22777 deaths ÷ (19450000 state population × 14.0% infected) = IFR of 0.84%

It is important to take deaths as of April 28 in order to minimize right censoring.

«Both the UK and NY State had a policy of sending recovering patients to nursing home»

Spain and Brazil did not do this and still exhibit an IFR of 1% add per the serosurveys I referenced.

> Both the UK and NY State had a policy of sending recovering (but potentially contagious) older covid patients back to nursing homes and it would have exacerbated the mortality rate vs regions that did a better job at protecting the elderly.

Isn't the death rate the percentage of population that dies when all are infected? Then nothing can be "exacerbated" by that alone? It then just reflects the death rate which results from the people being infected, no matter the speed?

The rate quoted by the parent, I believe, is the number of deaths divided by the number of people estimated to be infected, by prorating an antibody test sampling to the wider population. So that doesn’t assume everyone got exposed to the virus, and assumes the sampling is a representative sample (but in NY it was sampled in grocery stores, which tells you nothing about infection rate in nursing homes that made up 40% of the deaths).

> the number of deaths divided by the number of people estimated to be infected, by prorating an antibody test sampling to the wider population. So that doesn’t assume everyone got exposed to the virus

To get the rate one can indeed calculate it with smaller representative sample, but that just doesn't imply that the vulnerable people would somehow never become infected if the epidemic continues, so the deaths of the old can't be avoided then. That the old die much more is a fact, and nothing that by itself "exacerbates" the rate.

Edit: I haven't seen any argument that estimated more than 20% of NY population that were supposedly infected were somehow specially skewed sample to hit only old people, and I'd argue that if the sample is that big it's quite improbable. If the argument is that the virus got faster in the nursing homes, one can also argue that all the old people outside of nursing homes skewed in the another direction by managing to initially not get the infection, but that as epidemic progresses they would indeed eventually become infected and suffer.

Edit2: "the virus is rather showing signs of going away" claim is very curious to me. I don't see it "going away" looking at all the statistics across the different parts of the world. I see only the slowdown of the spread, which corresponds to people generally changing their behavior to slow it down.

But that sample may not be representative of the demographics of the people who got infected. It is possible that a lot more people in care homes have been infected than the grocery store sample, because of the policy of sending covid patients there (and the fact that the staff must have physical contact with each of the patients every day and therefore it will spread within a care home may very quickly).

If it is the case, you don't expect the same death rate to scale up as the wider population continues to get infected (if it is still happening, the virus is rather showing signs of going away).

Only 21% of Covid19 deaths in New York State occurred in nursing homes. Recent source (few days old): https://www.kff.org/health-costs/issue-brief/state-data-and-...

In the very article you link to the case of New York is mentioned by Bergstrom, specifically to critique that estimate, and point that New York disproves it.

I verified that claim:

We know that the antibody tests in NYC gave the estimate of "all infected" of 20% of all. But there were around 20K deaths, and NYC has 8.3M population. Also even if we expect that the spread will stop once the 70% of population is infected the result is: 100e3 * 0.7 / 8e6 = 0.87%

Still much more than 0.4%. That it's closer to 1% matches all the statistics of the countries of the world that did a lot of testing compared to the number of cases and deaths.

Back to the article:

Bergstrom in the article: "Given that these parameter sets underestimate fatality by a substantial margin compared to current scientific consensus, this is deeply problematic."

In the same article, even CDC disclaims that their numbers are predictions:

"The scenarios are intended to advance public health preparedness and planning. They are not predictions or estimates of the expected impact of COVID-19" the CDC says.

So it seems you intentionally misinterpret CDC, given that it's all in the very article you linked.

i’m 25 and this whole covid debacle and seeing how public health officials handle it has soured me on all “experts” for the rest of my life.

no wonder people don’t believe in global warming, these “experts” prioritize politics over everything

I'm older than you and I've lost alot of faith in 'experts' as well.

Today I read about several published studies that were retracted for unreliable data related to covid drugs.

I'm now just using all of these things as one data point to make a decision with. News, politicians, scientific publications, experts, data.

I've also lost faith in certain political parties which I was previously a member for their fanaticism and demonization of people who disagreed with their narrative and who still can't admit their thinking was flawed.

Wholeheartedly agree. I'm in my 30's with scientific education, but I will never take an "expert" opinion seriously after this.

Very sad to see science shoot itself in the foot in the name of dubious politics.

I’m too familiar with university advancement policies to not be skeptical of the actual expertise of the “experts”.

> no wonder people don’t believe in global warming, these “experts” prioritize politics over everything

I read this as a clear expression of your frustration. Completely reasonable given the situation.

Are you familiar with the YouTube channel "Smarter Every Day"? There's this three-part series that might offer a new perspective on the distrust and disillusionment you seem to be feeling:

[1]:https://www.youtube.com/watch?v=1PGm8LslEb4

[2]:https://www.youtube.com/watch?v=V-1RhQ1uuQ4

[3]:https://www.youtube.com/watch?v=FY_NtO7SIrY

In particular, the channel creator Destin Sandlin explores how YouTube, Twitter, and Facebook are being used as a sort of vanguard in a meta-game to undermine our trust in the social institutions we rely on.

It's a pretty dystopian-sounding and bleak theme. However, Destin is really good at conveying a message of hope.

Use your Critical Mind, of course, but also realize that there's a personal cost to adopting absolutist views like `"experts" prioritize politics over everything.'

> to undermine our trust in the social institutions we rely on.

Is it YTs fault that the WHO was the absolutely dead last institution to recommend face mask usage on the planet? That even some countries that are having a very poor response have already recommended (or made mandatory in some circumstances) the use of masks?

That the WHO is accepting all manners of political interference from China?

Is it YTs fault that Lancet and NEJM published a completely fabricated article about HCQ usage at the point where this has become a contentious point? Sure, in the same week we have had other serious studies about it, but that one was, most likely, a fraud, that was rubber stamped by journals.

That, at a critical moment, researchers from a prestigious epidemiology centre have pulled some models they had on the shelves without enough second-guessing it and predicting very catastrophic results (which granted, there might have been unknown at the time reasons for it)

So yeah, I don't think it's solely the fault of Youtube and Facebook.

while interesting, i dont quite see how thats related.

public health experts during this whole crisis have been morally and intellectually bankrupt. misinformation on social media is a separate issue

I think the point is that usually, a layman would suspect the expert opinion after being exposed to another view broadcast on social media. Social media is the source and the moderator of our contrarian/critics information.

I got very skeptical reading the reaction to the antibody studies here. Also, the total hate for Sweden really depressed me. I've always held this place in high regard but I suppose it's still just more of the same.

The prevalence is too low for the antibody tests to be reliable. Every public health expert has reported that but people refuse to listen. Sweden has admitted their strategy is not working.

They have done nothing of the sort. Tegnell was quoted as saying he would do some things differently, but was explicit that avoiding lockdowns was not something he would change.

https://uk.reuters.com/article/uk-health-coronavirus-sweden-...

Sweden is mid-pack amongst european nations for death rate due to covid, and notably lower than the UK, Italy and France:

https://coronavirus.jhu.edu/data/mortality

"Sweden has admitted their strategy is not working." No they did not say that. I suggest taking MSM news with a great pinch of salt.

i don’t think we’ll know what worked or didn’t for years from now. regardless of what even they say.

it could be we just delayed deaths that will happen eventually anyway while commuting economic seppuku

One ting everybod gnores right now regardign experts is, that this a novel virus. We don't have any prior exerience or knowledge about it. Wich means incomplete data and potentially wrong data from day one. Making decissions in such cirumstances is incredibly difficult, and I expect every expert to change his mind when the data changes.

Does that potential confuse people? Yes. Are experts always right? No. Are they still the best resource we have? Yes.

i’m talking about things like them lying saying masks don’t work because they didn’t have enough. the who took until june to admit they work

and now this whole thing about staying silent about the race riots because they support them even though they’re likely to cause a second wave

I mean, Sweden is fairing badly next to their neighbors, and horrendously compared to countries like Taiwan and South Korea (who also didn’t have lockdowns). I don’t think people hate the country so much as they’re assessing the relative failure of their approach.

Sweden failed to protect their own elderly, mainly because national authorities simply assumed that local authorities were ready to fight a pandemic, when they were in fact hopelessly underfunded and staffed by underpaid staff with no PPE and who were expected to do stay at home on their own initiative and without payment if they got sick.

The same happened in a few places here in Finland, and I am quite certain that if we'd let COVID-19 through retirement homes the way our dear neighbors did, we'd have a much higher death-rate.

The actual Swedish stragegy, i.e. a soft lock-down with strong recommendations and only minor restrictions in travelling and gatherings, could actually have worked. Unfortunately, we'll never know as they screwed the retirement home situation up as bad as they did.

Sweden did screw up the retirement home situation somewhat, but in terms of excess deaths all Nordic countries look identical. Finland, notably, doesn't even count covid deaths outside hospitals according to the THL, so comparing Swedish and Finnish covid stats is a bit silly.

The Swedish catastrophe is always another 2 weeks away, and secondary effects of a lockdown (like delaying non-critical medical procedures and not screening for cancer) are likely to be much more significant than anticipated. Let's not forget that lockdowns were a knee-jerk reaction enacted by scared politicians, not a carefully considered and data-backed policy.

> in terms of excess deaths all Nordic countries look identical Finland, notably, doesn't even count covid deaths outside hospitals according to the THL, so comparing Swedish and Finnish covid stats is a bit silly

Where did you get those numbers from? EUROMOMO doesn't include data from Iceland, but for the rest it's obvious that Sweden is an outlier in regards to the overall mortality rate: https://www.euromomo.eu/graphs-and-maps/#z-scores-by-country

Denmark, Finland and Norway are below the normal mortality rates for 65+ since the lockdowns began. Sweden is clearly above. I assume there's not another epidemic over there that we've missed?

Again, I'm not saying the Swedish strategy is wrong, I'm just saying that the failure to protect the elderly has invalidated Sweden as a data point.

There has definitely been a bunch of deaths related to COVID-19 in Finnish retirement homes, but in terms of overall mortality rates for people 65+ it's quite obvious that it's not a big problem. Actual COVID-19 diagnoses are still reported by THL, including everyone who gets diagnosed by the public health system in Finland. Finland has unrelated, considerable, issues with care for the elderly, but that's a completely different topic. :)

> Let's not forget that lockdowns were a knee-jerk reaction enacted by scared politicians, not a carefully considered and data-backed policy.

Definitely. Lock-downs are last-resort measures taken when you've already failed to do what you should have done in the first place; extensive testing of travellers and contact tracing/quarantine of people who are sick. The other Nordic countries failed miserably in that regard.

Chart cumulative all cause deaths per seasonal influenza year (meaning week 40 to week 39) for each of the nordic countries. Correct prior years for population growth. Then take the average all cause mortality of the past 7 (or 10, whatever) years and compare that to this year's all cause mortality and you'll get a completely different result. Or just eyeball the all cause mortality of the previous couple of years: https://pbs.twimg.com/media/EZlnYQCU0AA0jkv?format=png&name=...

It's so "obvious" that Sweden is an outlier that people don't bother to look at the data more seriously. Sweden didn't lock down ergo it must be a disaster, the data be damned.

> in terms of overall mortality rates for people 65+ it's quite obvious that it's not a big problem

That's correct. The overal mortality of all Nordic countries is completely unexceptional. Politicians panicked because they believed that this disease would be very deadly (it isn't), kills healthy young people (it doesn't), spreads exponentially (it never has), and spreads through asymptomatic hosts (it doesn't).

I think Sweden’s strategy is on the bad end of the spectrum and Taiwan and South Korea’s on the great end. I don’t anticipate any more catastrophe for them than their relative peers in the bad response group, but they did do quite bad compared to liberal democracies in SE Asia. Taiwan has had 11 deaths and South Korea about 300. Sweden has about 4700.

South Korea uses exceptionally privacy invasive types of tracking and tracing, so their approach is better described as "police state" than as "liberal democracy"

This coronavirus hasn't made in a big impact anywhere in SE Asia, even though countries responded in very different ways. This suggests that the virus doesn't take hold for a different reason, e.g. pre-existing immunity.

South Korea is not a “police state.” All of the same info is collected by advertising companies and 3-letter agencies in the US.

> This suggests that the virus doesn't take hold for a different reason, e.g. pre-existing immunity.

No, it suggests the variety of their responses were on the effective side of things, while Sweden’s was not. Taiwan’s VP is an epidemiologist who has guided their response from day one and should be credited for that work.

Maybe people are so hostile about Sweden because people keep insisting they be graded on a curve, contrary to the real success stories.

So it's not bad because the US is doing it too? Or, maybe, the US doesn't respect the privacy of its residents either.

Taiwan started taking action before the first case had even been reported. And yes, they do deserve credit for that.

Sweden's response was also effective, given that the virus had already spread widely across Europe by the time the politicians woke up. There is some variation in the way cases/deaths are tracked between countries, but when you look at All Cause Mortality it's clear that Sweden is right in the middle of the pack, and they accomplished that without the massive externalities (both human and financial) of a lockdown. That's a success, but yes, Europe should have responded aggressively in Dec as Taiwan did.

Sweden cooperates with the US on all that surveillance, so you can’t really argue that they’re better relative to the US or South Korea. Arguably worse, because South Korea actually saved lives with it while Sweden got no pandemic-fighting benefit in return.

The South Korean and Swedish responses began at about the same time, so again, this seems like special pleading. South Korea has more direct exchange with China as well.

If your argument is that Europe overall hasn’t done a great job, and Sweden isn’t that far of a deviation from that performance, ok. But again, that’s not an accomplishment relative to the actually successful countries like Taiwan and South Korea. I don’t understand how having many times more deaths be considered “effective” relative to these countries? Again, they didn’t have any of the economic damage caused by lockdowns either.

Just learn to think for yourself by reading the classics and fundamentals. Read Karl Popper, study stats, read blogs like Andrew Gelman’s.

I do hope you look more closely at the record. “Experts” are not a uniform monolith. Some are competent. Some aren’t.

This isn't weasel speak at all. They're pretty clear that it's risky. They're just saying that they won't condemn protestors as taking frivolous risks the way anti-lockdown protestors or fun-seekers are. Police brutality, systemic racism, income inequality are all major public health risks in their own right.

I don't understand -- are keeping people out of work and isolated at home not public health risks? If non-Covid related factors are being considered in weighing against the risks of exposure they should all be considered, not only some of them, selectively.

I didn't hear any virologist claiming that isolation isn't a health risk.But it seems to take more time to have serious effects, COVID-19 on the other hand has the short term effect of overwhelming a health care system an causing thousands of deaths. And the lock-downs have never been planned to be permanent, were they?

Don't be obtuse. Of course all factors were considered. Keeping people out of offices and shops is not a public health risk. People becoming impoverished and losing health insurance is. That's why the federal government spent $2T protecting people's financial health to offset the damage. The bigger question is why health care access is tied to employment, but there's no way the current regime would consider dealing with that issue.

Also, you're comparing government policy with an academic opinion.

No. Unemployment is generally regarded as a public health risk, beyond the immediate insurance consequences. There will moreover be people who suffer long-term impacts that these short-term payments can only partially mitigate.

That seems like a good argument to expand unemployment benefits during a global pandemic, and I suspect most public health officials would agree.

A number of countries have implemented wage subsidy schemes, in which the government pays employers to keep employees on payroll even while there is no work for them to do due to the COVID-19 lockdown. Those schemes are in some ways better than unemployment benefits, in that they maintain the employer-employee relationship which increases the odds the job will still be there to go back to when the crisis is over.

UK: https://www.gov.uk/guidance/claim-for-wages-through-the-coro...

Australia: https://www.ato.gov.au/general/jobkeeper-payment/

New Zealand: https://www.employment.govt.nz/leave-and-holidays/other-type...

Ireland: https://www.citizensinformation.ie/en/employment/unemploymen...

That makes sense. I intended to refer broadly to programs to compensate people due to lockdown-related reductions in income.

How does it work with workers in the food service industry where the workers are paid cash? Or maybe that’s not common outside the US

That's a unique US thing. In countries like New Zealand people in the service industry get the same minimum wage as anyone else ($18.90 per hour) and don't rely on tips, they're normal employees and go through the same normal tax system.

That's why there is the joke about people from overseas not knowing how to tip.

Seems to be a US thing. In Germany, every company can as for "Kurzarbeit", short-wok, or all or part of its employees. Which are on the payroll, thus properly registered, unless the company cheated. In whch case I wouldn't be surprsed of that company just closes shop and fires everyone.

It gets tricky for temps and contractors, so. If you are a temp, and employed by a third company lending you ut, that company can ask for Kurzarbeit. In agriculture and food processing, most of the work force are temps emplyed by sub-contractors. Thearetically, they are covered. In praxis, they are more often than not screwed. The sub-contractors sub-contractor is potentially ot evena german omany to begin with.

Shining light on this, is one of the few good things about Cocid-19, if you ask me.

Well, in Australia's case – the wage subsidy comes from the Australian Tax Office (ATO), which is our equivalent to the IRS. So if you haven't been withholding income tax from your employees, you can't get the subsidy for them (unless you confess your past tax evasion, which obviously you aren't going to do.)

But, paying employees cash only is much harder than it used to be. Many customers now only want to pay card. The tax office sees the card payments coming into your bank account, if you try to pay your employees cash it is easy for them to catch you. So, I think the number of workers actually hurt by that is relatively small.

COVID-19 has accelerated the transition from cash to card payment, because the health advice was to avoid cash payments (due to risk that cash may spread Coronavirus), and many businesses responded by refusing to accept cash entirely.

> So, I think the number of workers actually hurt by that is relatively small.

Guarantee you it is a huge number in Canada, and probably the U.S. as well. Tax fraud in food service, bars, and kitchens is the norm here in Ontario.

Unemployment is not the real problem there—people not having money is.

If the government would continue—and increase—the individual stimulus checks, it would matter much, much less how long the lockdown must continue. People would still be able to support themselves and keep themselves healthy.

The career damage from forced unemployment lasts longer than an unemployment check.

> Keeping people out of offices and shops is not a public health risk

Telling people to stay at home all the time does have a negative impact on many people's mental health. It can both exacerbate pre-existing mental illness, and in some cases even cause the new onset of mental illness.

> Of course all factors were considered.

That's not entirely accurate. Even Faucci answered, in response to Rand Paul, he was a virologist. Not a economist, etc.

There's been little public acknowledgement of increases in suicides, illness from delayed med treatments, economic fall out affecting deaths, etc.

Fauci doesn't set policy. The CDC doesn't set policy. Even the White House has limited authority. Policy was a mishmash set by governors and mayors with or without support from DC and based on recommendations from multiple health, public safety and economic advisors.

I'm not for or against Fauci. He did what he was asked to do. The problem was he was thrust to the front as The Expert. Again, not his fault. However, that did compromise our ability to have seats at the table for all the unintended consequences.

Actually that's a good point and damn scary: anti-lockdown protests are very risky, but these are supposed to be fine?

Not being in the US, I hadn't realized the incredible double-standard at play. The US seems to be almost completely paralyzed in trying to deal with this virus, various social dynamics that have been festering for decades are coming to light now.

Is that the job of health officials to determine? Whether a particular political cause is worth the risk?

"Andrew Sullivan calls our attention to epidemiologist Tara C. Smith, who moves with that curious herd of 'experts' suddenly not terribly concerned about social distancing when the protesters filling the streets are left-wing rather than right-wing. Writes Sullivan: 'The message to normies: going outside is killing grandma. The message to woke kids: never mind!'

"So which is it? Were people like Smith lying before about the danger of spreading the virus, in order to promote a political agenda? Or being honest about it but now willing to endanger countless lives, in order to promote a political agenda?

"Adding smug cluelessness to her dishonesty and/or recklessness, Smith also sniffs that the difference is that those who rallied to end the lockdown were merely 'protesting for their ability to get a haircut.'

"Yes, of course, haircuts. It had nothing to do with wanting to get back to work in order to support their families, salvage businesses it took a lifetime to build, avoid depleting their life savings, get their kids back in the classroom, etc. It was all about haircuts." [0]

I think that excerpt makes my point for me, so I won't belabor it. Unless you want to apply the obtuse label to yourself like you did to bmmayer1.

[0] https://edwardfeser.blogspot.com/2020/06/what-science-is-say...

To me, that seems like fairly precise language. They’re saying they do not believe the risk level is sufficiently high to condemn the gatherings. It doesn’t seem much different than saying grocery store visits are not condemned as risky, while music store visits are condemned as risky. The virus doesn’t care about what you’re shopping for either, it’s just that shopping for food is more important (by their estimation) than shopping for some vinyl.

That, and it's a healthy dose of pragmatism. If nobody is going to comply with your advice, you're doing more harm than good.

You can realistically tell people to shop for vinyl from the comfort of their couch, and they might do that.

Given the level of outrage, there were going to be large groups of protests across the country either way, but they were successfully convinced to wear masks, use hand sanitizer and spread out where they can. At least here, every time the mayor talks she urges people who went to protests to get tested.

Persuasion is still everything.

"They’re saying they do not believe the risk level is sufficiently high to condemn the gatherings."

But that's obviously nonsense, given that not all of the participants wear masks, distance cannot be kept, they stay at the same location for a longer time and some are chanting/yelling.

It it nonsense though? If that's true it sounds like there was no need for anyone to weigh in at all; it was evidently obvious that these protests must be condemned. Do you believe that's the case?

> That's a shining example of weasel speak. They don't explicitly say it's not risky - because that would be plain lying, it is obviously risky - but they are saying they are not condemning it as risky.

Another excerpt from the article state:

> "We created the letter in response to emerging narratives that seemed to malign demonstrations as risky for the public health because of Covid-19," according to the letter writers, many of whom are part of the University of Washington's Division of Allergy and Infectious Diseases. "Instead, we wanted to present a narrative that prioritizes opposition to racism as vital to the public health, including the epidemic response. We believe that the way forward is not to suppress protests in the name of public health but to respond to protesters demands in the name of public health, thereby addressing multiple public health crises."

They are not thinking about it in terms of supporting/opposing the protests. Rather the protests are a fact and you need to deal with them somehow. You can do that by either suppressing them or addressing their concerns. They do not want their concerns of COVID-19 to justify suppressing the protests, especially if addressing the protestor's concerns is a viable option.

> They are saying that the protest is too important to take health considerations into account, but they are reluctant to speak plainly and tell people there's risk but they should be adult and choose to manage the risks themselves and maybe neglect small risk in order to achieve bigger thing.

This seems almost exactly the sentiment they are addressing in the letter. COVID-19 is a public health concern, so is racial disparities that result in racial disparities in medical outcomes. Their concerns over COVID-19 transmission should not be taken as justification for suppressing the protests.

From the article,

> "Staying at home, social distancing, and public masking are effective at minimizing the spread of COVID-19. To the extent possible, we support the application of these public health best practices during demonstrations that call attention to the pervasive lethal force of white supremacy," the letter says.

They are still giving the same advice they've been giving. The letter also states protest-specific COVID-19 harm mitigation strategies for protestors & police.

> Just in this case, our betters had decided the COVID risk is less important than protesting - so it's OK for us. But only in cases which are approved by our betters.

A more charitable interpretation is that some medical professionals do not believe that the risk of COVID-19 spread is a compelling reason for suppressing protests against racial inequality, especially when the risk of COVID-19 spread can be addressed by responding to the protestors concerns & therefore advancing public health by both mitigating the spread of COVID-19 and addressing the role racism plays in medical outcomes.

The letter is gobbledegook. Police brutality isn’t a “public health problem.” It’s a bad thing, and it may well be that reasonable people feel like protesting police brutality justifies taking the risk of increased COVID-19 transmission. (I certainly feel that way.) They’re deciding that “protesting police brutality is worth some excess deaths from COVID.” But the authors don’t want to own the fact that they’re making a value judgment. So instead they resort to literal newspeak to make it seem like they’re making a scientific judgment instead of a political one.

Their letter makes it clear they are taking about racism, not necessarily just in police brutality.

The letter to me reads as 100% political because it is suggesting that you can get rid of the protests by addressing their concerns. That option is available to you. Their motivation for writing the letter is largely to say "hey, you can stop the protests by addressing their concerns" and to point out that addressing their concerns in this case also advances what they consider to be a public health interest.

It is possible we had different interpretations of what they wrote, but this felt more like "1000 doctors make a poltiical statement about the protests" rather than "1000 doctors say in their scientific opinions that protests are justified."

> They’re deciding that “protesting police brutality is worth some excess deaths from COVID.”

Why are you putting your own characterization in quotation marks as if you're quoting someone else? Or did I miss something and this is a quote from the the health professionals in question?

According to what definition are you claiming that police brutality is not a public health problem?

Oxford Textbook of Public Health: https://m.oxfordmedicine.com/mobile/view/10.1093/med/9780199.... Do you see any sections on police brutality?

Not to mention, I have family in the field, I grew up with probably a dozen public health experts attending Thanksgiving dinner, and did my first internship at a public health company. At no point in hearing decades of shop talk did I ever hear police brutality being mentioned as a public health issue. Words have meaning dammit.

I've seen some indications that many people in the public health field feel that everything that affects morbidity and mortality is potentially within scope for them, including, for example, intentional actions like assault or murder.

A difficulty with this view, at least potentially, is that it seems to allow everything in the world (certainly almost every area of public policy) to be in scope for public health, because almost everything in the world has potential to affect morbidity and mortality. At one level this broad view seems obviously correct, but at another level it seems obviously crazy (or at least likely to bring the public health profession into conflict with everyone over weighing in on every kind of decision that anyone ever makes).

In the past there was a fight between some CDC researchers and Congress over something about handgun policy because the researchers were studying something about guns and violence that made some gun rights activists nervous that there would be an argument presented under the banner of public health to limit access to guns. I believe the conclusion was that they told CDC to stop studying this, which, again, seems to me to be susceptible of some mix of "there might be a lot of legitimate reasons to have this information" and "does the public health profession get to weigh in with claimed expertise on every issue?".

I think it's a legitimately thorny conceptual problem because if you think of health as something like "flourishing" or "people having success in living the way they want" or "eudaemonia" or something, almost every public policy question can be conceived of as a "health" question. (Or even, maybe, "minimizing all-cause mortality"?) But if someone says that the policy answer to each question is therefore obvious because a particular profession thinks it knows what would maximize things it thinks it knows how to measure, I imagine a lot of the public is going to say that this doesn't match up with its notion of what health is.

Edit: after writing this, I had this weird imagine of public health as like a superintelligent AI that's super-focused on one goal and doesn't understand, or doesn't care very much, that people might have other goals too. We think there's obviously something that's going to remain outside of the scope of the AI's interest, but since the AI is smarter than we are, it discovers a way that that thing is actually relevant to its interests according to its utility function, after all! (I realize people have also had this kind of concern about other institutions that are happy to define their scope of action more broadly over time, such as profit-maximizing corporations, or militaries. The corporation says "we need to figure out what actions will maximize profit" or the military says "we need to figure out what actions will maximize our capacity to win wars" and perhaps the scope and ambition of their actions are soon larger than anyone would have expected.) I feel like this analogy is actually weirdly apposite, at least for some audiences. :-)

Yeah, that is a really broad definition. That results in everything becoming everything. For example, everything has some kind of economic impact, so everything becomes economics. Or, everything can have some affect on the arts, so everything becomes arts. This kind of failure to make distinctions makes the scope of every field to encompass everything, which eliminates the very notion of separate fields of study.

Probably a more sensible approach is to say the medical field concerns itself with the operation of the human body, and how to correct malfunctioning operations.

Good points!

However, public health continues to actively distinguish itself from medicine (they're different degrees and different departments in universities, for example, and you can get both an MD and a DPH), so I don't think your proposed definition for medicine will satisfy public health experts as a definition of their field. Although county health departments are often led by someone who has both a medical and public health degree, many of the people working in them will have public health training but not medical training.

Even looking at classic public health activities like sanitation/environmental health and epidemiology, sanitation and epidemiology aren't really about the functioning of the human body! They're more about conditions under which the human body is more likely to experience some particular kinds of morbidity...

Even your definition of medicine might be unsatisfactory to some people in the medical field, for example because they think mental health is medicine, or because (to pick an amusing example from my health insurer's claim form) pregnancy is not a disorder or malfunction of the body, but it requires a lot of medical expertise to manage its outcomes well. Other examples could be pain management and anaesthesia (pain, for example during surgery, is not necessarily a malfunction of the body—typically you would like the body to make you aware when it's being cut!) and elective surgeries.

Should public health officials weigh in on all issues? Yes. In my home state, every bill before the legislature has a financial assessment tied t it, because most laws cost money. The same should be true for health: we should figure out if an issue is positive, negative, mixed or neutral on public health. It should be part of the deliberation process.

Take your gun example: people should know that if they support the status quo gun laws how many people will die, or what the impact of a new lw is. That doesn’t mean the CDC regulates guns, but it does mean they should have a voice in the conversation.

Courts struck down a law in Florida in 2017 preventing Pediatricians from talking to parents about gun safety.

In my country, what counts as a 'public health' matter is essentially arbitrary. Or at least seems that way to me.

For example, smoking, sunblock usage, sugary drinks, STDs, binge drinking and falls by elderly people are widely seen as public health issues.

Safety nets on trampolines, malnutrition, illegal drugs, suicide, bad diets and road traffic accidents are sometimes seen as public health issues.

Skiing, rugby, workplace fall prevention, migrants using unseaworthy boats and violence between drug dealers are almost never seen as public health issues.

If there's a clear dividing line, I can't see what it is :)

Out of curiosity, were guns or poor maternal outcomes for black women discussed as public health issues? The former has long been thought of as a public health problem but it is rarely discussed due to politics. The latter has been a problem for decades but only acknowledged recently. I recognize you have some expertise here, but I don’t think there is a finite set of issues that can fall under ‘public health’.

I’ve never heard of guns spoken of as a public health issue by public health experts, as opposed to politicians. This is among a fairly uniformly left-leaning bunch of people. The worse maternal outcomes for black women is something I’ve heard discussed, because maternal health is a central focus of public health (it happens to be my dad’s area of expertise). Maternal mortality for black mothers is a problem everywhere in the world. Most developed countries don’t have enough black people to have rigorous data on this. Some that do, like France, don’t track these statistics by race as a matter of formal policy. But the UK has about the same maternal mortality rate for black women, (40 per 100k) as the US (37 per 100k). The gap between black and white is actually bigger in the UK (5x) than the US (3x). Nobody does a good job with maternal care for black women, and nobody really knows what the problem is.

By the way, I have no public health expertise myself; just recounting as a lay person what I’ve heard public health experts talk about as a proxy for the metes and bounds of the field.

Yes. But the Feds won’t allow government funded research into gun violence. For black moms the issue is wrapped up in obstetrics in the US which basically has refused to use checklists, crash carts etc... I am not sure if this has changed but there was no national standard protocol in the US. It varied by state! This has been widely reported on if you do a few google searches. Lastly there’s also a lack of access to prenatal care.

I wouldn’t expect that textbook to list all examples of public health issues, nor would I expect you to overhear discussion about all examples.

It really just makes it undeniable how political the official advice and accompanying commentary is. The slew of new rules put in place for BLM protests are incredibly dubious, from both a legal and safety perspective. It’s not up to the government to decide what speech or cause for assembly is important, and health officials should not have their risk assessments swayed by political considerations.

What new rules specifically? And what rules were not in place for the armed all-white protests in Michigan, for instance?

For example, countries permitting residents to "gather in groups of 12", or "protest in groups of up to 100".

For example, https://cchealth.org/press-releases/2020/0602-Businesses-Reo...

Why create specialized rules for protests that allow an order of magnitude more people to gather than those allowed in a "close cohort" gathering?

Because 12 people is not a threat of you are a politician

All such advice/regulations is weighing the benefit of imposing the restriction vs. the cost of imposing such restriction.

And, importantly, all this is not in the context of individual risk, but population risk. The distinction is tricky but important, and one that trips most people up. For any single individual, the personal risk from COVID19 tends to be small, often seemingly vanishingly small. However, since we don't have immunity, it will affect everyone and even a small individual risk multiplied by (almost) everyone is a large impact on the population in terms of overall deaths.

Anyway, how many political protests have you attended in the last 10 years? How many social gatherings?

For me, it is easily 1:100, if not more. Thus, the aggregate transmission risk from protests is much smaller, therefore we can be more permissive of them. And it is the aggregate risk that policymakers care about.

On the other hand, political protest is considered a very, very fundamental right of our democracies, restricting it something to be done only with the greatest reluctance.

The freedom to practice religion is also a very fundamental right of our democracies, yet it is still illegal in many places due to the lockdown such as California.

Yes, the frequency that people attend protests is on average much less, but the number of other people that one is exposed to is much greater hence why "larger gathering venues at a pace consistent with public health and safety, such as nightclubs, concert venues, and live audience sports" (which are often outdoors as well) are in the very final phase of California's reopening plan. If policy makers agree that protests have a low aggregate risk, why would they place things like concerts or sports events which happen mostly on the weekends in the final phase when there are now protests happening every day?

I do agree that political protest is a very fundamental right and rarely ever be restricted, but many who share your opinion were against the anti-lockdown protests which is contradictory if one believes BLM protests should not be restricted because they are political protest. People protesting the lockdown is also democracy in action, even if one believes the reason for protest is not as important. The democratic right to protest is not dependant on how important the issue is seen to be.

The lockdown policies inevitable have political component, because they are made by politicians and will be evaluated in a political framework. And for a politician it is always practical to err on the CYA side - one extra day of lockdown costs the politician very little, as the costs of it are not born by them personally and are largely very hard to quantify, they are distributed among the population and spread among many consequences, small and large. However, if the politician raises the lockdown prematurely, the blame - in a very quantifiable and ready-for-election-ad form of raising case numbers - would be directed personally at the politician. If the political power of those who suffer from the lockdown is not large enough and organized enough to exert significant pressure, the smart politician would extend the lockdown until there's no conceivable risk to be blamed if anything happens. Virus research, vaccine research, etc., is science, but decisions on what to do with it is always political. And thus those who want to influence it obviously make a political action.

With the current protest, the political situation changes. Opposing these protests is a political suicide. If you can't oppose them, the only way is to have some contrived argument where you are for lockdowns (because see above) but also for protests.

> health officials should not have their risk assessments swayed by political considerations.

You can publish raw information about risk - which is complex and uncertain, and step back, but then you will have little influence on political decisions that follow it. Or you can recommend a policy - and by that inevitably contaminate the scientific assessment with political stance and become invested in certain policy. I'd much like the former, but vast majority of the policy in the US lately completely rejects the idea that the population can be trusted with full information and making its own decisions about it.

The ruling paradigm is that the government should limit people's choices for their own good, and push them into actions that it thinks are beneficial for them. And most people expect that from politicians and blame those politicians which didn't limit their choices enough and allowed them to make choices which ultimately brought bad consequences. So, the politicians and people that want the political action to happen play the game that the public wants to be played.

> The lockdown policies inevitable have political component, because they are made by politicians and will be evaluated in a political framework

This is true for the policies, but absolutely not true for advice from public health officials. Globally the policies made in response to this pandemic have been justified almost entirely by appeals to the authority of health officials. The supposed basis of these policies was that those officials were providing expert and politically neutral advice on risk management. Having the expert health and safety advice show a readily apparent political motivation undermines all of it.

Please stop posting unsubstantive and/or flamebait comments to HN.

https://news.ycombinator.com/newsguidelines.html

Actually I do, why?

> That's a shining example of weasel speak. They don't explicitly say it's not risky - because that would be plain lying, it is obviously risky - but they are saying they are not condemning it as risky.

Perhaps it’s not so much weasel words as a carefully coded “caveat emptor”

A weasel in a cravat is still a weasel.

Observation: “weasel words” gets used a lot in HN comments as a cop out. I wish that phrase could be banned from this site because it is intellectually lazy. Commenters love to discredit articles and other commenters using that phrase rather than engaging in the actual effort to retort with facts. It’s the kind of broken culture that’s been turning HN into the same kind of cesspool that happened with slashdot.

The commenter seemed to have explained why they see the phrasing as "weasel words":

>They don't explicitly say it's not risky - because that would be plain lying, it is obviously risky - but they are saying they are not condemning it as risky. Which most people would take as implying it's not actually risky - even though they are not saying that. They are saying that the protest is too important to take health considerations into account, but they are reluctant to speak plainly and tell people there's risk but they should be adult and choose to manage the risks themselves and maybe neglect small risk in order to achieve bigger thing.

Is there anything about that explanation which is unsatisfactory? It's not as if they simply condemned the statement to be weasel words without any explanation as to why they see it as such.