The world is not going to wear masks forever. If we haven't solved the problem in the next two years people are just going to accept Coronavirus as a normal risk in life like car accidents, cancer and heart disease. Also, permanent contact tracing sounds like a real dystopia - and I can't imagine it holding up long-term in US courts.

One thing that could be permanent is the world wearing masks when they have cold symptoms. Like in Asian countries. The way to do that would be via social pressure (like in Asian countries) than legal measures.

> The way to do that would be via social pressure (like in Asian countries)

Except that its not really a pressure, but a social contract.

'I am sick so the least i can do is wear a mask while outside to protect others. So others do the same.'

Win-win.

One of the mechanisms of social contracts is pressure. Is this a radical idea? A few individuals always have a different perspective on any deal, and the majority will need a way to enforce the look and feel of community lifestyle.

Such as an agreement for racial harmony.

In Japan masks in public have been the default for many years.

The problem is, contact tracing in the U.S. is impossible right now, there's just way too many infections to possibly have an effective contact tracing program.

Agreed. I tried putting that into my comment, but it turned my comment from a nice factual statement about the article into a screed about the incompetence of government.

Hence the need for lockdowns to drive infections down to the level where contact tracing becomes feasible.

Lockdowns are not a thing being proposed as a future policy. They are here, and have been for several incubation periods. For that purpose, they have failed. Past tense.

I post this as a segue into the general observation that there's still way too many people speaking about hypotheticals as if we're not six months into this process, and have plenty of concrete data to consult rather than theory. If the purpose of X is Y, we are not in a place where we should start doing X to get Y; we are in a place to look to see if X got us Y. In this particular case, it apparently did not.

(It's also not a great time to say "Well, X would have led to Y if we just X'd harder". In a good chunk of the world, we X'd as hard as we can. If we didn't get Y, it's not something you're going to get in the future, either. That is something we have to accept and deal with, not wish we could just X harder.)

How didn’t they work? Every time they have been implemented properly (Hubei, Italy, Spain. NYC, New Zealand) they reached the objective of reducing the infection levels to a few new cases per day. Obviously they cannot be a permanent solution, but they were never meant to be one.

Look at Spain right now. Infection rate is huge again, even with masks being mandatory in public. Lockdown is useless and destroyed their economy, and masks are mostly useless. That's the hard reality.

Luckily, this virus is not making us zombies, or killing our children. It's killing our elders and people with a weakened immune system; it's sad but it's great. It could have been a lot worse.

> In a good chunk of the world, we X'd as hard as we can.

A good chunk of the USA very explicitly did not "X" anywhere near as hard or smart as they could have.

"Lockdown" pretty much never happened in the USA. There were these half-assed stay at home orders, which in practice ended up being voluntary and unenforced. People were out horsing around and very few enforcement actions happened, despite most of the orders being enforceable as misdemeanors. Fortunately most people voluntarily did the right thing, but not enough for it to matter.

Mileage varied significantly on those. I haven't seen a lot of evidence that better participation led to proportionately better outcomes.

Besides, lockdowns, which have never really been done like this before, may just be something that can not work. You can't suddenly demand that everyone in a society be in the 80%th percentile of conscientiousness, and also be just hunky dory with not going to work anymore and being under effective house arrest for extended periods of time.

This is probably one of those cases where HN is not equipped to make an accurate assessment, being exceedingly preferentially chosen from high conscientiousness and college-educated populations (as, if nothing else, college indicates a certain amount of discipline). If you project yourself and your peers out onto society, you are going to grossly misunderstand the real society. Plans to avoid contagion need to deal with the society that we have, not the one we want.

What do you do of the effects of lock-down in European countries?

If you set the parameters properly, modeling shows anything you want it to show.

The paper cited by the nature article does not explicitly consider masks or hand washing. It combines all measures recommended by the Mexican government, and makes a broad assumption about their overall effectiveness:

https://www.sciencedirect.com/science/article/pii/S002555642...

All of the models for handwashing and masks that I am aware of have made blithely optimistic assumptions about their effectiveness. The WHO meta-study of masks, eye protection and social distancing found that masks overall had an odds ratio of 0.33 - and most of that evidence came from N95 respirators, used in hospitals, for personal protection:

https://www.thelancet.com/journals/lancet/article/PIIS0140-6...

We have essentially no evidence that non-respirator masks, in the hands of the public, does anything at all:

https://www.cebm.net/covid-19/masking-lack-of-evidence-with-...

(Edit: as per usual, factual discussion of masks is censored on HN. This is not a political debate! I have provided links to legitimate scientific resources to support all of my arguments. Consider your bias before reflexively jabbing the downvote button.)

> We have essentially no evidence that non-respirator masks, in the hands of the public, does anything at all:

This is blatant misinformation. Masks work. We've known this for over a century. Using masks to control respiratory disease is one of those cool public-health hacks that almost sounds too good to be true, but if enough people do it, the virus stops burning through the population.

https://masks4all.co/

https://en.wikipedia.org/wiki/Face_masks_during_the_COVID-19...

You aren't so much being "censored" as just downvoted into the oblivion where a factually, empirically, and dangerously wrong statement like "We have essentially no evidence that non-respirator masks, in the hands of the public, does anything at all" belongs.

My link was from the Oxford University Center for Evidence-based Medicine, and summarizes the quality and outcome of all known clinical trials for masks.

Your link is a website made by a guy who teaches online ML classes, has no relevant expertise in science or medicine, and blatantly mischaracterizes the papers covered by the CEBM link.

I suggest you read the evidence I’ve provided, before concluding the matter is settled.

I always find the downvotes = censorship crowd mildly comical. To roughly quote something I read on here once: "the highly downvoted comments stand out more than the highly upvoted ones"

> We have essentially no evidence that non-respirator masks, in the hands of the public, does anything at all:

We have tons of evidence. Countries with high mask compliance have done a much better job of containing the virus. It's difficult to determine if it's causative or coincidental so it's not conclusive, but it certainly is evidence.

> in the hands of the public

You do realize that's an extremely important distinction. A shitty mask in use by a medical professional will do more "social" good than a good to great mask used by a moron (the general public).

A way to prove that, how do you wash your hands. Unless you're a medical professional or know of one, you've probably been doing it wrong to prevent the spread of germs. Look up how a surgeon is supposed to wash their hands. One important note, put your hands up so the water drips down your arm instead of to your fingers. Germs flow with the water, so the idea is, they can get locked into the creases in your fingers if they drips down there. People just "wash their hands longer"... which is not that effective to the proper way of doing it.

The masks... good God... the people who yell at folks not wearing masks typically have their nose exposed.

But hey, there's then the fact of infected moisture droplets on your clothing. Depending on the study, it can live for some amount of hours. Especially after it was found to be airborne anyways. A tshirt being pulled over your face with covid on it, that's okay?

Look, it's more that this whole thing is far more complicated than the general news has us believe. Perfect action to stop the spread by "the general public" is sort of like wishing for peace on Earth. Yea, we can do our little bongo circles and poster signs with glitter, signing whatever stupid treaty in random city... there will still be war. There will still be tons of people spreading whatever contagion because of not understanding the fundamentals of germ prevention. Which no one will ever bother learning or doing. To be fair, the whole process of perfect prevention or at least truly effective is super difficult and requires constant dedication without fail.

Don't let the perfect get in the way of the good.

Yes, it'd be nice to get R to 0. But any number below 1 is good enough.

Yea, but the problem with that, contagions don't work linearly. It doesn't take many missteps to screw up the whole thing. That, and the whole mask thing is starting to smell more like the crap from the 1950s, "If you see a nuclear flash, jump underneath your desk for protection."... yea... false hope is good and important. But only for a little while.

And don't get me wrong, I technically want to be wrong. But science and human nature butt heads. People are human, perfect lab conditions don't imitate human actions that well. Relying too much on lab condition results and ignoring the idea of, "How will Joe Schmoe fuck this up?" means you wasted lab time.

Hell, how many UI folks here? Or any programmers that have to deal with user testing? In your perfect locked away testing, everything is "perfect". Admit it. You think you solved all the ways users will screw up. Then it goes out into the wild, only to find out how incredibly stupid humans are. How many times have you said, "That's not the way you're supposed to use that!" regarding software and a random person?

Why is the HN community so willing to think this behavior doesn't apply outside computers?

A lot of that stuff from the 50s was actually pretty good advice. It wouldn't help if you were a mile from the blast, but if you were say 5-10 miles away, you have at least 20 seconds between the flash and when the blast wave hits. There may be glass and debris flying everywhere, and you have a much better chance of survival if you're under a desk with your head covered.

I cited the evidence - the links to the WHO meta-study and the oxford center for evidence-based medicine are comprehensive, and results are as I quoted them.

If you think there is additional evidence that they have not covered, cite it.

“Countries with high mask compliance” is not a definable parameter. Japan was held up as a “mask-wearing country”, but is currently in the midst of a major outbreak. Hawaii is locked down again. Singapore has had recurrent outbreaks, despite widespread mask use. Sweden and the Netherlands do not require masks, and have brought their epidemics under control.

Any attempt to draw conclusions based on what happens to a country after passing a mask rule, is an exercise in post hoc fallacious reasoning.

You said

"We have essentially no evidence"

And then you provided links that contain evidence. It may not be persuasive or conclusive, but there is evidence.

We have no evidence of positive effect.

We have some evidence that they’re almost completely ineffective in the hands of the general public, some that they may be actively harmful (the only RCT ever performed with cloth masks showed that those who wore cloth masks were 13 fold worse off than those in the control arm), and some studies that show modest positive effects when N95 respirators are used by doctors in hospitals.

If we are discussing “face covering” rules as enacted by governments today, which include everything from bandanas to paint respirators, then no, there is no supporting evidence.

For someone demanding "evidence," you could stand to provide sources for your own claims.

> the only RCT ever performed with cloth masks showed that those who wore cloth masks were 13 fold worse off than those in the control arm

I think you're referring to this study, please confirm: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4420971/

"The aim of this study was to compare the efficacy of cloth masks to medical masks in hospital healthcare workers (HCWs)"

You misrepresent the study in three critical ways:

1. You fail to note that the "control arm" was use of medical-grade masks, as opposed to no mask at all.

2. The study explicitly did not include a no-mask arm, as that would be ethically problematic. Their "control" arm actually consisted of "standard practice, which may or may not include mask use. Standard practice was used as control because the IRB deemed it unethical to ask participants to not wear a mask". The increased infection risk of cloth masks could be due to harm caused by cloth masks, benefit conferred by medical masks, or most likely both. As the authors point out, this study cannot determine this.

3. The study focused on healthcare workers, whereas the question at hand is whether convincing big portions of the general population to wear cloth masks in public enclosed spaces works.

Fun fact: the same authors of this study have submitted a follow-up article which is available for early release: https://wwwnc.cdc.gov/eid/article/26/10/20-0948_article

They write that "wearing cloth masks should not be mandated for healthcare workers. In community settings, however, cloth masks may be used to prevent community spread of infections by sick or asymptomatically infected persons, and the public should be educated about their correct use."

In other words:

- the mask RCT you referred to doesn't support your agenda of insisting that community use of cloth masks doesn't mitigate the spread of respiratory illness

- the same authors of that study have directly refuted your claims in an upcoming publication

You aren't being downvoted because the left-leaning HN hivemind is reflexively jabbing the down arrow because you're telling them something they don't like. It's because you're flat-out wrong.

> We have no evidence of positive effect.

Demonstrably and categorically false. I'm starting to wonder if you're trolling HN on a Friday morning; if so, congratulations.

If you aren't a troll, please review this body of literature helpfully curated by smart people who give a damn:

https://masks4all.co/facts/

My link is from the Oxford Center for Evidence-based Medicine. Yours is a propaganda website made by a guy who teaches online ML classes. Jeremy Howard has no background in science or medicine, and his website consistently mischaracterizes the same data presented by CEBM. If you have to believe two different interpretations of the same data, prudence indicates that you should choose the interpretation coming from an expert. That said:

1) the study in question had a control arm of voluntary compliance with surgical masks. These are neither “medical grade”, nor was the compliance rate verified.

2) Regardless, it doesn’t matter: cloth masks were significantly more harmful than the control.

3) I agree that we should be careful to discriminate between studies of respirators, masks, “face coverings”, PPE and source control. So you should take the time to actually read the studies that Jeremy Howard cites. You’ll find that nearly all of the studies on masks are for respirators in medical settings, and that (as the CEBM link confirms, if you bothered to read it), the few studies of mask use by the general public have had ambiguous or negative outcomes. It isn’t even close: if you omit the studies conducted in medical settings, there’s almost no evidence for masks at all.

4) The CDC link isn’t a scientific article, it’s a review. Moreover the authors are clear that they are not contradicting their previous findings:

” To our knowledge, only 1 randomized controlled trial (4) has been conducted to examine the efficacy of cloth masks in healthcare settings, and the results do not favor use of cloth masks.”

The authors are explicit that cloth masks are unsupported, possibly harmful, and only to be used as a last resort.

You really should read the links you cite before you make strong claims about what they say.