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I am not sure how much blame we should put on public health officials vs politicians. I just think of all those politicians who have exposed for breaking the own rules. The Austin mayor telling people not to see their family for thanksgiving while at Mexican vacation spot.

American and European politicians seems too weak and decadent to take the necessary steps to combat this pandemics. Even after they gained access to proper information about the viruses, they didn't take the successful measures that Asian and Australia did. Instead they only harped on about mask, while reopening in door bars and dining. Instead, they should have closed all airports for nothing but essential travel. Like Australia, they should quarantine entire cities whenever they were any cases in said city, preventing nonessential workers from entering or leaving. If they should have opened schools at any time, they should have opened them in the summer when outdoor classes were possible and cases were significantly lower. They should have forced anyone who was exposed to covid to quarantine with their family in a government run quarantine hotel. Masks are extremely helpful but American politicians treated them as a magic bullet to avoid any of the harsh but truly effective measures. I

It really lowed the destroyed my esteem in whole classes of Democratic governors and mayors. Cuomo, London Breed, Gavin Newsom, Lori Lightfoot, etc .They all talked a good game but all were too cowardly and delusional to actually combat this virus. Them endorsing masks doesn't make them significantly better than Republican politicians when both classes handled covid in a failing manner. Neither party truly believes in science, they only believe in stuff that lines up with their prior beliefs, in just so happens that science is on the Democrat's side more than Republicans. But this pandemic has truly exposed that Democratic politicians adherence to science is just as disloyal as Republicans.

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Yes, there is a whole other post to be written about Democratic Party politicians and their hypocritical antics.

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Not necessarily just the hypocritical things like not following their own Thanksgiving guidance. Cuomo has left indoor dining open for far too long and keeps changing the his metrics to avoid shutting it down. I think he's genuinely afraid of the restaurant lobby. Then in California you seem to have shutdowns that go way farther than necessary (e.g., playgrounds). I don't get it.

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I already was anti-Cuomo pre-pandemic and in the past couple of months he's burned whatever shreds of credibility he gained in his spring handling of NYC's surge by refusing to shut down indoor dining well into our second surge. Maybe he's worried the state's UI funds would be wiped out by servers filing for benefits? Anybody have insight on what might be going on here?

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It's not just Cuomo -- indoor dining is also still open in New Jersey. And yes I think it's concern for businesses.

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The problem these Governors are facing absent massive Federal stimulus is that if they shut these business down they will not be able to continue to be businesses.

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I was hopeful when Governor Gina Raimondo looked like she was going to do a cordon sanitaire for New York. But when Cuomo and the ACLU shut her down, jt really seems to have doomed the United States as no governor afterwards really took the dramatic actions necessary. https://www.cnn.com/2020/03/27/us/rhode-island-tracking-down-new-yorkers/index.html

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I think you have to account for how dramatic the opposition has been, even for (or especially for) Democratic politicians. I live in Michigan, where the Governor has been relatively strict by American standards, but lax by international standards. Nevertheless, hardly a day goes by without a new lawsuit landing on her desk, many of which are successful. The Michigan Supreme Court famously struck down Governor Whitmer's power to impose restrictions, just as the most recent wave was getting underway. Since then, the Governor has reinstituted modest restrictions based on the public health code, but the Republican legislature (whose consent the Michigan Supreme Court ruled was required) has shown no interest in the sort of responsible governance required to combat the virus. And we can't forget that Governor Whitmer's efforts have led to armed protests, and at least one plot to kidnap and execute the her, and blow up the Michigan Legislature, which led to fifteen indictments. So before calling Democratic governors "cowardly and delusional," let's consider the fraught cultural and political waters they're swimming in.

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Yes, thank you. In this thread is a lot of both-sides-ism that ignores reality. Democratic politicians only had so much power, and those who tried to do everything that was required got shut down by courts or had to face the threat of armed protests. Not to mention just the sheer fatigue that sets in with the populace after 9 months. Being a governor or a mayor doesn't come with the ability to magically do whatever you want. But it's a general trend in political discourse that Democrats are expected to be literal miracle workers and get attacked as being just as bad as Republicans when they can't.

None of this applies to Cuomo, he's just complete garbage. But I think the broad criticisms of the way people like Newsom and Breed have handled things are super misguided. There's a reason San Francisco had been relatively unscathed by this pandemic until recent weeks. (This does't mean every decision they've made have made sense—and I'm talking about their political decisions, not their personal ones, which are much less defensible—but it's insane to say, as the original commenter did, that Republicans and Democrats are equally anti-science.)

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Here in California, governor Newsom did not face hostile courts or armed mobs. What’s his excuse?

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I mean that’s not entirely correct. I saw some of those anti-Newsom protests.

But also he shut down the state earlier and stricter than any other governor. It’s weird to use him as the poster child for all this. (Even if, yes, his more recent actions haven’t made as much sense as his earlier actions did.)

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If you’re saying any protest is an armed mob, OK I guess? It is illegal to open carry in California and concealed weapons permits are near impossible to obtain. Whatever protests took place at the state capitol were nothing like the scenes in Michigan, and there has been no suggestion I’ve heard that Newsom have been under any sort of credible personal threat. You are right that California took early action, and my sense was people were generally happy with the response in March, April, etc., But there has been a steady move away from science-driven decision making, even people who are pro-science are fed up by that, the state is trending in a very bad direction while people see our political leaders engaging in behavior they say is too dangerous for others to participate in, and resistance to further virus containment measures is building daily as a direct result of that failed leadership. I am not suggesting he is a disaster on the order of some red state governors, but I think many well-informed Californians would not want to hold him up as any sort of example.

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Even enlightened, progressive Boston has allowed lots of indoor dining and drinking, at a time when many area schools were closed, and the case count was rising.

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Almost every Democratic mayor and governor okayed the re-opening of bars and indoor dining, despite clear knowledge of their role in superspreading. Early in the pandemic, one infected person in Korea spread it to over 100 people. Even Whitmer allowed bars and restaurant to re-open in June setting us up this terrible surge. I have a bit of sympathy for her being a governor restrained by Republicans but Gavin Newsom with his democratic supermajority did no better.

After all, it was Andrew Cuomo who lead the charge against cordon saniares, dooming all of America.

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If I were Philosopher King with plenary cultural control, I'd have done as you say. My primary focus would have been on reducing cases, saving lives, and then creating conditions for as many schools to safely open as possible. Institutions that could be saved with money, should have been. As data flowed in as to what was safe and what wasn't, we should have adapted accordingly. That should have been the plan.

But these things don't occur in a cultural or political vacuum. In Michigan, there was a real movement to disobey the Governor's authority, and the police weren't necessarily aligned with the Governor. There was an excellent argument that the political culture wasn't going to allow longer shutdowns, without at least trying to reopen businesses like restaurants. And when I say, "wasn't going to allow," I mean in reality. Businesses were likely going to open up (some were already) without any action by law enforcement. That would've been a huge political crisis stacked on top of the health crisis.

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This is key. This played out in both NH and MA.

In Massachusetts, persisted in defying the shutdown rules. A court order was issued, power and water was cut, and marshals eventually had to change the locks on the premises:

https://boston.cbslocal.com/2020/06/18/oxford-gym-prime-fitness-david-blondin-electricity-water-massachusetts-shutdown/

In NH, a racetrack initially defied the governor's shutdown order and promised to continue doing so. A week later they changed course and complied:

https://www.unionleader.com/news/health/coronavirus/groveton-racetrack-owners-cancel-saturday-race-after-warning-from-ag/article_d213b63b-d3bf-56ae-9430-939cb3eefd5a.html

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You can't divorce the decision to reopen bars from the decision to not pass any adequate relief measures. Even PPP was just interest-free loans. If we're going to ask bars and restaurants to close for a year or more, we need to pay them; otherwise, governors are forced to choose between viral catastrophe or economic catastrophe.

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PPP was much more than interest-free loans. The entire loan balance would be forgiven as long as 60% of the proceeds were used to fund payroll. The rest could be used to pay rent and other expenses and still got forgiven.

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Which means that if your payroll expenses were less than 60% of total expenses (which is the case for a lot of businesses, especially in places with high rents), then you wouldn't be eligible for forgiveness. So you could borrow enough to take care of payroll, and a bit more, but you'd be stuck paying rent on a business that's not bringing in any revenue. Judging by the carnage that's ongoing in the live venue/entertainment sector, I think we can clearly say that the government's financial response has been inadequate to the crisis.

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Okay, but what you originally said was "Even PPP was just interest-free loans." That seems substantively different from "PPP grants might not be big enough to cover all expenses."

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I mean, Cuomo was literally taped telling Orthodox rabbis that he was shutting down public activity by area based on "people's fear" and "not because it's the best policy." Science is not *leading* a damn thing in super-blue NY, science is the *scapegoat*.

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i think it bears mentioning anytime the hypocrisy comes up, especially in terms of what’s open and what isn’t, that it’s worth recalling that the people capable of allowing States or local officials the ability to make better public health choices in near term were Federal officials / Republicans in Congress who very much signaled that they were not going to help (and still haven’t) and at that point everything became a low key but totally apparent game of economic / public health triage, bad answers only...

That’s less so for folks breaking their own rules to eat inside a restaurant, but nuanced public health messaging (“thanksgiving *could* be done safe if everyone wears a mask indoors, food is eaten outside, distance is maintained) leaves a lot of room for abuse that many Americans it seems *love* to seek out and undermine any ultimate attempts at mitigation (“Oh, im drinking indoors...so i can keep my mask off for an hour while i nurse this drink because i can take a sip at any minute”).

Ultimately, it seems like a societal / Cultural problem that will undermine us again and again and won’t be easy to address... cynicism is just too easy to breed in people.

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Very well said.

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This strikes me as another area where the breakdown of Congress as an institution is a problem. When committees were strong, there would have been every incentive for chairs to initiate investigations of this sort of thing, but in a leadership driven Congress, the incentives are different. (Personally I’m really interested in what has gone wrong with long-term care facilities, but it sure looks like we’ll never have a reckoning with that, either.)

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Yes

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Actually long term care facility investigations might happen because it will be a chance for republicans to roast Cuomo! Use the self-interest of republicans to own the libs to get these commissions moving.

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I hope you're right.

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You've hit the nail on the head here.

"Orange man bad" has been a correct take regarding basically every issue the past ~5 years, but we're unironically dumping too much of the blame on him at this point.

The lionization of Cuomo, who objectively made horrible decisions (and then wrote a book halfway through the pandemic?) is another wild thing. Fauci is another weird case where he got things very wrong and lied to the American people in a way that led to mass deaths, so the hailing of him as a hero is crazy to me.

I'd go beyond your stance regarding the after action report and say that we actually do need to engage in finger pointing. Between the foolishness about masks and the inconsistency regarding ventilation, I think heads need to roll in the public health establishment.

I'm not in charge though, and I really shouldn't be.

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I saw a study the other day showing that there is significant public demand for news stories that portray COVID news in the most negative way possible, and the only plausible explanation it seems is because COVID pessimism is like, an anti-Trump thing. Same with Cuomo lionization. It's super weird.

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Also in the "public health heads should roll" dept, Trump was right about one thing: Operation Warp Speed should've been even faster.

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FYI, good masks ARE readily available, but maybe that's just because it seems no one cares. Even in the super-educated progressive multimillionaire retirement community I live in (Boulder), few people are wearing even KN95s, and I'm the only person I see wearing a P100.

But KN95s are cheap and readily available, and P100s are pretty inexpensive and available on Amazon (~$40 for mask and filters, which are reusable for the duration of the pandemic). The only thing you have to do with the P100 is tape a surgical mask over the exhalation valve, because the air you exhale isn't filtered, and you presumably want to protect others in case you're infected.

Also, it's pretty hilarious that pretty much everyone in Boulder will put on their mask for the 2 seconds while I pass them on my bicycle at a minimum distance of 6ft, but indoor dining and even bars were open (and packed!) until very recently.

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This is what I'm saying. After initially saying "masks don't work" when they should have said "use a cloth mask so medical professionals can use the high grade ones" they are now stuck on "any mask is good!" rather than "there are plenty of high grade masks available so use them instead."

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I've been able to buy respirators throughout this pandemic, but I've held off on doing so because I continue to hear of respirator shortages amongst front-line workers. Instead, I've recycled the respirators that we had prior to the pandemic; because we have regular forest fires, we had N95 respirators. Is there still a respirator shortage that might cause our government to hold off on recommending respirators instead of cloth masks?

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This is true...I was surprised that KN95s from China became readily available over the Summer from Amazon or Home Depot. I've been wearing them exclusively since because they provide more protection than a cloth mask and generally fit better.

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I still believe that if the surgeon general's tweet was truly believed by American public health officials until early April. They really did believe they were preventing a shortage of maskes for medical workers (that were useful) by telling the public not to wear them (which they honestly believe did nothing). Apparently public health is a field where a lot of people just don't know what they are talking about. Much like a lot of other fields.

It's going to be hard to convince Americans to trust the experts when Americans have witnessed experts getting it wrong so much (i.e. the "full employment of 2015).

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Well, one difference is that medical workers are trained on how to fit a KN95 mask and nobody else is; plus medical workers don't wear beards so the masks seal against the face. If you follow any doctors or nurses on Twitter who take selfies, you're surely noticing the KN95-shaped chafing around their mouth and nose and that's because that's how tightly you need to fit a KN95 mask for air not to flow around the sides and bypass it altogether.

So on it's face, it's not unreasonable to suspect that KN95 masks are effective for the medical workers who are trained to wear them correctly, and likely not to be very effective to Joe Sixpack who wears it under his fucking nose.

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We had exactly the same situation in France. Experts played down the need for masks in the context of a mask shortage and out of a concern about ensuring healthcare providers got them first. The concern was legitimate; the messaging unforgivable. What would have been the problem with just being candid about the mask shortage and the need to give priority to first-line defenders? Well, experts make mistakes just like other people. Does that mean we pay no attention to them in the future? I suspect there was a lot of pressure on them from the political side which further proves the old adage that when you mix science and politics bullshit is the result.

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I think it would have been tough to put out the message to people saying the virus is dangerous and masks will help protect you, but please don't go buy them, so we can preserve limited supplies for healthcare workers.

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This is all correct. However, as a Dutch person in DC I do think Americans overestimate how much worse their government response has been than in Europe. The Dutch government only started recommending mask use somewhere by the end of September after Anthony Fauci himself urgently advised the head of the RIVM (Dutch CDC) to start keeping up with the literature. Public health experts opinions are still divided about mask use; it is so strange. The Dutch were way later than the rest of Europe, but this shows that the US response has not been much worse than in Europe (yes Trump is horrible but policy in Europe was also very bad except for Germany).

South East Asia has really been so much better than the rest of the world and I really appreciated your calls to start learning from this context instead of Europe.

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Doesn't the Dutch government have an especially fatalistic approach to healthcare in general? I believe they also don't like prescribing antibiotics and generally less attempts to extend the life of elderly patients.

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Think the US can learn a bit about not prescribing antibiotics too fast; https://dutchreview.com/culture/living-in-the-netherlands/what-the-dutch-are-getting-right-antibiotics-in-the-netherlands/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6338985/

I do not think there are fewer attempts to extend the life of elderly patients.

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Of course there are fewer attempts at extending life of elderly patients. No one else goes to the ridiculous lengths of end of life care that the US does.

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In Baltimore we have the curious combination where you must wear a mask outdoors at ALL times (under threat of arrest, 1 year jail/$5,000 fine) but you can dine indoors! This is something that would only make sense to someone with a doctorate in public health -- for the rest of us it's nonsensical. Fortunately, the Baltimore City Police Department is not enforcing this rule. (The link to the order can be found here https://coronavirus.baltimorecity.gov/ page 3 of the dashboard.)

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I live in a mid city area of Baton Rouge and while we have a mask mandate for indoor and outdoor stuff areas, there aren't very many crowded outdoor spaces where you literally can't maintain 10, 20, 50, or hell 100-500 ft of space at all times from someone in most days without minimal effort (walk to other side of street, etc) and I commonly go without masks while also seeing people faithfully complying on their evening walks alone. I sort of wonder whether I'm being judged....but at the same time...I know the risks are literally as minimal as they could be anyway. The City itself seems to care not about enforcing these rules...but I definitely see how a "one size fits all" public health mandate can easily undermine wider confidence (while also realizing that the grey areas that come with a nuanced view can easily be undermined by allowing folks with different comfort levels to set varying levels of sensitivity in close spaces, especially outside). That's why I am torn about the whole debate over whether runners should be wearing masks or not...kinda depends!

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Similar to air purifiers, the wide availability of KN95 masks, despite few being used by the public, seems to me like yet another public health messaging failure.

While cloth masks are much better than nothing, as I understand it, they're not nearly as good as surgical masks, and surgical masks aren't nearly as good as KN95 masks. Now that KN95 masks are widely available shouldn't this should be the standard guidance? Scott Gottlieb did some tweets about this a few months ago, but the "expert community" isn't really pushing this message, as best as I can tell.

It seems like the message now shouldn't be "wear a mask," but rather "wear a KN95 mask."

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“And they should have used the Defense Production Act to ensure that good masks were widely available.”

This is my pet peeve. This long into the pandemic, we should be delivering N95 masks to Americans for free. Instead, many people are wearing useless bandanas and such.

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At the very least, take advantage of the DPA to crank out N95s for the need over the next year and stockpile them for the next respratory virus that strikes while borrowing costs are LOW...

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Very good post and thanks for the information on air purifiers. We have been buying Dysons, and it looks like we have not optimized.

Trump is a convenient scapegoat to throw over the cliff. But, the numbers don't lie. The great divide between the effectiveness of the response is between East and West.

In short, in our response to Covid, we in the West have spectacularly failed the famous "marshmallow test."

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FWIW, I got one of those Coway filters four years ago and it has been running nonstop ever since. Very reliable and very effective.

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I still often think about all the folks who were blindly repeating, without context, that *actually* if you improperly wear an N95 because you aren’t “trained” to use one...it’s more likely to make you sick than a regular cloth or surgical mask.

Of course the full context of that is basically that’s only true in an ER / triage setting where blood and spit is literally everywhere and you are trying to decontaminate...it has no bearing on wearing one inside a bank or school for 30 minutes at a time.

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Your comment that "the actual policy choices [across states] have not been all that different and the outcomes also haven’t been different" is very important.

As the comments to this thread show, people latch onto the mask as a panacea, when studies and experience have shown a negligible effect on transmission rates. Forced quarantine, travel bans, mass and intrusive contract tracing are the only thing shown to truly work. But the masks do serve a vital purpose: to separate out the 'good' from the 'bad'. We want so desperately to blame someone for the virus and the mask (of the lack thereof) is a visual, public way to identify those who should be shunned.

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It would be helpful to cite these studies. Most of the info I have is that they are highly effective. Studies, new understanding of the transmission vectors, talking to docs I know who actually work in Covid heavy hospitals...

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There's a significant difference between ideal mask use and actual mask use. In the ideal scenario, people would keep on masks when talking to friends and family outside their bubble/pod. In reality , people usually take off their masks when around friends and family they aren't quarantining with, while keeping it on when shopping, a lower risk activity.

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See this, from the Annals of Internal Medicine. https://www.acpjournals.org/doi/10.7326/M20-6817

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Huh? This is the conclusion:

The recommendation to wear surgical masks to supplement other public health measures did not reduce the SARS-CoV-2 infection rate among wearers by more than 50% in a community with modest infection rates, some degree of social distancing, and uncommon general mask use. The data were compatible with lesser degrees of self-protection.

I’ll take 50%!! Note that Denmark was far more sensible than the US and had less community spread. This does not convince me at all that mask wearing is useless.

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That study only analyzes a recommendation to wear masks. In many places there is a requirement to wear them in many indoor public places.

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I agree about the crappy masks people actually use, but there are masks that do work (N95s and especially P100s).

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In terms of effect size, I think the much more stringent lockdowns and travel bans/restrictions of Pacific nations played a larger role than masks, no? I agree with the tenor of the previous COVID failure post, that travel restrictions were really effective, and I think that's what drove the biggest difference in outcome between East and West, which the East seemed to learn from their SARS experiences.

Politically it's tough though. Any admission of mistakes by "experts" will only be laundered through the right wing propaganda echo chamber and used against those of us still engaged in reality-based politics. I hope the public health authorities learn the lessons from COVID that SARS taught Eastern nations, and god forbid we need to apply those lessons again, we do, but I don't know how much good an airing of expert failure would be.

Then again, if experts don't air their post-mortems, the right will suddenly become expert in critiquing the early response. Damned if you do, damned if you don't. It's hard when one side will say literally anything to gain an advantage.

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The mask controversy was an own-goal that only fed mistrust of authority. It smacks of disinformation and cover-up. Isolation would have been the best strategy but nobody was willing to take the heat. We dramatically failed the marshmallow test and extended and exacerbated the pandemic far more than we could have.

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I think it is too glib to say we "failed the marshmallow test." The population largely passed the test that was given, which was to hunker down for a short while to Flatten The Curve. We did that. Hospitals were not overwhelmed, which was the goal provided. Test passed.

Then we all saw mass protests, supported in by the same government officials who were then shifting the goal from Flatten the Curve to Squash the Virus. Businesses shut, playgrounds, museums, hardware stores (but not walmart) all closed. But the nightly gatherings to protest were just fine. After seeing the politicians really didn't take the virus seriously, the rest of us followed.

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> But the nightly gatherings to protest were just fine.

But they _were_ just fine. That's the part that I don't understand about this criticism - when public health officials came out and said that mass, distanced protests outdoors by masked individuals were fine, we basically ran that experiment in every major city and the result was _fewer_ cases largely because the protests kept people from going to restaurants and bars in dense city centers and weren't themselves associated with any community spread (people at protests didn't infect each other.)

Experts turned out to be right and you turned out to be wrong, but your mind that somehow diminishes the credibility of _experts._ How does that work?

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The criticism is the totality of the decisions. No graveside gatherings, no school, closed playgrounds, closed hardware stores. None of those were vectors of spread, but the protests were OK due to approval of the message.

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Hardware stores are indoors, indoor transmission is the primary means by which the pandemic is spreading. Close the hardware stores the same way you should close all non-essential indoor retail.

Nobody in public health is saying "we need to close playgrounds." They're saying "we need to close gyms" and then idiot politicians say "well, a playground is like a gym for children, guess they mean close that too."

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I don't mean to nitpick, but hardware stores are absolutely essential for people in the trades and construction, or for somebody whose house needs an emergency repair.

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Right, I'd like to see the peer review white paper that establish that mass protest during a pandemic was totally ok from a transmission point of view. The fact that it (probably) meant less transmission than sitting indoors in bars while drunk does not make it to the gold standard of behaviour during a pandemic.

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Me, too. My bet is it was "sort of" okay, given the fact that the protests were outdoors and during the summer decline in cases. If we had those protests right now, it might be a different story. Anyway, you're right: this and a host of other issues have to be studied, if for no other reason than to learn what to do the next time.

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No one said it was "the gold standard of behavior" - they said it was basically ok, like going to the grocery store or eating outdoors.

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The examples you gave are in fact life essential activities. It was the decision of public health authorities that political protests they agreed with fell under the same category that is the issue.

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I think in retrospect “flatten the curve” while well-intentioned, was a mistake. So we flatten the curve- then what? Is it over? That was the implied implication anyway. Also, “flatten the curve” was implemented in all kinds of places that probably had zero infections- so they went through the same kind of pain, and (correctly) believed that it was pointless (for them), and now believe COVID isn’t a big deal. I think that describes places like Wisconsin, which of course are now getting slammed. The right messaging would have been war- we need to kill this thing, and “flatten the curve” is just going to be the first of many steps to win that war, which will include testing, contact tracing and centralized quarantine. (Centralized quarantine could have also helped with the economic impacts to hotels and restaurants, which could have been redeployed to serve the quarantined.) But I think Matt is probably right that opposition to these kinds of measures might have gone well beyond just the orange man.

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I remember when the governor of Rhode Island tried to make New Yorkers quarantine after entering the state. That got nothing but pushback by Cuomo, ACLU, and the media. Instead, the they should have praised that governor and encouraged a creation of cordon sanitaire around New York and any other hotspots. Instead, after the backlash American politicians were too cowardly and weak to take effective measures against this virus.

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> I think in retrospect “flatten the curve” while well-intentioned, was a mistake. So we flatten the curve- then what?

Then, the IFR doesn't hit 15% as people die gasping in the streets.

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Yeah, I think this goes back to the "art of the possible."

Relatively draconian control measures are easy to justify and implement when the death toll is 15% compared with what people will accept when the IFR is .5% to 1%.

Still, the "then what" question shouldn't stop at avoiding the 15% IFR. The body count we're seeing with a .5%-1% IFR is still pretty shocking and represents a devastating failure of our society compared to others that responded more effectively.

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Flatten The Curve was the message at a time when we thought that there may truly be no stopping the exponential nature of the virus, and before we knew that the weather would be so effective at dampening it. FTC makes a lot more sense in a context where you think that ~ 50 % of people are going to get COVID in a 12 month period.

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Maybe. At what point was it clear that China had been able to contain it in Wuhan? Was that before or after FTC? The timelines on this stuff are fuzzy.

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I was thinking about this TL as well with respect to Wuhan, I think at the time there was significant skepticism of a) whether or not Wuhan was actually successful in terms of stamping-out the virus in China and b) whether or not western lockdowns would be able to replicate this succes.

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I get your point, but I read our pandemic response as being more of a failure of current western culture rather than a simple failure of leadership. Nearly all Asian countries have been able to beat this while nearly all western countries have failed.

My opinion is this is because we dropped the requirement of duty to country and to fellow man from our societal ethos and at the same time, stepped up our emphasis on freedom and individual rights.

While I support the increased emphasis on freedom and rights, I don't think it can hold without a corresponding increase in our emphasis on duty and responsibility to something greater than ourselves.

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I disagree with the "Western vs. Asian culture" analysis. Within Canada, there's a big contrast between the Atlantic provinces (which imposed travel restrictions and followed an eradication strategy, 13 new cases yesterday with a population of 10 million) and Alberta (which has been very slow to tighten restrictions, 1700 new cases yesterday with a population of 4.3 million).

As noted by Matt, Australia and New Zealand may be islands, but they're linked to the rest of the world by air travel. (They require arrivals to stay at centralized quarantine facilities.)

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Fair criticism. Framing this in terms of Western vs. Asian culture is painting with a very broad brush. A better analysis would dig into specific aspects of culture like maybe sense of duty to country and others, trust in experts, respect for government authority, rule following tendency.

Do you think the differences with Canada and Australia are entirely explained by leadership decision-making or could there also be cultural factors at play?

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There's a whole array of factors at play. From upstream to downstream: existing institutions (e.g. states in the US cannot run deficits); luck and circumstance (Quebec was hit hard because of its early spring break); advice from public health officials (the focus of Matt's post); decisions made by elected leaders (whether to act early or late, communication); the response from society at large (compliance vs. defiance).

I think it's true that social cohesion ("we're all in this together") seems to be stronger in Canada than in the US. But that's only one factor.

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South East Asians clearly had an advantage because of lessons from SARS. What I find surprising is the limited willingness to learn from their experiences both in Europe and the United States.

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This is a really good point. There certainly are partisan lines but there are plenty of people in both parties eating in restaurants (I mean Pelosi tried to have a dinner for new congressmen), going to baby showers and seeing family with no restriction leading to ongoing spread. As a whole its clear these behaviors lead to much more virus circulation (and death).

To the extent there is a partisan divide on behavior I think this post is giving Trump a pass too much. His messaging post about April has been awful at best and has been adopted by the base and man GOP politicians.

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Yeah, I am torn on how to apportion causality of the failure between cultural failure from 1) individualism without duty or responsibility, versus 2) general mistrust and defiance of authority.

My sense is that both left and right are guilty of 1, while it's mostly the right that has been guilty of 2. Although the BLM protests could probably be categorized as a either/both.

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Yeah, Flatten The Curve worked as a message more or less everywhere. Then the right shat the bed with liberty! and the left did likewise with protest! No moral high ground after that.

This is not likely to be a popular opinion here, but I think think the whole mask thing is a tad more complicated than wear something around your facial area that covers mouth and nose. It is true that the East have been good at suppressing the virus but I don't think we can put that down to face-covering only. Most of Europe have strong mask mandates which does not seem to put a dent in the second wave. My unqualified guess is that westerners have a tendency to view masks as a substitute for physical distancing, while the East are better at enforcing both mask wearing and physical distancing.

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My point isn't that masks could have fixed everything, it's that the mask guidance was clearly wrong and it's one example of the need for a searching inquiry that goes beyond Trump and superficial criticism.

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Yes, also washing hands seems less useful than was initially thought. Physical distancing and ruthless quarantine did the trick, though. I agree that blaming it all on Trump (or Anders Tegnell if you are of Scandinavian descent) is counterproductive. It is clear that countries with experience of SARS did more or less everything right. Also, China did show how it could have been done - a lesson that probably is going to be forgotten in a fog of accusations of how they lied, misled and covered everything up.

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Sure - but in this piece and elsewhere you've made it sound like there was a public health conspiracy, where the experts all secretly knew masks were the right thing to do. No. As others are pointing out here, experts at the time were not sure if mask wearing would encourage more risky behavior, like still congregating inside. Even today, it's not clear that the mask wearing is really effective when people use them as an excuse to engage in all their usual activities (and then take their masks off when eating and leave them off).

Moreover, there was not any scientific evidence in March backing cloth masks as suitable; the only published evidence on cloth masks said they were much worse than surgical masks, and many scientists posited that they would make things WORSE, because people would touch their faces more. We didn't understand fomite transmission of SARS-CoV-2, which is important in other diseases (including in other respiratory diseases).

The truly catastrophic blunder that was not Trump's fault was the CDC sending out their own test that did not pass quality control while refusing to use the Chinese/European version.

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“experts at the time were not sure if mask wearing would encourage more risky behavior, like still congregating inside.” - well, yes, that’s the problem, that these experts decided based on no evidence whatsoever that the best strategy is essentially reverse psychology.

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I looked to Asian public health officials during that time as they had the most recent experience with a similar pandemic disease SARS. And they all mandated or recommended masks and ,some governments were even distributing masks to people. Instead of trying to be armchair psychologist, they actually followed the science.

American public health officials in February already acknowledged that sick people should wear any type of masks and knew that at a huge percentage of cases were spread by pre/asymptomatic carriers. It makes no sense for them to not tell people to wear any type of masks, as the basic physics of masks ensured they keep many virus droplets in instead of spraying them to unsuspecting bystanders.

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A key point here is that experts may not be the best people to make decisions when faced with large amount of uncertainty. When there is a lot of uncertainty no body is an expert and we need our political leadership to make prudent decisions that they are accountable too. Unfortunately, the Trump administration effectively abdicated decision making to CDC and left them in a position where they needed to make decision that were well outside of their range of expertise (remember we knew approximately nothing about COVID 19 in January). I agree with the point that public health experts made the wrong call, but I feel like the issue was that we were asking them to make a call when that was really the job of POTUS/ state governors.

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Yes. I feel like something is getting lost in translation here - the scientists are comfortable with uncertainty, the politicians demand a clear message. There was no clear message to give - journalists don't seem to like that, and prefer a conspiracy, but that was the state of things in March.

But the one area the scientists really messed up was entirely their purview - that is, with the CDC and the test.

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Somewhere around late February to early March, 2020 Star Slate Codex did a review of the mask issue. At the time, some public health authorities were against the widespread use of masks, and not necessarily just because of supply shortages. So, SSC reviewed the literature. The first thing he noticed was the literature was surprisingly scant. Then he noticed that what there was of it should have been interpreted as an endorsement for wearing masks in a pandemic. But it's 20/20 hindsight to think, a priori, the benefits of mask wearing were 100% obvious. Some experts even thought they would make matters worse, because people would touch their faces too much. Of course, as the data streamed in, it became more and more obvious SSC was right that masks were helpful. But it's probably an error to suppose what is known now was known then, even by experts.

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The western public health establishment apparently had no interest in studying a decade plus of respiratory disease prevalence in Asia related to masking. Then, when they didn't know if masks work, they decided erring on the side of doing nothing was the correct decision for some reason. Strange.

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There is a certain moral hazard problem in pushing mask wearing as a panacea. The perceived safety in masks will encourage people to congregate in situations which increase exposure.

The emphasis on opening restaurants in particular is problematic in that eating is an inherently risky behavior in that continual mask wearing in literally impossible.

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This is a good point, although I wonder how encouraging mask-wearing (of course, it's not a panacea) affected public behavior in the aggregate. Maybe it encouraged the premature opening of restaurants. Maybe it didn't, though. Maybe they were going to open anyway. There was enormous pressure to do so. But in the aggregate, mask wearing in public may have kept it foremost in the minds of most that there was a very real, airborne danger out there, and we should all be careful. If this issue is possible to study, it should be.

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Yes - this is why the public health experts genuinely did not agree that encouraging masks was a good idea.

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Perhaps Trump's role can be overstated, but here's where it can't be left out. Way before George Floyd was killed, Trump dramatically undermined efforts to fight the virus -- and offered no long-term plan at all. He just quit trying to manage the crisis, and his messaging was beyond terrible.

I would reverse your proposed chain of causation. The virus struck, with the African-American community being among the hardest hit. Public health officials urged various measures, then Trump and his surrogates undermined their messaging. This led to widespread, usually all-white, often armed, protests against the public health measures. *Then*, on May 26, 2020, Minneapolis police killed George Floyd. Ask yourself, what were the chances that African-Americans, enraged by yet another police killing, and who watched white protesters violate public health measures with impunity, should now swallow their anger for the public good? Seems like a big ask, and one almost certainly destined to fail. And let's not forget: Trump did everything he could to make the racial tensions worse, calculating (perhaps correctly) such tensions would enhance his re-election prospects.

The timing of America's most recent racial outrage was indeed terrible, although, the protests having been outdoors and while cases were declining, the data seems to show they did little damage, in terms of the pandemic. I concede this was a bit lucky.

Finally, I've heard a lot of complaints about "flatten the curve" vs "squash the curve." Aren't these outdated? With around a quarter million new cases and over 2000 deaths per day, isn't it clear the goal all along should have been to get the number of cases as low as possible, to mitigate the magnitude of wave we're currently experiencing, which is again visiting upon us death, serious illness and economic devastation?

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The mask debacle, as well as the the inability or unwillingness to immediately and dramatically increase PPE production, should be in public health textbooks in 50 years as cautionary tales. Andrew Cuomo's disastrous order to send COVID19 patients into nursing homes is another epic failure that likely led to thousands of excess deaths (despite his administration's reports claiming the contrary, widely looked at by outside experts as unconvincing).

The ventilation story is another big one. When universities and K-12 school districts were holding open fora, webinars, etc leading up to the start of the academic year in the Fall (I watched several of these because I work at a university and have two school-aged kids), they prominently featured some Facilities guy talking in excruciating detail about air purifiers and ventilation. However, when they actually sent kids and teachers back into the classroom, there was deafening silence on this point as they either couldn't pull it off or just forgot about it. For my kid's middle school gym class, they walk around in a circle outside and aren't allowed to exert themselves to avoid heavy breathing. Talking is also forbidden during lunch time and everyone is at their own table. What happened to the ventilation plans!?

In the end, some universities did OK this Fall semester (including my own) because of high fidelity in terms of mask wearing, lower density populations on campus, and probably most importantly, high-quality testing regimes. For example, two tests within 2 weeks upon reentry, and then surveillance testing of everyone once a month (supplemented with symptom checks). When small outbreaks occurred, it was largely among students living off campus. Some interesting insights here:

https://www.wbur.org/commonhealth/2020/11/25/on-campus-testing-colleges-broad

Routine testing has been underutilized.

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I agree on the value of testing. The "college experiment" has shown that disease spread can be controlled with well implemented "epidemiology 101" public health measures.

That said, I do wonder how much compliance and respect for authority by students contributed to the success. I remember the story of a college in Boston that kicked out some students without giving a tuition refund for having a small gathering in violation of the rules. There was a public discussion about whether the penalty was too harsh, but no discussion about whether the rules were too harsh.

If our national debate was about harshness of the penalties for violating rules instead of about whether the rules themselves are legitimate, we'd probably be in a very different place.

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Agree with Jim here. College students are a captive audience that were threatened and cajoled into following the rules, so may not be a great example for others. In the face of governmental failure, employers and others institutions might have set up their own rules like universities but there was very little guidance or examples to follow.

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Sorry, I had a typo my the post above so I deleted it and reposted it below. I probably shouldn't do that.

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