I don't understand why we continue with anything other than vaccination at this point outside of particularly sensitive places (hospitals, nursing homes, etc.). Masks and social distancing make sense when there is nothing else but we're way passed that. I can't be the only person that thinks its farcical to walk into a restaurant masked, remove it at the table for an hour while talking and eating, then put it back on to leave. I mean, does the virus call a truce while we sip our beers? Was it fooled by wearing a mask at the hostess stand?
If we were a more mature people socially and politically we would drop the silly theater, mitigate as best we can with our (really quite amazing) vaccine technology, and then go about our lives.
Additionally very, very few people are wearing masks effectively. Part of my job was training employees how to properly fit N95 masks. Achieving and maintaining a tight fit is not all that easy. Talking, coughing, even smiling behind your mask could break the fit requiring frequent adjustment. So while this type mask may be 79-90% effective when tightly fitted I’m quite sure 89-99% are not worn this way.
To both of your points, I'm not sure how many people are wearing masks with the intent of antiviral effectiveness, rather than the intent of "I am complying with the letter of your mandate".
I'm well to the covid-hawk of the average bear, but I'm firmly in the latter camp. Triple-shotted, got (presumably) omicron a few weeks ago and it was mostly a cold... your roof, your rules, but why are we play-acting any of this?
I have sourced the loosest and most comfortable scrap of fabric I could find as my “mask.” I am under zero illusion that it is a public health tool, I just don’t want to get scolded.
I’m triple vaccinated and I’ve had COVID in the last quarter, as have my spouse and infant. I’m done.
Exactly. Masks work when used correctly. Virtually no one is using them correctly in any kind of consistent way, and in fairness it's probably too much to expect them to.
I get this point overall, but I'm a bit suspicious about this binary view of mask efficacy and fit.
Before covid I only wore N95 masks for home improvement projects like insulating and spray painting. From this experience, I know first hand that N95 masks definitely "work" at reducing the amount of bad stuff that gets into my nose and lungs during these projects. I'm sure the fit in these cases is relatively poor and this means some bad stuff still leaks in, just not enough to irritate my lungs or make my snot turn the color of whatever I'm painting.
In a real-world fit situation, what percentage of the air that's inhaled and exhaled do you think flows through the mask material versus bypassing the filter due to bad fit?
My guess is that even with a bad fit, a very large percentage of inhaled/exhaled air gets filtered. So while personal risk is not completely eliminated with a badly fitted mask, if a large percentage of the air moves through the filter, that should still result in a lower rate of spread and less severe infections for those that do get sick.
> What's wrong with my logic [re lower-but-non-zero filtering effectiveness with imperfect mask seals] here?
Nothing. But people don't understand dose-response curves and think that if one virion makes it around the mask you're going to get infected, so it needs to be perfect or you might as well not bother. In reality, the fewer virons you get exposed to, (1) the lower the chance you have of any of them managing to attach to a receptor, and (2) the lower the number of cells that will get infected before your immune system is able to counterattack, thereby reducing the severity of your infection, if any. Perfect mask seals are great! Imperfect ones are still better than nothing!
This same misunderstanding shows up in how people think about radiation exposure, too.
I think most people can understand just fine that 10 virus particles are less infectious than 10k virus particles inhaled during a particular activity. My sense is most sentiments that get expressed as "why bother if it's not a perfect seal?" come more from them having accepted the inevitability that from a long-term perspective, there doesn't seem to be much point in reducing one's own viral exposure in a particular instance. Unlike with toxic paint fumes, I don't see much point in reducing (or even eliminating) virus exposure during one particular activity unless it's part of a long term strategy to do what it will take to meaningfully dodge infectious doses of 🦠 every day, during every activity, for, at minimum, the next few years. I'm enthusiastically vaccinated (and boosted) because that's an action that provides durable protection from severity - it's not a never-ending slow-motion whack-a-mole game.
If the virus was only in the air on leap days, sure, I could conceivably play whack-a-mole a couple times a decade. A concerted effort to play whack a mole by breathing only mostly-filtered and/or non-shared air every day for the next decade does not seem feasible or worthwhile or desirable in any way.
That's why we say things like 'Why bother?' Some admittedly use a rhetorical sleight-of-hand to project that resignedness onto the imperfect-albeit-good short term filtration effectiveness of a particular mask.
Pre-vaccine I agree. Post vaccine I still think it's the right thing to do in certain settings with lots of vulnerable people. What I don't see is much benefit to it in general retail, restaurants, or other public spaces for vaccinated people.
This seems reasonable but it isn't where I've landed, at least for now.
For me personally, I still voluntarily always wear a good mask when indoors and I plan to until the case numbers in my area get down to the 10-20 per 100k range.
I'm retired, so it's easy for me to avoid exposure if I want to. I expect I'll eventually get covid, but I'm willing to pay a small price to try to hold it off until the hospitals in my area aren't full (eg elective surgeries are suspended right now) and maybe even until we're not rationing high efficacy treatments (maybe in a month or two?).
In my social circle of somewhat older folks, hardly anyone is socializing indoors or eating in restaurants. We do gather freely outside, where we don't wear masks or worry much about covid.
This is the first rationale I've heard from someone taking this cautious approach, in a long time, that attempts to make logical cause-and-effect sense, avoid guilt tripping others to do the same, and see the future in realistic terms. Well done.
If a boosted person is looking to reduce their risk of getting COVID and missing a couple of days of work, throwing on a KN-95 in Target, gas stations, etc isn’t going to be of benefit when case counts are high? Genuinely curious.
Nothing, and this is what drives me crazy about the “no more masks” line. They don’t have to be perfect. They just have to be somewhat effective, enough to help to reduce R. They are a relatively cheap and easy intervention.
As for nobody using them properly, probably depends where you are. I don’t care what people do outdoors or in huge indoor spaces like Home Depot. Indoors in the Bay Area I see 100% compliance indoors and people wearing whatever masks they have properly, along with increasing percentages of KN95s. Guess what, we also had far fewer cases this time than SoCal where compliance is much worse.
The places where I see good compliance are places where the public mandate isn't the binding issue. Like, where even before we re-introduced our local mandate, masking was still very high either do to a private institution having the rule, or nearly everyone doing it voluntarily. Whereas in the kinds of places where people dropped masking when the government let them, masking is really poor. If people want to mask at this point, they're going to, but I'm not sure how much the government is really prepared to make them do it well.
I agree that local culture sets actual compliance, but in places inclined to high compliance, the mandate I think obviously helps to set expectations and apply social pressure. Even if enforcement by police is virtually nonexistent, it licenses eg store workers to ask politely, with some teeth (far) behind it. (Trespass is still prosecuted and even the biggest cranks know it.) And it makes the store’s policy not a quixotic aberration but something they can shrug and point to the rule (even if they were already inclined to do it).
Laws and rules have effects beyond their enforcement, but for sure they’re not magic wands in a population who generally disagree.
It reduces total penetration of each wave. It does not “drag things out”, it means fewer people in total get infected.
And everyone will not get it. The reason everyone does not get the flu every year is that the flu’s R is low to start with and its effective R fluctuates right around 1 depending on vaccines, prior immunity, climate, and behavioral factors. And prior immunity is not necessarily a large factor.
The value of mask mandates is also hugely different depending on community prevalence. At peak Omicron, wearing a good mask might have 100x the protective effect it had during a lull, simply because there are so many infectious people around.
I hope to have our local school mask mandates drop after Omicron. I dislike wearing a mask. But during a big wave I’ll put up with it.
Right now, the main reason is healthcare system capacity. Despite the fact it poses less individual risk than previous variants, Omicron is still a major challenge due to the absolute number of hospitalizations. The major hospital system where I work - in a highly vaccinated region of the country - is having to decline transfers and admissions of very sick patients because we are at capacity.
In the near-term, there's an argument that would should continue layered NPIs to reduce R until antivirals like Paxlovid are widely available and the under-5 vaccine series' have been approved. I think the scope and extent of those NPIs is up for debate, but it's not an unreasonable position. Having Paxlovid available could make a big difference when an immunocompromised person finally gets COVID-19.
In the long-term, re-institution of NPIs may be important during surges of new variants or during the winter respiratory season. It's worth remembering that our previous 'normal' existed in a world where the circulating population of respiratory viruses/bacteria caused 2-10x less mortality (and this is assuming a fully vaccinated population). You would have seen much different social practices if the annual toll from viral PNA was 150-300k instead of 30-60k. Look at the impact that the original SARS virus had on public health in East and SE Asia.
You talk as though everyone is going to get sick exactly once in their life and then be done with it. I agree that if R was high enough that we couldn't prevent everyone from getting sick once, and if immunity was perfect enough that a vanishing fraction of people would get sick more than once, then it doesn't matter to drag it out more than just enough to avoid the worst hospital crunch.
But it looks like immunity *isn't* perfect enough to prevent people from getting reinfected. So reducing R means reducing the frequency with which people get reinfected. Getting sick once every three years rather than once every two years seems better, no?
No, air is like water following the path of least resistance. While indeed some air will be filtered, much more will slip by in the gaps. To that add how much less virus needs to get by than paint mist. So sure wear a mask, I would, just don’t be misled by claims of 79-90% protection that are only achieved in a lab.
Not disagreeing with you at all, but this spurred a thought I wanted to share. It seems like the actual brand/construction of the mask is a HUGE factor in how good you can get a good fit!
Basically the only mask out of the dozen I've tried that I can get to reliably fit is 3M Aura N95 masks from Home Depot. And I get a good fit (as defined by "won't fog my glasses") without a a lot of fiddling.
What do you mean correctly. The except while actively eating or drinking loophole means you are wearing it correctly even if it off for long periods of time.
Why is there no operations research on this? If the question doesn't occur to some school of public health, why doesn't a business association of bars and restaurants commission the research. For that matter, why doesn't the city health department or whoever executes venue restrictions commission such research?
I think the effective version of the research would have to involve sending known infected people into spaces with known uninfected people with and without masks and counting how many got infected. I don’t think challenge trials were that necessary for vaccines, which could be tested easily the other way, but for these things, challenge trials of this sort would be essential.
Real live researchers (I'm not one) should be able to figure out the how. My guess is that masking would be done by having masked and non-masked infected people (a range of degrees and times since infection) in defined spaces and test for the detection of the virus at different distances and times that could then be modeled.
I've heard different things about the difference HCT's could have made. I don't see much downside.
When you say “we”, are you talking about official policy or individual behavior? My policy is still not to eat in indoor restaurants, or do anything else that involves public indoor unmasked activity, when local case counts are above 20 per 100,000 per day. It’s a pretty easy policy to follow (though quite annoying in winter to have to cook every day). Do you think this is ineffective? Or a harmful strategy for an individual? I wouldn’t want to legally mandate this (except maybe with a much higher case count threshold) but I think individual actions are the vast majority of what “we” are doing now. Legal mandates are mostly gone and/or toothless in large parts of the country.
I'm not going to tell anyone how to live their lives. But to your question I don't understand why a vaccinated, otherwise healthy and non-elderly person would self-impose those sorts of restrictions. If you're vaccinated and boosted you've done all you can.
I'm not sure what you mean by "you've done all you can", when we are specifically talking about an additional set of things to do that seem extremely effective, and not very difficult if it's just about a few weeks.
My main thinking is that I don't like getting sick, and if the choice is between voluntarily not going to restaurants and bars for a few weeks, or going and maybe getting sick and then involuntarily not going for a few weeks, the former seems better (though admittedly the calculus might be different if I lived in a place with better restaurant options).
Where I disagree is the assumption that any one is going to avoid getting covid forever. Maybe some small number will but the vast, vast majority won't and where it happens I think it will be more luck than any particular individual efforts.
The ethical obligation IMO is really to prevent yourself from being unnecessarily hospitalized so there are beds for others who need them. If you're healthy and vaccinated you've already done way more to that end than a mask will.
At this point I'm not treating this as an ethical obligation to others, but just as a simple cost-benefit analysis for myself. I don't need to avoid getting covid forever to get the benefit of reducing the frequency with which I get covid.
I expect most people will get covid repeatedly over the course of their lives. I used to get significant colds multiple times a year, but haven't the past two years. I'd be much happier if I get them once every year or two rather than once every few months.
The relevant question is then, what behaviors reduce my frequency of respiratory infections more than they cost me in terms of present fun. I think that avoiding restaurants for a couple weeks during the height of an outbreak is on one side of that cost-benefit analysis, but during June/July and November/December I was totally happy going out and doing indoor things, and I expect to be in a few weeks again.
100% agree. Keeping our family from getting knocked on our ass for 3-4 days (which does happen when boosted) is more annoying than wearing a KN-95 indoors when omicron is surging.
I work in tech and multiple projects have been hindered from vaccinated folks being out in Jan.
If I can avoid some of that via a KN-95 indoors, I’ll wear the mask.
I don't understand what you're saying. Are you claiming that case counts won't get below 20 per 100,000 per day? They have been for about half of the last seven months, despite the big waves we've had. We're definitely not talking years of waiting here, just a couple weeks.
I'm saying there has to be a level of acceptable risk, but you seem to be saying the same thing, while thinking you're disagreeing with me. Are you just thinking that my level of acceptable risk, which seems like it should apply most of the time other than during acute waves, is still too high a level? I think that as long as that level only kicks in for a few weeks during bad waves, then that seems like a minor price to pay to eliminate most of my infection risk. I'm definitely not suggesting that we wait until case counts be below 1 per 100,000 per day or anything like that.
Kenny, let’s talk about your infection risk. Presumably, you are vaccinated against covid. You are probably also boosted. I doubt that you are vaccinated against the common cold because there isn’t a vaccine and even if you are vaccinated against influenza, that vaccination isn’t hugely effective.
Your covid infection risk is probably less than half of your totally risk from respiratory diseases. Even when covid levels crater, your total respiratory disease risk will only decline somewhat.
Did you socially distance every January before covid? Was it reckless not to? Unless you think thst every modern human should distance for a month every winter, you are being more risk averse than 2019 normal. I want 2019 back and the psychological benefits will be great.
At this point, if you're under 70ish and vaccinated, I suspect you're in more danger of norovirus from a cook who pooped and didn't wash his hands carefully, and you will be forever.
If that's the framework in which you want to make your own health risk decisions, of course you're welcome to do that.
When you say "more danger" what do you mean? It sounds like the base rate of covid infections is much higher right now than the rate of norovirus infections I've had from eating out. Maybe covid infections are a bit less bad, but they're more predictable based on case numbers.
That sounds right. I think the threshold of frequency of norovirus cases that would make me avoid eating out is probably a factor of ten lower than my threshold of frequency of covid cases. I don't believe those have ever been anywhere as near a tenth as common as covid cases have been the last couple weeks (but I admit I've also never had access to statistics on those).
so you’d rather have food poisoning ten times than post vaccine covid once. i’d rather have post vaccine covid two or three times than one bad stomach bug
I'm talking policy. Personally, being triple vaxxed, even though I'm in a statistically very vulnerable age group, I spend an evening with a group in a bar with everyone including me unmasked (obviously). I don't think masking protects me at all, (and I have "moral certainty" that I am not infectious) so I see almost zero benefits to my wearing a mask, but the costs are low, so I'm happy to go along with a local indoor mask requirement as it presumably represents other people having more confidence in the protective value of masking than I do.
> though quite annoying in winter to have to cook every day
Does College Station get cold enough regularly that eating outside is impractical? SF restaurants have been doing it year-round, and while it's been a warm winter, it's not _that_ warm....
We usually only have a few days a year when the high temperature is below freezing, but probably about half of January and a few weeks of December and February have highs below 50 and lows below freezing. I think in the ten years I lived in the Bay Area there were probably a few nights below freezing, but I don't think there was a single day where the high was below freezing, the way it was here in College Station yesterday.
We spent the first half of 2021 in Austin, and there's plenty of space for outdoor dining there. We did use some of them on evenings when it was in the 40s, but not often. Outside of Austin, most Texans seem to think that the summers make outdoor dining impractical as well, so restaurants and bars outside of Austin often just don't have outdoor seating at all, or only have a tiny bit, which has been really annoying.
Vaccination is only mildly effective at preventing the spread of omicron, which causes misery to the vaccinated and potential death to the elderly, immunocompromised, and unvaccinated.
I guess wearing a piece of thin cloth on your mouth to protect your friends, family, and neighbors is just too much of a hassle for you, but don't kid yourself that you're doing "the best you can".
Mild or not it still has a heck of a net benefit over cost. And although the benefits are not great, the costs of masking are also extremely low. [School for young children may be an exception with quite high costs.]
What about ventilation? We should be improving ventilation in public spaces to prevent asthma alone, but I think it could also be good for preventing COVID spread in some cases.
That got cut for length but what I found is that HEPA filters are precise enough to catch Covid particles but it's unclear if they would catch them before you inhale them. One study found that they really reduced the amount of Covid particles in the air in a hospital setting so it might be useful there.
They absolutely would catch the particles, and for that matter so do MERV13 filters. It’s the exact same concept as masks, at larger scale. This is why aircraft cabins were not a significant source of spread, despite long durations in close quarters with well-mixed air.
Masks get all the press, but filtration is the next best thing after vaccines.
Yes, the best thing to do re:COVID is to find ways of decreasing its partisan salience so that people start following common sense (get vaxxed, avoid sick people, live life) instead of the tribal imperative (flout adherence/non-adherence).
Yes, I keep trying to persuade my all-vaccinated low risk lefty cohort that we have to start acting more normal for the political benefit that will accrue. MY has of course been making this point too.
Unfortunately it's so invisible that nobody ever talks about it, thus outside of experts in the air quality industry, there is mass ignorance on how much it helps, and therefore we have a thousand articles about mask wars.
If the average person had any idea how much safety they could buy with a $20 box fan, some furnace filters, and a roll of duct tape, you wouldn't be able to keep them on the store shelves.
Yes, but he said it was unclear if they caught them before you inhaled them.
If you're breathing out COVID particles 2 feet from me and the air ventilation is 20 feet away, I'm going to breathe in virus.
I'm sure it reduces infection, but how well it does seems like it's going to be incredibly implementation-specific and you're never going to know how well ventilation is implemented wherever you go.
Nothing will save you from an extremely localized source except a well-fitted, high-quality mask: that's just facts about proximity.
But aerosolized virus can survive airborne for hours. If there's a room with stagnant air and a source of virus, a mask is insufficient: you're sitting in a soup and even an N95 won't be good enough, eventually something will get through. Someone shedding virus can infect someone clear across the room. You *have* to get the virus out of the air. Filtration is good, ventilation is better, both is best.
It is absolutely the case that clearing virus from the air will help on net, and the most important thing you can do to stop indoor transmission. Can't get infected if you can't get dosed.
I was team ventilation right up until today, but there's been new studies that the virus does NOT hang in the air for hours. They now think it in fact loses it's ability to infect after it leaves the host in about 5 to 20 minutes.
Obviously, outdoors and open windows is still better than closed. But with a little recent googling I see that Milan has a point. I'll still ventilate, but I'm gonna' start stepping back when speaking to neighbors unmasked on the street.
100% agree, I was just pointing out that your comment read as if you thought you were rebutting Milan, but saying "filters do catch viruses" is not a rebuttal to "filters might not catch viruses before you breathe them in".
There's nothing to rebut, and TBH he didn't even answer the question (filtration and ventilation are different things). I was just confirming the fact that HEPA works, extended it to MERV 13s as well, and gave a real-world example that wasn't a hospital setting.
I don't want people reading this thread to walk out with the impression that clean air is some expensive intervention with dubious efficacy that you will only see in high-risk medical settings.
Anybody with 30 bucks and a roll of duct tape can have clean air.
Even if someone's standing two feet away from you, it matters whether each exhale adds virus to the amount that's already floating in your vicinity, or whether the ventilation system has created a gentle pressure gradient so that each exhale just causes a temporary cloud of virus that is sucked away before the next exhale adds to it.
The HVAC system in my home is definitely not sufficient for the volume of some of the rooms - particularly in the master closet and master bathroom, there's always a huge amount of stagnant air even if the HVAC is blowing. But in a well-designed system, like an airplane cabin, you've got air intake on one side of the space and air outflow on the other (in the airplane cabin air comes in above each seat and leaves below each seat) to prevent these stagnant pockets.
Yes! More research needed but I don't see any possible harm in installing filters in classrooms so let's use some of the ARP money or the $5B state tax surplus to roll out some pilot programs in Massachusetts.
Can't hurt might help! In fact, couldn't they do a test? Where two comparable schools, one with & one without updated filtration is studied during the next variant wave and we see if there's less breakouts?
They are perfect for schools, and some people are pushing for it. I built a DIY Corsi-Rosenthal box for my son's classroom. On a low setting, it's only ~50db at a distance of 6 feet, and pushes out 400+ cubic feet per minute or filtered air.
They have not had a COVID outbreak for the entire pandemic.
I bought portable air filtration systems for both my wife's class (she's a teacher) and my son's class (he's in Kindergarten). I don't think most school districts have actually given this much thought.
My kid's school has made some too. Although even if our kids classes haven't had breakouts that's still anecdotal. I wish someone would really study this. But I looked around and Milan's right. There's no hard evidence that it lowers spread that I can find. Send me some links if you have any.
The high ceilings and big windows in housing built for the middle class and up in the late 19th and early 20th century were actually an party an infection control feature. Tuberculosis was very common and the high ceilings allowed mixing of the air and therefore diluted the infectious dose. Opening windows is also very effective at diluting anything in the air.
I've often wondered if the better results in Germany have been mostly driven by building standards and cultural norms that focus on more ventilation. When I lived there, my friends would just open up the windows in the middle of a cold winter day.
Unfortunately, in my contemporary home, the high ceilings and un-openable windows mean that the HVAC system often can't move all of the air in the space. I think a lot of recent building codes have emphasized HVAC rather than openable windows for reasons of energy efficiency and/or fire safety, but this has had a lot of downside for the pandemic. (It would probably be great if your air quality concern is forest fires and traffic emissions though.)
Came here to say this, also to bring up filtration. You cannot just talk about vaccines, masks, and distance. Buildup of aerosolized virus particles is why indoor spread is a thing.
I thought so too. Looked into it fresh after reading Milan's article. Like him I can't find any proof. And I ALWAYS open my windows indoors, in Ubers or cabs. Plus I bought an air purifier at my home. Wife got covid. kid & I didn't. But someone's gotta' really study it. I haven't seen any other than this Japanese thing that's almost 2 years old now.
Plus there's new studies saying that covid does NOT hang in the air as for hours like they first thought. Now they say it loses it's infection capabilites in 5 to 20 minutes. Here's that article. Much more recent.
First off, I want to say I can see why Matt hired you - you are a good writer and you managed to condense a lot of information into a something that was not a chore to read, so well done.
Here are a few thoughts:
In many ways I think it's useful to think of this as three pandemics and not one pandemic. That's because the three major variants have not been affected by our interventions in the same way, particularly vaccine and masking effectiveness.
Secondly, with regard to mandates, process and legitimacy matter a great deal. Austria's parliament passing a mandate into law is not the same thing as the Biden administration trolling through regulations looking for something to shoehorn into a mandate. Personally, I have no problem with mandates, but there needs to be democratic accountability and support. Two years into this we should not be relying on emergency powers and gimmicks like the OSHA ETS rule.
And since the government has done such a bad job at building credibility, any hope for a democratically-legitimate mandate is pretty much gone. And two years in, it's quite depressing to see that the same mistakes are being made that contribute to a lack of public confidence.
Given these realities, I'm basically where you are. Vaccination is the best option and that ought to be encouraged, but at the end of the day, it's a choice and if people want to roll the dice, then they can do that.
I am so, so mad at my local authorities continuing to exercise power by declaring emergency stuff, over and over and over.
*Two years ago* we knew we had to do emergency stuff. Now we don't. We have regular-process systems to control or mitigate spread, or not. The voters control those systems. Use them.
If you buy "Covid Zero" doesn't make sense, and I do, then it doesn't really matter that much how good masks work. They're only a delay tactic, which is only useful in a few circumstances that mostly no longer apply (like the hospitals are full or vaccines are around the corner).
This is why the "I support mask mandates because I CARE and people are DYING" people are so incredibly frustrating. Because you're doing this "until COVID is gone" but COVID is only gone after some combination of everyone is vaccinated, exposed, or both. So all you're doing is taking the same outcome and stretching it out slightly, all the while tut-tutting at the monsters who have taken a moment to think this through. I am truly, deeply confused at why this can't be explained to so many people.
It matters how well masks work *because* they are useful in a few circumstances — if I was going to visit my grandparents in MD I might want to know what mask to wear because I don't want to get them sick, even if I wouldn't wear a mask if I was out and about on my own.
I agree, I just think that a lot of people think of it as "we need masks and vaccines" when it should be "we need vaccines, vaccines, vaccines, and also vaccines, and then we can behave normally except in a few specific circumstances where masks might be helpful".
So many I overstated it a little, I should qualify it as it doesn't matter much how masks work when thinking about the big covid picture, but it may be of interest for those few circumstances.
Yeah. Vaccines are way more important than anything. If Democrats make it seem like we're gonna' be wearing masks for the rest of our lives then we're not gonna' change any Republican or anti-vaxxers mind.
"delay tactic" - Thank you! I wanted to say something along these lines. All these measures of NPI effectiveness, ie masks are X% effective when worn correctly, cloth is Y%, ventilation reduced by Z%, etc.. They're only measuring effectiveness over short timespans. If covid is sticking around, everyone is exposed eventually, multiple times. Sure you can reduce the frequency of exposure, but eventually we all have to rely on our immune systems and acquired (vaccine or through infection) immunity. Nothing in Milan's summary of NPI's convinced me that any of them are long term solutions.
I don't understand why we continue with anything other than vaccination at this point outside of particularly sensitive places (hospitals, nursing homes, etc.). Masks and social distancing make sense when there is nothing else but we're way passed that. I can't be the only person that thinks its farcical to walk into a restaurant masked, remove it at the table for an hour while talking and eating, then put it back on to leave. I mean, does the virus call a truce while we sip our beers? Was it fooled by wearing a mask at the hostess stand?
If we were a more mature people socially and politically we would drop the silly theater, mitigate as best we can with our (really quite amazing) vaccine technology, and then go about our lives.
Additionally very, very few people are wearing masks effectively. Part of my job was training employees how to properly fit N95 masks. Achieving and maintaining a tight fit is not all that easy. Talking, coughing, even smiling behind your mask could break the fit requiring frequent adjustment. So while this type mask may be 79-90% effective when tightly fitted I’m quite sure 89-99% are not worn this way.
To both of your points, I'm not sure how many people are wearing masks with the intent of antiviral effectiveness, rather than the intent of "I am complying with the letter of your mandate".
I'm well to the covid-hawk of the average bear, but I'm firmly in the latter camp. Triple-shotted, got (presumably) omicron a few weeks ago and it was mostly a cold... your roof, your rules, but why are we play-acting any of this?
I have sourced the loosest and most comfortable scrap of fabric I could find as my “mask.” I am under zero illusion that it is a public health tool, I just don’t want to get scolded.
I’m triple vaccinated and I’ve had COVID in the last quarter, as have my spouse and infant. I’m done.
I would guess the people wearing N95s or the like really care, the rest are just going along with it.
Exactly. Masks work when used correctly. Virtually no one is using them correctly in any kind of consistent way, and in fairness it's probably too much to expect them to.
I get this point overall, but I'm a bit suspicious about this binary view of mask efficacy and fit.
Before covid I only wore N95 masks for home improvement projects like insulating and spray painting. From this experience, I know first hand that N95 masks definitely "work" at reducing the amount of bad stuff that gets into my nose and lungs during these projects. I'm sure the fit in these cases is relatively poor and this means some bad stuff still leaks in, just not enough to irritate my lungs or make my snot turn the color of whatever I'm painting.
In a real-world fit situation, what percentage of the air that's inhaled and exhaled do you think flows through the mask material versus bypassing the filter due to bad fit?
My guess is that even with a bad fit, a very large percentage of inhaled/exhaled air gets filtered. So while personal risk is not completely eliminated with a badly fitted mask, if a large percentage of the air moves through the filter, that should still result in a lower rate of spread and less severe infections for those that do get sick.
What's wrong with my logic here?
> What's wrong with my logic [re lower-but-non-zero filtering effectiveness with imperfect mask seals] here?
Nothing. But people don't understand dose-response curves and think that if one virion makes it around the mask you're going to get infected, so it needs to be perfect or you might as well not bother. In reality, the fewer virons you get exposed to, (1) the lower the chance you have of any of them managing to attach to a receptor, and (2) the lower the number of cells that will get infected before your immune system is able to counterattack, thereby reducing the severity of your infection, if any. Perfect mask seals are great! Imperfect ones are still better than nothing!
This same misunderstanding shows up in how people think about radiation exposure, too.
I think most people can understand just fine that 10 virus particles are less infectious than 10k virus particles inhaled during a particular activity. My sense is most sentiments that get expressed as "why bother if it's not a perfect seal?" come more from them having accepted the inevitability that from a long-term perspective, there doesn't seem to be much point in reducing one's own viral exposure in a particular instance. Unlike with toxic paint fumes, I don't see much point in reducing (or even eliminating) virus exposure during one particular activity unless it's part of a long term strategy to do what it will take to meaningfully dodge infectious doses of 🦠 every day, during every activity, for, at minimum, the next few years. I'm enthusiastically vaccinated (and boosted) because that's an action that provides durable protection from severity - it's not a never-ending slow-motion whack-a-mole game.
If the virus was only in the air on leap days, sure, I could conceivably play whack-a-mole a couple times a decade. A concerted effort to play whack a mole by breathing only mostly-filtered and/or non-shared air every day for the next decade does not seem feasible or worthwhile or desirable in any way.
That's why we say things like 'Why bother?' Some admittedly use a rhetorical sleight-of-hand to project that resignedness onto the imperfect-albeit-good short term filtration effectiveness of a particular mask.
Pre-vaccine I agree. Post vaccine I still think it's the right thing to do in certain settings with lots of vulnerable people. What I don't see is much benefit to it in general retail, restaurants, or other public spaces for vaccinated people.
Pandemic-fetish is absolutely a real thing and I want to crush those views into tiny pieces.
GET VACCINATED AND THEN GET ON WITH IT ALL.
This seems reasonable but it isn't where I've landed, at least for now.
For me personally, I still voluntarily always wear a good mask when indoors and I plan to until the case numbers in my area get down to the 10-20 per 100k range.
I'm retired, so it's easy for me to avoid exposure if I want to. I expect I'll eventually get covid, but I'm willing to pay a small price to try to hold it off until the hospitals in my area aren't full (eg elective surgeries are suspended right now) and maybe even until we're not rationing high efficacy treatments (maybe in a month or two?).
In my social circle of somewhat older folks, hardly anyone is socializing indoors or eating in restaurants. We do gather freely outside, where we don't wear masks or worry much about covid.
This is the first rationale I've heard from someone taking this cautious approach, in a long time, that attempts to make logical cause-and-effect sense, avoid guilt tripping others to do the same, and see the future in realistic terms. Well done.
If a boosted person is looking to reduce their risk of getting COVID and missing a couple of days of work, throwing on a KN-95 in Target, gas stations, etc isn’t going to be of benefit when case counts are high? Genuinely curious.
Nothing, and this is what drives me crazy about the “no more masks” line. They don’t have to be perfect. They just have to be somewhat effective, enough to help to reduce R. They are a relatively cheap and easy intervention.
As for nobody using them properly, probably depends where you are. I don’t care what people do outdoors or in huge indoor spaces like Home Depot. Indoors in the Bay Area I see 100% compliance indoors and people wearing whatever masks they have properly, along with increasing percentages of KN95s. Guess what, we also had far fewer cases this time than SoCal where compliance is much worse.
The places where I see good compliance are places where the public mandate isn't the binding issue. Like, where even before we re-introduced our local mandate, masking was still very high either do to a private institution having the rule, or nearly everyone doing it voluntarily. Whereas in the kinds of places where people dropped masking when the government let them, masking is really poor. If people want to mask at this point, they're going to, but I'm not sure how much the government is really prepared to make them do it well.
I agree that local culture sets actual compliance, but in places inclined to high compliance, the mandate I think obviously helps to set expectations and apply social pressure. Even if enforcement by police is virtually nonexistent, it licenses eg store workers to ask politely, with some teeth (far) behind it. (Trespass is still prosecuted and even the biggest cranks know it.) And it makes the store’s policy not a quixotic aberration but something they can shrug and point to the rule (even if they were already inclined to do it).
Laws and rules have effects beyond their enforcement, but for sure they’re not magic wands in a population who generally disagree.
What is the point in reducing the R when every normal person is going to be exposed anyway? Why drag it out even longer?
It reduces total penetration of each wave. It does not “drag things out”, it means fewer people in total get infected.
And everyone will not get it. The reason everyone does not get the flu every year is that the flu’s R is low to start with and its effective R fluctuates right around 1 depending on vaccines, prior immunity, climate, and behavioral factors. And prior immunity is not necessarily a large factor.
The value of mask mandates is also hugely different depending on community prevalence. At peak Omicron, wearing a good mask might have 100x the protective effect it had during a lull, simply because there are so many infectious people around.
I hope to have our local school mask mandates drop after Omicron. I dislike wearing a mask. But during a big wave I’ll put up with it.
Right now, the main reason is healthcare system capacity. Despite the fact it poses less individual risk than previous variants, Omicron is still a major challenge due to the absolute number of hospitalizations. The major hospital system where I work - in a highly vaccinated region of the country - is having to decline transfers and admissions of very sick patients because we are at capacity.
In the near-term, there's an argument that would should continue layered NPIs to reduce R until antivirals like Paxlovid are widely available and the under-5 vaccine series' have been approved. I think the scope and extent of those NPIs is up for debate, but it's not an unreasonable position. Having Paxlovid available could make a big difference when an immunocompromised person finally gets COVID-19.
In the long-term, re-institution of NPIs may be important during surges of new variants or during the winter respiratory season. It's worth remembering that our previous 'normal' existed in a world where the circulating population of respiratory viruses/bacteria caused 2-10x less mortality (and this is assuming a fully vaccinated population). You would have seen much different social practices if the annual toll from viral PNA was 150-300k instead of 30-60k. Look at the impact that the original SARS virus had on public health in East and SE Asia.
You talk as though everyone is going to get sick exactly once in their life and then be done with it. I agree that if R was high enough that we couldn't prevent everyone from getting sick once, and if immunity was perfect enough that a vanishing fraction of people would get sick more than once, then it doesn't matter to drag it out more than just enough to avoid the worst hospital crunch.
But it looks like immunity *isn't* perfect enough to prevent people from getting reinfected. So reducing R means reducing the frequency with which people get reinfected. Getting sick once every three years rather than once every two years seems better, no?
Two years on, we still haven't recovered or moved on from binary thinking.
No, air is like water following the path of least resistance. While indeed some air will be filtered, much more will slip by in the gaps. To that add how much less virus needs to get by than paint mist. So sure wear a mask, I would, just don’t be misled by claims of 79-90% protection that are only achieved in a lab.
Not disagreeing with you at all, but this spurred a thought I wanted to share. It seems like the actual brand/construction of the mask is a HUGE factor in how good you can get a good fit!
Basically the only mask out of the dozen I've tried that I can get to reliably fit is 3M Aura N95 masks from Home Depot. And I get a good fit (as defined by "won't fog my glasses") without a a lot of fiddling.
What do you mean correctly. The except while actively eating or drinking loophole means you are wearing it correctly even if it off for long periods of time.
Why is there no operations research on this? If the question doesn't occur to some school of public health, why doesn't a business association of bars and restaurants commission the research. For that matter, why doesn't the city health department or whoever executes venue restrictions commission such research?
You can run randomized trials. The problem has been that even suggesting a randomized trial was very controversial until recently.
I didn't see it get enough attention to be "controversial." :) There were never enough controversial ideas discussed.
I think the effective version of the research would have to involve sending known infected people into spaces with known uninfected people with and without masks and counting how many got infected. I don’t think challenge trials were that necessary for vaccines, which could be tested easily the other way, but for these things, challenge trials of this sort would be essential.
Real live researchers (I'm not one) should be able to figure out the how. My guess is that masking would be done by having masked and non-masked infected people (a range of degrees and times since infection) in defined spaces and test for the detection of the virus at different distances and times that could then be modeled.
I've heard different things about the difference HCT's could have made. I don't see much downside.
When you say “we”, are you talking about official policy or individual behavior? My policy is still not to eat in indoor restaurants, or do anything else that involves public indoor unmasked activity, when local case counts are above 20 per 100,000 per day. It’s a pretty easy policy to follow (though quite annoying in winter to have to cook every day). Do you think this is ineffective? Or a harmful strategy for an individual? I wouldn’t want to legally mandate this (except maybe with a much higher case count threshold) but I think individual actions are the vast majority of what “we” are doing now. Legal mandates are mostly gone and/or toothless in large parts of the country.
I'm not going to tell anyone how to live their lives. But to your question I don't understand why a vaccinated, otherwise healthy and non-elderly person would self-impose those sorts of restrictions. If you're vaccinated and boosted you've done all you can.
I'm not sure what you mean by "you've done all you can", when we are specifically talking about an additional set of things to do that seem extremely effective, and not very difficult if it's just about a few weeks.
My main thinking is that I don't like getting sick, and if the choice is between voluntarily not going to restaurants and bars for a few weeks, or going and maybe getting sick and then involuntarily not going for a few weeks, the former seems better (though admittedly the calculus might be different if I lived in a place with better restaurant options).
Where I disagree is the assumption that any one is going to avoid getting covid forever. Maybe some small number will but the vast, vast majority won't and where it happens I think it will be more luck than any particular individual efforts.
The ethical obligation IMO is really to prevent yourself from being unnecessarily hospitalized so there are beds for others who need them. If you're healthy and vaccinated you've already done way more to that end than a mask will.
At this point I'm not treating this as an ethical obligation to others, but just as a simple cost-benefit analysis for myself. I don't need to avoid getting covid forever to get the benefit of reducing the frequency with which I get covid.
I expect most people will get covid repeatedly over the course of their lives. I used to get significant colds multiple times a year, but haven't the past two years. I'd be much happier if I get them once every year or two rather than once every few months.
The relevant question is then, what behaviors reduce my frequency of respiratory infections more than they cost me in terms of present fun. I think that avoiding restaurants for a couple weeks during the height of an outbreak is on one side of that cost-benefit analysis, but during June/July and November/December I was totally happy going out and doing indoor things, and I expect to be in a few weeks again.
100% agree. Keeping our family from getting knocked on our ass for 3-4 days (which does happen when boosted) is more annoying than wearing a KN-95 indoors when omicron is surging.
I work in tech and multiple projects have been hindered from vaccinated folks being out in Jan.
If I can avoid some of that via a KN-95 indoors, I’ll wear the mask.
More like a few years. There’s no guarantee Covid is ever going away. They’ll always be a risk. (Unless they really developed a universal vaccine.)
Are you prepared to not do anything indoors in public for years to come?
And what about the Amazon & Fresh Direct workers? They have to work indoors with other people or we all starve.
There has to be a level of acceptable risk.
I don't understand what you're saying. Are you claiming that case counts won't get below 20 per 100,000 per day? They have been for about half of the last seven months, despite the big waves we've had. We're definitely not talking years of waiting here, just a couple weeks.
I'm saying there has to be a level of acceptable risk, but you seem to be saying the same thing, while thinking you're disagreeing with me. Are you just thinking that my level of acceptable risk, which seems like it should apply most of the time other than during acute waves, is still too high a level? I think that as long as that level only kicks in for a few weeks during bad waves, then that seems like a minor price to pay to eliminate most of my infection risk. I'm definitely not suggesting that we wait until case counts be below 1 per 100,000 per day or anything like that.
Kenny, let’s talk about your infection risk. Presumably, you are vaccinated against covid. You are probably also boosted. I doubt that you are vaccinated against the common cold because there isn’t a vaccine and even if you are vaccinated against influenza, that vaccination isn’t hugely effective.
Your covid infection risk is probably less than half of your totally risk from respiratory diseases. Even when covid levels crater, your total respiratory disease risk will only decline somewhat.
Did you socially distance every January before covid? Was it reckless not to? Unless you think thst every modern human should distance for a month every winter, you are being more risk averse than 2019 normal. I want 2019 back and the psychological benefits will be great.
At this point, if you're under 70ish and vaccinated, I suspect you're in more danger of norovirus from a cook who pooped and didn't wash his hands carefully, and you will be forever.
If that's the framework in which you want to make your own health risk decisions, of course you're welcome to do that.
When you say "more danger" what do you mean? It sounds like the base rate of covid infections is much higher right now than the rate of norovirus infections I've had from eating out. Maybe covid infections are a bit less bad, but they're more predictable based on case numbers.
Post-vaccination covid sent me to bed early in a sweatshirt and sweatpants, rather than violently assaulting the toilet for two days.
That sounds right. I think the threshold of frequency of norovirus cases that would make me avoid eating out is probably a factor of ten lower than my threshold of frequency of covid cases. I don't believe those have ever been anywhere as near a tenth as common as covid cases have been the last couple weeks (but I admit I've also never had access to statistics on those).
so you’d rather have food poisoning ten times than post vaccine covid once. i’d rather have post vaccine covid two or three times than one bad stomach bug
I'm talking policy. Personally, being triple vaxxed, even though I'm in a statistically very vulnerable age group, I spend an evening with a group in a bar with everyone including me unmasked (obviously). I don't think masking protects me at all, (and I have "moral certainty" that I am not infectious) so I see almost zero benefits to my wearing a mask, but the costs are low, so I'm happy to go along with a local indoor mask requirement as it presumably represents other people having more confidence in the protective value of masking than I do.
> though quite annoying in winter to have to cook every day
Does College Station get cold enough regularly that eating outside is impractical? SF restaurants have been doing it year-round, and while it's been a warm winter, it's not _that_ warm....
We usually only have a few days a year when the high temperature is below freezing, but probably about half of January and a few weeks of December and February have highs below 50 and lows below freezing. I think in the ten years I lived in the Bay Area there were probably a few nights below freezing, but I don't think there was a single day where the high was below freezing, the way it was here in College Station yesterday.
We spent the first half of 2021 in Austin, and there's plenty of space for outdoor dining there. We did use some of them on evenings when it was in the 40s, but not often. Outside of Austin, most Texans seem to think that the summers make outdoor dining impractical as well, so restaurants and bars outside of Austin often just don't have outdoor seating at all, or only have a tiny bit, which has been really annoying.
Vaccination is only mildly effective at preventing the spread of omicron, which causes misery to the vaccinated and potential death to the elderly, immunocompromised, and unvaccinated.
I guess wearing a piece of thin cloth on your mouth to protect your friends, family, and neighbors is just too much of a hassle for you, but don't kid yourself that you're doing "the best you can".
Mild or not it still has a heck of a net benefit over cost. And although the benefits are not great, the costs of masking are also extremely low. [School for young children may be an exception with quite high costs.]
What about ventilation? We should be improving ventilation in public spaces to prevent asthma alone, but I think it could also be good for preventing COVID spread in some cases.
That got cut for length but what I found is that HEPA filters are precise enough to catch Covid particles but it's unclear if they would catch them before you inhale them. One study found that they really reduced the amount of Covid particles in the air in a hospital setting so it might be useful there.
They absolutely would catch the particles, and for that matter so do MERV13 filters. It’s the exact same concept as masks, at larger scale. This is why aircraft cabins were not a significant source of spread, despite long durations in close quarters with well-mixed air.
Masks get all the press, but filtration is the next best thing after vaccines.
Ventilation also has the advantage of being invisible infrastructure. That makes thinks look more normal than a bunch of people wearing masks.
Ventilation has the *disadvantage* of not being a signpost of How Much We're Taking This Seriously.
Had GWB or Mitt Romney been president in 2020, I think it's an open question how much blue-leaning metros would give a crap about masks in early 2022.
Yes, the best thing to do re:COVID is to find ways of decreasing its partisan salience so that people start following common sense (get vaxxed, avoid sick people, live life) instead of the tribal imperative (flout adherence/non-adherence).
Yes, I keep trying to persuade my all-vaccinated low risk lefty cohort that we have to start acting more normal for the political benefit that will accrue. MY has of course been making this point too.
Unfortunately it's so invisible that nobody ever talks about it, thus outside of experts in the air quality industry, there is mass ignorance on how much it helps, and therefore we have a thousand articles about mask wars.
If the average person had any idea how much safety they could buy with a $20 box fan, some furnace filters, and a roll of duct tape, you wouldn't be able to keep them on the store shelves.
Gosh, everyone I know that traveled by air somewhere (Florida, etc. from the NE) came home sick.
I'd say it's likely that riding in a plane was not the riskiest activity that most travelers engaged in during their trips.
Almost certainly right. A few months ago, I recall reading that flight attendants had a lower proportion of cases than the general public.
Yes, but he said it was unclear if they caught them before you inhaled them.
If you're breathing out COVID particles 2 feet from me and the air ventilation is 20 feet away, I'm going to breathe in virus.
I'm sure it reduces infection, but how well it does seems like it's going to be incredibly implementation-specific and you're never going to know how well ventilation is implemented wherever you go.
(I still think it's a good idea)
Nothing will save you from an extremely localized source except a well-fitted, high-quality mask: that's just facts about proximity.
But aerosolized virus can survive airborne for hours. If there's a room with stagnant air and a source of virus, a mask is insufficient: you're sitting in a soup and even an N95 won't be good enough, eventually something will get through. Someone shedding virus can infect someone clear across the room. You *have* to get the virus out of the air. Filtration is good, ventilation is better, both is best.
It is absolutely the case that clearing virus from the air will help on net, and the most important thing you can do to stop indoor transmission. Can't get infected if you can't get dosed.
I was team ventilation right up until today, but there's been new studies that the virus does NOT hang in the air for hours. They now think it in fact loses it's ability to infect after it leaves the host in about 5 to 20 minutes.
Obviously, outdoors and open windows is still better than closed. But with a little recent googling I see that Milan has a point. I'll still ventilate, but I'm gonna' start stepping back when speaking to neighbors unmasked on the street.
https://www.theguardian.com/world/2022/jan/11/covid-loses-90-of-ability-to-infect-within-five-minutes-in-air-study
With respect, outdoor masking was always absurd, even in March of 2020.
100% agree, I was just pointing out that your comment read as if you thought you were rebutting Milan, but saying "filters do catch viruses" is not a rebuttal to "filters might not catch viruses before you breathe them in".
There's nothing to rebut, and TBH he didn't even answer the question (filtration and ventilation are different things). I was just confirming the fact that HEPA works, extended it to MERV 13s as well, and gave a real-world example that wasn't a hospital setting.
I don't want people reading this thread to walk out with the impression that clean air is some expensive intervention with dubious efficacy that you will only see in high-risk medical settings.
Anybody with 30 bucks and a roll of duct tape can have clean air.
Even if someone's standing two feet away from you, it matters whether each exhale adds virus to the amount that's already floating in your vicinity, or whether the ventilation system has created a gentle pressure gradient so that each exhale just causes a temporary cloud of virus that is sucked away before the next exhale adds to it.
The HVAC system in my home is definitely not sufficient for the volume of some of the rooms - particularly in the master closet and master bathroom, there's always a huge amount of stagnant air even if the HVAC is blowing. But in a well-designed system, like an airplane cabin, you've got air intake on one side of the space and air outflow on the other (in the airplane cabin air comes in above each seat and leaves below each seat) to prevent these stagnant pockets.
What we really need to know is how effective they are in schools. Is no one trying to figure that out?
https://www.vox.com/2020/1/8/21051869/indoor-air-pollution-student-achievement
Well, if filters help raise test scores and MIGHT lower Covid spread that's a win / win, right?
Yes! More research needed but I don't see any possible harm in installing filters in classrooms so let's use some of the ARP money or the $5B state tax surplus to roll out some pilot programs in Massachusetts.
Can't hurt might help! In fact, couldn't they do a test? Where two comparable schools, one with & one without updated filtration is studied during the next variant wave and we see if there's less breakouts?
Wow, that's amazing!
They are perfect for schools, and some people are pushing for it. I built a DIY Corsi-Rosenthal box for my son's classroom. On a low setting, it's only ~50db at a distance of 6 feet, and pushes out 400+ cubic feet per minute or filtered air.
They have not had a COVID outbreak for the entire pandemic.
I bought portable air filtration systems for both my wife's class (she's a teacher) and my son's class (he's in Kindergarten). I don't think most school districts have actually given this much thought.
I talked my boss into buying air purifiers for each office at our company. Now I'm worried that won't help. Ha!
My kid's school has made some too. Although even if our kids classes haven't had breakouts that's still anecdotal. I wish someone would really study this. But I looked around and Milan's right. There's no hard evidence that it lowers spread that I can find. Send me some links if you have any.
Any place on Slow Boring where your could post your supplementary materials (like an annex). I'd be interested in reading it!
The high ceilings and big windows in housing built for the middle class and up in the late 19th and early 20th century were actually an party an infection control feature. Tuberculosis was very common and the high ceilings allowed mixing of the air and therefore diluted the infectious dose. Opening windows is also very effective at diluting anything in the air.
I've often wondered if the better results in Germany have been mostly driven by building standards and cultural norms that focus on more ventilation. When I lived there, my friends would just open up the windows in the middle of a cold winter day.
Unfortunately, in my contemporary home, the high ceilings and un-openable windows mean that the HVAC system often can't move all of the air in the space. I think a lot of recent building codes have emphasized HVAC rather than openable windows for reasons of energy efficiency and/or fire safety, but this has had a lot of downside for the pandemic. (It would probably be great if your air quality concern is forest fires and traffic emissions though.)
Interesting.
Came here to say this, also to bring up filtration. You cannot just talk about vaccines, masks, and distance. Buildup of aerosolized virus particles is why indoor spread is a thing.
I thought so too. Looked into it fresh after reading Milan's article. Like him I can't find any proof. And I ALWAYS open my windows indoors, in Ubers or cabs. Plus I bought an air purifier at my home. Wife got covid. kid & I didn't. But someone's gotta' really study it. I haven't seen any other than this Japanese thing that's almost 2 years old now.
https://www.weforum.org/agenda/2020/04/coronavirus-microdroplets-talking-breathing-spread-covid-19/
Plus there's new studies saying that covid does NOT hang in the air as for hours like they first thought. Now they say it loses it's infection capabilites in 5 to 20 minutes. Here's that article. Much more recent.
https://www.theguardian.com/world/2022/jan/11/covid-loses-90-of-ability-to-infect-within-five-minutes-in-air-study
Amen. I've managed to find exactly one restauranteur who talks publicly about their air quality --- and he was on this bandwagon pre-COVID: https://www.civilbeat.org/2021/03/covid-19-is-airborne-so-why-doesnt-hawaii-have-pandemic-air-quality-standards/
(Seriously, 24 air changes per hour? That's incredibly good ventilation.)
So, uh, I shouldn’t be sterilizing my groceries anymore?
First off, I want to say I can see why Matt hired you - you are a good writer and you managed to condense a lot of information into a something that was not a chore to read, so well done.
Here are a few thoughts:
In many ways I think it's useful to think of this as three pandemics and not one pandemic. That's because the three major variants have not been affected by our interventions in the same way, particularly vaccine and masking effectiveness.
Secondly, with regard to mandates, process and legitimacy matter a great deal. Austria's parliament passing a mandate into law is not the same thing as the Biden administration trolling through regulations looking for something to shoehorn into a mandate. Personally, I have no problem with mandates, but there needs to be democratic accountability and support. Two years into this we should not be relying on emergency powers and gimmicks like the OSHA ETS rule.
And since the government has done such a bad job at building credibility, any hope for a democratically-legitimate mandate is pretty much gone. And two years in, it's quite depressing to see that the same mistakes are being made that contribute to a lack of public confidence.
Given these realities, I'm basically where you are. Vaccination is the best option and that ought to be encouraged, but at the end of the day, it's a choice and if people want to roll the dice, then they can do that.
I am so, so mad at my local authorities continuing to exercise power by declaring emergency stuff, over and over and over.
*Two years ago* we knew we had to do emergency stuff. Now we don't. We have regular-process systems to control or mitigate spread, or not. The voters control those systems. Use them.
Yeah, totally agree!
If you buy "Covid Zero" doesn't make sense, and I do, then it doesn't really matter that much how good masks work. They're only a delay tactic, which is only useful in a few circumstances that mostly no longer apply (like the hospitals are full or vaccines are around the corner).
This is why the "I support mask mandates because I CARE and people are DYING" people are so incredibly frustrating. Because you're doing this "until COVID is gone" but COVID is only gone after some combination of everyone is vaccinated, exposed, or both. So all you're doing is taking the same outcome and stretching it out slightly, all the while tut-tutting at the monsters who have taken a moment to think this through. I am truly, deeply confused at why this can't be explained to so many people.
It matters how well masks work *because* they are useful in a few circumstances — if I was going to visit my grandparents in MD I might want to know what mask to wear because I don't want to get them sick, even if I wouldn't wear a mask if I was out and about on my own.
I agree, I just think that a lot of people think of it as "we need masks and vaccines" when it should be "we need vaccines, vaccines, vaccines, and also vaccines, and then we can behave normally except in a few specific circumstances where masks might be helpful".
So many I overstated it a little, I should qualify it as it doesn't matter much how masks work when thinking about the big covid picture, but it may be of interest for those few circumstances.
Yeah I agree with that
Yeah. Vaccines are way more important than anything. If Democrats make it seem like we're gonna' be wearing masks for the rest of our lives then we're not gonna' change any Republican or anti-vaxxers mind.
Society is not just for the young. Society includes all of us. Your premise seems to infer that the vulnerable are not important to society.
"delay tactic" - Thank you! I wanted to say something along these lines. All these measures of NPI effectiveness, ie masks are X% effective when worn correctly, cloth is Y%, ventilation reduced by Z%, etc.. They're only measuring effectiveness over short timespans. If covid is sticking around, everyone is exposed eventually, multiple times. Sure you can reduce the frequency of exposure, but eventually we all have to rely on our immune systems and acquired (vaccine or through infection) immunity. Nothing in Milan's summary of NPI's convinced me that any of them are long term solutions.