I disagree. I think the CDC did actually perform a cross-benefit analysis on masks during the initial segment of the outbreak. Given the not-incontrovertible, yet positive, efficacy of masks, combined with the implications of a PPE shortage for healthcare workers meant that there probably was a calculated decision made to not recommend masks. Though at this point, without some more transparency, I'm not sure what we can say about the CDC's decisionmaking here.
> not sure what we can say about the CDC's decisionmaking here.
We can say "gee, we should appoint more truthful bureaucrats".
It isn't a crazy guess that (for this pandemic) a useful mask for a normal everyday person is anything that puts something in front of their face that makes it a little harder to breath and baffles the air currents.
There may be a shortage of proven face masks but there is no shortage at all of things that could be sewn up to cover faces and deaden air currents. The cost is tiny vs the risk of it not working.
Officials who are more worried about preventing a response to the potential crisis than the potential crisis should not be in charge if there is a potential crisis. We want people to change their behaviors if there is a crisis. Ideally even before the evidence in overwhelming that there is a problem.
The cost of recommending masks is that a large minority of people will decide they need the best mask to protect themselves, and buy them up thus depriving the healthcare workers of them. Yes, in an ideal world, the entire situation would be spelled out and only those people who are truly at higher risk would acquire some of the limited supply of more-effective masks.
For that to work, however, requires a sense of community and level of trust in government that has been in short supply in the US in recent years. These factors were also in play for swine flu and the other potential pandemics the article examined CDC rsponses for. In a crisis, officials have to base their decisions on current conditions, not on what they should ideally be. Restoring trust in government is extremely important, but can’t be accomplished in the timescale necessary to be useful for this crisis.
There isn't a coach and team in the world, real or hypothetical, who could win a football game down by 10 goals with 5minutes on the clock. The mask stuff was deck chairs on the Titanic.
Agreed. There's a difference between "stop buying masks because we need to save them for nurses" and "stop buying masks because they don't help at all*".
Potentially, but then surely a Cost/benefit analysis would strongly encourage the CDC to stockpile them in advance too? Perhaps nations need strategic PPE reserves.
TFA actually mentioned that point specifically, if you read it...
> I went into it thinking they’d lied to us, hoping to prevent hoarders from buying up so many masks that there weren’t enough for health workers. Turns out that’s not true. The CDC has been singing the same tune for the past ten years. Swine flu, don’t wear masks. SARS, don’t wear masks. They’ve been really consistent on this point. But why?
That's very weak reasoning, and I felt it was more musing than anything else. What evidence do we have for it not to be true? Why do we think consistency with previous advice trumps scientific evidence here? It feels like a cop-out to rule out a cost-benefit analysis simply because this advice mirrors advice in the past.
>I think the CDC did actually perform a cross-benefit analysis on masks during the initial segment of the outbreak. Given the not-incontrovertible, yet positive, efficacy of masks, combined with the implications of a PPE shortage for healthcare workers meant that there probably was a calculated decision made to not recommend masks. (emphasis added)
You postulated that the CDC not recommending masks was due to a recent cost-benefit analysis taking into account a circumstance (mask shortage) that has only been true for a few months. The article and link shows that the recommendation predated that by 10 years. Ergo the mask shortage could not be the cause of that recommendation.
There's no reason to even think that the CDC considered recommending masks - surely the default position is to leave pre-existing recommendations (don't wear masks) in place. You speculated that they did an analysis, which is not in evidence, and made a conclusion based on factors that may or may not have been important even had the analysis happened. That seems pretty weak to me.
> There's no reason to even think that the CDC considered recommending masks - surely the default position is to leave pre-existing recommendations (don't wear masks) in place. You speculated that they did an analysis, which is not in evidence, and made a conclusion based on factors that may or may not have been important even had the analysis happened. That seems pretty weak to me.
You're right, there is a hidden assumption I have here that I did not document. I believe the CDC is, within human limits, a capable organization of experts. I assumed that it was more likely for an organization of experts to perform a cost-benefit analysis than simply reiterate advice given in the past under similar situations. If you disagree with this assumption, then that's where we disagree.
They did an effectiveness analysis at some point in the past. If the situation had not changed from that point in a way that would indicate masks should be used, why would they reevaluate the whole thing? No organization, no matter how capable or expert, has infinite time or resources to reevaluate every past policy every day.
You seem to think they looked at it, found evidence that masks were effective, but then decided not to tell anyone due to the shortage. But then, a few months later, while that mask shortage was still in effect they decided to reverse that decision. Which is completely irrational.
I'd say I'm assuming it's an organization like any other. You're assuming it's populated by maliciously irrational people who are out to get you.
> If the situation had not changed from that point in a way that would indicate masks should be used, why would they reevaluate the whole thing?
Changed from what? During previous coronavirus epidemics, the CDC did not recommend wearing masks, and during the earlier stages of the pandemic they did not either.
> why would they reevaluate the whole thing? No organization, no matter how capable or expert, has infinite time or resources to reevaluate every past policy every day
What... else would they be doing? The CDC's entire mission is to steward American public health. If they can't reevaluate in the face of a new threat, well, what good are they really?
> You seem to think they looked at it, found evidence that masks were effective
Yes, I do think the CDC is capable of performing a literature survey on masks. There have been several papers on masks, N95 or not, during previous epidemics. You can find several papers related to masks dating from the original SARS epidemic. Some of these papers were funded by the CDC themselves, so it makes absolute sense to look back at one's own publications.
> but then decided not to tell anyone due to the shortage.
I believe the CDC made a calculated decision based on an American population would hoard resources. In hindsight, some of this is occurring. Despite no actual shortages in production of toilet paper, flour, and yeast, there are shortages in supermarkets throughout the US, and I've heard anecdotes from friends' parents who decided to hoard masks, flour, and yest because they "were worried".
> But then, a few months later, while that mask shortage was still in effect they decided to reverse that decision. Which is completely irrational.
Guidance changes. Factors that go into updating your risk cost-benefit analysis (better understanding of transmission rates, political pressure, etc.) change over time, and an effective leader does not double down on previous decisions in the face of new information. There's nothing irrational about changing your position.
You've managed to argue with the individual phrases while missing the actual point.
Tell you what, let's assume that you're right. The CDC is continuously reevaluating mask usage by the general public, but recommended against it due to fears of a shortage and/or hoarding. That being the case, please help me understand the following:
1) Why did the CDC change guidance on mask usage despite the shortage and risks of hoarding being, if anything, worse than before? If it was the controlling factor before, why is it not a concern anymore?
2) If they are continuously reevaluating policies, and believed masks should be used, why was the guidance not changed at any point in the last 10 years when there was no shortage or any particular reason to worry about hoarding?
3) Why is this a more parsimonious or plausible explanation than the one advanced in TFA, which is that they had a very high standard of evidence which they have relaxed somewhat in the face of a pandemic?
It's actually the strongest form of logical reasoning, a formally valid argument. This argument is true no matter what you substitute for A and B:
* You said X did A only because of situation B.
* But X does A even in situation not-B.
* Therefore, situation B is not a necessary condition to cause A.
The only way to rescue "mask shortage" as causing the WHO's advice is if you can show that whatever caused the advice last time was missing this time, so the WHO was primed to reverse the advice until "mask shortage" brought it back to do the same advice again.
> It's actually the strongest form of logical reasoning, a formally valid argument
Garbage In, Garbage Out. You are making several assumptions in order to apply this "logical" (which logic? This isn't FOL, since FOL has no concept of time, so I'm guessing you're invoking some Temporal Logic) argument, you need to assume that the CDC is a static, homogeneous organization that, for the purposes of this statement, continues to be a valid X between the past and the present. This seems naive to me; the CDC has changed in funding, priorities, membership, and leadership over time, and it's unclear to me how you can use past behavior as an indicator of future communication.
