The measures that seem like they should have worked, but people claim they didn't are:
- masks: clearly they worked for the medical professionals that were treating patients during the first waves, as they were directly exposed and didn't get sick, why didn't they work for the population at large? Did we not wear them correctly, consistently?
- schools: It seems obvious that schools could be a huge vector of transmission, kids largely were asymptomatic and when they got sick, they would still spread it, both inside the school and to their vulnerable relatives. Were the school shutdowns a mistake? Should they have been done differently?
RE: masks, paper masks don't do shit, gators even worse. That's what 90% of the population wore. Had we enough N-95s for everyone, I think the mask effectiveness would've increased dramatically, but I doubt folks would put up with wearing one. For me, I still wear N-95s on planes and in crowded places, I understand their effectiveness and it fits my risk/reward profile.
RE: schools, they have been and continue to be a reservoir for COVID and other nasties. Even this September, like clockwork, COVID is ticking back up in the waste treatment tests. I'm still waiting for society to have a conversation about what role schools should fill and how we ensure schools operate the way that people think they should. Additionally, schools should be able to turn away students who are sick--right now it's all honor based and kids with fevers have to be accommodated.
N-95 masks work to keep you from catching the virus and cloth or paper masks (somewhat) prevented you from spreading the virus. Ideally everyone would have worn N-95 masks but the US had four problems:
1) The US didn’t have enough N-95 masks. In Asia where masks in public were more common people used masks from their home supply. I think some segments of the population were resentful that the US didn’t have access to the best masks and Asia did.
2) We had only a general idea of who was high risk.
3) We had only a general idea of the long term impacts of the virus. There was some initial concern that the virus could be like the Zitka virus where mortality rates dramatically increase with the second exposure. If that were the case the second waves could have killed off half the population with wide transmission.
4) Households aren’t homogeneous and it is near impossible to prevent transmission from a possibly asymptomatic child to a high risk adult when they share the same home.
Unfortunately given the lack of consistent messaging about masks in the US one segment of the populations believed that the masks were to protect themselves and the other segment believed it was to protect others. Those that were low risk and believed it was to protect themselves resented the masks and those that saw the masks as a way to protect others resented those that resented the masks. I think those polarized views still persist today.
5) A not insignificant part of the population heard and understood that masks protect others and said "why should I suffer to protect them?"
I observed this sentiment in particular about return to school, and not just about masks. A sizable portion of the population would seemingly do anything to avoid accidentally helping someone else.
Related: I wasn't in the US at the time, but I think a close 6) would have to be the intense polarization and ongoing "culture war," wherein one side was already being told that something else coming out of their mouth was literally killing people, and doubting the veracity of the statement. Wearing a mask is slightly panic-inducing anyway (ever try to muzzle a dog?), and coupled with the fact that one side of the political isle took up its championing, this allowed some members of one side to wear the mask sanctimoniously and some members of the other to avoid or disbelieve any rhetoric (scientific or otherwise) promoting their use. As long as the more general lack of cooperation carries on, the US is at risk of not being able to unify over important things like public health.
Yeah 5) was a real eye opener for me. A lot of conservative thought revolves around the idea that government shouldn't provide services that family, faith, and friends can provide, but when it came right down to it voluntary mask wearing was out because of exactly what you said.
> For me, I still wear N-95s on planes and in crowded places, I understand their effectiveness and it fits my risk/reward profile.
Likewise, however I should also add that in my case there's no risk component — not only because I get free FFP2 masks at my workplace, but also because it appears that one of the many ways that I'm unusual is that masks (and I mean this literally) cause me less issues than does my underwear.
Even if I wear a mask for a 31 km walk, it's the socks and underpants that pinch or restrict first, not the mask.
Paper masks (and, by some measure, even gaiters) are for source control, and they work just fine for that purpose if the literature is anything to go by. Every software project needs it, and our squishy bodies are decidedly not an exception.
I am a little frustrated over an apparent lack of curiosity around mask effectiveness.
* If you think they're an effective measure for the public in general (which is probably closest to my position), then the variation in studies seems like it should still give you pause because it seems like the way mandates and messaging are implemented could undermine the usefulness.
* If you think they're effective in individual cases when people do it diligently, it still seems like you should be worried about the possibility that a lot of people who think they're diligently and correctly masking aren't, including some medical professionals who are regularly exposed to the disease.
* Honestly, even if you don't think they work at all, it still seems like learning why masks don't work would expand our knowledge of the disease.
Of course, we do know about plenty of factors that undermine mask effectiveness: people avoiding them altogether, people wearing ones that don't fit, people not covering their nose, etc. And of course researchers can skew the results with their methodological choices. But there seems to be enough variability in these studies that unknown or underappreciated factors could be significant.
what variability? AFAIK in controlled studies masks work (as in when you actually test things in a lab rather than looking at population statistics), are more effective when both people in the room are wearing them, we know the size of particle they filter and we know the viruses are bigger than that. there's 0 doubt at this point they do what they are supposed to do.
I'm talking about variability in the studies on population-wide masking. The consistency in lab studies is a major part of why I belive masking is an effective public health measure but would like more study on what's causing the variation in ecological studies.
Do viruses float freely in the air, or are they mostly in aerosolized bodily fluids when from an infected persons coughs and sneezes? Cloth masks are great at trapping those and greatly reducing the "muzzle velocity" of droplets that do escape.
Yes, this is the key insight. The mere fact that the virons are smaller than holes in the mask means nothing. The virons aren't expelled from our mouths or noses on their own, but are attached to moisture droplets which _are_ effectively trapped by surgical (and better) masks.
I personally don't know how best to interpret lots of research from the medical community. However, I do believe that the meta-analysis based Cochrane reviews[1] are the most reliable reviews of medical intervention for non-experts (and I consider even the vast majority of doctors as non-experts outside of their particular specialization). The Cochrane Collaboration isn't all knowing, but I don't know of a better alternative source of such information.
In a large meta-analysis[2] the Cochrane Collaboration did not find convincing evidence that masks work. Here is a single sentence taken from the author's conclusions:
"The pooled results of RCTs [Randomly Controlled Trials] did not show a clear reduction in respiratory viral infection with the use of medical/surgical masks."
This gives me pause; I was one of the dedicated mask wearers during the pandemic, but now I realize that we don't know that they did any good. Please note that I am saying we don't know if the masks worked; I'm not saying that the masks didn't work, just that we don't know that they did.
I've included above just a single sentence from the the Cochrane review titled Do physical measures such as hand-washing or wearing masks stop or slow down the spread of respiratory viruses?, the review is available online and is easy to read. I encourage those that think they know that masks either work or don't work to read the entire review for themselves.
My attitude pretty much the whole pandemic was 80/20 rule. Everybody seemed to be fighting for the extremes which gave us less optimal results. I didn't see anybody suggesting masking kids indoors especially during deep winter, but then giving them extra time for outdoor play with no restrictions (distancing etc). The transmission outdoors might not be zero but it would be much less, so it would be a much reduced vector. That seems like a good tradeoff for their mental health. Or if not this exactly, something like this. Or what about class outdoors, or open windows and fans instead of masks. I don't recall there even being a discussion like this; granted I'm not a parent.
(caveat: This all assumes masks work and that kids are actually a big vector. I've heard contrary views on both.)
- masks: clearly they worked for the medical professionals that were treating patients during the first waves, as they were directly exposed and didn't get sick, why didn't they work for the population at large? Did we not wear them correctly, consistently?
- schools: It seems obvious that schools could be a huge vector of transmission, kids largely were asymptomatic and when they got sick, they would still spread it, both inside the school and to their vulnerable relatives. Were the school shutdowns a mistake? Should they have been done differently?