Masks work well on airplanes
This story caught my eye:
Early in the coronavirus pandemic, air travel looked like a risky endeavor. Some scientists even worried that airplanes could be sites of superspreading events. For example, in March a Vietnamese businesswoman with a sore throat and a cough boarded a flight in London. Ten hours later, she landed in Hanoi, Vietnam; she infected 15 people on the flight, including more than half of the passengers sitting with her in business class.
Then in April, airlines shifted course. Many started requiring passengers to wear masks on planes — and some airlines even enforced the policy. . . .“Since April, Emirates has had a very rigid masking policy,” Freedman says. Not only does the airline require passengers and crew members to wear masks, but flight attendants also make sure everyone keeps on their masks, as much as possible, throughout the entire flight.
Freedman looked at all Emirates flights from Dubai to Hong Kong between June 16 and July 5. What he found is quite telling. During those three weeks, Emirates had five flights with seven or more infected passengers on each flight, for a total of 58 coronavirus-positive passengers flying on eight-hour trips. And yet, nobody else on the planes — none of the other 1,500 to 2,000 passengers — picked up the virus, Freedman and his colleague report in the Journal of Travel Medicine.
And people wonder how Taiwan was able to control the virus.
Masks work.
PS. And this:
Universal masking in the U.S. could save some 130,000 lives by the end of February, according to projections by some of the nation’s top Covid-19 trackers at the University of Washington.
The analysis, which appeared Friday in the journal Nature Medicine, models the impact of different levels of social distancing on the trajectory of the pandemic from this fall to the end of February 2021. White House officials and public health leaders said they don’t expect a vaccine to be widely available until March or April, which means wearing masks and other non-pharmaceutical measures will likely be the only option to reduce the spread of the virus until the end of February.
Tags:
23. October 2020 at 12:22
The data we’ve analyzed indicates much the same – masks can make a difference in affecting the rate of new infections. They should be considered part of any mitigation strategy in the absence of an effective vaccine, generally required for people grouped in confined spaces or passing through ‘choke points’ at public venues, and an absolute requirement for anyone who tests positive for COVID-19 until the active virus has cleared their system.
If you knew how air is circulated in modern aircraft during flight, you would know the odds of transmission were already very low. Cabin air is changed out with fresh air every 2-3 minutes and its extremely dry at altitude, so it’s inhospitable for spreading the airborne virus. Not surprising to see masks reduce the low risk to nearly “nonexistent”.
That said, some of the data coming out of Europe is raising questions about how governments should adopt mask requirements for their populations. Italy, which has enforced a compulsory public mask order for months since its first experience with COVID, is one of the countries experiencing a surge in new infections, which shouldn’t be the case if wearing masks in public alone were fully effective in preventing its spread. There are still things we don’t know.
23. October 2020 at 12:32
There is strong evidence in support of masks reducing transmission. This much is clear.
There is also strong evidence that Americans do not wear masks correctly even when mandated to do so. I believe this will be a significant confounder when attempting to measure mask policy efficacy in the US using statistical analysis. Apparently no one is bothering to do real studies of mask compliance and measuring the effects?
https://www.nytimes.com/2020/08/20/nyregion/nyc-face-masks.html
Note in one borough it goes from 99% (Flushing in the least surprising result of all time) down to 20%. And this is in NYC
23. October 2020 at 13:13
I’m not opposed to masks working (though the appropriate counterfactual isn’t clear to me – do we allow for people to act less carefully when wearing a mask?). It’s great if something as simple as a mask “works” to slow the spread of the virus.
That said, I’m not convinced by the evidence. There appears to be lots of it, and most of it (that I have seen) is of poor quality. Lots of garbage data is not worth as much as even a bit of good data, and we must add to this the fact that a result like “masks don’t work” will certainly not get published. As a mathematician, the horror that is “statistical analysis” in covid-19 studies is really quite shocking. I really have no trust in the “nation’s top Covid-19 trackers at the University of Washington” – after all, in order to calculate “lives saved” one needs to accurately predict the counterfactual. Whether or not mask policies “work” should be tested with a randomized control trial.
23. October 2020 at 13:16
Ironman, You said:
“If you knew how air is circulated in modern aircraft during flight, you would know the odds of transmission were already very low.”
Perhaps, but there are numerous cases of a single infected person giving Covid to many other people on an airplane.
23. October 2020 at 13:30
Matty, Given that doctors have been using masks for decades, and given that common sense suggests they’d help, and given that many, many studies have shown they help, I’d say at this point the burden of proof is on those who say they don’t work. It’s possible they don’t work, but I’m highly skeptical of that claim.
23. October 2020 at 13:49
https://www.medrxiv.org/content/10.1101/2020.10.21.20208728v1 is from an MIT/UCSF group of researchers who parsed data down to the county level in the US. Money quote, ” Mask mandates across 1083 counties in the U.S. in 49 states decreased hospitalization rates from COVID-19 even when controlling for other factors that could impact disease severity, including age, testing access, number of cases, and mobility (as a proxy for other non-Pharmaceutical interventions such as sheltering-in-place).”
I have been grinding my newsletter out daily since mid-March and would say the evidence is pretty solid that masks do work. It is a pity that the US populace is so divided over this. Had there been real leadership at the Federal level we would not be in the situation we are right now. Things could have adapted to a social distancing scenario with masks and the economy would not be as reliant on Amazon as it is now.
23. October 2020 at 13:53
“… and given that common sense suggests they’d help, and given that many, many studies have shown they help, I’d say at this point the burden of proof is on those who say they don’t work.”
Here are many, many studies:
“In our systematic review, we identified 10 RCTs that reported estimates of the effectiveness of face masks in reducing laboratory-confirmed influenza virus infections in the community from literature published during 1946–July 27, 2018. In pooled analysis, we found **no significant reduction** in influenza transmission with the use of face masks (RR 0.78, 95% CI 0.51–1.20; I2 = 30%, p = 0.25) (Figure 2).”
May 20, 2020
https://wwwnc.cdc.gov/eid/article/26/5/19-0994_article
23. October 2020 at 13:59
From the abstract:
Although mechanistic studies support the potential effect of hand hygiene or face masks, evidence from 14 randomized controlled trials of these measures did not support a substantial effect on transmission of laboratory-confirmed influenza.
23. October 2020 at 14:01
I think masks are so effective because the virus ended up not being very likely to be transmitted via touching (fomites). So as I’ve said before, in March officials still believed the virus could be transmitted via fomites so I figured I would get it, and being healthy and younger than 50, I thought I would be likely to transmit it without knowing I was infected. And so at that point I started wearing a mask not necessarily to protect myself but to protect others because the virus would still have to come out of my mouth or nose and get onto a surface for me to spread it. So an infected person that transmits it via fomites doesn’t transmit it via skin touching surfaces unless I coughed in my hand and then touched a surface. (and I wasn’t around any high risk people and at some point high risk people were advised to shop at specific time where people like me wouldn’t be around them)
23. October 2020 at 14:18
One thing that has become apparent to me since the Trump era began is that a large portion, if not most, Americans are incapable of what I used to consider adult thought. This gives me even more confidence in my long-term criticism of the Democrat approach to politics. Democrats have to learn to talk to voters as if they are children. They need to come across as strong and decisive, but empathetic. They need to dumb down their policy messaging(and hopefully adopt smart policies at the same time, unlike most of the ones they push now).
They also need make sure they have the candidates that look the best on camera. If you look at Presidential elections, in particular, it seems obvious that the candidate who looks the best on camera wins. Hence, it should be clear from the outset that candidates like Elizabth Warren and Bernie Sanders will have no shot at winning the White House, except in very strange times. I still think Bernie could have won last cycle and this cycle, due largely to his outsider status, as these are strange times.
US politics has rarely ever been much about substance. It really makes me question whether we should have democratic primaries at all, or have some sort of system in which party elites again choose candidates. At least then, people like Trump, or someone like a Chavez, would have no hope of even competing for the nomination of either party.
23. October 2020 at 14:24
I do about 30-40 throat and nose swabs per day in patients with suspected Covid-19, wearing only a pretty average mask, my normal glasses and gloves. About 1-2 tests per day are positive. The throat-nose-swab can be a bit unpleasant, patients like to choke and cough while doing it or right after. The whole room must be full of aerosols.
In addition, there are all the positive Covid-19 patients who need follow-up auscultation and repeated swabs.
I have not been infected once so far.
So either masks work well or this disease does not exist or is not transmitted by air or I am simply the luckiest person on earth.
So far we have had two infections in our medical practice. It was right at the beginning of the pandemic, a medical assistant stood behind the counter and gave a patient a prescription briefly. The patient was Covid-19 positive. He then submitted a blood sample to another medical assistant and infected her as well. All three did not wear a mask. The following day we introduced a strict mask requirement. Since then, no employee has ever been infected again, although the number of cases has exploded.
23. October 2020 at 14:34
^
Those are beautiful anecdotes Mr. List.
23. October 2020 at 14:53
Taiwan was able to get the virus under control through data collection. When a passenger arrived they would be taken to quarantine for 14 days. If they tested positive during the time, the government would use data collection techniques to locate every other passenger, their relatives, and anyone they may have come in contact with. They then forced those individuals to enter quarantine, regardless if they had symptoms or not.
You have been told this before. Yet, you continue to peddle disinformation about Taiwan and their “amazing response”. That “amazing response” boils down to geographical, legal, and technological factors that are not possible to duplicate in the United States.
One of these days, that data might get through your thick skull.
And hopefully its soon, so we can stop reading these nonsense articles based on faulty assumptions, and start getting back to the economics: which you actually have some expertise in.
23. October 2020 at 15:06
Stick do your wonder dietary supplements, Todd. You told a hundred anecdotes about how they repair your brain damage, but the evidence suggests otherwise.
It’s so ironic how the dietary supplement wonder pill clown suddenly insists on study results.
We could present a 100 studies that prove an effect and one small study that suggests the opposite. You would pick out the little study and proclaim “I always knew it”.
Haven’t you found any miracle food supplements against Covid-19 yet? Is there no amulet or divining rod?
Here is another impossibility: Make an idiot understand that he is an idiot.
23. October 2020 at 15:08
MIT studies on masks don’t show much efficacy. 95% penetration rate for cloth masks.
But anyways, this is the problem with Sumner. He believes that everyone should conform. That everyone should believe the same thing. And not just him. But most academics. They see everyone else as idiots, who need to LISTEN and OBEY.
Even if a cloth mask has 5% efficacy its still worth wearing. But I WONT wear it precisely because these apparatchiks are trying to mandate it.
Nobody should be forced to wear anything. And any government that tries to force you to wear masks is a dystopian totalitarian autocracy. People deserve a choice.
23. October 2020 at 15:12
The US happens to be much farther away from China than Taiwan is. Taiwan also happens to have many times more direct flights from Hubei province than the US does, which AFAIK has approximately zero.
From a legal and technological perspective, the NSA can read every single email you send that hits a foreign server without a warrant. They also have a backend route in if necessary provided by every major technology company in case it doesn’t hit a foreign server. They have backends into your social media accounts and every ISP and interaction you have on the internet can and will be turned over immediately without bothering with a warrant. And don’t be daft, they can easily query a database to see flight manifests.
We know this already thanks to Snowden.
Let’s not pretend we’re less successful because we’re freer. We are both less successful AND less free
23. October 2020 at 15:27
I find it laughable and sad to read the posts of Todd Kreider and xu. I’ve been reading all the literature since mid-March and there are multiple studies about how masks can prevent the spread of COVID-19. Scott linked to the Nature Medicine paper that was published today.
You can live in a dream world where the use of masks is an individual right and see lots of people getting sick or you can be part of the solution and not write stupid stuff. If you want to go the first route, look at what is happening is the land of freedom, northern Idaho. No mask mandate and lots of hospitalizations.
23. October 2020 at 15:58
@Scott: I’m not saying masks don’t “work”, I just haven’t seen good evidence. My priors are that they probably reduce spread, all else equal. I do agree that e.g. mask use as done by doctors is probably sensible and I’m sure there are RCTs for this. But all else is not equal, and mask use by doctors is a very different beast from mask use by normal people – I for one tend to keep a mask in my pocket that I frequently take on and off when moving between (currently quite crowded, probably because everyone trusts the masks) public transport. I visited Germany this summer and observed absolutely full trains with everyone awkwardly pressed up against each other while wearing a mask. So I do wonder how much effect mask mandates have – several European countries, for example, do not have them and they witnessed similar covid-19 dynamics as other countries did.
@Alan: the study you linked is one of those which I would consider of poor quality. Correlation just isn’t causation, especially in cases like this – the super obvious confounder is that communities that are more careful will tend to be more willing to institute mask mandates. And as far as I can tell, the methods in the study weren’t preregistered, meaning that all of the scepticism we should have from the replication crisis should apply – especially since they control for a lot of stuff and don’t even seem to include what statistical method they use. I’m quite shocked actually by this last point – isn’t that standard by now? Note that the more I read the paper, the more confused I am – it seems like *all* of the counties they study had a mask mandate, so they’re not actually comparing “counties with mask mandate” to “counties without mask mandate”? My (somewhat uncharitable) skimming of the paper is that they basically are just plotting “increase vs decrease in covid-19 hospitalisations after mask policies were instituted”, but since that obviously would be silly I’m hoping they actually somehow control for the general decrease in covid-19 hospitalisations (maybe due to the weather, but nobody really knows) we have seen even those places without mask mandates. But even if do control for this (I see no evidence that they do) – could they just be finding regression-to-the-mean effects, where counties institute masks once it gets really bad in terms of hospitalisations (which sometimes just happens at random)? These are the kind of questions I’d expect a serious paper on this to at least mention, but I see none of this. If I had to review that paper, I would reject it immediately – but it seems like it hasn’t undergone peer review (yet), so my hope is that the reviewers do this. Note that they find only a 7% drop in hospitalisations, which really isn’t a huge effect, and certainly not enough to explain the huge drop in R we have seen (from 3 to around 1).
23. October 2020 at 16:52
The evidence is piling up for sure. To the anti-mask folks… do you cover your mouth when you sneeze or cough? Why?
23. October 2020 at 17:09
Seems to me the government can require mask-wearing in public, and private enterprise can, or cannot, enforce the rule on private premises as they wish.
In Thailand, government offices, malls and large stores require a temperature test and masks before entry, but these rules are disregarded in most if not all other circumstances.
For some reason, there is no C19 in Thailand. Before C19, people joked they had “visited China”—that meant going to a popular Thai tourist spot, sure to be thronging with Chinese.
Every day I wonder why there is so little scrutiny of the Thai (Cambodia, Laos, Vietnam, but possibly not Burma) resistance to C19.
23. October 2020 at 17:36
I think of the mask science as bearing striking similarities to the science on the minimum wage. Logically, there has to be an effect, but in practice it is small enough that there are plenty of studies saying “we couldn’t find an effect” and plenty of people motivated to believe that it doesn’t have an effect.
23. October 2020 at 18:05
Suppose Trump came out in favor of masks back in February… would the libs have just opposed it because Trump said it, in which case we would end up in the same place anyways (just flipped)… or wild libs have succumbed to the data quicker?
23. October 2020 at 18:08
> I think of the mask science as bearing striking similarities to the science on the minimum wage. Logically, there has to be an effect
I disagree if you consider the second order effects around disposable income.
23. October 2020 at 18:18
Some COVID flying stats: According to the IATA, there are 44 confirmed cases of COVID transmission that took place on commercial transport aircraft between January and July 2020, a period of time when some 1.2 billion passengers traveled by air. Masks reduce that low risk further, which would mean that airlines could place passengers in the dreaded middle seat.
23. October 2020 at 19:43
I saw a video somewhere I don’t recall (so iffy) that some planes now have ventilation systems that swap out the air every 6 minutes. As I recall the cdc recommends every 15 minutes as being safe.
That’s the other thing we aren’t focusing enough on. Ventilation. Going into winter restaurants and such better be buying outdoor heaters or figuring out how to rig up some kind of way to recycle air effectively and in the safest way… With good masks and mask wearing and ventilation and we could prolly open schools for example. Even If that means turning the heat up, wearing sweatshirts and opening all the windows and doors and windows and teachers bringing their own virus rated stand alone filter that does 450ft in 15 min or so.
23. October 2020 at 20:01
Masks are useful and a cult at the same time. How? Let’s apply common sense.
Bigger droplets, not to mention to spray and snot from sneezing, end up in the mask. Good. Smaller droplets and aerosols leak out the side or pass throught the mask. Bad.
How many people are within 6 feet of you on an airplane? At least 5, up to maybe 20. All those people could be hit by your flying snot droplets, that are stopped by a mask.
But the mask doesn’t stop aerosols, which are small in volume but can accumulate over long periods of time. But that’s where airplane filtration comes in handy. The aerosols land on other people, but they don’t accumulate over the flight.
How about doctors? Exactly the same as airplanes. You do NOT want a patient spraying their snot and spittle in your face during an exam, but you are still exposed to aerosols. Better to not spend too too much time examining them. And wear a mask.
But masking is still a cult. I’ve observed that a majority of people from deep blue places (e.g. California or Boston) wears masks outdoors, in the woods. This is dumb and anti-science. But super virtuous (lol).
The other reason masking is a cult is that evidence shows close to 80% of virus spread occurs at home, or at work. We are talking people who are together 8 to 16 hours a day. Relatively little occurs shopping, and almost none outdoors.
What’s the plan for this? Well, there isn’t one. Lockdown and wear your muzzle, deplorable!
Another relevant factor is most superspreader event are LOUD…because talking and yelling is a big problem. Call centers, nightclubs, choirs, meatpackers, etc. Oh, what are Asian people known for? Being reserved. I’m confident that helps. And there’s my “racism” for the night. Time for Sumner to bloviate.
23. October 2020 at 20:15
I’m reminded of the 80/20 (or 90/10) rule of computer programming. 80 percent the time is wasted in 20 percent of the algorithm.
The problem with the mask debate is we are getting the 80/20 rule backwards. We are spending 80% of effort shaming 20% of virus spread. And completely ignoring everything else.
That’s why it’s a cult. Not because masks don’t work in face-to-face settings like doctors offices or airplanes. They do. But because it is ruthlessly inefficient to ignore everything else.
23. October 2020 at 20:24
I realize Sumner’s sources are in the business of setting the bar low and/or making allowances for bureaucratic obstruction, but this is interesting:
https://www.dailymail.co.uk/news/article-8852159/The-video-world-longed-Covid-vaccines-rolling-production-line.html
Drug giant Pfizer has already manufactured ‘several hundred thousand doses’ of the jab at its plant in Puurs, Belgium, The Mail on Sunday can reveal.
They are being stockpiled ready to be rolled out worldwide if clinical trials are a success, and regulators deem it safe and effective.
The US giant hopes to make 100 million doses available this year, of which 40 million are destined for the UK – a figure that will be dwarfed by the 1.3 billion jabs the company aims to manufacture in 2021.
23. October 2020 at 20:25
Dosing Steve… dosing. The dose each person gets with masks in much smaller than without even in bad ventilation but masking.
23. October 2020 at 21:20
Mr. List: Stick do your wonder dietary supplements, Todd. You told a hundred anecdotes about how they repair your brain damage, but the evidence suggests otherwise”
You lie as expected. I never said anything about the brain, moron. Here is an update for the uninformed such as yourself:
1) NR has been shown to reduce Covid-19 sickness by 30 percent.
2) NR beat the latest ALS drug in 2018 and now has a larger 300 person study in Norway.
23. October 2020 at 21:36
“But masking is still a cult. I’ve observed that a majority of people from deep blue places (e.g. California or Boston) wears masks outdoors, in the woods. This is dumb and anti-science.’
Of course it is a cult, but we shouldn’t make fun of religious people like Scott Sumner and Christian List. After all, they have anecdotes on their side.
23. October 2020 at 22:02
I agree that people wearing masks in the woods in nuts…. but that’s not what we mean todd. I recently saw tho two people by themselves wearing a mask hiking through a section of the Monongahela National Forest, hahaha. Wtf. No one was within 1000 yards of the. 😆
24. October 2020 at 03:49
I find opposition to masks bizarre. Smart people here oppose mask wearing. Todd K, Steve, Matty W: Why not just wear masks? How hard is it? There’s good reason to think you might save someone’s life. So what if some nuts wear masks alone in the woods? How is that relevant? So what if some people wear masks because they’re part of a cult? So what if the data isn’t 100% conclusive about how many lives mask wearing will save? Every doctor and nurse in every hospital in the world wears masks to reduce the spread of deadly pathogens. It’s completely reasonable to assume that masks can provide benefit miles beyond the miniscule cost of wearing one. If the dollar value of a human life is $10 million, and the probability of saving one life in a given year by wearing a mask is 2%, and the cost of wearing a mask for the next year is $100 (which seem like reasonable guesses to me), then the benefit of mask wearing outweighs the cost by 2000x. Which number do you think is wrong? Do you think a human life is worth $1M, the chance that mask wearing will save a life is 0.1%, and the cost of wearing a mask is $500? Seems unlikely, but it’s *still* worth it to wear a mask.
What possible cost-benefit analysis leads you to conclude that you shouldn’t wear a mask?
My friend’s father didn’t have to die. Your “right” to be a pompous ass isn’t worth his life.
The politicization of mask wearing — the idea that refusing to follow a simple, common-sense public health guideline is a way to display your identity — is maybe the greatest American tragedy of 2020.
Kenneth Duda
Menlo Park, CA
24. October 2020 at 04:05
” There’s good reason to think you might save someone’s life.”
This is simply false. That is the problem. Scott repeatedly says what you say is backed by scientific studies, but he won’t actually link to any studies. Why? Because they don’t exist.
24. October 2020 at 04:23
@Kenneth: I don’t think you need to call people pompous asses because they don’t believe your pixie dust protection story.
A 2015 study of medical masks, cloth masks and no masks among health care workers:
“An analysis by mask use showed ILI {} and laboratory-confirmed virus {} were significantly higher in the cloth masks group compared with the medical masks group. Penetration of cloth masks by particles was almost 97% and medical masks 44%.”
” For example, a contaminated cloth mask may transfer pathogen from the mask to the bare hands of the wearer. We also showed that filtration was extremely poor (almost 0%) for the cloth masks.”
“Although efficacy for medical masks was not shown, efficacy of a magnitude that was too small to be detected is possible.”
“The rate of ILI [influenza like illness] was also significantly higher in the cloth masks arm (RR=3.49 and 95% CI 1.00 to 12.17), compared with the control arm.”
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4420971/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4420971/
24. October 2020 at 05:13
@Alan Goldhammer
I thought you said people shouldn’t write stupid things yet your next sentence is: “If you want to go the first route, look at what is happening is the land of freedom, northern Idaho. No mask mandate and lots of hospitalizations.”
At 0.0003 deaths per capita, Idaho is among the lowest in the U.S. Ohio, with a mask mandate, has a death toll that is 40% higher and cases are rapidly increasing.
Obviously, there is a lot more going on than mask use, which most ignore. Still, it is a little interesting that mask-wearing Italy and France have had cases increase 3% and 4% a day, respectively, this past week. Idaho’s cases have been increasing at 1.6% a day. Then again, they have different population profiles and different degrees of testing.
24. October 2020 at 06:07
I agree with the point of the post, but still see a problem in the ambiguity. Is the claim that masks “work” to protect the wearer, or “work” to protect people around the wearer? I think doubt about the first claim undermines the second.
And the policy responses and missaging are different.
The first leads to a paternalistic, “Please/You must take the precautions I say for your own good.” The second leads to “Please/You must take the precautions I say for the good of your fellow citizens (and it may be of some good to you, too).”
24. October 2020 at 06:50
^
Then there is Dr. Fauci who said in February that masks don’t protect anyone:
“The masks sold at drugstores don’t truly protect anyone. If you look at the masks that you buy in a drug store, the leakage around that doesn’t do much to protect you.”
Dr. Fauci probably knows more about this topic than Dr. Sumner.
24. October 2020 at 07:19
Who is against wearing masks? No one. Many are against the claims made about how effective they are. Like me. I wear it as a “why not”. One of the things we have forgotten is that masks are part of a proscribed group of preventative measures, almost all forgotten by people like Scott. How many still focus on “not touching your face”, or washing or changing masks, or using hand cleansers every time you touch your mask?
This may explain why there appears to be little correlation between mask rules and cases in countries—-certainly no correlation on deaths.
Most importantly, let’s assume the best. Taiwan does all these things to perfection. Scott can not possibly believe this is the cause of the massive difference in deaths between Taiwan/Japan and the west. No science supports this.
For what it’s worth CDC used to believe that these procedures would reduce number of flu cases by 20%—-at least according to a CDC notice hanging in my building. That is a spread measure. Since 99% plus who get Covid do not die (let’s double 20 to 40), the deaths would decline by a small barely measurable number——does not mean don’t do it—-it does mean thinking that it causes Taiwan/US difference is absurd.
24. October 2020 at 07:34
@Kenneth: I do wear a mask, nowhere did say that I oppose mask wearing. I said I haven’t seen any good evidence that mask mandates are significantly positive.
“So what if the data isn’t 100% conclusive about how many lives mask wearing will save?” – I’m opposed to forcing large amounts of people to do things just because someone has a hunch that it might help someone a bit. For example, are the small psychological and environmental effects from large amounts of mask wearing comparable in size from the small epidemiological effects? Nobody knows, and playing off small effects against each other is Pascal’s mugging.
As for your utility calculation: 2% of saving a life is ridiculously high, let’s do this Fermi-calculation again. If we assume that a person has a 10% chance of being infected and asymptomatic (unrealistically high), then passes the virus on to 3 people on average (this is the R everyone is talking about), and about 0.5% of those people die (far too high IFR for the kind of people I meet while wearing a mask as I’m not walking around care-homes), then we get a number of 0.15% – and this is assuming that masks are 100% effective, and I’m 100% responsible for infecting the 3 people. Assume that R is more around 1 if the other person wears a mask+socially distances from me, and 0.5 of that is due to masks (after all, nobody wears a mask at home or while having lunch with colleagues, or at the gym), and we get 0.025%. I don’t calculate knock-on infections as those are “caused” by other people. With your 10M cost, this is a factor 25x, not 2000x under somewhat generous assumptions to you. Of course, if you want to lay the blame for anyone upstream of me in the “infection chain” solely on me, then the calculation may look different.
But again, I’m not opposed to masks. I wear them when I have to, and sometimes when I don’t. I think their primary use is in making people more confident in leading a more “normal” life than they would without masks – and this is surely worth more than the $2500/year I sketched above.
24. October 2020 at 08:55
Matty, Yes, I very rarely wear a mask. I’m usually home or outside; I only wear them in grocery stores or a few other places.
Ben, You said:
“Seems to me the government can require mask-wearing in public, and private enterprise can, or cannot, enforce the rule on private premises as they wish.”
I don’t see a need to wear masks outside, except perhaps in NYC. And stores can decide to mandate masks on their private property. I don’t see a big need for government here, except perhaps in public buildings like a courthouse.
Students, The “libs” might have opposed masks for a few weeks because Trump favored them, but they would have come around (influence by other countries.)
Trump made a huge mistake in March by not saying “I KNOW MORE THAN THE EXPERTS–WEAR MASKS!”
He’s be winning now. He really should read my blog.
Steve, You said:
“I’ve observed that a majority of people from deep blue places (e.g. California or Boston) wears masks outdoors”
I live in CA–you can’t fool me with your nonsense.
Todd, You lie, I have linked to scientific studies, like the one in Canada. Here’s another example:
https://www.themoneyillusion.com/masks-not-lockdowns/
I don’t recall how many I’ve linked to, but there are all over the place. Maybe you should read the news and keep up with what’s going on in the world, instead of saying there are no studies that show that masks work.
Ken, Yes, this is what’s so bizarre. Say there was only a 30% chance that masks help. Then obviously we should still wear them!! The complaints are absurd. First of all, you only need a mask on rare occasions, not at home or outdoors. Second, they aren’t at all uncomfortable. Every day I experience 100 times the discomfort of masks for just ordinary minor physical ailments. Are Americans really that soft? What’s wrong with people.
Meanwhile the East Asian countries just laugh at us.
24. October 2020 at 09:11
“Todd, You lie, I have linked to scientific studies, like the one in Canada. Here’s another example:
https://www.themoneyillusion.com/masks-not-lockdowns/
I don’t recall how many I’ve linked to, but there are all over the place.”
Now I see the problem. You don’t know the difference between a model and a scientific study.
“I don’t see a need to wear masks outside, except perhaps in NYC.”
To switch Dave Berry’s quote: “You cannot make this up.”
24. October 2020 at 11:27
Two cents:
1. Masks are a worthy thing to debate. It’s a foundational question about societal risk with potentially big downsides and upsides.
2. Reducing viral circulation can not be a long-term solution. Our immune system is falling behind the two hundred or so viruses currently in circulation. We risk losing immunity to the common cold, and CV19/CV20 could be worse. Any mandate should at the very least come with an expiration date.
3. Because masks are such an important societal question, we should do good RCTs and first-principles studies. We should also allow them to be published.
4. That second study was one of the least convincing papers I’ve read in a while.
5. I’d like to see a baseline for the airplane study.
24. October 2020 at 11:39
Todd,
This is the impossibility I talked about. I often inspect a certain institution with certain, lovely, specially gifted people. What often helps there is simple, loud repetition of the same message. So let’s try it: Stick do your wonder dietary supplements, Todd. You told a hundred anecdotes about how they repair your brain damage, but the evidence suggests otherwise.
What kind of person are you? Why are you putting yourself in checkmate? Fauci had this opinion at the very beginning of the pandemic for a short time, he changed his opinion quickly and today the media write sentences about him such as: Dr. Fauci wants all Americans to wear a mask, and now, as of yesterday, he even favors a mask mandate in order to make that happen.
https://www.marketwatch.com/story/dr-fauci-says-if-people-are-not-wearing-masks-then-maybe-we-should-be-mandating-as-new-us-covid-19-cases-hit-85000-2020-10-24
As Scott says, we have already linked dozens of overview studies here, one has to google them for you every single time though. Again and again. Currently I have found on Examine.com:
“Coronavirus masks: What’s the latest evidence? We analyzed over 80 studies to help answer your mask questions: efficacy of different types, storage, and more. The specifics vary by mask type, but the overall evidence is clear: masks save lives.[1][2][3]”
I personally prefer and recommend surgical masks and N95 masks (in Europe FFP2 to FFP3), also KN95 can be used partially, depending on the charge, personally I don’t like cloth masks, but everything has its advantages and disadvantages.
The problem is that you are not interested in this at all. You are completely resistant to facts.
Do people have to envy you because you are so specially gifted? Or is it a moral question, are you extremely malicious? Or is it a combination of both?
That’s just great Todd-specific news, but hey, why are you taking it then? Do you have Covid-19 or ALS?
You need something strong against something else, but you said yourself that your wonder dietary supplements won’t help you with this at all. You should be trying olanzapine, clozapine, risperidone or in the beginning maybe even some haloperidol.
I have just read that olanzapine contains A LOT of NR, so go to your doctor and he might prescribe it for you, the effects are breathtaking indeed.
24. October 2020 at 11:44
My intuition is most “mask haters” are worried about the dynamics of mask culture:
1. Politicians are old and frail.
2. Weakening immune system leads to viscous cycle.
3. Politicians afraid of a “wave” damaging their reputation, act in abundance of caution against the public interest.
4. The mask/medical/research industry profit.
5. Small cohort of alarmists can annoy the hell out of politicians.
Let’s not kid ourselves, the dynamics are important and probably a big part of why the WHO warned about it in 2011:
https://www.aier.org/article/the-world-health-organization-in-2011-warned-against-a-culture-of-fear/
24. October 2020 at 12:23
@Christian List
I never said anything about Nictonimide Riboside (NR), sold as Niagen, doing anything for the brain but there is a study underway that may help you in the future, Mr. List: “Effects Of Nicotinamide Riboside (NR) On Bioenergetics And Oxidative Stress In Mild Cognitive Impairment/Alzheimer’s Dementia”
1) With respect to Covid-19: “New Phase 2 Clinical In COVID-19 Patients Finds Hydroxychloroquine (HCQ) Plus Nutritional Protocol Including Nicotinamide Riboside Significantly Improved Recovery Time Vs. HCQ Alone” (The recovery time was 30% faster with NR than without.)
2) Efficacy and tolerability of EH301 for amyotrophic lateral sclerosis: a randomized, double-blind, placebo-controlled human pilot study”
Results: Compared to placebo, participants treated with EH301 (NR/pterostilbine) demonstrated significant improvements in the ALSFRS-R score, pulmonary function, muscular strength, and in skeletal muscle/fat weight ratio. EH301 was shown to significantly slow the progression of ALS relative to placebo, and even showed improvements in several key outcome measures compared with baseline”
The most advanced ASL drug that costs $140,000 a year only slowed the decline in ASL patients by 30% as opposed to improvement with NR. A 300 person trial is underway in Norway.
Oh, did I mention that Dr. Fauci was merely repeating what health organizations around the world were stating with respect to masks in February?
“The masks sold at drugstores don’t truly protect anyone. If you look at the masks that you buy in a drug store, the leakage around that doesn’t do much to protect you.”
https://www.aboutnad.com/perspectives/new-phase-2-clinical-in-covid-19-patients-finds-hydroxychloroquine-hcq-plus-nutritional-protocol-including-nicotinamide-riboside-significantly-improved-recovery-time-vs-hcq-alone
24. October 2020 at 12:38
“A May 2020 evidence review cited by The Lancet – a review of dozens of scientific studies – found:
‘The preponderance of evidence indicates that mask wearing reduces the transmissibility per contact by reducing transmission of infected droplets in both laboratory and clinical contexts. Public mask wearing is most effective at stopping spread of the virus when compliance is high. The decreased transmissibility could substantially reduce the death toll and economic impact while the cost of the intervention is low. Thus we recommend the adoption of public cloth mask wearing, as an effective form of source control, in conjunction with existing hygiene, distancing, and contact tracing strategies. We recommend that public officials and governments strongly encourage the use of widespread face masks in public, including the use of appropriate regulation.’”
https://www.medialens.org/2020/conspiracy-theories-malign-and-benign-face-masks-and-israeli-training-of-us-police/
“Cloth face coverings, even homemade masks made of the correct material, are effective in reducing the spread of COVID-19 – for the wearer and those around them – according to a new study from Oxford’s Leverhulme Centre for Demographic Science.“
https://www.ox.ac.uk/news/2020-07-08-oxford-covid-19-study-face-masks-and-coverings-work-act-now
24. October 2020 at 13:54
““A May 2020 evidence review cited by The Lancet – a review of dozens of scientific studies – found:”
No, the Lancet opinion piece did not do that. There aren’t “dozens of scientific studies” on masks, but ten.
In the second part, there was a report that listed the results of four studies where one showed no protection and three showed minimal protection.
This from The New England Jnl. of Medicine
May 21, 2020
“We know that wearing a mask outside health care facilities offers little, if any, protection from infection. … In many cases, the desire for widespread masking is a reflexive reaction to anxiety over the pandemic.”
That op-ed also is not a study.
https://www.nejm.org/doi/full/10.1056/NEJMp2006372
24. October 2020 at 14:31
Todd,
yes, that was in February. Have you looked at a calendar recently? Why don’t you tell us what Fauci and the health organizations say today? You are raising Fauci and these organizations as persons with authority, but only the versions of February 2020.
You seriously seem to think that this is a valid argument. Dr. Fauci of today must have been brainwashed and abducted by aliens, I guess. What the Fauci version from February 2020 said is now valid for all eternity.
Your ability to detect sarcasm is outstanding by the way. You have convinced me. We should all stop wearing masks and take NR instead. Where can I buy the stuff, do you have any recommendations? The cheapest way so far was the prescription of olanzapine. Just one pill a day, in your case maybe three.
24. October 2020 at 17:28
Not much rigour in most these mask studies
https://threadreaderapp.com/thread/1319845401881681920.html
They either start by assuming masks are effective, or mix masks up with bunch of confounding variables – even tho we can see high mask compliance is a sort to sign that folks there are doing a bunch of covid things right.
Here is one of the few studies which did tease out masks effectiveness by itself. Very weak, 71% vs 74%..but they fail to discuss this strong finding in the conclusion ..
https://www.cdc.gov/mmwr/volumes/69/wr/mm6936a5.htm?s_cid=mm6936a5_w
24. October 2020 at 19:56
Mr. List,
You are just a dumb dude, but I will respond anyway. You wrote:
“yes, that was in February. Have you looked at a calendar recently? Why don’t you tell us what Fauci and the health organizations say today?”
You aren’t curious enough to ask why Fauci flipped 180 degrees with no explanation. Many health organizations in Europe still advise against lockdowns and masks, but perhaps you have never heard of Sweden, the Netherlands and Germany
I can’t help you with your cognitive decline but interesting that a leading expert in Alzheimer’s disease thinks NR is promising against dementia.
24. October 2020 at 20:33
Scott,
Here is an example of what is wrong with this discussion.
You said to Todd; “Todd, You lie, I have linked to scientific studies, like the one in Canada. Here’s another example:
https://www.themoneyillusion.com/masks-not-lockdowns/”
1. You did not link to a study, you linked to an article about the study.
2. It also seems like you didn’t read the actual “study” because it was not in fact a “study. It was a mathematical “modelling framework”, which basically said, if masks reduce transmission by x%, and if y% of the population wears masks, then transmission will be reduced by z%. No study, no data. Nothing to back up any of the assumptions. Absolutely zero value in evaluating the efficacy of masks in reducing C19 transmission.
It’s become impossible to have a rationale discussion about anything anymore. There’s a complete lack of civility. No one makes a serious effort to carefully evaluate information. And you know in advance what everyone is going to say based on their political views.
24. October 2020 at 23:14
Since aerosols (fluid particles less than 5um) are the primary means of coronavirus transmission, containing coronavirus transmission is primarily an aerosol physics problem. Recognizing that fact, a group of aerosol physicists assembled this extraordinarily comprehensive and useful FAQ on coronavirus:
https://docs.google.com/document/d/1fB5pysccOHvxphpTmCG_TGdytavMmc1cUumn8m0pwzo/
It’s chock full of practical advice on things such as proper ventilation and efficacy of masks and includes numerous studies behind the advice. Here, for example, is a referenced study that may clear up some of the confusion surrounding the efficacy of masks: https://www.nature.com/articles/s41591-020-0843-2/figures/1. It shows, for example, why the influenza studies cited by Todd Kreider are not appropriate proxies for coronaviruses. The study shows that masks are effective for stopping the transmission of both influenza and coronavirus particles in droplets(gt 5um) but only coronavirus particles in aerosols(lt 5um).
25. October 2020 at 00:44
Scott, everyone,
there is a simple way to drive mask compliance to 99% or more in the US: Have the government tell the people they can’t have them.
This comment section discussion is surreal. Hairsplitting about probabilities that this and that study has x % odds to be right or wrong when you could literally save your life (and grandma’s) by sticking a $0.20 device on front of your face for the next few months. And only when you’re out in the mall, mind you, not at home in the shower. But that seems to be a worse fate to most people than if they’d been asked to sacrifice their first born. I changed my mind too on masks – the aerosol transmission by symptomless people wasn’t obvious at first. But since, what, at best April, masks in public are an utter no brainer.
25. October 2020 at 01:33
Todd. Thanks for that.
25. October 2020 at 02:08
I shouldn’t have followed Mr. List down to his low road. He isn’t dumb, just uncurious.
25. October 2020 at 04:43
@Todd Kreider
You’re building your argument on the misconception that influenza and coronaviruses are transmitted equally well through masks. As this study that I link to above shows that is not the case: https://www.nature.com/articles/s41591-020-0843-2/figures/1.
25. October 2020 at 05:33
One point of clarification in my earlier post about aerosol size. Aerosol physicists place the boundary between aerosols and droplets at 100um not 5 um. The distinction between droplets and aerosols is that the latter stay airborne for a long period of time. The study I referenced on the different efficacy of masks for stopping transmission of flu and coronaviruses, for simplicity sake in their charts, used the term droplet to refer to both droplets and coarse aerosols ( aerosols greater than 5um) and the term aerosols for fine-particle aerosols( aerosols less than 5um). So, to be more precise in my terms, what the study shows is that masks are effective for filtering droplets and coarse aerosols containing influenza and coronavirus. Masks are also effective for stopping fine-particle aerosols containing coronavirus but not fine-particle aerosols containing influenza.
25. October 2020 at 08:51
Todd, Your nitpicking about terminology is hilarious. A mathematical modeling exercise is certainly a “study” by any reasonable definition. In any case, I also mentioned the Canadian study, which is empirical:
https://voxeu.org/article/face-mask-mandates-slowed-spread-covid-19-canada
An honest person would have apologized.
dtoh, The link said:
“The study’s findings were published in the “Proceedings of the Royal Society A” scientific journal.
At the onset of the pandemic, scientific evidence on the effectiveness of face masks in slowing transmission of respiratory diseases was limited, and there was no data on COVID-19 since it was a previously unknown disease.
But, prompted by some new research in recent weeks, the World Health Organization said on Friday it now recommends that everyone wear fabric face masks in public to try to reduce disease spread.”
You may disagree with this research, but Todd was pretending it doesn’t exist. If Todd had said he didn’t trust these studies, that would be an entirely different argument.
I also mentioned the Canadian study in my reply, which was of course empirical.
BTW, you probably have no idea what I have to deal with in Todd, who’s just a troll. Here’s Todd on October 3rd:
“Scott wrote: “Even worse, there’s a slight uptick in cases in the US, suggesting the Covid-19 problem will remain severe throughout October. It won’t “magically” vanish.”
Cases don’t say anything interesting now because they many are different than those detected in spring when a very high percentage of cases were of people who were symptomatic, whereas since August not only has the testing continued to increase but a large percentage have been of asymptomatic students. Often the tests are so sensitive that they are only detecting strands of RNA so the vast majority can’t be spreaders. You probably read about this in the NY Times in August.
Over the past seven days, the increase in Covid-19 deaths in the U.S. has reached a low of 0.3% per day, down from an increase of 0.9% per day the first week of September, and this should continue to decline unless a second wave begins sometime in November.”
LOL. He does this all the time. And being spectacularly wrong hasn’t stopped him from acting like a jerk over here almost every single day.
mbka, What’s so funny about this is that if Trump had said in March that the experts were wrong and that masks work, all the Trumpistas would now be arguing exactly the opposite, that the “experts” were covering up evidence that masks work.
25. October 2020 at 11:30
“Todd, Your nitpicking about terminology is hilarious. A mathematical modeling exercise is certainly a “study” by any reasonable definition. In any case, I also mentioned the Canadian study, which is empirical:”
Scott,
Others have tried to help you out of your confusion.
25. October 2020 at 11:34
Scott,
You repeatedly insult commenters, and I’m somehow a troll? You do not know what a troll is just as you don’t know what scientific thinking is. For some reason you have the hubris to think you understand the pandemic than those like Michael Levitt, a biophysicist at Stanford and a Nobel laureate.
26. October 2020 at 06:21
@Todd Kreider
I can see that you’ve cited reputable sources to come to this conclusion:
What I believe those mask studies are missing, and is pointed out in the mask study I reference, is that when it comes to fine-particle aerosols, influenza viruses and coronaviruses behave differently.
26. October 2020 at 09:05
Todd, When someone studies an important policy issue, writes a paper supporting one side of the debate, publishes it in a scientific journal, it’s generally called a “study”. If your argument is going to depend on nitpicking terms, I’ll draw the logical conclusion.
And yes, you are a troll.
26. October 2020 at 14:51
Scott,
that’s certainly true.
I also would like to know what the left would say if Trump had propagated masks very early on, if he had acted more authoritarian, if he had stopped the flights immediately, if no one had been allowed to enter the country except for at least 14 days of quarantine. Something like that.
dtho,
this is a bit too simple. My political views are known. But that has nothing to do with how I think about masks. The consensus on masks has been reached a few months ago. We also said where to find the consensus. Picking out individual studies and fiddling around with them does not make any sense. You need to listen to the consensus, especially when you are no expert in the field.
Todd,
no, as a German I have never heard of Germany. I don’t know the actual German guidelines either, it’s best if you take over our GP practice from now on.
Todd,
yes, I’m *super-curious*. You raised Fauci as a person of authority, emphasizing how super-smart he is. A normal person would assume that he changed his mind based on the facts. What is your opinion, why did he *really* change his mind? Was it NR?
26. October 2020 at 17:28
I think the recent EU case data makes it pretty clear that masks, as currently being used, are not a keystone variable. Further, it’s seems to be a big scandal that the huge Danish RCT is being withheld from publication. The authors are outspoken about being unhappy, but are withholding comment. I haven’t been able to find even basic studies:
1. No studies with control group throwing away surgical mask every day vs. groups that doesn’t.
2. No population studies on cloth vs. surgical vs. N95 masks.
3. No studies on UV masks.
4. No regional RCTs (e.g. one county given a mandate, the other not).
This is a travesty. We need to understand what works and what doesn’t. What we’re doing right now clearly is not working.
26. October 2020 at 18:04
I would like to have a study whether really all people breathe oxygen. Astonishingly, many commentators seem to get along without it. Seen in this light, Trump should easily win the election again.
28. October 2020 at 06:31
Scott- I am surprised you seem to dismiss the difference between a pure model study versus testing the model against reality. I know you do the opposite in monetary policy—e.g., Phillips curve. The latter curve fits data—the former makes assumptions about relationships and does “if-then” analysis. I like “if-then” studies—-but it does not relate to reality until the relationships are shown to be linked to reality.
28. October 2020 at 10:08
Michael, In economics I believe you need both theory and evidence. I suspect the same is true in epidemiology. I cited both types of studies in various posts.