Yves here. In a bit of synchronicity, some readers yesterday were voicing skepticism over the claim of the efficacy of masks in reducing Covid-19 spread, despite the success of many large Asian cities in keeping infection levels way down post lockdowns or other restrictions. Even their outbreaks show total infections at a vastly lower level than US states with much smaller populations.
Taleb shows the impact of mask usage on infection levels. And I get a kick out of his jabs at libertarians.
By Nassim Nicholas Taleb. Originally published at Medium
Incompetence and Errors in Reasoning Around Face Covering
SIX ERRORS: 1) missing the compounding effects of masks, 2) missing the nonlinearity of the probability of infection to viral exposures, 3) missing absence of evidence (of benefits of mask wearing) for evidence of absence (of benefits of mask wearing), 4) missing the point that people do not need governments to produce facial covering: they can make their own, 5) missing the compounding effects of statistical signals, 6) ignoring the Non-Aggression Principle by pseudolibertarians (masks are also to protect others from you; it’s a multiplicative process: every person you infect will infect others).
In fact masks (and faceshields) supplemented with constraints of superspreader events can save us trillions of dollars in future lockdowns (and lawsuits) and be potentially sufficient (under adequate compliance) to stem the pandemic. Bureaucrats do not like simple solutions.
First Error: Missing the Compounding Effect
People who are good at exams (and become bureaucrats, economists, or hacks), my experience has been, are not good at understanding nonlinearities and dynamics.
The WHO, CDC and other bureaucracies initially failed to quickly realize that the benefits of masks compound, simply because two people are wearing them and you have to look at the interaction.
Let us say (to simplify) that masks reduce both transmission and reception to p. What effect on the R0(that is, the rate of spreading of the infection)?
Simply the naive approach (used by the CDC/WHO bureaucrats and other imbeciles) is to say if masks reduce the transmission probability to ¼, one would think it would then drop from, say R0= 5, to R0=1 ¼. Yuuge, but there is better.
For one should count both sides. Under our simplification, with p=1/4 we get R0′= p² R0 . The drop in R becomes 93.75%! You divide R by 16! Even with masks working at 50% we get a 75% drop in R0.
Second Error: Missing the Nonlinearity of the Risk of Infection
The error is to think that if I reduce the exposure to the virus by, say, ½, I would then reduce the risk, expressed as probability of infection, by ½ as well. Not quite.
Now consider (Fig 1) that probability must follow a nonlinear dose-response, an “S curve”. In the convex part of the curve, gains are disproportionately large: a reduction of x% of viral exposure leads to a drop of much more than x in risk of infection. And, patently we are in the convex part of the curve. For example, to use the case above, a reduction of viral load by 75% for a short exposure could reduce the probability of infection by 95% or more!
Third Error: Mistaking Absence of Evidence for Evidence of Absence
“There is no evidence that masks work”, I kept hearing repeated to me by the usual idiots calling themselves “evidence based” scientists. The point is that there is no evidence that locking the door tonight will prevent me from being burglarized. But everything that may block transmission could help. Unlike school, real life is not about certainties. When in doubt, use what protection you can. Some invoked the flawed rationalization that masks induce false confidence: in fact there is a strong argument that masks makes one more alert to the risks and more conservative in behavior.
Fourth Error: Misunderstanding the Market and People
Paternalistic bureaucrats resisted inviting the general public to use masks on grounds that the supply was limited and would be needed by health professionals — hence they lied to us saying “masks are not effective”. They did not get the inventiveness and industriousness of people who do not need a government to produce masks for them: they can rapidly convert about anything into well-functioning protective face covering appendages, say rags into which one can stitch coffee filters… about anything. Nor did bureaucrats heed the notion of markets and the existence of opportunists who can supply people with what they want.
Fifth Error: Missing Extremely Strong Statistical Signals
Many people who deal with statistics think in terms of either mechanistic concepts (say correlation) they don’t quite understand, or local results; they fear to be presenting “anecdotes”, and fail to grasp the broader notion of statistical signals where you look at the whole story, not the body parts. For here, again, evidence compounds. We have a) the salon story where two infected stylists failed to infect all their 140 clients (making the probability of infection for bilateral mask wearing safely below 1% for a salon-style exposure) — we know the probability of infection for non mask wearers from tens of thousands of data points and the various R0 estimations) plus b) the rate of infection of countries where masks were mandatory, plus c) tons of papers with more or less flawed methodologies, etc.
Sixth Error: The Non-Aggression Principle
“Libertarians” (in brackets) are resisting mask wearing on grounds that it constrains their freedom. Yet the entire concept of liberty lies in the Non-Aggression Principle, the equivalent of the Silver Rule: do not harm others; they in turn should not harm you. Even more insulting is the demand by pseudolibertarians that Costco should banned from forcing customers to wear mask — but libertarianism allows you to set the rules on your own property. Costco should be able to force visitors to wear pink shirts and purple glasses if they wished.
Note that by infecting another person you are not infecting just another person. You are infecting many many more and causing systemic risk.
Wear a mask. For the Sake of Others.
1- I commend the very very very few writers such as Zeynep Tufekci who have been fighting the fight in the media.
2- I truly believe that the pseudolibertarians are sociopaths and misanthropes looking for a political party that they think fits their misanthropy.
I was one of those skeptics. This article is helpful. Thanks yves
One thing I think about is that i know people working in offices who are going to be required to go back to the office and wear a mask for 8 hours a day. Not by policy but under state law.
At the same time they are using communal bathrooms. So states like mine (PA) are coming across as rushed and arbitrary. The mask wearing is good but it’s not enough and American working culture has been about “ass in seat.”
I did appreciate too what he said about libertarianism. Unfortunately the government did itself no favors by lying. And even now, I see very little education on HOW to use a mask.
I like to see good reactions like this :) On the how, we are all learning! I see many, for instance, leaving their nose unmasked, noooooooooooo!
Yep, exactly. The CDC and WHO have spent a ton of time on hand sanitizing, which is useful, but not nearly as useful as proper mask wearing, IMO.
Agreed. But I was never hearing “mask are not effective.” I was hearing healthcare workers need them more – which implies masks are helpful and that we didn’t have enough.
Handmade masks and the allergy and pollution mask sold in Asian markets were rarely mentioned in March. At work, one of our CDC or WHO links was for a study of types of masks and their effectiveness. Not much else for a while.
Meanwhile, at my local pharmacy where at least one of the pharmacists has been sick with Covid, a clerk never has her mask over her nose and rubs her face all day. Everyone, even the neighbors having dinner parties, is scandalized.
I live in a 90-unit building in Whitechapel, London.
The following is the post I received two weeks ago from management after six weeks of begging and pleading with them that all employees and outside inspectors should be masked in public areas.
Actually the hand sanitizing (“door knob effect”) doesn’t apply for the case of Coronavirus. This has been separately verified in NY and Europe.
At my office, we’re maintaining a minimal presence. We are mandated to wear masks while entering the building, all common use areas, and all places where we’re not able to maintain a proper social distance. For the most part, I’ve seen people complying (event in the restrooms), but I’ve had to “gently” remind people to wear a mask a few times. For the most part people are happy to comply, though the ones with issues seem to be the Trumpsters and their fellow travellers.
However, I do not believe our Lords and Masters should wear masks. They should instead wear well fitting corks in the mouth and nostrils.
Despite the proven efficacy of masks in the prevention of transmission, as long as the pandemic hasn’t subsided I think asking people to go back to work at an office wearing masks is a bad idea from both a health standpoint and a liability standpoint.
As you noted, even if everyone wears a mask at all times, there are still communal bathrooms, elevators, etc to worry about. And not everyone will wear the mask at all times – it will slip off for a few seconds accidentally, be removed to eat, etc.
One slip up and one sneeze from an infected person causing an outbreak that can be traced back, and that workplace is going to get sued hugely for asking people to come back before the pandemic was declared over by health officials.
And even if legal liability were not a concern and the company is seriously taking to heart the health of their employees, I would argue that asking people to return before the pandemic is declared over is still too risky. Yes, masks worn by everyone can reduce the risk of transmission per contact to well under 1% if everyone wears the best masks all the time, etc. However in an office with a few hundred people, you are contacting masked people dozens or hundreds of times per day, so a minimal risk of transmissions multiplied by dozens or hundreds of transmission possibilities still increases the overall risk of transmission significantly. So you still want to reduce the risk of transmission and keep your distance, so there are fewer opportunities for transmission in the first place.
We have at least one person at our office who is 70+ and whose spouse has other health issues making their risk of a bad infection greater and they will not come back to the office at all until the pandemic is declared over, masks or no masks. The consequences of catching it for a high risk category of person are just too great.
Taleb does lose me sometimes (I’d have to bust out my old stats textbook to even try to make sense of why note 2 is correct), but I’d like to think he would agree about the risk of working in a crowded office environment during the pandemic even with masks worn by everyone when the consequence of slipping up is potential death.
If I’m wrong, someone please set me straight.
“there are still communal bathrooms,”
Iv’e heard this more than once, who the hell takes their mask off to pee and crap? Leave the damn thing on!
“Yes, masks worn by everyone can reduce the risk of transmission per contact to well under 1% if everyone wears the best masks all the time, etc. However in an office with a few hundred people, you are contacting masked people dozens or hundreds of times per day, so a minimal risk of transmissions multiplied by dozens or hundreds of transmission possibilities still increases the overall risk of transmission significantly.”
First – this ignores that guidelines can (and have) been made that businesses can and should follow to reorganize the workplace to promote social distancing, and/or significantly reduce transmission. If the argument is that even a reduction to 7% must be multiplied by allegedly multiple close contacts, I need not explain why these same multiple contacts are not far more damaging at 100%.
Office toilets don’t have lids, so there may be risk from the flush plume.
“I truly believe that the pseudolibertarians are sociopaths and misanthropes looking for a political party that they think fits their misanthropy.”
My add to this would be that we seem to be socially learning this sociopathy and misanthropy. Learning it to the extent that goes beyond their normative appearance in a stable social society.
I sometimes wonder if it is coming from the top down this behaviour and I was reading about something similar. In the book “Treasure Islands” there is mention of a wealthy guy going off at a guy on a motorcycle. His crime? Because he was wearing a helmet and the wealthy dude took affront at this restriction of personal liberty, even for someone else. Maybe he is a follower of Ayn Rand. Obviously the wealthy guy has never heard of ‘donorcycles.’
I am unable to find “Treasure Islands”. Are you sure that’s the name?
Homemade masks and surgical style masks don’t seal very well. If you have to spend time in indoor spaces with other people here is a simple fix for that (looks like Taleb has some sort of improvised seal as well):
That’s good but the overall point is they don’t have to.
The more “masking” everybody does, whether it’s a heroic effort to wear a sealed N95 morning till night or just a homemade cloth mask, the more it just works.
This is so weirdly obvious that it made piles of PhD’s feel they had to “disprove” it and thus it took a top mathematician like Dr. Taleb to un-disprove it again.
That’s actually untrue. The KIND of mask one wears is key. A homemade cloth mask is particular ineffective:
PS I’d just as soon work from home rather than wear a mask the whole day in an office. As for a long journey wearing goggles as well as a mask like Taleb, I’d just as soon stay at home and wait for a vaccine.
Ha. I raise you a link:
or even this https://www.cambridge.org/core/journals/disaster-medicine-and-public-health-preparedness/article/testing-the-efficacy-of-homemade-masks-would-they-protect-in-an-influenza-pandemic/0921A05A69A9419C862FA2F35F819D55/core-reader
because the key part is that surgical mask is “only” twice as good as a “scarf” in capturing >7 micro meter droplets (which form > 90% of coughed out aerosols, I provided link before that I can’t be bothered to redo). Which is broadly in line with the other test (surgical mask 90% vs scarf 50%).
Viral reduction by 50% has a much more powerful effect than halving the infection rate (because, as Taleb correctly points out, it’s convex).
And don’t forget the decreased viral load just from wearing any kind of mask, which I’ve been hounding family and friends about for months…
And I would think 2 masks if people were both wearing them would make it 50% of 50% or 75% reduction vs 10% of 10% or 99% reduction. 2 mediocre masks aren’t as good as two good ones but a greater than 75% reduction in Rt is still huge.
Osterholm’s interview is a brilliant example of 4 out of 6 of the reasoning errors described by Taleb.
Osterholm’s main objection is the lack of formal aersol studies supporting cloth masks. At the same time he admits surgical masks have the same lack of evidence. Odd how he doesn’t go on to say surgical teams should not wear masks. There seems to be an inconsistency in his reasoning, given how very careful he is to require scientific evidence. Why does he require a high degree of certainty when giving recommendations to the public during a health crisis — recommendations which he agrees are, at worst, harmless — when he doesn’t require the same certainty for precautions taken by doctors like himself in surgery?
Osterholm’s other objection is that cloth masks may not fit well. He describes the process of forming CDC guidelines in detail and mourns the lack of evidence. So, isn’t it strange how the CDC recommends that people should “cover their coughs” and sneezes, even though the expelled virus particles can escape even easier than they do when a person is wearing a mask? If the choice is between sneezing into an elbow versus sneezing into a cloth mask, it seems truly reckless for the CDC to recommend the elbow but not the mask. And it seems equally reckless for Osterholm to object on the grounds that the mask may not fit well. I suggest that virtually all masks fit better than an elbow, and have the advantage of being on one’s face already.
This is what Taleb refers to as incompetence and errors in reasoning.
Even if a cloth mask does nothing more than reduce the risk of transmission by 10%, or convinces others to stand 10% further from you, that in itself (when multiplied by an entire population) is a heck of a lot more effective than any other measure we’ve found so far. The countries that have best controlled the virus were islands that resorted to draconian lockdown regimes or have populations that masked up en masse. I guess, in the US, we get neither.
Back when the CDC was still discouraging domestic mask use to preserve stocks for medical, I simplified all this for myself saying “Wearing a mask might help at least a little, and it can’t possibly hurt.”
I assume you intended to say A homemade cloth mask is particularly ineffective:? I just skimmed your very long pdf link but didn’t find anywhere the author said ALL homemade cloth masks were particularly ineffective. In between pitching his book (which may be very good) he repeats – I believe several times – what appears on page 3:
Your preceding sentence seems to be more in harmony with vlade’s link: https://smartairfilters.com/en/blog/best-materials-make-diy-masks-virus/.
Pulling it all together (please someone more mathematically and scientifically literate correct me if I’ve got this wrong):
1- using cloth masks to reduce the transmission probability by some percentage compounds to reduce that probability by its square when (just about?) everyone wears them
2- maybe even more when “the nonlinearity of the probability of infection to viral exposures,” is included. Or is that built into the squaring in item 1?
Vlade’s link – https://smartairfilters.com/en/blog/best-materials-make-diy-masks-virus/ – for 0.02 micron Bacteriophage MS2 particles appear to be a conservative estimate of household materials’ effectiveness against 0.02 micron particles states a filtering effectiveness in the 70% range for dish towels and cotton blends. How does that number translate to Taleb’s reduction of transmission probability? If the numbers compare apples with apples, it would seem Taleb is understating the case for properly made cloth masks.
The point isn’t to seal in the droplets, but to disrupt their flow away from your face. Even a screen would cause enough turbulence to interrupt the flow of droplets from your face to someone else’s.
On the effective combination of “Bureaucrats do not like simple solutions” and “Absence of evidence”:
How I hear this all the time; “There is no evidence for you simple solution so we should not test it or do it. Instead let us go with this complicated and expensive solution we have received funding for from the company that will sell it to us.”
This fits in with the MTA homeless debacle in Links today. Simple solution, give them free housing.
I always liked Taleb but never understood him until I started reading and following him more during the pandemic. I think he is crazy like me and I like that he uses math to promote common sense. And he talks like a neurotic as well, which to me is a positive trait, saying things like “You should prepare for extreme events” and “unreliable data — or any source of uncertainty — should make us follow the most paranoid route.”
It is the opposite of “Just Do It” and “Move fast and break things” horrible culture.
This attitude also annoys me to no end.
In the UK, tracing of contacts of infected cases was given up on in March, supposedly because there wasn’t enough PCR test capacity. Never mind that some countries did it without testing, the gumshoe way, going door to door to check people’s symptoms and taking their temperature. I suspect the main reason was that there was no crappy app to hand out money to.
“There is no evidence for you simple solution so we should not test it or do it. ”
eg- Early preemptive treatment w Hydroxychloroquine and zinc sulfate.
After the bogus Lancet study, Fauci and the WHO made it sound as if HCQ + zinc studies abound, but the only active one at https://clinicaltrials.gov/ct2/results?cond=&term=hydroxychloroquine+and+zinc&cntry=&state=&city=&dist= is at St. Francis Hospital in NY (and only in recruitment phase), where they do not expect final completion until December 31, 2020.
The NIH site lists 7 other HCQ + Zn studies, but only one, in Turkey, is even in recruitment phase.
If the Fauci, NIH, FDA, WHO vampires were truly serious about wanting to save lives and to know efficacy (or not) of HCQ + zinc, don’t you think they would have a flock of studies in progress?
But there aren’t– and the patently false idea that serious studies are ongoing should be aggressively challenged and exposed for the murderous lie it is.
Apparently because they know how well Chloroquine did in earlier studies.
Here is an article from the NIH’s very own Virology Journal dated August 22, 2005 titled “ Chloroquine is a potent inhibitor is SARS coronavirus infection and spread”
I’m impressed by how clever and funny he is. Just stating the hard facts – who knew that could be so amusing? But comedy does just that. Thinking here that Taleb might want to consider doing a talk show. Really. I also appreciate his clarity on the word “liberty” – “The entire concept of Liberty lies in the Non-aggression Principle.” Which I paraphrase as: I won’t steal your silverware if you won’t steal mine. I’m sorry I always thought Taleb was just another, but very good, bean-counter. Now, I think he should go big-screen. We really need something like this.
Taleb would be horrified at the idea of hosting a talk show, unless he was allowed to bring on guests and publicly skewer them for their self-interested positions. And, unfortunately, such guests would avoid his show like the plague.
As the consequences of covid-19 are so dire, taking all precautions and preparing for the worst seem sensible not neurotic. See Pascal’s wager.
His point one is wrong, and I’m surprised he’s not seeing it.
The reality is somewhat different, and you need to consider a number of scenarios, i.e. the infectiousness of both parties.
If neither party is infectious, then clearly masks don’t do anything (but that would not affect the overall likelyhood of infection, so no harm done in the first place).
If _both_ parties are infectious, then they cannot infect the other one already, althogh you could argue that there might be a chance that they increase the viral load. I’m not a virologist, but I’d expect that if you are in the stage where you’re shedding virus strongly enough to be substantially infectious, then any other dose you may get from others is more or less irrelevan.
So the only relevant part is when one and only one of the parties is infectious. So the reduction in infection is really 1/4 in his scenario.
In practice, this is actually much more complicated, as you’d have to figure out what are the probabilities of the scenarios above, and clearly the last one (both parties infected) is the smallest for most of the time.
Initially, the first scenario (neither infected) is the most common – but reducing the likelyhood of the spread will reduce the likelyhood of the last scenario (one party infected). Introducing a mask there will make the convex zone much smaller.
He’s also making a second mistake, attributing the reluctance on masks to faceless beaurocrats, without much evidence. The fact that WHO said so is not evidence, as clearly WHO was under a lot of political pressure in this crisis, so the decisions were anything but beaurocratic or scientific. For further evidence, look no further than the supposed ‘UK evidence based approach’, which was really political (as in “we have no clear evidence to the contrary, so will do nothing”, covered in his absence of evidence is not evidence of absence).
The mask or not mask is _entirely_ political decision. The various “but if you touch the mask, it can spread the virus” had less evidence than the effectivness of masks (given that the current thinking is that surface-spread is way less important than aerosol one). The only argument against masks was “would take them from first-line personell”, but as there was _some_ evidence that even home-made masks are better than nothing, I find it pretty weak.
I would say it is a long shot that Taleb missed this, but let me help you see some of your problems in thinking about this,
Let’s play this game with AIDS becasue I feel it is easier since it is not new.
“If neither party is infect”ed with AIDS wearing a condom is useless. If you do not know if the person you were having sex with had AIDS I am sure you would wear a condom. Yes? The problem now is that we do not know who has “AIDS”.
“If both parties” have AIDS then that really sucks for both of them. Maybe they should have worn condoms. And they should wear condoms when they are having sex becasue they do not know if a higher viral load will make the other more ill. Again, when unknowns are involved the only play is to play it safe.
“So the only relevant part is when one and only one of the parties” has AIDS. Which is where ALL the risk lays! So since we do not know who is contagious, the safest play is to always wear a condom.
I’m not disputing that wearing a mask is useful, which is what you seem to think. In fact, I have been vocal pro-mask advocate for a long time, arguing that the fastest and cheapest way to a “herd immunity” is widespread adoption of masks. Plenty of evidence of that (my support) around.
But Taleb makes a claim that is nonsensical, that if _both_ parties are infectious the infection is cut down to a 16th. Duh? I could make a claim that if _neither_ party is infectious, the infection rate is 1/16th too. And that would be actually more correct, as 1/16th of a zero is still a zero.
One sixteenth of one is not one though – no matter how many masks they will wear, if both parties are infected, by the end of their encounter they will be both infected with probability of 1.
I am curious about the reasoning within the “freedom USA!” crowds on the beaches and bars that they are personally at low risk of infection. It’s not like AIDS, where long term monogomous couples were genuinely low risk (until that blood transfusion).
Vlade, did you leave the people around the infected pair wearing masks out of the equation? They are protected. The environment is protected due to reduction of inoculum. That reduction and subsequent avoidance is the best possible scenario for least transmission.
Thanks Nassim. I don’t understand the questioning of a policy that has been in place since shortly after Lister and Pasteur (among many others) demonstrated infection control. I suspect the denial is due to the lack of biology courses being taught to everyone in our schools here in the US as a standard part of the curriculum. It becomes a choice to ignore science very early. I can’t comment about other nations and how they institutionalize science studies.
But the most obvious reason is that our nation simply was not prepared for any health emergency. Embarrasment at the restriction of science is something the whole world knows and that our managers encourage here. It makes us woefully unprepared for asking the proper questions.
Taleb in his equation takes only a pair. Ultimately, it doesn’t matter though. If a mask reduces viral load by a quarter, it reduces the viral load by a quarter – but only between one infected and (any number of) unifected.
For any number of people N, masks matter only if there’s at least one of both infected and uninfected. Given that (for a number of reasons) basic non-filter masks worn by uninfected reduce the chance of infection by a trivial amount, we can assume worst-case of 0 (i.e. if only healthy people in the crowd wore the masks, the infection rate would not change).
The infection rate changes when infected people wear masks (and, to repeat it again and again, and people seem to jump to conclusions – given that the asymptotic people can be infectious and cost of wearing mask is trivial compared to continuous testing of everyone, everyone wearing a masks regardless DOES MAKE SENSE).
Unless you want to get to some fancies math, a simple assumption to be made was that masks on the infected person reduce the total viral load by X (say quarter NT uses). But it’s by a quarter regardless of how many infected and non-infected people are there, as long as they are _both_ on the crowd. If all of them are infected (or healthy) wearing masks doesn’t matter, their “state” will stay the same with probability of 1.
There are now multiple strains of covid-19. Can people be infected with more than one strain at a time? If first person has strain A and also contracts strain B from second person is the recovery prognosis worse for first person who’s now infected with 2 (or more) covid-19 strains? So many questions.
Check Taleb’s Twitter, as he has considered this.
I don’t think that he is making the mistake you have identified.
I think he is saying that mask studies commonly look at the reduction in the chance of infection if a person is wearing a mask, and then draw a conclusion on the reduction of infectivity generally. But as I understand it (simplistically) that is to look at it as if there are two people in the room, one infected, and one of them is wearing a mask. It forgets that if there are two people in the room, one infected, and BOTH wearing a mask then the risk of infection is not simply reduced by the “mask reduction factor”, but by the mask reduction factor compounded.
So, if I have a single person in the room, who is infected. Without a mask, the viral load in air of the room will be X. With a mask, the viral load of the room will be X*y.
Surely you are not saying that by adding a person into the room the viral load will change? (well, it will change if both are infected, but in that case both will still leave the room infected with probability of 1, so it doesn’t matter).
The only case of changing the viral load would be if you assume that the unifected person’s mask provides as much protection agains the viral load intake as the infected one’s reduces the expelled load.
Which we know is not the case, or, at best, the reduction is order of magnitude lower than the expelled load reduction (that’s the whole point of “my masks protects you”. Not “my mask protects me”).
Yes, well as he is saying, he is simplifying. The second person who enters does reduce further his risk of infection if he is wearing a mask as well as the infected person.
I seem to recall reading a complaint that most of the studies on the reduction of the chance of infection were measuring “my mask protects me”, not “my mask protects you”, but I do not know if that is still the case.
The reduction of “my mask protects me” is trivial for home-made masks, and small even for surgical masks.
In fact, wearing a mask that has captured infected liquids long term can be bad, because with each breath you’re very likely to increase your viral load (unless the mask you’re wearing is a N95 or better grade respirator, in which case the viral load increase is trivial).
“My mask protects me” was the thinking that lead a lot of people (myself included until I educated myself on it a bit) ignore masks as a solution initially.
Have you ever seen the move “Pi“?
Just wear a mask, like you say.
you might want to read up on good homemade masks. Some can approach N95 in a vareity of tests.
I make masks out of Swiffers, string, and a stapler.
I am not up on all the maths, but it seems to me he is talking about R0 and you are not.
No, the difference is that he’s making assumption that mask protects the wearer the same as it protects the others. Which is not a valid assumption by far (which is what confused me, as it’s very well known invalid assumption)
But his number one assumption is:
“unreliable data — or any source of uncertainty — should make us follow the most paranoid route.”
Wearing masks, regardless of any of these metal shenanigans, is the most paranoid route.
Help me. Do you have this wrong. From Scientific American:
Well spotted on point one (if I understand his point and yours correctly, my brain isn’t quite behind monday morning mode yet).
I’m not entirely sure I agree entirely that the opposition to masks is political. There is certainly a political element, but I can think of at least two very senior public health scientists who have been very strongly personally opposed to mask use, for reasons I can’t quite understand. I can only speculate as to why, but I think a strong element is the type of training doctors or biological scientists have over masks – they think of them as precisely designed protection for use only in a hospital or lab environment, and are intellectually resistant to the notion that they can be used effectively by the general public. To some limited extent this is correct – I live in an area with a lot of hostels for homeless and addicts, and for months they’ve been handing out masks for these people to use. I see very few using them, but a lot of boxes of masks and gloves scattered around the streets every morning.
And I feel like a broken record here for always saying this, but I think there is a real failure of scientific logic at work within the broad field. A lot of the statements I’ve read by medical professionals implicitly seem to try to apply the same rules of proof to masks (or for that matter, vitamins) that they do for vaccines or new medicines. They seem to think this is what you do if you are trying to be intellectually rigorous and consistent, but its actually a very false form of scientific knowledge – there are many different levels of ‘proof’ and ‘evidence’ according to context, something that many seem to fail to see. Or put another way, a lot of scientists need to be put through a course in epistemology.
I’d argue that the example you give (of doctors disagreeing with masks because of their conviction and strict evidence) is political. Because they see it as undermining the “evidence based science”, and fight it “for the good of the science”, not for the good of the mankind.
Even when it’s not underming any evidence based science, but they don’t seem to understand that handling pandemic is not about science, it’s about risk management in a crisis. Where a lot of new measures get thrown on the wall with hope that something sticks. I’d argue that a role of the science here is twofold – to remove things that absolutely certainly could not have stuck (hello bleach), but also to understand why something stuck post-facto.
To your last point:
IMO there’s a very good argument to be made that the whole medical stuff is still more quackery than a science, cf the massive number of “scientific” debacles we had in the last three months. Most of them were found because there was a laser-like focus on that part, and I have very little belief that similar results would not be found elsewhere in the field of medicine under even normal circumstance. But in normal circumstances no-one cares.
I don’t get people who will argue about benefits of hydrochloroquine one second (especially before any large double-blind tests were conducted) and diss mask the other, saying that one “has studies” and the other “doesn’t”, do the first one is clearly a good thing and the other is not.
PlutoniumKun and vlade: Good points by both of you. However, I am going to interject because I have been wondering mightily about this mask phenomenon in U.S. culture. Having also seen the antics of the U.K. Conservative Party, I will extend my remarks to Englo-America. Yes, with an E.
I am finding that the people in the Mediterranean world have a much different relation to masks–so that I am also going to venture that the “Southern” world + Catholicism + Orthodox Christianity produces different results from tired Englo-American warmed-over Methodism and related evangelical tropes. Of course, those denominations, which are one step from paganism, don’t believe in invidual salvation–it’s redemption of humanity, theologically. So the group of larger than one atomized person.
In my neighborhood in Chicago, dogwalkers have almost uniformly stopped wearing masks. Yet people on foot usually are masked. Many bicyclists wear masks. I regularly see runners in masks–which takes much thought and effort.
What I see is less political than the use of fetish objects in U.S. culture. The right led a backlash and fetishized a protective device into a Danger to Freedom. Meanwhile, in my local Portlandia, the fetish object, the dog, somehow gives immunity to infection. (Although I note that one of the ultra-expensive local pet-supply stores, the kind with salmon doggie treats in the window, is boarded over–one of the few shops on Clark Street in need of protection. Hmmm.)
Likewise, in U.S. culture, firearms have become fetishes. How else can one explain these displays of fake weapons for the sake of “open carry”? And the current debate over the Confederate flag in the U.S. of A. is debate over a fetish.
It almost makes me wonder what it is in Englo-American culture that produces such fetishes. Many of these fetishes are downright counterproductive. It isn’t as if we are arguing over how to wear a Scots kilt properly, or how much sauce an Italian would allow on a dish of pasta, or what constitutes real Catalan pà amb tomàquet, or how to tie one’s obi.
As many Americans are starting to point out, we are getting symptoms here of a death cult–the revenge and terror of apocalyptic thinking. And masks somehow don’t fit into the Book of Revelations.
Person A and Person B are riding a bus together. Person B is COVID positive, asymptomatic but shedding.
If person A wears a mask and person B does not wear a mask, then the risk of person A contracting the virus is reduced by 3/4 or what have you.
If both persons A and B wear masks, the risk is reduced more because B’s mask will suppress some of their shedding.
If person A and person B are both infectious, the probability of them being infected at the end of the trip is still 1. Same as if they are both healthy, the probability of them being infected at eh end of the trip is 0. In both scenario it’s true regardless of any masks or whatever.
The only scenario where mask make difference (and again, I’m NOT saying masks are useless, just looking at Taleb’s math) is if one but only one of the A or B is infectious.
The scenario is entirely symmetric, so for purpose of our math we call call person A to be _always_ the person infected and B the healthy one, they are just labels. Person B’s mask reduced “infection” rate by exactly 0, person’s A reduces the infection rate by 1/4th. So the overall reduction is 1/4th.
I don’t get your last sentence. If person A’s mask reduces the risk of her infecting person B by 75% (as in Taleb’s example), and person B’s mask reduces her risk of getting infected by person A by 75%, then if both are wearing masks, the overall reduction in risk (assuming simple compounding) is 93.75%.
Assume A is infected. So the risk of infection is reduced by 75%
– uninfected. But then she can’t infect A (who’s already infected anyways). Reduction of infection rate of A – nil. Reduction of infection rate of B is as above.
– infected. B can’t infect A (who’s already infected). B can’t be infected. Reduction of infection rate of either – nil.
If a person is infected, they cannot be reinfected. They state is stable. Only a healthy person can be infected. That means the only reasonable scenario where the virus spreads (in a pair situation) is with one healthy and one is not. W/o giving up anything, we can say A is always the one infected (because the scenario is perfectly symetrical, i.e. we cannot say whether it’s A or B that is more likely to be infected – they both have the same likelyhood).
If you want, you can think about it in the terms of viral loads.
Both healthy – no viral load
Both infected – viral load doesn’t matter, both stay infected.
One healthy, one infected. Viral load depends on whether masked or not.
I now re-read Taleb’s text, and now see where he’s going to – he’s making an assumption that “masks reduce both transmission and reception to p”. Which is wrong by pretty much all the stuidies available. The transmission is reduced by an order of magnitude compared to reception, to the point that we can ignore the reception transmission reduction.
I have three points.
One: Transmision. I don’t understand why you’re talking at all about scenarios where there is no possibility of transmission. To me, this suggests some basic misunderstanding of Taleb’s point.
I don’t think you can ignore the benefits of uninfected people wearing masks – because of the second error, nonlinear response.
Say that you are uninfected, and are hit with a viral load of L, with a probability of infection of P. Now say that you wearing a mask reduces the viral by a factor of r: with mask, it is L*r. If the relationship between viral load and probability of infection were linear, then the probability of infection with mask would be P*r.
He is saying that this is wrong. The probability of infection is less than P*r. Possibly quite a bit less. If you reduce viral load by 50%, chance of infection drops by more than 50% – it could well be by 75% or 90%.
If the other party is already wearing a mask, then that last (nonlinear) reduction could be the crucial bit that prevents transmission. Wearing a mask for self-protection might (I’m not sure) become even more effective when infected people are masked.
Keep in mind that we are concerned with population level effects. Say that wearing a masks reduces the chance that an individual becomes infected by 10%. That might seem relatively insignificant. But because the number of infected compounds as the disease passes through the population, that 10% could be the difference between a disease that continues to spread (R0 > 1) or one that dies out (R < 1).
Three: Leaky masks. This raises what I think is a crucial error that Taleb does not address (related to the above, and indirectly covered by his second point). We heard repeatedly that masks would not work because most masks or are not worn correctly, allowing the virus to circumvent the mask.
If you are a nurse treating infected patients all day long, day after day, and your mask leaks, then your viral load is continually ramping up. Your chance of infection approaches 100%. Such a mask may be virtually useless.
In contrast, a member of the public likely has only fleeting contact with infected individuals. An imperfect mask can massively reduce the chance of infection.
Medical experts are like the scuba diver who looks at the water-resistant watch and say, “that’s not going to fail” – because for them, it would. They forget that for most people, resisting a splash of water is all they need. When they project the standards needed to guarantee their safety as measures for reducing transmission among the public, they completely miss the mark.
Personally, I find shocking the pervasive narrow thinking and lack of common sense throughout the medical profession, extending to public health experts whose job should be to think holistically. I furthermore think that saying that “masks don’t help” when the reality is “we lack conclusive scientific evidence about the merits of masks” is appalling dishonesty, representative of an expert class who think of the public as ignorant children and unperturbed by the prospect of lying to achieve a desired effect.
“I now re-read Taleb’s text, and now see where he’s going to – he’s making an assumption that “masks reduce both transmission and reception to p”.”
I really think there’s some confusion here over p. P is just a variable that expresses the separate transmission and reception numbers in combination as one number.
So p is literally just the expression of (transmission reduction %) x (reception reduction %) = total reduction % = p.
P is not a constant, and the numbers in the rest of his scenario depend on the numbers that get plugged in to arrive at p. He says 25% for both transmission and reception as an example, but it could be any number.
At the end of your comment, you say the transmission numbers are too insignificant to matter, and that would, to me, express where your issue with his equation lies. Taleb obviously thinks the transmission numbers are more significant.
Either way, it seems to me his equation is fine, and you are simply punching in different numbers to the equation, and therefore coming up with different results.
Not to beat a dead horse, but I’ve reread point 1 in the feature and all your responses. I think I am out of my depth in the math and should not have used just a 2 person example. However, my understanding of R0 is that it is a metric that measures how many people on average 1 infected person will infect. I think your scenarios of two infected and two non-infected are valid and will happen in daily life, but I don’t think it can be part of the R0 consideration.
I do thank you for helping me to challenge my assumptions and I look forward to a challenging response.
ok, I’ve re-read Taleb’s text and he’s making an assumption that “masks reduce both transmission and reception to p”
As I write in another comment, this is not supported by any studies, in fact most studies I have seen say that the transmission is reduced by order of magnitude compared to reception unless one uses N95/FFP3 type of masks (i.e. respirators that fit and all).
It’s very definitely not true for homemade masks or anything simple, which would reduce reception by trivial amounts. Mask will stop a lot of the exhaled liquids and they will stay on the mask. Their spread into free space will be fairly limited compared with cough that sprays particles metres away from the coughing person.
It’s perfectly possible to inhale liquid particles from a mask that was sprayed on from the outside. In fact, it may increase the likelyhood of infection as you’re breathing the infected particles over longer time, increasing your viral load literally with each breath (while the nice and cosy moist and warmish mask provides good environment for the virus to survive).
Why all the sturm and drang? To accept Taleb’s model means that you have to accept his assumptions. What Taleb was doing was a back of the envelope calculation to stress a point in his article. His model was simplistic for a reason and you cannot fix his simplistic model by simply rejecting his assumptions because his choice of a model is based on those assumptions.
I am sure the mathematics behind mask wearing has more in common with the Travelling Salesman problem than it does with any simple Binomial Distribution and would be more in line with a PhD thesis in mathematics than a simple post to an online magazine. Is that what you were looking for?
Nevertheless, we do have empirical evidence, often stated here in many links, that mask wearing does reduce Covid-19 spread. I think that is what is important. Throw his simplistic mathematics for the crowd model out the window if you must, but listen to what else he is saying.
Because he’s Taleb and he takes pride in shooting down stupid things. Which means he’d double check his assumptions at least. And if he makes a “I’m shooting down stupid stuff” post, it’s even _more_ important to do so, because making mistakes there gives the opponents openings.
Especially if he’s wrong immediately on the first point, for people who want to be persuaded that masks don’t do much, it reinforces the message (that the pro-mask are just winging it at best, lying at worst) and makes the other ones pretty much irrelevant (and here again, for the umpteenth time I’ll say I am pro-mask, and was so for the last two month or so, often against a significant opposition even here on NC. He doesn’t have to persuade me. He has to persuade people who are much harder to persuade).
Re the model – you can make it as complex or as simple as you want, the question is what you want from your model. In this case, IMO the whole point is that even if you make some extremely conservative assumptions, the simplified conservative model shows that the reduction is massive. No point in trying to make it more complex – we’d jump up and down for any solution that can reduce the infections by half (by wearing a simple scarf, not some bleeding-edge PPE), and as cheap one as home-made masks?
Instead people will argue whether the right social distancing is 1.8 or 2m (for example), when it’s irrelevant not to mention totally impractical (who’s gonna measure it? Are we all going to wear truck tires to make sure we don’t touch each other?).
To your point about masks increasing viral load, there’s this study:
“Masks can spread all virus, but coronavirus specifically. Exhaled viruses will not be able to escape and may concentrate in the nasal passages. “
Perlman S et al. Spread of a neurotropic murine coronavirus into the CNS via the trigeminal and olfactory nerves. Virology 1989;170:556-560. https://pubmed.ncbi.nlm.nih.gov/2543129/
“Into the CNS”… Central nervous system. So I take that to mean increased risk of brain infection.
Vlade, that is not his point.
His point is that each barrier has an independent reduction on transmission. The infectious person’s mask reduces exhalation of virus, the susceptible person’s mask reduces inhalation o virus. 50%*50*=25%. Now this model is aerodynamically naive – you cannot put a match out at arms length by breathing in, the forces at work are not the same as breathing out, but the point is still valid that a percentage X of a percentage Y is smaller than Y alone.
This is just plain nuts this. We know that face masks are effective in pandemics and have known that for over a century. You don’t see arguments breaking out in surgery theaters between those doctors & nurses who wear masks and those that want to do without. Personally I am in favour of empirical-based evidence and all that I have seen and heard is that if you are in the middle of a pandemic, then mask up. As the saying goes – my mask protects you, your mask protects me. No party politics, no ideological positioning, just simple empirical-based analysis.
It is know that through governments screwing up, that face masks were in short supply. So governments went out and told people ‘Look, we are short of face masks so we have to save them for healthcare workers. As soon as we get them in, we will give them to all who want them for free’. Oh wait, they did not do that at all. They said instead that wearing masks was dangerous and people would be better off not wearing masks at all. So we are still living with the effects of that colossal stuff up. All too often governments have been treating people like kids and a mommy-knows-best approach and this whole thing about face masks is just one aspect of it all.
Agree. With the exception of some Asian nations, governments’ actions and messaging was inexcusably terrible.
Ars Technica has good info on masks, including how to make one’s own, and the difference between masks that provide “source control” (stopping one’s infected aerosols from traveling beyond the face) and masks that provide “protection” (keeping the wearer safe from others’ virus particles). The article discusses the screening efficacy of various fabrics, and the importance of layers, including an electrostatic layer.
I live in a pretty ‘red’ rural western state, and it may be my self-consciousness, or paranoia, but I wear a mask, with diligence, and the derision I sense from non-masked folks , the judging… its palpable.
I’m white in a wonder-bread vastly-Caucasian neck of the woods.
Not in any way the beginning of empathy with a person of color, but wearing a mask gives a visual label, and attendant assumptions, immediately. Perhaps a bit like a heavy melanin lode in skin tone. Timely!
Becoming “The Other” Covid— our gift!
This behavior should become self-evidently counterproductive fairly soon. And if our assumptions are wrong, then how nice for everyone!
Fortunately, I live in an Asian society where masks are mandatory and universally worn. But if I didn’t, I’d persuade who I could, ignore/avoid those I couldn’t, and just try to keep myself well. Hectoring idiots whose behavior won’t change until their own immediate contacts start getting sick doesn’t seem like a good way to accomplish the last.
Empathy is dangerous and must be eradicated.
Having empathy with someone and trying to understand where they are coming from is not the same as saying you know exactly what it’s like to be in that person’s shoes. But nuance is so 1990s.
It is horrifying that people now have to add “of course I, as a person from identity grouping y could never ever understand or imagine how it must feel to be in the shoes of a person from identity grouping x”. So empathy across identity “lines” is now taboo. This is going to do wonders for race and gender relations.
Talk about the road to hell being paved with good intentions.
I don’t agree in the slightest that empathy should be eradicated, not least because if it didn’t have adaptive value, it would have been unlikely to have arisen and survived in nature (and would also seem to be part of higher-order functions like respect, love, etc.).
But like anything else, empathy — more precisely the display of empathy — can be exercised in bad faith, for abhorrent forms of emotional manipulation (watch especially for pictures of children). The manipulation should be eliminated.
Likewise, there are preening displays of “Look at how empathetic I am being” which are also in bad faith, since the focus is on one’s self, and not the putatively empathized-with subject (reminiscent of Dicken’s Mrs. Jellyby).
And the whole concept of ascriptive identities as essentially sovereigns is bizarre and ultimately self-defeating.
That said, empathy — at least for an INTJ like me — can be achieved through hard work and is very satisfying. I think it matters that you have “skin in the game,” instead of being, in essence, a tourist photographing the happy (or sad) natives. Empathy, I think, when coupled with action (not performance) produces good karma. Probably this is not very clear….
My own observation from experience is that these sorts of points are almost impossible to make to the general public and the media in a way that gets them across. (The same is true of almost any even slightly complex issue you care to name). This is a particularly difficult example for two reasons.
First, it goes against the grain of a liberal society where personal autonomy is the highest good, and the vocabulary of collective or social protection has fallen into disuse. It’s impossible to convince me that it’s in my narrow, personal, immediate interest to wear a mask. In fact, if I don’t wear a mask and everybody else does, I come out ahead.
Second, it’s inherently counter-intuitive. We normally wear masks to protect ourselves. Here, the general public has been led to understand that wearing a mask doesn’t provide any particular personal protection (most people are unable to follow arcane arguments about particle sizes) and that wearing a mask only protects others if you yourself are already contagious. Thus, it appears, the only point of me wearing a mask is to contribute to everyone, or almost everyone, wearing a mask, in which case everyone, or almost everyone, who is contagious will be prevented from contaminating others. Try making a 15 second sound-bite or a Twitter hashtag out of that.
In the end, the only effective message that can be passed is PLEASE DO THIS BECAUSE WE TELL YOU, DETAILS TO FOLLOW. But after fifty years of anti-government and anti-authority propaganda, deference to such suggestions is a thing of the past. After all, the government lied about WMD in Iraq, so they are obviously lying now, so why should I wear a mask?
In most countries, therefore, passing a message of this complexity which relied on trusting governments and authorities, was a non-starter from the beginning. Taleb doesn’t understand this because he doesn’t understand politics and government. It’s not “bureaucrats” who were behind the confused response. That response was partly based on the complexities above, but mostly based on embarrassment. Of all things, you’d expect a competent government to have stocks of simple things like masks. “Make yourselves masks because we forgot to buy any” is not an easy message to pass. In France, for example, the government prevaricated for weeks, and only advised wearing masks (it’s compulsory now) once there were stocks in the country, for fear of looking stupid.
Again, I’m not sold. Czechs are about as anti-govt as you get int he Europe and distrustful of the govt and all. CZ has the highest distrust of the EU in the EU now that UK is out, for example.
Yes, the mask requirement was sold here quickly and efficiently, and compliance is very high (way higher than social distancing compliance, I do a train journey every day and the compliance is pretty much 100%, the only thing tends to be the not-covered-nose stuff in about 5% of cases).
When a masked woman was beaten up by a guy in a supermarket’s parking in early March for wearing a mask, the revulsion in the society was extremely high – and in general, even liberarians here (and there’s a few of them around) would despise anyone who forces them to wear the mask as much as somone who forces them not to wear one should they choose to.
I have to say, I was stunned by the compliance with the mask rules, and as I wrote before, I believe that a large part of it was that all the elites (political, cultural and port) very visibly and very quickly 100% complied. From mid March till early June you literally could not see an unmasked person on the TV or in the newspapers, unless it was something shot before early March or a video share from their home. The state run TV instead of ads run edutaiments on masks, really very simple ones, and the “My mask protects YOU, your mask protects me” was everyhere and mask became “normal” within a space of a week or less.
I didn’t suggest that distrust of government was the only factor: it’s one of three (with complexity and hyper-individualism) that have particularly undermined the effort to get people to wear masks in the UK and the US. But it’s interesting that in France, wearing of masks (and social distancing), once introduced, were adopted quickly and almost universally. There were a number of tiresome pro forma human rights challenges, but the vast majority of people complied immediately, thanks to all those traditions of solidarity that M. Macron has been trying to finally kill off, and in spite of the well-known French tradition of bolshiness.
I wouldn’t necessarily categorise the UK (this may be true too of the US, but I can’t speak with any degree of certainty on that country so I’ll confine myself to just the UK here) as anti-government. It’s more that it’s cynical of authority, sceptical (through years of bitter experience at being hoodwinked) of experts and generally a culture if you tell it to do A, it will do B just to be contrary.
In short, while the prevailing UK culture doesn’t mind you telling it about your hunches and theories, unless you present something which will slap it right in the chops, you might get a polite hearing but then the average Brit is too lazy (as in, reluctant to change unless there’s an obvious pay-off then-and-there), too set in our ways and to autonomous to actually do anything, just because you’ve said so. There’s still a lot of Brits who were brought up on this sort of thing (the viewing and resonance of which probably perplexes and goes straight over the heads of most non-nationals who try to make sense of the place, which isn’t easy!) — and old attitudes die hard.
So in the face of not-overwhelming evidence supporting the proposition and contrasting that with what the public can directly observe — for example, Scotland, which has had no deaths for several days now or only one or two deaths in the past week but has done absolutely bugger all regarding face covering adoption and has a statistical COVID-19 impact which is pretty comparable to similarly-sized and located Ireland (despite following the UK’s non-existent protection of care home residents and late-to-the-party lock down) — it is, in the UK cultural context, a tough sell.
Your first para is something that would describe the average Czech pretty well, and has for decades (in a way, it was the way to survive the communist government).
Even the second para you could change the UK /Brit to a Czech and wouldn’t be far off.
Re Scotland – well, to my knowledge (PK?), Ireland didn’t introduce mandatory masks. it had “a guidance”, and a pretty confused message I’m told.
Irish population is half the Czech, and has more than twice the cases and five times the deaths. And that’s with the Czech Rep having literally high tens of thousands turists in the most hit Italian region during the last week of Feb (Lombardy and Italian Alps in general are very popular regions for winter school mid term).
Then I am at a loss to explain the dichotomy. Perhaps, and here I am theorising, CZ is going through the sort of phase that the UK went through 20 or so years ago, up until about 2010 whereby — after years of being the Bad Guy (and all-too-often the UK really was a Bad Guy — we desperately tried to please that unseen but yet all-too-discernible (although equally often imaginary) international-equivalent of “polite society”.
By which I mean, if I can express it in more live-experience terms, we wanted as a nation to be the girl who you’d have secretly wished you’d introduce to your stern and often critical parents to announce your engagement and that girl would be the girl they’d always dreamed you’d find and somehow (despite all the low odds) by some miracle persuade to marry you. Not the cute party girl type of country who wasn’t too bright and kept leaving her knickers in all the wrong places that we really are.
Eventually, we discovered that no matter how pious we tried to be, no matter how we tried not to bump into the geopolitical furniture and no matter how right-on hey-bro’-how’s-things-in-the-‘hood jive talk we tried to emulate to hang with the kool kidz, they were still going to think we were rubbish anyway. So we kind-a stopped trying after a while.
TBH, I don’t get it either. The phase you describe was in the CZ in early 90s, where everyone was excited about the fall of the regime and expected that within 10 years most of them would be driving Mercedes, spend holidays in Ibiza and have their own house. And then 10% of the population is subject to a court order (due to shark loans, with the average being 5 court orders if you believe it), although a non-trivial part of the population finally got within something approximating the original wish (ex Mercedes, Audi or even Skoda Superb seems to be just fine, and the house might have turned into a 2 bed flat in a new development, when if you’re lucky you don’t hear everything your neighbors do).
I really really don’t get it – but that’s why I’m saying that it’s likely more complex than we think.
Maybe you have more social solidarity than us atomized Anglos.
Compare and contrast Taleb’s position to Denninger’s the past 4 months. I will take the latter. First 40 minutes of his podcast yesterday is a nice summation. Preview: it’s not about masks, it’s about hand washing, toilets – and poop.
Let us know how it goes!
His written blog today has it all. Includes why meatpacking plants, homeless camps, Native American reservations and prisons have their various characteristics for contracting the virus and morbidly rates. Also includes comments on Japan and urban areas of South Korea with widespread use of bidets.
Another great day for a Long Run here.
An item on the teevee nooze this a.m. claims that masks with an exhalation valve Do Not protect others as well as plain masks – they are designed to protect the wearer only. The claim is that an infected wearer can still exhale potentially infected droplets through the valve.
Anyone else hear/read anything like this?
Adding to the reasons why public trust in “officials” is low regarding masks and other aspects of the pandemic:
“When American Airlines flight 341 to Los Angeles lifted off the tarmac at New York’s John F. Kennedy Airport on a cloudy Thursday in mid-March, much of the country was already on coronavirus lockdown. The flight was far from full, but the 49 passengers and eight crew shared restrooms, cabin air and a narrow aisle for the six-hour trip.
Though no one knew it then, a man in first class, a retired Manhattan surgeon, was infected with the virus. The day after the flight, he was rushed by ambulance to Cedars-Sinai Medical Center with a high fever and phlegmy cough. The virus spread quickly among those he had come in contact with in the hours after leaving LAX, including at a Westside assisted living facility where a 32-year-old nurse and a dozen others later died.
L.A. was still in an early stage of the COVID-19 pandemic when the surgeon’s flight touched down, with fewer than 250 confirmed cases. Local health officials regularly assured the public then that the county was investigating each case and engaging in aggressive contact tracing to control the spread of the virus.
Despite these pledges, no one in public health informed any of the passengers and crew who had flown cross country with the surgeon that they were at risk. The airline only recently learned of the case from The Times.” [italics added]
I think there was sufficient experience and understanding among pandemic specialists to know the value of masks in respiratory transmission — in particular because they produced much of the evidence to show it. What went wrong in the federal and local bureaucracies was insufficient power over decision making by the knowing experts and too much political influence. We are not getting the best information from the bureaucracies because of politicization and dismantling that has been happening. The public response is the result of scarce resources and public disinvestment being skillfully hidden as cultural schism for political reasons. It may seem like stupidity but it is actually an Orwellian calculation.
You will get more people on your side if you stop referring to others as stupid. It may temporarily relieve frustration but it is also putting up a barrier to other like-minded people.
Uwe Reinhardt had a tongue in cheek kind of humor when writing about health policy making. It brought readers along with him despite the awful policy making and cultural effects that he discussed.
I have the impression that mask wearing habits here in Boston took a dramatic turn this weekend. Some restaurants opened service outdoors. It looks so unsafe that I don’t want to walk by on the sidewalk. Parties on stools spill over into the street. A party on next door back patio was all shouting for about 5 hours. Gatherings in the park have fewer masks.
It’s as though we passed a point where we can all see that we’re going to half-ass being careful so we’re all going to get the virus sooner or later and, that being so, why not party?
I think one of the reasons a lot of Americans do not wear masks is that they are in deathly fear of appearing to be uncool. Masks show consciousness; consciousness is not cool. Masks show caution; caution is not cool. Masks show concern for others; concern for others is not cool. What is cool is a macho, careless, fuck-you attitude. This is a deeply ingrained cultural phenomenon, prominent in our politics, not a reasoned position, libertarian rants to the contrary notwithstanding.
“Marlboro Country” (!!)
There are many experts who think mask wearing increases danger of catching coronavirus. Hundreds of studies, from mainstream journals. Just dig around on any site skeptical of mask use.
Just one example:
“Masks can spread all virus, but coronavirus specifically. Exhaled viruses will not be able to escape and may concentrate in the nasal passages. “
Perlman S et al. Spread of a neurotropic murine coronavirus into the CNS via the trigeminal and olfactory nerves. Virology 1989;170:556-560. https://pubmed.ncbi.nlm.nih.gov/2543129/
(Sorry for reposting from reply to vlade above, but some may not reread earlier comment threads.)
I’m not sure I get the point?
“Exhaled viruses will not be able to escape and may concentrate in the nasal passages.“
So if an infected person breathes into a mask, the exhaled viruses will not be able to escape the mask? Isn’t that the point? Are they saying an infected person can get more infected than they already are by wearing a mask? I’m really not sure what this has to do with an uninfected person wearing a mask.
Sorry I’m not trawling through the link you provided without a better reason to do so.
I think they mean it increases viral load, and risk that you will actually become infected. Sans mask, you are better able to rid yourself of the virus.
Also maybe a concern that by collecting in nasal passage it leads to brain infection, maybe worse than just coming in by lungs?
How will/can masks work in K-12 settings? Interestingly, my principal informed us teachers that stay-at-home distance learning will not be considered for next year. We were told this in May. Even if we go with a hybrid model of some students at home and some on campus, can teachers and students reasonably be expected to wear masks all day?
San Antonio currently has the highest virus case numbers and hospitalizations we’ve had since this nightmare began.
An anecdote for you, to illustrate the pitfalls of « magical » mask wearing :
The gym in my building has just reopened (in Malaysia, supposedly a success story thanks to mask wearing attitudes). I was longing for it because, just as Yves and Nassim, I need my dose of weightlifting to stay healthy as I age.
What about the use of masks ? Well – and I am not joking – the instructions posted at the door is that mask is made compulsory except when one exercises !!!, so essentially, while one is preparing weights for a lifting set, one must wear a mask, but a dude five meters away breathing heavily on the treadmill unmasked is OK. Also, one is not supposed to grunt when lifting… Mask masquerade indeed !
This illustrates the compliance problem I keep on pointing at : mask wearing « à la Taleb » (as in his picture) is not sustainable in time (people become eventually resistant to compliance out of the annoyance it creates) and space (there are some activities where mask wearing is resisted to, even today). It is better to aim for permanent and universal, even if possibly less efficient, behaviour change.
For those interested, I keep my mask on the whole time I stay in the gym room, with nose uncovered so that I can do my sets without blowing a fuse. I also quit the room immediately if someone starts to use the treadmills ! I do the same with lifts : if I am not alone in the lift, I simply don’t use it.
My gym has made a point of limiting how many go in at once, and the treadmills/cardio machines have an eight foot aisle between them, with most machines well behind that asile and (only a couple) of weightlifting stations, and the others have been spaced way apart, more than 8 feet apart. But most gyms aren’t going to those lengths.
The one sure thing is that coronavirus risks are not spelled out clearly anywhere. Being elderly, if infected, I have roughly a ten percent chance of dying. Being supplied by Amazon and avoiding contact with others; I have not been hospitalized yet. I’ve had symptoms like diarrhea and aches and pains but they go away and there is no need to risk getting tested.
Nations that controlled the virus stopped foreign arrivals early, society wore masks, traced contacts and isolated the infected. Masks help. They reduce transmission. But if the infected are free to move about without masks, I am not protected even if I wear a mask. Since there is no universal use of face masks, testing, tracing or quarantines in the USA, I am playing Russian roulette if I have contact with others. It is just that the number of chambers is unknown.
I am incarcerated at home for almost five months and have contracted Trump & Biden Derangement Syndrome. I can’t leave unless I am really sick or in pain. I think most prudent people will have figured this out. It means that the economy cannot recover until there is a vaccine or until Washington DC reconstitutes the federal public health system and requires universal testing, contact tracing, isolation of the infected and mandatory wearing of masks. Then we know it is safe to go outside or not.
This is all on the Elite. They have purposefully divided the USA. Donald Trump followers are the ones not wearing masks and buying tickets for the Tulsa Rally. The Democrats are hiding in the basement. Western oligarchs neutered the democratic governments into total incompetency to end taxes and regulations. As a result, Americans are dying waiting for the pharmaceutical industry’s for-profit patentable vaccine.
Something like this debate about masks could never have happened in pre-internet society. If the coronavirus pandemic had happened in 1990, governments would have made a decision and broadcast it on TV, radio, in newspapers, on billboards and in mailed information. Almost all people would probably go along with the government mandated “rules” if they passed the common sense test.
The internet as it presently exists has become a kind of curse that encourages echo chamberism, farcical contrarianism and fragmentation. Instead of using the internet as a tool to complement life, we have let Big Data sell us a system of screen mediated communication networks that replaces human interaction and community with an inferior but hyperreal facsimile of what we used to have.
The oligarchs who control these companies get their wealth and power from covertly spying on us, psychologically manipulating us and monetizing our attention span, thoughts, desires, vulnerabilities, and any other data they can collect.
The “social” media/smartphone revolution of 2007 onward has gotta be the biggest bait and switch scam ever undertaken. A hyper individualistic neoliberal society combined with the internet in its present form truly is a match made in hell.