Government Covid Response part 2: Masks

 In an earlier post I talked about the lockdowns and I expressed the view that I think it's very unlikely that stay-at-home orders like those issued in Early 2020 will ever be imposed again.  In this post I'm talking about masks and I'll start with the opposite conclusion: it's very hard for me to see a time when masks are not required (or at least the norm) in at least some circumstances.

The mask orders came about several months after the "social distancing" and hand-washing recommendations.  Together, these formed the unholy trinity of covid response and any deviation from their teachings was regarded as heresy.

Well, not really,  Of the three, masking is by far the most controversial, and it's also the most visible.  No can really tell if you are washing your hands frequently enough, or even correctly.  I personally never washed my hands more that usual.  And social distancing is kind of obvious but kind of not.  Are people standing in line at the grocery store social distancing or not?  But everyone can tell if you're wearing a mask, or wearing it improperly.

And everyone wanted you to wear a mask.  The media would show up at any event that wished and count how many people were wearing a mask.   That actually happened over and over. The CNN link is designed to dunk on Trump, but they made a career of dunking on Trump and any stick was good enough to beat him with.  But even on the local news, the reporters would count up who was and wasn't wearing a mask. It was almost like news reporters had suddenly been replaced by fashion reporters at the Oscars.

It was, in short a mark of tribal identity. Those wearing masks were proud of the fact that they were "following the science" and looked down on those not wearing a mask as "science denying" morons or worse.  Those that didn't want to wear a mask were proud of their defense of liberty and looked down on the mask-wearers as "sheeple" or worse.

Today, as I write this, there are no nationwide masking orders in place except the CDC still recommends (or requires) masks at doctor's offices.  Which leads to the strange circumstance of getting a prostate exam with your pants on the floor while wearing a mask (the doctor might appreciate HIS mask, in that case...).  According to this website (which I'm too lazy to double check) six states still have mask orders: Hawaii, Illinois, Nevada, New Mexico, Oregon and Washington.  It is my contention that masks will be required in some circumstances (ex, at the doctor, specifically, the doctors and nurses even if not the patients) for a long time to come.  Maybe forever.

But back to the masks.  It's a cliche to say that the mask order's have been inconsistent.  Originally, the medical bigs (for instance, Anthony Fauci and Surgeon General Jerome Adams) told people to NOT wear masks.  Infamously, in late February 2020, Jerome Adams tweeted "Seriously people: STOP BUYING MASKS", only to reverse that a month later.  The purported reason was that the "science" wasn't there and there was a fear that people would hoard masks.  (People hoarded toilet paper so I guess there was merit to that fear).

Now as an aside, that never bothered me.  I work in a sort-of scientific field (as an engineer) and we change our theories about various problems that come up all the time as new data comes to light.  And I'll say that some people are better than others when it comes to incorporating new data into an existing working-model.  Sometimes you have to scrap the fix you originally proposed, sometimes you have to modify it and sometimes you have to keep it as it is but add an additional fix because there are more failure modes than you expected.  It happens. You have to be flexible and do what the data says.  I don't expect anyone to know exactly how to deal with the virus two months after it was discovered.  A little humility would go a long way, however.  "Seriously people: STOP BUYING MASKS" sound pretty definitive.  And when you reverse that and start blaming everyone who got sick for their lack of mask wearing, you'll destroy your credibility.  And I'll again raise the issue that "slowing viral spread" should be a well-honed skill given the annual experience we have with the cold and flu.  But with the rona, you'd have thought no one ever saw a virus before.

But before we get to the science, there's a question of logic.  People wanted to wear masks because doctors and nurses sometimes wear them. And some cultures (like the Japanese) wear them.  So if masks help medical people, why won't they help non-medical people?  And, for that matter, why do masks help medical people?  Your normal nurse doesn't wear a mask when taking your temperature.  But they do wear a mask when operating.  Or cleaning teeth. So masks only work when around blood and mucus membranes? Do the nurses and doctors wear masks to protect themselves or the patients? 

And when the stance was reversed,  it was due to the science.  But what science?  What's the relative risk of catching the rona with a mask vs no mask? In fact, what the relative risk of catching the rona at all?  If a rona-positive person spent 5 minutes or 10 minutes or 30 minutes in close proximity to a non-infected person, what are the odds of infection?  And what are the odds if the infected is wearing a mask? If the non-infected is wearing a mask? If both are?

No one knows.

Early on in the mask regime, it was speculated that the mask was more to prevent the transmission of the virus rather than breathing in the virus.  That is, it was more important for the infected to wear one rather than the non-infected. 

But there is no science that I've ever seen to justify that.  There are several retrospective studies that show that when masking orders were put in place, the viral spread slowed down.  But those are problematic for several reasons.  Viral spread goes up and down regardless of public orders.  It seems to me that a local viral outbreak normally takes about 2 months to go down.  So any masking order has to be viewed against that: was the viral outbreak near its end anyway?  And of course, you can't state with certainty that a viral outbreak would have happened if people weren't wearing masks.  Even in very local areas viral outbreaks don't always coincide.  The DFW area is practically one continuous urban area yet Fort Worth and Dallas often had relatively different viral outbreaks (Dallas higher than FW one time, FW higher than Dallas another, one outbreak rises and falls at different times than another).  If Dallas generally had harsher masking orders than FW, it's hard to see the impact.

The chief argument against masking is that the virus particle is way, way, way smaller than the openings in a cheapo cotton mask (and during the mask regime a cheapo cotton mask was a definite upgrade from the bandanas and scarfs you sometimes saw).  But even that is lacking in science.  A lot of what people exhale is moist air: as the fog on my glasses can attest. So how many viral particles are in the water droplets and how many are free-floating in air?   And the breath has to go somewhere.  If it goes down, presumably the viruses end up on the floor where they aren't breathed in, but what about the ones that go up (and on my glasses)?  And even if a bunch of viruses are in the water vapor, are enough present in raw free-floating viral form to infect a person?

No one knows.

When discussing the Physical Activity Guidelines, I mentioned that there's remarkable agreement on the recommendations.   One could  turn that around and say that there's too much agreement.  There's an old saw that if two co-workers always agree, one of the is redundant.  What about 100 doctors that all agree on "150 minutes of physical activity per week".  Is it reasonable that all 100 doctors reviewed the evidence that 150 minutes is the appropriate target?  Or is it reasonable to assume that they are just going along because it sounds good?  Or is is reasonable to assume that maybe 5 or 10 or 20 of those doctors think the recommendations are nonsense but are afraid to say so because of peer pressure.  I mean, who's going to stand up and say exercise is a waste of time?  Everyone knows better.  Or should, right?

I suspect a lot of that was present with the masks.  If everyone is saying that masking is essential, then my BS-meter starts ringing.  Anyone who's been at work trying to get 3 of their coworkers to agree on lunch should be suspicious of every health person from the government, to doctors and nurses and pharmacists, to idiot reporters, to the quacks on TV all using the exact same words to extol the miraculous virtues of ... anything, including masks (or exercise, for that matter).

When I was writing about the Dietary Guidelines, I mentioned that the USDA only grudgingly released the scientific research that supports their guidelines, and some of the research they did release was underwhelming.  Yet they confidently proclaimed a brighter future if the guidelines were followed.  There's definitely a "trust us" aspect specific to those guidelines. "We did all this work, you can trust the conclusions.  Just look at all the work we did.  So you can trust us when we say what we say because you know we did all the work and you can trust us to be honest" is the tedious, bureaucratic message that pervades the documents.  And that is definitely the case with most of the coronavirus requirements in general and masking in particular.  "Just trust us."

And yet, it doesn't have to be that way.  This researcher is generally supportive of the guidelines but not so supportive of the way it's presented.  That's fair.  And there's plenty of room for polite disagreement about wearing masks: how masks are worn, what kind of masks are worn, how long masks are worn, in which circumstances masks are worn.  But we got none of that.  It almost seemed that there was a reluctance to dilute the message.

I started out this endless series postulating that every health initiative (or every public initiative) has to have a blend of marketing and science.  And I further specified that the message needs to be easy to understand and easy to follow.  "Wear a mask" is easy to understand.  "Wear a mask, but only this type and only in specific circumstances and only this way" is harder to understand.  And if you put out there that masks aren't required in some circumstances you run the risk of people expanding that list to include everything they do during the day. It's easier just to say "always wear a mask".

But that's not science.  That's marketing.

So do masks work?  Again, due to the differences in demographics and seasons and everything else, I don't know if we'll ever know for sure.  My own opinion is that they probably help a little bit, but perhaps not for the reason the doctors told us.

• I am certain there's some amount of virus that is in the moisture droplet that mask block or redirect.  And that redirection may cause some aerosol viruses to also be swept to the floor.  That may reduce the number of viruses exhaled by a measurable amount.  And that might reduce the number of people that get sick.
• Masks are unpleasant to wear for many people, so the requirement to wear them will cause some people to stay home instead of going to the movies or going to a restaurant. It may cause people to use pick-up or delivery services for groceries or other necessities. And that will limit human contact and probably reduce the spread of the virus.
• For many work-from-homers they had the option of going into work, but if they did, they'd have to wear a mask.  They may not feel like doing that and continue to work from home, or at least limit the amount of time at work.

So I think masks probably helped a little.  But what what the downside?  

• Masks were kind of nasty.  People would get a cloth mask and wear it for months without ever washing it.  That could cause a build up of other germs in the mask.  Maybe the fresh rona germs in the wearer's body would be blocked or redirected but he'd blow left-over cold germs in your face.  Or maybe not, but it's still kind of gross. 
• A lot of people don't like them.  They might feel claustrophobic, or just find it itchy and uncomfortable.  So they would suffer accordingly and the people around them would suffer from the complaining and fussing.
• The smug and inconsistent guidance about masks unleashed an army of "Karens", so-called mask warriors, proverbially young-to-middle-aged women who would shout and scream and people not wearing masks, or not wearing them correctly.  And it also caused a backlash of people (not given a handy name for some reason) of people who didn't want to wear a mask screaming at shop clerks or flight attendants trying to enforce a mask mandate.
• I sometimes wonder how many problems were caused by poor communication.  Some high percentage of communication is supposed to be non-verbal so wearing a mask will limit that. Also a person's voice is muffled with a mask so that prevents effective verbal communication.  I don't know what problems that caused, but maybe in schools it was an issue and maybe at work.  Or maybe it set off the Karens mentioned above because they couldn't tell if someone was joking or not.  But I think it hurt interactions at some level.
• At some point they just seemed stupid.  People would wear a mask in the park, or on the beach, or at home.  People would be wearing a mask alone in their car, which I understand is likely due to the fact they just forgot to take them off.  But Masks! Masks! Masks!  It was kind of infantile, like a child clinging to a blanket.  It was just annoying to see.
• Masks can give a false sense of security.  Someone might do something undeniably risky because they think a ten-cent paper mask will block all viruses.

So overall, were they worth it?  Did the benefits outweigh the problems? I honestly don't know.  Of all the restrictions, masks didn't bother me that much.  I work in a semiconductor manufacturing place and am at ease gowning up from head to toe: including wearing a face mask.  However, I also know that a lot of people freak out in those suits, so I have sympathy for people that mentally can't bring themselves to wear a mask all day.  When Texas lifted it's mask mandate, I posted a video on Facebook of me burning my mask, but now 6 months later I'm still resigned to the fact that I'll probably always have to wear one in at least some settings.

I wish it wasn't so.  The rona broke a lot of people.  It shattered their sense of security.  If masks help them get some of that security back, then I guess I don't care.  But I don't like the fact that masks became THE weapon against the virus.  Maybe it's just my contrarian nature.

I guess I just don't like "trust me".