CDC Weighs Advising Everyone to Wear a Mask | Hacker News Reader

CDC Weighs Advising Everyone to Wear a Mask

nytimes.com

29 pointsfortran7714 comments

"masks don't work" and "save them for health workers" was always nonsensical and covering for the fact we had not prepared for a known threat. I don't just mean Wuhan in January, but pandemics generally were a known problem. It's not a black swan event. I get the "noble lie" argument considering the situation we found ourselves in, but that has long term consequences, seeds confusion and erosion of trust.

Asian countries have shown the way here. Let's get moving on adopting social norms and habits around mask usage.

The erosion of trust also means telling people not to panic buy becomes less authoritative, and it’s giving credibility to extremist theories. Noble lies are a kind of moral credit card.

"Masks don't work" and "save them for health workers" was always nonsensical and covering for the fact we had not prepared for a known threat.

Of course it was.

But they weren't considering the possibility that the people they were charged with "protecting" would be capable of independent thought.

I don't think the CDC/WHO recommendations started as a noble lie, just as a medical/bureaucratic orthodoxy, consistently expressed before any shortage.

The orthodoxy drew too sharp a distinction between airborne and droplet modes of transmission, it didn't anticipate the possibly extensive asymptomatic spread of this new virus, and it tried, given the low bandwidth of public health messaging in the old days, to speak simply and authoritartively in favor of the interventions with the strongest evidence for the largest effects. Even to healthcare workers, the emphasis in the setting of something like flu was on handwashing. Masks in clinic went on coughing patients, not us. For a public less consistently exposed, the number needed to mask to prevent a single infection was judged too low to bother. Masks in Asia were seen as public health theater, like spraying fog machines in the streets. And maybe most dangerously, most complicating a reversal, expressing an understanding of this mildly counterintuitive finding - covering faces doesn't stop respiratory viruses - was taken as a mark of scientificness. (And remember, it's still largely true, the effect is probably fairly small, N95 or cloth mask no matter. The virus spread well in places with mask-wearing, and dampened more quickly there for reasons other than masks.)

The CDC/WHO people are under pressure to change deeply held and strongly stated beliefs in public, and then to live with the implication that their confident error cost lives. Relative to that, communicating that we should wear masks, but leave the respirators for medical workers, is easy peasy.

For fun background on the orthodoxy, including a case where a single flu patient infected dozens of people on a plane in the 70s without managing to persuade people of some meaningful amount of airborne/fine aerosol spread: https://twitter.com/rkhamsi/status/1244659064350670848?s=19

>One concern, which Dr. Anthony Fauci, the director of the National Institute of Allergy and Infectious Diseases, voiced in an interview with CNN, is that such a recommendation could cause even worse shortages of N95 and other medical masks for health care workers, who need them most.

If there is indeed a scarcity of masks, isn't this question a no brainer? Of course the masks should be allocated to hospital workers, who are exposed to coronavirus for 8+ hours a day, rather than everyone else, who might only come in contact with the coronavirus some part of the day, if at all.

Also, if there's a scarcity of masks, is there a reason why existing supplies (eg. in warehouses) or incoming shippments can't be commandeered/seized by the government under eminent domain?

Non-N95 and DIY masks are also very helpful, but the dogged "you only need to wear one if you're sick or caring for someone who is" advice discourages even this level of prevention, and makes the disease seem less serious and contagious than it really is. It's counterproductive to lie and say "masks don't work" when what you really mean is "we need N95 masks for frontline workers."

I'm increasingly of the opinion that there's no such thing as a "no brainer" when it comes to giving instruction to a broad group of people (and "broad" might be as small as n=10).

You know the rules of program optimization? (#1 Don't #2 (for experts only) Don't yet). I suspect that illustrates the issue that experts are having here. Yes, in any program there are optimizations to be done that can change margins that matter. But without deeper experience even the average practitioner is unlikely to have good judgment about this. So the experts have to balance the effectiveness of higher-resolution explanations where details will get lost in translation (likely degrading any marginal gains to be had) with a low-resolution blanket rule that sacrifices potential gains for an acceptable average.

Several kinds of masks appear to be several degrees of marginally effective, but it's probably very difficult to give this guidance to the public without some segment of it hearing "I need N95 masks" and scrambling after supply, because "Any mask might be helpful to get me to be conscientious about touching my face and provide a marginal droplet barrier, N95s are for people spending time with the sick" is a higher resolution message that's subject to a lot of social/individual entropy.

There's a shortage of N95 masks, but even a home made mask works wonders. If you are infected and wearing a mask, when you cough, your chance of infecting others is much lower.

Previous discussion: https://news.ycombinator.com/item?id=22734159

Finally some sanity from CDC. Early on there's evidence that people got infected but they didn't know it, yet they can infect others. The only logical conclusion is everyone should wear mask. See the Asian countries that are doing that got the virus pretty well controlled. I was surprised CDC didn't err on the safe side.

You don't need to recommend everyone wear N95. Surgical face masks or homemade masks works too.

The ship is sinking and there aren’t enough lifeboats.

History doesn’t repeat itself but it often rhymes

They are likely waiting until there isn't a supply issue. People will rush out to buy masks of all types.

any face covering helps though.

one positive is that universal mask use will make facial recognition a lot harder.

Which is handy until you actually need the police to find an actual criminal.

well widespread facial recognition technology has only just recently been available to law enforcement and the police have been catching criminals since their inception. it might be a useful law enforcement tool but it is hardly a requirement for them to be able to catch someone.

Reply on news.ycombinator.com