How the pandemic might play out in 2021 and beyond
nature.com
nature.com
Disease experts are very cautiously optimistic over a period of years. Economists are in sharp disagreement whether we will see a quick or multi-year recovery, with a few dissenters pointing out the the economic effects could last decades. And politicians seem to have unbridled optimism, which to an outsider can only be explained by access to a persistent vault of champagne.
It's very easy to blame the politicians, the average American has led a largely comfortable, coddled life and is unprepared to hear anything negative. Politicians are also sales-persons and they tell the public what it wants to hear.
That's because it's a sure fire way to get elected in a democracy.
I post this as a segue into the general observation that there's still way too many people speaking about hypotheticals as if we're not six months into this process, and have plenty of concrete data to consult rather than theory. If the purpose of X is Y, we are not in a place where we should start doing X to get Y; we are in a place to look to see if X got us Y. In this particular case, it apparently did not.
(It's also not a great time to say "Well, X would have led to Y if we just X'd harder". In a good chunk of the world, we X'd as hard as we can. If we didn't get Y, it's not something you're going to get in the future, either. That is something we have to accept and deal with, not wish we could just X harder.)
A good chunk of the USA very explicitly did not "X" anywhere near as hard or smart as they could have.
Besides, lockdowns, which have never really been done like this before, may just be something that can not work. You can't suddenly demand that everyone in a society be in the 80%th percentile of conscientiousness, and also be just hunky dory with not going to work anymore and being under effective house arrest for extended periods of time.
This is probably one of those cases where HN is not equipped to make an accurate assessment, being exceedingly preferentially chosen from high conscientiousness and college-educated populations (as, if nothing else, college indicates a certain amount of discipline). If you project yourself and your peers out onto society, you are going to grossly misunderstand the real society. Plans to avoid contagion need to deal with the society that we have, not the one we want.
Luckily, this virus is not making us zombies, or killing our children. It's killing our elders and people with a weakened immune system; it's sad but it's great. It could have been a lot worse.
The paper cited by the nature article does not explicitly consider masks or hand washing. It combines all measures recommended by the Mexican government, and makes a broad assumption about their overall effectiveness:
https://www.sciencedirect.com/science/article/pii/S002555642...
All of the models for handwashing and masks that I am aware of have made blithely optimistic assumptions about their effectiveness. The WHO meta-study of masks, eye protection and social distancing found that masks overall had an odds ratio of 0.33 - and most of that evidence came from N95 respirators, used in hospitals, for personal protection:
https://www.thelancet.com/journals/lancet/article/PIIS0140-6...
We have essentially no evidence that non-respirator masks, in the hands of the public, does anything at all:
https://www.cebm.net/covid-19/masking-lack-of-evidence-with-...
(Edit: as per usual, factual discussion of masks is censored on HN. This is not a political debate! I have provided links to legitimate scientific resources to support all of my arguments. Consider your bias before reflexively jabbing the downvote button.)
We have tons of evidence. Countries with high mask compliance have done a much better job of containing the virus. It's difficult to determine if it's causative or coincidental so it's not conclusive, but it certainly is evidence.
If you think there is additional evidence that they have not covered, cite it.
“Countries with high mask compliance” is not a definable parameter. Japan was held up as a “mask-wearing country”, but is currently in the midst of a major outbreak. Hawaii is locked down again. Singapore has had recurrent outbreaks, despite widespread mask use. Sweden and the Netherlands do not require masks, and have brought their epidemics under control.
Any attempt to draw conclusions based on what happens to a country after passing a mask rule, is an exercise in post hoc fallacious reasoning.
"We have essentially no evidence"
And then you provided links that contain evidence. It may not be persuasive or conclusive, but there is evidence.
We have some evidence that they’re almost completely ineffective in the hands of the general public, some that they may be actively harmful (the only RCT ever performed with cloth masks showed that those who wore cloth masks were 13 fold worse off than those in the control arm), and some studies that show modest positive effects when N95 respirators are used by doctors in hospitals.
If we are discussing “face covering” rules as enacted by governments today, which include everything from bandanas to paint respirators, then no, there is no supporting evidence.
> the only RCT ever performed with cloth masks showed that those who wore cloth masks were 13 fold worse off than those in the control arm
I think you're referring to this study, please confirm: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4420971/
"The aim of this study was to compare the efficacy of cloth masks to medical masks in hospital healthcare workers (HCWs)"
You misrepresent the study in three critical ways:
1. You fail to note that the "control arm" was use of medical-grade masks, as opposed to no mask at all.
2. The study explicitly did not include a no-mask arm, as that would be ethically problematic. Their "control" arm actually consisted of "standard practice, which may or may not include mask use. Standard practice was used as control because the IRB deemed it unethical to ask participants to not wear a mask". The increased infection risk of cloth masks could be due to harm caused by cloth masks, benefit conferred by medical masks, or most likely both. As the authors point out, this study cannot determine this.
3. The study focused on healthcare workers, whereas the question at hand is whether convincing big portions of the general population to wear cloth masks in public enclosed spaces works.
Fun fact: the same authors of this study have submitted a follow-up article which is available for early release: https://wwwnc.cdc.gov/eid/article/26/10/20-0948_article
They write that "wearing cloth masks should not be mandated for healthcare workers. In community settings, however, cloth masks may be used to prevent community spread of infections by sick or asymptomatically infected persons, and the public should be educated about their correct use."
In other words:
- the mask RCT you referred to doesn't support your agenda of insisting that community use of cloth masks doesn't mitigate the spread of respiratory illness
- the same authors of that study have directly refuted your claims in an upcoming publication
You aren't being downvoted because the left-leaning HN hivemind is reflexively jabbing the down arrow because you're telling them something they don't like. It's because you're flat-out wrong.
> We have no evidence of positive effect.
Demonstrably and categorically false. I'm starting to wonder if you're trolling HN on a Friday morning; if so, congratulations.
If you aren't a troll, please review this body of literature helpfully curated by smart people who give a damn:
1) the study in question had a control arm of voluntary compliance with surgical masks. These are neither “medical grade”, nor was the compliance rate verified.
2) Regardless, it doesn’t matter: cloth masks were significantly more harmful than the control.
3) I agree that we should be careful to discriminate between studies of respirators, masks, “face coverings”, PPE and source control. So you should take the time to actually read the studies that Jeremy Howard cites. You’ll find that nearly all of the studies on masks are for respirators in medical settings, and that (as the CEBM link confirms, if you bothered to read it), the few studies of mask use by the general public have had ambiguous or negative outcomes. It isn’t even close: if you omit the studies conducted in medical settings, there’s almost no evidence for masks at all.
4) The CDC link isn’t a scientific article, it’s a review. Moreover the authors are clear that they are not contradicting their previous findings:
” To our knowledge, only 1 randomized controlled trial (4) has been conducted to examine the efficacy of cloth masks in healthcare settings, and the results do not favor use of cloth masks.”
The authors are explicit that cloth masks are unsupported, possibly harmful, and only to be used as a last resort.
You really should read the links you cite before you make strong claims about what they say.
You do realize that's an extremely important distinction. A shitty mask in use by a medical professional will do more "social" good than a good to great mask used by a moron (the general public).
A way to prove that, how do you wash your hands. Unless you're a medical professional or know of one, you've probably been doing it wrong to prevent the spread of germs. Look up how a surgeon is supposed to wash their hands. One important note, put your hands up so the water drips down your arm instead of to your fingers. Germs flow with the water, so the idea is, they can get locked into the creases in your fingers if they drips down there. People just "wash their hands longer"... which is not that effective to the proper way of doing it.
The masks... good God... the people who yell at folks not wearing masks typically have their nose exposed.
But hey, there's then the fact of infected moisture droplets on your clothing. Depending on the study, it can live for some amount of hours. Especially after it was found to be airborne anyways. A tshirt being pulled over your face with covid on it, that's okay?
Look, it's more that this whole thing is far more complicated than the general news has us believe. Perfect action to stop the spread by "the general public" is sort of like wishing for peace on Earth. Yea, we can do our little bongo circles and poster signs with glitter, signing whatever stupid treaty in random city... there will still be war. There will still be tons of people spreading whatever contagion because of not understanding the fundamentals of germ prevention. Which no one will ever bother learning or doing. To be fair, the whole process of perfect prevention or at least truly effective is super difficult and requires constant dedication without fail.
Yes, it'd be nice to get R to 0. But any number below 1 is good enough.
And don't get me wrong, I technically want to be wrong. But science and human nature butt heads. People are human, perfect lab conditions don't imitate human actions that well. Relying too much on lab condition results and ignoring the idea of, "How will Joe Schmoe fuck this up?" means you wasted lab time.
Hell, how many UI folks here? Or any programmers that have to deal with user testing? In your perfect locked away testing, everything is "perfect". Admit it. You think you solved all the ways users will screw up. Then it goes out into the wild, only to find out how incredibly stupid humans are. How many times have you said, "That's not the way you're supposed to use that!" regarding software and a random person?
Why is the HN community so willing to think this behavior doesn't apply outside computers?
This is blatant misinformation. Masks work. We've known this for over a century. Using masks to control respiratory disease is one of those cool public-health hacks that almost sounds too good to be true, but if enough people do it, the virus stops burning through the population.
https://en.wikipedia.org/wiki/Face_masks_during_the_COVID-19...
You aren't so much being "censored" as just downvoted into the oblivion where a factually, empirically, and dangerously wrong statement like "We have essentially no evidence that non-respirator masks, in the hands of the public, does anything at all" belongs.
Your link is a website made by a guy who teaches online ML classes, has no relevant expertise in science or medicine, and blatantly mischaracterizes the papers covered by the CEBM link.
I suggest you read the evidence I’ve provided, before concluding the matter is settled.
Except that its not really a pressure, but a social contract.
'I am sick so the least i can do is wear a mask while outside to protect others. So others do the same.'
Win-win.
Such as an agreement for racial harmony.
- As time has gone on, we've learned more about the virus, how to prevent it and how to treat it, leading to a much lower fatality rate. If there were no lockdowns when New York City was facing the worst of the virus, the outcome would have been much, much worse. This trend is continuing, and there's no reason to assume that we won't continue to get better at treating it, so slowing the spread until it's less of a problem saves lives.
- Even assuming that we know everything there is to know about COVID, we will get no better at treating it, and vaccines aren't going to work, the best way that we DO know to handle outbreaks of COVID-19 (extensive contact tracing and quarantines) are impossible solutions in places like the U.S. where the infection rate is high enough to make contact tracing a pointless exercise.
People aren't poo-pooing the lockdowns because it's the chic thing to do. The impact is becoming worse than the virus itself. The WHO in January 2020 said with 80% compliance in social distancing and hygiene, the USA will have 2mil deaths by around july/august... yea, compliance was no where that high.
This was all about flattening the curve so hospitals weren't overloaded at once, which was fair. We are past that. So much so, hospitals in the usa have been shutting down in summer because they haven't been able to fill beds. Something like this should have been able to keep them operating for longer if they were at constant capacity.
I've said it before, 1 death is 1 too many. But at the same time, I dont see victory when the global society lives in perpetual fear and hardship either and decides to just kill themselves, literally.
Right now global death numbers, covid doesn't make the top 10 causes of death in the world. You are statistically more likely to die of a diarrhea related illness than of covid. No one cries over the 2mil people, every year, dying of that. Which for the most part, is extremely preventable if the world community actually gave a shit.
Sure its been tough. But not as tough as millions dead.
Next part, is it still winning if more people commit suicide due to the countermeasures than the amount of deaths of covid? Or are you someone that believes less humans is good all around?
I get hindsight will always be 20/20. But when do we all stop with the political fear mongering and adjust actions? Theres this weird moral high horse mentality in folks who are uber fearful of contracting covid.
Click on US on the left; look at Daily Cases on the lower right. That's what we did - stopped geometric growth. Never mind models.
You could make the case that lockdowns are not a net good but I think you will have a really hard time convincing anyone that the harm that comes is like the harm of experimenting on humans.
Meanwhile, lots of other countries have locked down more seriously, held firm until the virus was under control, did good testing and tracing as they eased up, convinced people to make some small effort to protect each others' lives by wearing masks, and now are opening their economies without having to accept endemic disease and mass death.
I was in the grocery store line yesterday. A lady in her late 50s behind me said “how long is this going to take?”
I thought she was asking about the line, so I said “maybe 2 minutes”
She responded “No, I meant the virus”
I told her “I have no idea, I hope it goes away soon”
The social distancing is having a negative effect on people psychology in my opinion.
Something good that can come out of this is a better way to develop vaccines and testing technology.
Another possibility is that immunity to SARS-CoV-2 is permanent. In that case, even without a vaccine, it is possible that after a world-sweeping outbreak, the virus could burn itself out and disappear by 2021. However, if immunity is moderate, lasting about two years, then it might seem as if the virus has disappeared, but it could surge back as late as 2024, the Harvard team found.
I'm always amazed when I need to go into the city by how few people there are on the train. There's a significant decrease, my personal impression is something like -50%. I can't tell whether it's people being afraid and avoiding public transport, most of the entertainment venues being closed or limited so there's nothing to do downtown, or some other reason, but it feels like there has been a lot of really-not-necessary traffic and it's highlighted now.
It isn't though. It might seem that way to people in cushy software development positions in the valley, but I don't believe that is happening very many other places.
It might be an upside for some people but it is definitely a downside for others.
PS: I've worked from home for more than 10 years, for several companies.
I know that I personally have been a lot snippier with people as this has gone on and on.
Honestly at this point the only thought I really give to Coronavirus is that I wear a mask at the grocery store as a courtesy to others.
We avoided all our friends from March - July. The past two months we've started just seeing them as normal. It's been beneficial for all of us.
But at the same time, we used to go to a coffee shop as a family every day for lunch. Haven't done that in six months. Don't know if it's a habit we'll pick back up or not when someday things go back to normal. On the one hand, we spend a lot less money. On the other hand, we miss out on a lot of spontaneous interaction with our community.
On the same note, we used to be pretty involved in our church. We went weekly, had our kids in Sunday School, went on Wednesdays during Lent and Advent.
Now? Haven't been in six months. Thought about going back, but they (fairly) care more about avoiding any possibility of risk than getting bodies back in pews. I have no desire to make three preschools try to sit through a church service wearing masks and not interacting with anyone.
My prediction is that the lockdowns will be absolutely devastating to religious observance in the US. At the very least, I expect it will drive a lot of already financially-precarious churches to permanently close their doors.
This should be something we can determine in the near future right? If the outbreak started in China in mid or late december, then early infectees of the virus should already be around week 35 or so.
You might be asymptomatic now but what about 15 years from now on?
I dont think we should allow more viruses to become endemic and as widespread as flu or cold.
Imagine a world where it's highly probable that you will catch a virus that will make your life miserable even for a short period of time.
I think just a mere existence of flu or cold was a mistake. We should have eradicated those years ago.
er.. how?
It's not clear to me how eradicating these would have ever been possible in the past, or will be in the foreseeable future. The flu has (probably) been around since at least 6000 BC, and numerous strains can be spread by birds & many other species.
It would be possible but we just never really tried.