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Comment by neilwilson | Hacker News Reader

The reliance on unusual concepts - like asymptomatic transmission and the effect of wearing masks which have become semi-religious in their belief even though there isn’t really any actual solid RCT evidence they do that much good out in the field rather than in the lab (much like hydroxychloroquine which is similarly effective in a lab but not in the field). There is no blow out in Texas et al and Sweden has just tracked the same path as everybody else suffering much less than Belgium for example, and today isn’t anywhere near the top of the charts.

There’s an awful lot of curve fitting to beliefs going on - because it is so difficult to do solid experiments.

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> ...wearing masks which have become semi-religious in their belief even though there isn’t really any actual solid RCT evidence

My favorite example of how it's become semi-religious is people wearing them on outdoor walks in the suburbs where, worst case, they'll with within 6 feet of someone for a total of 30 seconds. The virus spreads very poorly in those conditions. Ironically, you're more likely to get the virus at home from a family member, but there's been minimal push for masking at home because it's political suicide.

It’s definitely become a semi-religious thing where I’m at. I generally don’t wear a mask outside and people have asked me to put one on from about 10m away. I’ll comply, just to not be combative at that particular moment in time, but remove it once they’ve passed by. I’m fully vaccinated now. I expect this social norm to be semi-permanent and I don’t really have a good idea for how to break it. Even carrying a vaccine card everywhere would, I expect, elicit pseudoscientific retorts that “vaccines don’t affect transmission”.

But we really don't have an evidence that vaccine-induced immunity response prevents virus transmission. And we do have evidence that people recovered from COVID-19 months ago can bear high viral load in their respiratory system: https://www.medrxiv.org/content/10.1101/2021.01.13.21249642v...

Two out of 6,614 previously infected were reinfected and showed documented high viral load.

That’s a very low proportion.

A prior history of SARS-CoV-2 infection was associated with an 83% lower risk of infection

I understand and hope that vaccination/natural immunity will prevent virus from spreading. But currently we only have evidence of decreased risk of sickness. Virus may still live in respiratory system and spread asymptomatically. BTW, vaccination strengthens lymph/blood system immunity, but not nose/throat lining, where viral aerosol producing.

I’ve not seen that last claim before. Do you have a reference?

It's in a paper I linked to upper in the thread.

> BTW, vaccination strengthens lymph/blood system immunity, but not nose/throat lining, where viral aerosol producing

I don’t see that in the paper you referenced.

>But we really don't have an evidence that vaccine-induced immunity response prevents virus transmission.

What I have a problem with here is how the goalposts for going back to normal just continue to push out like this. First it was just reducing R0 to a certain level. Then it was vaccination. Now it's something else that is yet undefined. It's impossible to come up with a rule because someone will always bring up some extreme edge case and say "well we don't really know with P99 certainty". This isn't a reasonable way to manage a society. At some point we need to acknowledge and ingest the remaining risk so that, for mental health reasons and others, our society can return to something that resembles normalcy.

So... while I accept the premise that mask wearing in a situation where you are also distanced, outside and vaccinated is probably a needless optimization, it's still an optimization. People wearing a mask are less likely to get sick. People wearing a mask are less likely to spread disease. That is true whether their base chance was 50% (a sick person eating across a table in an indoor restaurant for half an hour, say) or 0.01% as it is in your hypothetical. The difference is only in the calculation of the absolute, not relative, protection.

It's not "pseudoscientific" to or "religious" to make a different risk analysis decision. People just have different tolerances.

Broadly: be nice. You're not as right as you think you are, you're just braver.

What's more, no one else can tell you're vaccinated. It's polite to be visibly making every attempt to prevent transmission to other people.

There's also an argument that it's safer to have an easy, blanket rule, rather than permit everyone to editorialize on why they are super special and should be given a pass. There's a solidarity angle as well. Just wear the mask, darn it!

> it's still an optimization

Maybe. Once you get to measures that have a negligible effect, weird things start to take over. Behavior change (feeling safer in a mask) is probably a bigger factor than the mask, itself, at that point.

> Maybe. Once you get to measures that have a negligible effect

No, always. Masks are mechanical, they reduce risk by some fraction, period. Some fraction of particles that would enter or leave the lungs and into the environment don't, because they get trapped in the fabric. That doesn't have anything to do with how many particles there are.

I think your logic mistake here is that you're assuming that all these mitigation strategies are correlated, that you need to stay distanced OR outside OR masked, etc... But that's not the way this works. All of those strategies help INDEPENDENTLY, and doing them all leads to less risk.

Now, if you're 40' away from the nearest person and outside, it's true that your absolute risk is almost certainly so negligible as to make a mask irrelevant. But believing otherwise isn't "pseudoscience" or "religion", it's just a calculation error.

Be nice.

>But believing otherwise isn't "pseudoscience" or "religion", it's just a calculation error.

I think you're assuming that these people who want mask compliance at a 40' distance are doing the statistics like you are making the same conclusion about what behavior should be normal (a conclusion I disagree with). Some might be, but I doubt it's any non-trivial percentage. It's just a social norm now that's based not on science, but on a particular person's or group of persons' feelings.

That is pseudoscience. Being "nice" is a, well, "nice" platitude but it isn't science. And after being lectured for more than a year about how "we need to follow the science" I find it more than a little annoying, but not unsurprising, that we're going to do otherwise.

So much this

But you don't need to wear a mask at home, just open the damn windows and let the air circulate

People's level of actual cognition seems to have gone down and being replaced by dogmatic fervour one way or the other, leading to a competition of who screams their allegiance louder.

If you think a mask don't help you're welcome to volunteer at a Covid ward without one. NPIs (stay at home, lockdowns, etc) have been used since the black death

Sure you won't hurt anybody but yourself by wearing a mask (or two) outdoors with no one around (for prolonged periods of time) or "staying at home" at all costs needlessly, but yeah, you'll still looking like a fool.

Asymptomatic transmission isn't at all an unusual concept in infectious disease epidemiology.

The question isn't whether or not it can happen, I think everyone agrees that this virus can spread through both presymptomatic and asymptomatic individuals.

The question is how common is it? How large a percentage of all cases are caused by it? And the whole "always wear a mask" hinges on asymptomatic/presumptomatic spread being high.

Because if it isn't high, then we're focusing on the wrong thing, we're needlessly being suspicious of every single random stranger, we're choosing something that's easily virtue-signalable, over things that actually stop the spread.

If it isn't high the situation wouldn't have gotten as bad as it got. Especially with people more alert to people showing symptoms

How is symptomatic transmission unusual concept?

Asymptomatic transmission is the concept in question. Symptomatic transmission is the typical case -- you cough, sneeze, etc., and give it to others.

There's still quite a bit of debate over this question, despite the article's insistence that the matter is settled. The data supporting it comes mostly from modeling studies, and real-world data is thin on the ground. Mostly anecdotes.

We have lots of examples of pre-symptomatic (or minimally-symptomatic) transmission for other illnesses, but these tend to be limited (e.g. spread within households), and it's always been a bit of a stretch to make the claim that completely healthy people are spreading diseases widely in "super-spreader" events via casual encounters. Does it happen? Sure. Is it common? Ehhhh.

Even with Covid, we know that the majority of transmission (something like 80%) occurs within households. Of the remainder, as TFA notes, there's an "overdispersion", where a few people are responsible for most of the spread. Is it really likely that these "superspreader" people are mostly completely healthy, without symptoms, and yet unknowingly spreading it to vast numbers of people? Or is that just something that we've found a few times, and makes the most memorable anecdotes?

It is certainly not the hypothesis you would favor based on parsimony alone. If you were a betting person, you'd probably put your money on the idea that someone is a little bit sick (but not so sick as to stay home in bed), and the disease can spread by aerosol or droplet with low probability. That's a much simpler explanation for the same pattern: someone has a tickle in their throat or a slight fever, but goes to the restaurant/office/wherever anyway. Set the probability of transmission to a low p-value, and let the poisson distribution do the rest. Just by chance alone, you will see rare occasions where large(r) groups of people get infected.

I had typo. But AFAIK, asymptomatic transmission is not novel concept. We have been learning about it in elementary school in the context of other diseases.

There is absolutely nothing new about it as concept. It is not something that appeared with covid first time in history of diseases.

If it was a concept in this situation we could easily prove it. Get people who pass a lateral flow test or PCR test into a room and measure their pre-sympomatic viral output.

Why hasn't that experiment been done?

It has? Repeatedly?

This is the news from three days ago: https://www.independent.co.uk/news/health/covid-symptoms-rep...

Showing that people with Covid can be asymptomatic is not evidence that asymptomatic people transmit the virus, and the article you linked to just leaps directly to the conclusion.

Here's an actual paper from 2021 that shows that -- as you might expect -- that exhaled particles correlate with age, weight and viral load:

https://www.pnas.org/content/118/8/e2021830118

In other words: older, fatter, sicker people are more likely to shed the kind of particles that facilitate transmission. They make a point of noting that nobody in their test under the age of 26 was a significant source of aerosol.

Anyway, GP is not wrong. We could do these experiments, instead of just guessing.

>Sweden has just tracked the same path as everybody else

That's very much false. You compare apples to apples to get a useable result, not apples to sour grapes. Sweden's policy have caused much much worse results compared to the countries you should compare it to: Norway, Denmark and Finland.

For example deaths per 100k citizens is 12 in Norway and 134 in Sweden. Sweden is the perfect counterexample to your point.

Nice graphs (Sweden is the yellow line that always stand out): https://www.vg.no/spesial/corona/norden/

Why not Belgium, Peru, Poland, Hungary, Romania, even Gibraltar or the UK?

Why do you want to compare to those specific countries you quote rather than the countries, say, that Sweden has distant transport links to?

See what I mean about myths propagating.

Because Nordic countries are very similar culturally and compare between each other all the time. I have a Finnish girlfriend and my impression is that first thing that Finnish people do when considering a policy is to ask how it's done in Sweden. They overall rejected Swedish approach with good results.

All the other countries you mentioned have vastly different cultures. E.g. I'm Polish and I can say that Polish government doesn't care about law and Polish people are fine with it. It's not to the extent Ukraine or Russia does it, but still. Poles also do not respect authority. This is in exact opposite to how things go in Finland or Sweden. It's almost a taboo to question authorities in Sweden or Finland.

There's no biological theory underpinning cherry picking of a handful of Sweden's neighbours. It's not like Sweden is ground zero of some genetically identical but non-deadly strain of SARS-CoV-2 that inexplicably can only spread within physical proximity of Stockholm.

So not surprisingly, if you do the cherry picking honestly by including all Sweden's neighbours, including Latvia, Estonia, Lithuania etc, then Sweden stops being the worst in that little bounding box and we're back to Sweden disproving the models. Which it has done, comprehensively, because no model or theory postulates a Nordic exception.

Comparing between Nordic countries is not specific to COVID-19. They do it all the time with everything.

Their cultures are very similar so the comparisons are very apples to apples.

Latvia, Estonia, Lithuania are post soviet republics. Vastly different influences.

> There's no biological theory underpinning cherry picking of a handful of Sweden's neighbours.

Uh... the whole premise was to cherry pick Sweden and try to make a broad determination based on that one data point! You don't get to demand broad statistics if you didn't do it originally.

Sweden isn't cherry picked because there are only a handful of regions that chose not to lock down and the relevant argument is about the impact of locking down or not. Therefore looking at it specifically follows naturally from the question being investigated.

The converse, attempting to argue that Sweden suffered harshly by looking only at physical neighbours, doesn't follow naturally from any scientific question anyone is actually raising. For that comparison to be useful you'd need a theory of the form, "Nordic peoples are genetically superior to other peoples in ways that makes them naturally resistant to COVID, and thus whilst original models neglected that factor, Nordic Exceptionalism means Sweden should have been identical to Norway and they weren't therefore their decision was a bad one". But obviously such an argument would be nonsense and nobody is claiming that - just implying it.

It's irrelevant for another reason: Sweden only looks like it did "badly" compared to Norway when using percentages. If you look at it in terms of absolute change in excess death, it's small, and depending on how you calculate, you can actually argue COVID had no effect on excess death in Sweden ([1] has an example of such calculations). The impact on Sweden of not locking down, even if you ascribe all differences between these arbitrarily chosen countries to that, is so tiny that it cannot justify the costs of the policy.

At any rate, if you like there are other examples and they all support the same argument. For example, in the USA Florida is a reasonable choice. They released their restrictions relatively early without disaster. Or South Dakota (=identical curves to North Dakota despite very different levels of restrictions), or the recent example of Texas unlocking, or Belarus.

Sweden is a popular choice because it's a very clear counter-example that's been widely discussed in Europe, and because - as I already noted - no model predictions or epidemiological theories make any exceptions for Sweden or Nordic countries. In fact modellers predicted specifically that Sweden would have had 90,000 deaths from COVID by May, but in fact they had about 98,000 deaths in total from all causes by the end of the year. It's therefore sufficient by itself to disprove the models.

[1] https://softwaredevelopmentperestroika.wordpress.com/2021/01...

This is an outstanding Gish gallop, and I salute you for it. All those gaggling facts are just being used to obscure.

Really all you're saying here is that the data is noisy (duh). So we can't refute your argument with local data about Scandinavia because that's "cherry picking". But when your argument is about a SINGLE DATA POINT IN ISOLATION (Sweden's results) then... that's totally valid analysis that needs to be accepted without question or worry about confounding noise?

No, that's bad science. It's quite clear that nations with both good mitigation strategies and good compliance (Finland, Germany, Japan) had low case counts, and those that didn't (everywhere else) had bad outbreaks. It's true you can find outliers, but so what?

There seems to be a basic logic issue here. Maybe an example will help. If you argue "all swans are white" then to disprove your theory all I have to do is identify a single black swan. One is enough, and presenting such a black swan is not "cherry picking" because the original theory was total and had no exceptions: it posited the absence of "cherries".

If your response is, "well obviously all swans are white in this part of the lake" then you've lost the argument, because your original theory is the one being debated, not one with a random ad-hoc revision that makes no sense.

Arguments about Sweden and lockdown are like this. The debate in question is whether lockdowns were required. Their justification is entirely based on models that claim to accurately simulate the counter-factual: that not locking down will yield enormous death numbers. To disprove this theory and thus eliminate it as the justification for lockdowns only requires one counter example, because the original theory is total and has no exceptions for proximity to Stockholm/Nordic culture/whatever today's excuse is.

Now as I've pointed out, Sweden is not the only counter-example, there are quite a few in different parts of the world. But that doesn't matter because by the nature of the original claim, a single counter-example is sufficient. To re-establish a justification for lockdowns would require a revised theory that is actually coherent and explains all the exceptions, not just a single one: this is basic logic.

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