Covid patients breathe out large amounts of virus early on | Hacker News Reader

Covid patients breathe out large amounts of virus early on

news.northwestern.edu

89 pointsbelltaco169 comments

> COVID patients exhale high numbers of virus during the first eight days after symptoms start...then drop steeply."

Eek. Eight days is longer than I expected.

Here in Switzerland you’re considered infectious 10 days after symptoms start (for mild cases)

That's what it used to be in the US, too, but it was reduced to 5 days about a year ago (which dramatically reduced school truancy, whether covid positive kids were still sick or not).

Seems like the CDC reducing the suggested isolation time from 10 days to 5 was a mistake.

Not when the intent behind the decision was to keep people at work, consequences be damned.

Yes, it was only a mistake if you consider that control of the spread of the virus was of utmost importance. The real mistake was letting controlling spread take precedence over literally everything.

My family (2 adults, 2 kids) was all vaccinated and the adults boosted when we got Covid for the first time. We all tested positive for 7+ days, and the baby was positive on Day 10 via a PCR test. Just one data point but 5 days has never seemed like long enough to me.

I kinda wonder if the test is really good at catching more sinus-nasal infections and not so much lung-driven infections where there’s a lot more surface area to shed virus from.

Or am I to assume if you’re infected, it’s caked along the entire respiratory tract.

You can test positive after no longer being contagious:

https://www.health.com/condition/infectious-diseases/coronav...

"You may test positive for as long as three months after having COVID-19"

That said, yes 10 days seems much safer as a rule!

That happened when Omicron initially hit the US and there were millions of cases a day during the 2021 holiday season. Airlines were running out of staff to run flights. It always felt more of a convenience decision than a medical one.

"We further found that levels of exhaled viral RNA increased with self-rated symptom-severity, though individual variation was high." I was curious on how high the variation was, so checked that out. There is a fairly wide swing in measurements. Not clear what that means on things. Would love to see more conversation on that.

Most concerning on this, though, is "Levels of exhaled viral RNA did not differ across age, sex, time of day, vaccination status or viral variant." I think the data was clear enough that the vaccines are worth getting. However, this seems to shatter any thoughts folks may have that they are safer to others when they are vaccinated? I know that was at least a hope? (Question as I am not sure that was correct.)

I seem to remember a previous study that showed super spreaders exist out there. In that some individuals shed substantially more virus than others. In ways that we don't understand, yet.

If you don’t get Covid because you got the vaccine, that’s a benefit to others.

That only happened for a few months in 2021. Since then theh haven't stopped anyone from getting it.

And if the vaccine makes you an asymptomatic carrier, that's a harm to others.

I think it's more useful to start with the question of what is actually happening, and examine the consequences from there. Otherwise, we find ourselves arguing in favor of our priors, which helps no one.

This PR article doesn’t do a good job explaining but it seems the severity was treated as an independent variable and controlled for, so with that assumption the article actually does imply vaccinated individuals shed less - yes the same amount when controlled for severity - but the cases are less severe.

Why I say that is because of the two paragraphs:

“”“ Mild and moderately symptomatic patients with COVID still exhale large amounts of virus, though severely symptomatic cases exhale higher levels on average, the study reports.

Vaccinated and unvaccinated patients exhale similar levels of virus over the course of infection, the research shows.”””

Edit: the actual preprint states “ We further found that levels of exhaled viral RNA increased with self-rated symptom-severity” so some of these statements in the PR article and article aren’t all squaring together.

My quote was from the study, directly.

My interpretation is basically that, to the extent that the vaccine reduces symptoms, it reduces shedding. If you still get sick, you are still shedding. If you are asymptomatic, you shed the same amount no matter your vaccination status.

Edit oops didn’t see it which comment was being referred to at first.

the study says severity was controlled for when assessing the impact of vaccination.

That leads to an obvious problem as vaccines lead to lower severity.

Yeah, I don't know how to make sense of the quote I pulled out, to be honest. Why say that, if everyone that had the vaccine was lower in symptoms? Seems to be the kind of thing you would only say if the vaccinated people in your study were represented across the spread?

It's pretty clear actually. The point the paper is making about vaccine status is this:

If you have strong symptoms, you shed lots of virus, regardless of whether you are vaccinated or not.

From separate studies, we know that if you are vaccinated, you are less likely to have serious symptoms.

Put the two together. Fewer people seriously ill is fewer people shedding lots of virus, and more people vaccinated is fewer people seriously ill

Having these as carve outs, though, gives me pause there. The claim seems to be that, on average, higher symptoms means more shedding. However, trying to control for any other variable results in no significant finding. This would imply that they did not find a correlation between vaccination and severity of symptoms in their testing.

I'm willing to chalk that up to them not having enough vaccinated people in their study. That fits the caveat they give regarding vaccinated people. It does not automatically support your read, though.

I don’t think this is quite right of a reading “This would imply that they did not find a correlation between vaccination and severity of symptoms in their testing.”

Instead, I think a more accurate rough understanding of their process is they first backed out the effect of severity and then checked if vaccine was correlated with that adjusted number - they found it wasn’t. They didn’t make an assessment on how vaccines effect severity.

My read wasn't that they made an assessment of vaccine on severity. Rather, I read that they found that it had no impact on transmission. They found that, on average, self reported severity correlated with transmission. However, they then state that transmission does not correlate with vaccination status.

I could hope that they mean there is no extra relation between vaccination status and transmission above reduced symptoms. I don't know why they would state it in the way they do if that is what they mean, though.

I agree it is poorly stated, but that is what they mean, no extra impact beyond reduced symptoms and the benefit thereof.

How do you know that?

Because their paper states it. That’s what is meant by “when accounting for etc” in:

“We found that vaccinated and unvaccinated participants exhaled similar numbers of SARS-CoV-2 RNA copies (Fig 2C), when accounting for age, sex, presence of co-morbidities, days since symptom onset and symptom severity”

That... doesn't say anything about them exhaling less? It specifically says that they exhibit the same. You can make a logical jump to say that, combined with a high variance but statistically significant link to self reported symptoms, that maybe vaccinated would have people that self report lower levels. But, that is specifically not in the comparison that you quoted. It says only that vaccinated and unvaccinated are not distinguishable.

It’s saying indistinguishable when adjusted for severity.

It’s like saying night and day in Yosemite are equally bright when effects of the sun and moon are controlled for.

Look, this doesn’t appear to be sticking, it’s a basic statistical modeling thing. At this point the options are accept it at face value, study stats, or be like the kid saying “why” 100 times after every explanation.

But they specifically say that differently? As I said in another, you are jumping from severity correlating with vaccine to get to this idea. But, they actually call out self reported severity as correlating. Such that, if the correlations were strong enough it would have also showed up in their control for that variable.

Stated differently, you have variables

  A = self-reported severity
  B = amount shed
  C = vaccinated status

If A and B are correlated, and A and C are correlated, there will a floor to how correlated B and C can be. Their later sentence is that the correlation between B and C is below the significance floor. They never comment on how correlated A and C are. You could argue there is another variable D = Actual Severity, but that is not covered in the statements I remember.

This is where the mistaken reasoning is, they aren’t measuring or reporting on that naive correlation between B and C that you’re focusing on.

They are saying after backing out the correlation between A and B to get adjusted B, there is no correlation between C and adjusted B. That is an ELI5 explanation of their statement “controlled for” about the factors like severity.

Yes their focus is not on how A and C relate, but we know that relation from other sources.

That is what controlled for means. “Hello” means a greeting in English. It’s the definition. Same concept, it’s the meaning of controlled for. It’s what it was defined to mean.

The quote they use is "We found no impact of vaccination status, viral variant, age, sex, or presence of co-morbidities." Specifically, in the section "Exhaled SARS-CoV-2 RNA levels increased with self-reported symptom severity," they say that they found folks with reported severe symptoms were higher than the others. However, it is worded and presented such that really only "severe" was higher. Indeed, figure 3c shows that vaccinated individuals have similar spikes as otherwise. (The CI is actually higher and wider on the chart for vaccinated?) That chart also highlights that people reporting "none" exhale more than people that report "some" and has peaks as high as those that say severe. Really, the "severe" just shows that at that level it is harder to ignore for anyone. (The min is higher.)

Now, the section "Vaccinated and unvaccinated individuals exhaled similar levels of SARS-CoV-2 RNA," calls out the actual high data points for unvaccinated as being actually higher, with a max of 876 to 549. Though, again, it shows the CI is wider for vaccinated.

Again, I'm mostly willing to get behind the claim that vaccinated people shed less. But that isn't strongly supported by the data. The data does support that super spreaders of 500+ exhaled breaths are unvaccinated.

So, if you want to limit the claim to "vaccinated people are kept from severe symptoms," I feel that is mostly known and agreed with today. If you try to move the claim to "vaccinated shed less than unvaccinated," the data clearly indicates that is not supported. Again the 95% CI is higher for vaccinated individuals on this study.

Look, I’m explaining how to interpret the experiment results they report, which they base their analysis and conclusions on.

What I’m doing is going to the original foundation. What you’re looking at is the decorations they put on the foundation.

I’ve explained over and over what their foundational experiment showed as described. stop being hung up on the decorations.

The decorations are pretty bows and wrapping paper. That’s what you’re focusing on. Stop it.

Bob went to France and got annoying no one said “hi” to him. His friend tried to explain what they said, “bonjour” meant hi. He wouldn’t accept it.

We went to the land of academics, I explained what the academese means. You’re not accepting it, focusing instead on the wrong thing.

No, you are adding to it. Literally. Their data shows that vaccinated has a wider and higher 95% CI for exhaled. There are larger outliers in unvaccinated, but the signal in the data that they can isolate shows that you cannot claim vaccinated shed less. Which is why they don't claim that.

You may have tried to go to the land of academics, but you are injecting stronger claims into what this paper reports than they are making. They never say anything about controlling for severity. They only show that self reported severity correlates with more shedding. Though, again, that is with a very high variance across the board for the other severity. Their chart showed, and all they claim, is that there is a correlation of "severe" with higher shedding over the other reported values. Note that this is not reporting that self reported symptoms correlates. It is specifically self reported "severe" does. Indeed, their data shows that folks that report "none" have higher 95% ranges than "mild" reports do.

This is the quote where they state they controlled for severity aka “accounted for”. I already posted it btw. Have a good day. Keep denying it.

“ We found that vaccinated and unvaccinated participants exhaled similar numbers of SARS-CoV-2 RNA copies (Fig 2C), when accounting for age, sex, presence of co-morbidities, days since symptom onset and symptom severity”

Right, and if you read the data they use to make this claim, you see that it supports the fact that vaccinated shed as much as unvaccinated. If you restrict your claim to "vaccinated don't get severe symptoms, and therefore don't have the highest shedding," I agree with you. What you cannot claim, is that vaccinated shed less. At the 95% CI of the data, vaccinated is actually higher for the sample size they have here.

Again, their data literally shows that, outside of samples outside the 95% CI, you can't tell vaccinated from unvaccinated.

I think if you are arguing that this is only breakthrough cases in vaccinated individuals, the stronger claim probably sticks, but they don't have the data to make that claim in this study.

Bonjour. It is clear the proverbial horse does not want water.

Am I misstating the data? Which literally shows more virus exhaled by 95% of all vaccinated versus 95% of unvaccinated?

And where do they state that vaccinated exhale less than unvaccinated? Specifically, where do they say that? They show the total range of exhaled values is larger for unvaccinated, but the 95% range is higher for vaccinated.

It looks dangerously like you are forcing the reading for what you want the truth to be. Not for what the data supports. Note that i want that same value for the truth. I just don't see the data supporting it. And the paper seems to agree, as they are not making as strong of a claim as you are.

This is consistent with the scenario in which the vaccine trials did not lead to the desired outcome ("the pandemic will be cured by the vaccine"), and so institutional powers tried to dress it up as a success. Note that the researchers and authors of this paper do not need to be involved for this to be true. They simply publish a factual result, but it is somehow deformed/ignored during the course of public service campaigns. "Vaccine lowers severity of symptoms" becomes "vaccines work".

More speculatively, with this in mind, it is troubling to think of how the vaccine safety trials may have been interpreted, and why major pharmaceutical companies insisted upon total civil immunity.

>If you are asymptomatic, you shed the same amount no matter your vaccination status.

Which, importantly, is "not nearly as much as a sick person". "Asymptomatic" is just a very very low grade infection, not some magic "you are chock full of virus that you are shedding but somehow unaffected" state.

unfortunately the CDC said early on that if you're vaccinated, you can't spread covid, that's clearly not the case. At this point, the vaccine only seems to prevent severe hospitalization (and that's assuming you still have immunity from your last dose, since it appears your protection wanes to almost nothing after 4-6 months)

Has it been shown that the vaccine keeps you from getting it?

I do think it is worth calling out my point is FAR from a panic moment. The study calls out they had very few vaccinated people, for one. For two, again, the data is clear that you are much safer for yourself if you are vaccinated.

Receiving the COVID vaccine does not prevent the contraction of COVID or ability to spread it, it only lessens the symptoms after infection

Intuitively, it seems that if it reduced symptoms after infection, than it would have been seen as correlated to exhalation.

Now, I realize that it could just negatively correlate with self-reporting symptoms? Or it could be that that correlation between self reporting and how much you exhaled was just very lightly correlated, such that the other correlation is low? Neither of which would be that surprising, I guess. They do disappoint me, for some reason.

> it only lessens the symptoms after infection

No, it also lowers the possibility of becoming ill in the first place, which does make one less likely to infect others

> I think the data was clear enough that the vaccines are worth getting

Unlike like measles or polio, these misnamed 'vaccines' don't prevent getting the disease nor transmitting the virus. I think young healthy people should get the disease, recover, develop antibodies, and be done with it. We did this for chicken pox until a couple decades ago.

>Unlike like measles or polio

The polio vaccine children receive today in the United States is non-steralizing.

If this anti-vaxxer assumption was meaningful, we wouldn't have fewer cases of polio.

>We did this for chicken pox until a couple decades ago.

Fun, because that's having great side effects, notably, that shingles sucks ass, and now that there isn't a giant amount of chickenpox virus in every closed space because kids are vaccinated, my generation has a 1/3 chance to develop shingles, even at a young age. Meanwhile, those kids that were vaccinated do not have such worries.

Oh, and >get the disease, recover, develop antibodies, and be done with it

I guess you aren't familiar with people getting covid multiple times, regardless of vaccination status? It's like how everyone told my mom you can't get mono more than once, despite her having flare ups every year.

The public never knew shit about infectious agents and I really don't care about their opinion, much in the same way I don't ask my grandfather who stopped using Windows in 1996 where to find the network settings.

I'm not familiar with _unvaxed_ people getting coronavirus multiple times (prior infection confirmed by antibody blood test).

I got it once and blood tests show continued strong antibodies. Since then I haven't even had the flu in a couple years. I have heard of many vaxed people getting coronavirus multiple times, including prominent world leaders.

>I'm not familiar with _unvaxed_ people getting coronavirus multiple times (prior infection confirmed by antibody blood test).

Then you simply aren't paying attention. Most of my anti-vax relatives have gotten covid multiple times.

Do they know this from a blood test that looks for antibodies? That is what I did for testing.

The nasal swab amplication test looks for fragments in the air intake filter, not actual infection.

By the way, I had vaccines for polio measles tetanus and others. Being in decent physical health, my doctor confirmed I was not in a risk group which would benefit from the jab which was authorized for emergency use only. The risk/reward for my profile was not worth it.

It absolutely happens, I don't know how you're not familiar with it: https://www.thelancet.com/journals/lanepe/article/PIIS2666-7...

> I think the data was clear enough that the vaccines are worth getting. However, this seems to shatter any thoughts folks may have that they are safer to others when they are vaccinated?

That's not the correct conclusion from this statement though. Taking the vaccine increases the likelihood that your immune system will be able to get kill the virus almost immediately after exposure, so that you don't start exhibiting symptoms at all. You can still get COVID and thus exhibit symptoms after being vaccinated, it's just less likely.

However, this statement is concerning those who got infected and then started exhibiting symptoms. Of those, i.e. when your immune system wasn't able to immediately deal with the virus and needs to learn how to do it, the viral load expelled was roughly the same in every case, peaking at 8 days. That's probably not too unexpected really, but it does seem to indicate that the immunity given by the vaccine is probably all or nothing for any particular variant you're exposed to - it either works immediately and stops you getting ill, or the immune system still has to start from scratch in figuring it out.

I'm game to see more on that. This study specifically, shows that you can be vaccinated and get it. You will have fewer symptoms, but still shed just as much virus. That is literally what their callout was about, no?

If you are claiming that you are less likely to get it when you are vaccinated, that kind of contradicts a lot of what I've seen out there. I'm happy to learn that is mostly paranoia, though? I haven't actually followed too much there, as it doesn't seem to impact my behavior. I'll get vaccinated when eligible, just as I have done for other things for most of my life.

> This study specifically, shows that you can be vaccinated and get it. You will have fewer symptoms, but still shed just as much virus.

no. the study shows that the vaccine status doesn't change how much you shed for a given level of symptoms. aka high symptomatic => high viral shed. lowly symptomatic => low viral shed.

from the actual pre-print's[0] abstract:

> We further found that levels of exhaled viral RNA increased with self-rated symptom-severity, though individual variation was high. Levels of exhaled viral RNA did not differ across age, sex, time of day, vaccination status or viral variant.

0. https://www.medrxiv.org/content/10.1101/2023.09.06.23295138v...

Apologies, that is inline with what I meant. You will shed proportional to your level of symptoms. If you were vaccinated and still get heavily sick, you will still shed as any other heavily sick person.

That said, the caveat of "though individual variation was high" makes me curious if some of the correlation to self-rated symptom goes away when you only look at something like vaccination status.

This PR purports to answer a question I had since the beginning of the epidemic when it was clear that transmission was through-air.

"""“For example, if we assume the infectious dose for COVID is 300 copies, then a person who is exhaling 1,000 viral copies per minute would exhale an infectious dose in 20 seconds (highly risky in an elevator), whereas a person who is exhaling two viral copies per minute would exhale an infectious dose in about two hours (probably safe in an elevator),” Lane said. """

Can someone clarify the concept of "infectious dose"?

My layman's understanding is that even one virion can potentially infect someone. It's just that the odds of infection generally increase with the number of virions. (Modulo many other factors like where the virions reside, immune response, etc.)

But the concept of "an infectious dose" sounds much more binary to me.

EDIT:s/viron/virion/g

I'm not speaking as an authortiative individual here, but likely it's defined probabilistically in that 50% of people given a dosage show signs of infection later. See more here: https://en.wikipedia.org/wiki/Minimal_infective_dose

It would be nice to find some charts of what that would be for various virii.

not all virions are equal.

the viral assembly process, and the RNA replication process is error prone.

many copies, of the covid virion, are incapable of cell entry or reproductive infection, due to defects in manufacture.

I have seen some small scale research suggesting the likely number for necessary copies to become infected is 34. That makes one breath likely enough.

The concept of measuring "viral copies" in breath is pretty cool, seems like a brand new technique? I can see it being invaluable in studying respitory viruses going forward.

The only shortcoming of this study is the lack of data points _prior_ to symptoms. One of the hotly contested points of hygiene policy during the pandemic was about how the virus spreads before symptoms show up.

I'm unsure if there's a study that already settles this, but this new method seems like a sure fire way.

cOvId is AiRbOrNe, isn't over, and never went away.

It doesn't matter how fast its spreading, it continues to spread, be highly contagious, with unknown long term effects. It makes all spaces unsafe and we need to work to live without it.

Take measures to stop the spread and protect yourself and others. Stop getting infected. 3.5+ years into this if you're not helping, you just choosing to prolong the pandemic.

I wonder how this compares to other respiratory viruses, such as various flu strains?

Shedding a lot of virus early, before the immune system has had a chance to develop and mount an attack, seems like what one would expect. But not sure if all viruses are like this?

Disclaimer: that is not my domain, consider it may be all wrong.

One big difference in my understanding is the symptoms. For SARS-1 and MERS, people get symptoms earlier on, so they can be quarantine earlier and infect fewer people.

I would guess that parts of the symptoms are triggered when the immune system starts reacting, and hence maybe for those two, it would just happen earlier?

> Shedding a lot of virus early, before the immune system has had a chance to develop and mount an attack, seems like what one would expect.

But yeah, that's generally what I would expect too.

I know a guy who still wears a half-face respirator every time he's in public even for just a second. I think at this rate he'll be wearing it for the rest of his life, unable to accept a new level of risk and move on with his life. I'd like to help him but I see no possible way, he's convinced that I and 99% of the rest of the public are suicidally insane like people who play literal russian roulette.

This is an odd hot-take for an active globally invasive and life altering virus.

That person has assessed their risk level and determined that their community's disregard for their personal risk, negatively impacts their personal model. Therefore they have to use a different device to mitigate their risk.

Seems pretty logical, matches with known science, with a minor exception that the half face respirator may not offer greater protection vs a well fitting* N95/KN95

* well-fitting being the crucial note there.

What if he’s right?

when almost everyone has already had the disease and was able to observe what it did to them -- which is the state we're at -- it's pretty hard to say that everyone needs to protect themselves.

I know what COVID will do to me, because I had it already. He's not right. I was vaccinated, and the vaccine didn't work (it didn't prevent me from getting ill, get out of here with the 'better outcomes' bullshit, I'm healthy and COVID was still a flu-like illness for me, and I'm convinced the vaccine I was promised was 'safe and effective' did little or nothing) and masks didn't matter.

It's like asking why we don't go around with masks on 24/7/365 to protect ourselves from the flu. Well, I've had the flu, and it's unpleasant, but it isn't worth the many downsides of proper N95 masking, and anything less than proper N95 masking is pointless.

Most of the people I see wearing masks in public now are wearing completely ineffective cloth masks and a large number of them STILL wear them under their noses. These people are not thinking critically or looking at data. They're still just trapped in the media fear cycle from 2020.

I would argue you now know what COVID did to you that one time. You do not know what COVID will do to you.

yeah there have been studies showing repeat infection having an increasingly deleterious effect on your immune system. we don't know the long term harms associated with it.

I don't think anybody has answered the question "is every COVID infection an individual gets going to give the same level of response"? IE, will you get COVID and then get better, but later get COVID and end up with Long COVID symptoms? Is it random every time you are infected?

At least 3 big studies looking at this, the most recent of them on 150k people, so very robust numbers. Subsequent infections do increasing damage and each infection increases your chance of developing Long Covid and not recovering. People with existing new symptoms after a Covid infection also get worse very often.

Rather than building immunity we are accruing damage and the evidence underpinning it from the VA study and the more recent ones is massive.

Well, if that's true, it would be really bad (in a simple model it means basically everybody gets infected repeatedly and gets more and more damage and then most of the population has long covid). I am not hearing much concern this from my larger medical community.

Large numbers in a study is good, but if the study design isn't right, then large numbers won't make up for that. It's absurdly hard to really conclude reliably.

For example, from: https://www.nytimes.com/2023/08/17/well/live/covid-reinfecti... """For many people who get Covid multiple times, subsequent infections will be as mild as or milder than their first, emerging data shows, likely because of partial immunity from previous infections, vaccination and the fact that the latest circulating variants generally cause less severe symptoms.""" which is much more consistent with my understanding of COVID repeat infections.

If you have a link to the VA study I will look at it.

The VA study in Nature - https://www.nature.com/articles/s41591-022-02051-3

"The Covid vaccine didn't have any effect onbthe severity of my infection" is the most utterly idiotic take if have read given the mountains of evidence that it massively reduces the severity of the infection

> I was vaccinated, and the vaccine didn't work (it didn't prevent me from getting ill, get out of here with the 'better outcomes' bullshit

How do you know it wouldn't have been worse without vaccination?

> I was vaccinated, and the vaccine didn't work

Thank goodness you got the vaccine! If your body hadn't been primed and ready to take on the real infection, imagine how much worse your body would have responded, and how much poorly you would have felt.

The existence of the human race says he is wrong..

Medieval Peasant 1: "I think we should stop dumping raw sewage near our water supply. It is probably making us all sick."

Medieval Peasant 2: "If it was making us all sick, how come only half of my children have died before the age of five?"

Don't forget to take your 10th injection and make sure to always have a dirty piece of paper in your pocket!

Right about what? That there is risk in taking off the mask? Of course he's right about that. Right about taking off the mask being suicidal, like playing russian roulette? He obviously isn't right about that.

> I'd like to help him

Help yourself by minding your own business.

You know that's self-defeating advice right? You telling me to mind my business is you not minding your own business. You clearly don't live by this principle, and I won't either. I don't subscribe to the kind of radical individualism you are promoting, and you don't either. Nobody should, we live in a society. Everybody has a responsibility to speak their mind when they see somebody else behaving foolishly. You do so, you freely share your perspective on the way other people live and so do I.

I'm not telling you to do anything - are you hung up with how English uses second person possessive adjectives to communicate? I don't know if I have a solution to that.

"behaving foolishly" is a judgement call you made on someone else, for an act that doesn't really affect you directly. You yourself are allowing it to affect you - it seems to be overpowering you, maybe ask yourself why you allow it to. You do have a choice: just put it down. Keep carrying a load of heavy things, and you're not going to go anywhere very far. It is your choice. Have a good one.

People who lived though the great depression often had trouble throwing things away, their kids sometimes would inherit the disorder and now we have hoarding television shows.

Prediction: in 30 years a TV crew will follow someone around who needs to go maskless in public for some reason (dental care, kiss wife on wedding day) as they struggle with it.

There's a good chance your buddy has an immune disease or something along those lines. Or knows someone who does.

What's the harm? Especially when long COVID can cause long term effects that can cause professional harm (ie, an existential threat)

"a guy"? I see people like this every day...and I'm one myself. Not outdoors, but when I enter a building.

We don't yet know the long term sequelae of an epithelial infection, nor do we know why about 10% of those infected appear to get "long covid". Why should I risk it when the burden of reducing the chance is negligible?

I also wear a seatbelt.

"I know a guy", as we grew up down the road from each other and I was a groomsman at his wedding. We've known each other for 30 years. This isn't some random guy I see on the street. I see maybe one in a hundred strangers in public still wearing a mask, which is why I mentioned 99% of the public. That's my estimate for how many people gave up masks. I take it you are among the 1% of those who keep it up.

It used to be 80% of people didn't wear a seatbelt. By your logic the 20% that did should have had someone try to "help them" be normal.

> It used to be 80% of people didn't wear a seatbelt.

A few years ago, 80% of people who wore a mask. Which way are these things trending? Wearing a seatbelt has become the normal attitude towards car risk. Wearing a mask was briefly the normal attitude towards risk, but has since become [again] an abnormal attitude towards risk.

If you're so keen to be abnormally safe and think everybody else is being unreasonable, why don't you get your three-point seatbelt replaced with a five-point harness? It's established well characterized technology that undeniably makes you safer You'll definitely be an odd man out rejecting social trends so expect to have people wonder why you're so paranoid. But by your logic you shouldn't care about that.

I don't understand what point you are trying to make. Are people with masks hurting you in some way?

> Are people with masks hurting you in some way?

they are making the people that want to pretend the virus is just something you have to live with instead of taking precautionary measures feel bad.

Oh, thanks! I will now straighten my shoulders and walk with pride, knowing I am repressing some busybodies who want to butt into my business.

Who said they're hurting me? People who live in fear are hurting themselves. I don't care, except in the case of my friend. I don't like to see my friend hurt himself, is that so radical? Radical to you maybe.

I think you have to understand that to your friend and a large number of people wearing a mask isn't hurting him.

I don't know where you live, but I live it's somewhere between 5 and 10%, asymmetrically distributed by age and social group.

I still attend scientific conferences this year that require 100% masking indoors and proof of vaccination to attend in person.

At my work all the scientist (mainly microbiologists) are still masking indoors, not just in the lab.

I don't care a whit if other people mask or not, but I do. I don't understand what kind of "help" you have in mind, but would genuinely be interested in learning.

I don't wear a mask, but you should not judge. Probably some are people at a higher risk than you are - they might look "normal" and alright, but they don't have to tell you if they have heart diseases, diabetes or whatever.

If there's literally no downside for him to wearing a mask, why do you even care?

I thought the anti-mask revolution was because they didn't want to be "forced" but now nobody is forcing them and they still can't shut up about masks worn willingly by others.

It was always about forcing a consensus about what's normal, same with so much other human antagonization of outgroups.

easily one of my biggest annoyances about people online who say mask wearers in 2023 are sheep. There's maybe 5-10% of people masking when i'm on public transit or shopping and that's a pretty big maybe.

If I was sick, or if there was a meaningful sickness in the air, I would wear a mask.

But I wouldn't say there is zero downside to wearing a mask, atleast the way 98% of people wore one during covid. (The same one all day, if not a week, touching it, putting it in pockets, around your neck, on your greasy forehead, so on).

I used to wear a mask because allergies when I mowed the lawn or even dirtbiking during certain seasons. It absolutely reduces your ability to take it oxygen easily. I get winded a lot easier wearing a mask. Is that meaningless to children wearing them all day at school? Idk.

"It absolutely reduces your ability to take it oxygen easily."

This is absolutely false. There is very strong evidence that masks do not effect gas exchange. One example of many: https://www1.racgp.org.au/newsgp/clinical/face-masks-may-inc...

Masks do make your lung muscles work slightly harder, but there's nothing wrong with that.

This is only talking about low oxygen demand scenarios.

"Each participant performed a six-minute walk test"

I've personally tested (out of curiosity) bicycling performance while wearing a half-face respirator that's barely noticeable during walking. Both measured speed and subjective difficulty were severely affected during high intensity exercise.

That sounds reasonable, but even then it doesn't mean someone shouldn't wear a mask. Their performance would be decreased, but it doesn't mean that it would be medically dangerous (they would not have low blood oxygenation, for example).

I'm currently dating a 6th grade school teacher. She said when they returned to school with masks the kids were for sure more lethargic and even woozy more often than she had ever seen in her 10 years teaching. As masks were removed over time, it went away more and more.

There are lots of other explanations for that. For example, it could be confirmation bias. It could also be that a lot of the kids had long COVID and the effects are wearing off over time.

Makes sense, since we have zero proof of any real reason, let's go with the ones with even less obvious explanations.

Children and long covid? Children barely got covid in the first place... Long covid? In so many kids a teacher could notice? Give me a break.

It occurred to me that cycling primarily involves heart, lungs, and legs. You train all of them simultaneously, so they'll naturally have balanced performance. If you selectively impair one of the three, it will become a bottleneck. However, it seems to me that the lungs have the easiest job (e.g. cycling is easier than tasks like inflating balloons), so it should be possible to recover almost all the lost performance by training with the respirator on, bringing the lungs back into balance with the heart and legs.

What's the point of that when there's no need to wear a respirator in the first place?

The point is to acknowledge a limitation of my testing.

Your first sentence and last sentence basically contradict each other....

It means your diaphragm has to do more work to open and close your lungs. However you’re still able to get plenty of oxygen.

I guess my personal experiences mowing lawns and dirtbiking in a mask are meaningless and false. I got it. I just have to do more work, but it's no harder, and I can still get 'plenty' of air, as long as I don't need more than totally sedentary.

People care because it impinges on the mass denial all of all the death and harm inflicted during the pandemic, as well as the ongoing dangers and unknowns of our new, post-COVID reality.

This isn’t uncommon in history, but it unfortunately tends to take a few cycles of mass death before humans adapt their culture and social behavior to the world as it exists (vs. how it was before or they wish it could be). We’re still early in this reality for COVID. It took decades for the reality of HIV/AIDS to change behavior around things like testing, condom usage, prophylactic drugs etc. Comparably, we’re in the like mid-1980s of COVID, even though it’s killed more people than HIV/AIDS did in the past 40+ years.

Some of the more concerning research this year has been the immune dysfunction showing the same CD4/8 inversions and progression towards immune deficiency. Initially the goal was to look at the immune systems of Covid Long haulers but they had a hard time finding controls as a lot of the people who were apparently well were also developing immune issues. Both of the studies I read had to pay people who have never had Novid and put in substantial mitigations to ensure they didn't catch it to participate in the research.

This might not be all that dissimilar to the HIV/AIDS pandemic in impact on the sufferers other than the immune effects are showing up faster and its airborne and 95% of the population has had it. I sure hope it turns around at some point and it doesn't become C-AIDS, but it explains why Flu and RSV and sepsis et el are going crazy at the moment, immune systems are in bad shape.

Very few people are dying of COVID-19 anymore. There's no valid reason to change human culture and social behavior just because we now have five endemic coronaviruses instead of four.

I’m not sure why you think this. It’s on track to kill another 200K people this year. Before it’s emergence, this would’ve been considered quite bad for any other disease:

https://covid.cdc.gov/covid-data-tracker/#trends_totaldeaths...

It's on track to kill 200 thousand people this year in the United States alone. It's likely that millions will die this year worldwide, and tens of millions will become disabled to some extent by long covid. The usual response is "this is a small number compared to the total population," but it's still millions upon millions of people. Health care systems around the world are already stretched thin, and the increased burden caused by covid will only make things worse.

Completely agree. Compared to the response to other diseases that have killed far fewer people, its quite wild how much this has been normalized.

I get your perspective, but everybody has their own risk assessment and comfort, and yours is no more necessarily right than his :).

Some people still wear masks, some people still take booster shots, some people people still wash their hands, some people sneeze into elbows, some people stay inside, etc. Others may not do some or any of those things.

"Accept new risk" and "this is the new normal" is as validly executed by him as by yourself. (Also, honestly, wearing a mask in public may not be as life changing/limiting as it seems. I know people who haven't stopped complaining about seatbelts for 3 decades now, but it's a habit that doesn't bother me :).

> I get your perspective, but everybody has their own risk assessment and comfort

Yeah I get that, but with him it seems very out of character. He likes to ski and is a general aviation pilot; these aren't low risk activities. I hope he comes to term with the new normal soon because he's still young and spending the rest of his life paranoid behind a mask would be truly sad.

For him, the reward of those activities possibly justifies the risk in his mind.

I sometimes also mask in public, because it bothers me approximately zero.

But again, the risk stats and perspectives and acceptance may differ. You may need to work on yourself to develop empathy for your and his personal choices and stop thinking of him as "sad", more than work on him and try to "help" him :-). The word "paranoid" seems out of place as well - the risk is actual and demonstrable.

For example, skiing is fun. Flying airplanes is fun. And general aviation is quite safe for those who take it seriously. So while there's risk, there's also a reward. And that risk / reward ratio may be what they choose to personally accept.

There's no reward for getting covid! There's no fun in it! And many people either don't want to get it at all (given the risk of either bad immediate symptoms or long term impact), or had bad experience and don't want to recur, or don't want to contribute to chain and infect others yet.

Heck... I'm persuading myself to start wearing mask again (the only reason I stopped is that I work from home, but have a 2yo in daycare and 4yo in kindergarten which massively outweighs any risk I bring into house).

(I do want to ask though - are they wearing like n95 or surgical mask... Or as you mentioned in original post a full painting-sryle respirator with two big round filters etc? That, I'll agree, is a significant comittment if they don't have significant personal risk factors)

In my experience, a half-face respirator is more comfortable than a FFP2 (European standard similar to N95) or surgical mask. They have soft silicone seals, and bigger filters and exhalation valves that minimize breathing resistance. If you want to reduce your chances of getting COVID-19 it seems the obvious choice.

> He likes to ski and is a general aviation pilot; these aren't low risk activities.

So… spending micromorts on worthwhile activities, rather than on queueing at the supermarket? Sounds pretty consistent to me.

TIL about micomorts :). That is fascinating!

https://en.wikipedia.org/wiki/Micromort

Literally micro-optimizing your risks? Yeah, that sounds totally normal dude. Make sure to wear a helmet everywhere you go just in case a tree branch bonks you on the head or something.

> He likes to ski and is a general aviation pilot; these aren't low risk activities.

So? These are situations where he is kinda in control no? Out in public, how much control does he have about people, with or without symptoms, going to the same shop?

I mask in close indoor situations. I am not paranoid. Why do you think he is paranoid?

I like to woodwork and walk.

Spending 3 weeks in bed with COVID before the vaccines existed made me super risk adverse to people and especially people coughing. You have no concept of how long a week in bed is, let alone 3 of them. The long nights in pain. The long days just wishing you could get through the enormous headache to rest and sleep. The powerless feeling that you can't even sit up enough to do anything you have previously enjoyed. Heck, I still remember my son bringing in my copy of Cyberpunk that just came out and I didn't even have the energy to turn on my laptop on my lap to install it. Even when I got COVID again 2 years later and it was just a couple days in bed, I get super pissed off when people belittle it and the people who try to stay away from it.

Just last Saturday night, I was out shopping and some lady was walking around with a "smoker's cough". I tried to stay away and not go back into places she had been. When I got in line to check out and got stalled in front from a lady with a huge cartload and the cougher got behind me and started hacking her brains out, I just abandoned my cart and left.

I am not spending that many days of my life being sick again like that if I can ever help it. So when I say that YOU NEED TO REPRIORITIZE YOUR EMPATHY. Take that to mean that if this wasn't on a forum that I need to talk nice-nice, I would not be talking nice-nice.

if I was in his shoes and I'd probably be worried about getting long covid and that stopping me from skiing or piloting.

The symptoms of long covid can be pretty debilitating and a lot of people just don't get better.

> For some people, Long COVID can last weeks, months, or years after COVID-19 illness and can sometimes result in disability.

https://www.cdc.gov/coronavirus/2019-ncov/long-term-effects/...

https://www.mayoclinic.org/diseases-conditions/coronavirus/i...

Also. I think it's rational for myself to wear a mask because getting COVID was one of the worst experiences of my life. It's like if I burned my hand on a stove and someone tried to convince me burning your hand on the stove is normal so no need to take precautions.

It was bad for me too. But I assume that the next infection won't be nearly as bad, because of built up immune response, several vaccine injections, and current variants being much milder than the initial one.

Unfortunately that doesn't seem to be the case

> Compared with those infected once, patients who were reinfected showed that they were more prone to complications in various organ systems and more likely to be diagnosed with long COVID than those infected only once. These findings were consistent regardless of vaccination status.

> For those who had COVID-19 two times or more, the data appeared to show a:

> Two times increased risk of death > Three times increased risk of hospitalization > Two times increased risk of long COVID and chronic fatigue > Three times increased risk of heart issues and blood clotting disorders

https://www.nebraskamed.com/COVID/do-repeat-covid-infections...

I suspect there's a lot of individual variation too.

COVID for me was exceptionally mild with the only annoyance being the total lost of smell for ~12 days. Otherwise, the dry cough wasn't any worse than the one I get when my allergies are in full force. Some people are just going to get worse cases and others won't. That's going to impact personal risk assessment.

My mother had an even milder case of COVID than I did (no cough), but RSV almost sent her to the hospital this past Thanksgiving. For all the fixation on COVID we tend to forget that there are other virus that can be lethal to certain demographics (e.g. advancing age).

This reminds me of a comment I saw there a few years ago, by an HN user who wears safety goggles every time they leave the house because they once almost walked into a low hanging tree branch.

27 years ago, there was a movie that perfectly shows that mindset:

https://www.imdb.com/title/tt0114323/?ref_=fn_al_tt_5

If it wasn't covid, it'd be something else with people like your friend.

I know several people who continue to wear masks for completely non-health related reasons. Perhaps he is trying to avoid interacting with you specifically.

One of the first proponents for hand washing and hygiene during medical practice wound up dying in a mental asylum.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7240806

What's considered normal socially is not always what's supported by the evidence at hand, and sometimes what that supports is well outside of the acceptable range of discussion or behavior at the time.

Are you truly concerned that this person has made an error in judgment based on evidence or do they just make you uncomfortable for breaking norms? Are you motivated to post about this because you've considered their reasons and think they've made a harmful, critical error in judgment or are you just seeking approval of your normalcy bias? Do you know enough about their health situation or their family's to be sure that their risk calculation is unreasonable?

The best course of action if you're absolutely sure that there's no threat to you is to ignore them and move on with your life.

What you just demonstrated is called Survivor Bias or Survivorship Bias:

https://en.wikipedia.org/wiki/Survivorship_bias

what about all the people who challenged what was "considered normal socially" and actually were proven wrong? One never hears about those.

I'm not sure what kind of strawman you're building here. Are you thinking that I'm arguing that all or even most norm-breakers are proven correct? I am arguing only that some norm breakers turn out to be prescient and thus overconfidence based on norms alone is treacherous and bound to be proven wrong at times as we learn more, and Normalcy Bias often prevents people from adequately assessing that risk. Here's another wikipedia link!

https://en.wikipedia.org/wiki/Normalcy_bias

A "strawman" ? you said, "One of the first proponents for hand washing and hygiene during medical practice wound up dying in a mental asylum."

Maybe if you'd added, "of course, lots of people who wound up dying in a mental asylum are forgotten, with good reason" then I would've had nothing to say.

As it was, you cited an example as though that proved anything.

> what about all the people who challenged what was "considered normal socially" and actually were proven wrong?

There are not many of those, because of herd mentality. (Edit: I mean Normalcy Bias, thanks "notabee")

If a person is unusual enough, they are dismissed as cranks without any sort of proof required.

This isn't even a response to anything.

notabee held up one example, which is relevant only if the argument was "everyone who challenges the norms is insane." That would be a counterexample, and only one is required.

as for "There are not many of those" I don't even know what to say. Of course those people were forgotten and there are no citations, because they weren't newsworthy. That was the whole point.

Sadly, he'll lower risk of one thing and increase risks of another thing -- most likely, cancer.

There is no living with it. None. There's no immunity. Only continued sickness and damage. Masking is a protection to help stop the spread and if you are not helping, you're in the way of us trying to live without it.

You are spreading misinformation. There is immunity to COVID-19 just like any other respiratory disease.

https://peterattiamd.com/covid-part2/

Our ancestors apparently lived with HCoV-OC43 after it killed a lot of people in the initial pandemic. That virus is quite similar to SARS-CoV-2 in terms of genetics and symptoms. And it's still around infecting people today. So relax, we'll (mostly) be fine.

https://www.slowboring.com/p/covid-1889

There is immunity in the sense of "the body is able to mount an immune response due to previous exposure." Early claims of immunity to infection didn't pan out, especially post-Delta. There are benefits to having immunity, but I believe they are often overstated. (I say this as someone who is currently wearing an N95 respirator around others 100% of the time, including around my partner and family).

Maybe they are immunocompromised or spend time with people that are? I had a friend that would never get together even after vaccines were plentiful and infection rates were low because he spends time around people that are.

I'm surprised this is news after 3+ years. I would've figured this would've been one of the first things to figure out. I'm sure many would've volunteered to be infected and closely studied early on to collect this information.

Intentionally infecting people for study isn't something that really fits with our medical ethics, at least as I understand them.

IIRC it can be done when there is little risk of serious adverse effects, or there is a known treatment that works well and mitigates risk of adverse effects.

It’s common practice for diseases where healthy people are unlikely to have severe issues, even if they may be deadly for some segment of the population.

https://youtu.be/1v8u3ua6BPk?si=lzAQcZlmnBc1xvj1

It can be controversial, but is done: https://en.wikipedia.org/wiki/Human_challenge_study

Imperial College London conducted a COVID-19 human challenge clinical trial. The risk to healthy subjects without comorbid conditions is extremely low.

https://www.imperial.ac.uk/infectious-disease/research/human...

Yeah, the medical "ethics" field is full of really weird and damaging decisions.

Someone needs to do the work exposing what the hell is going on there.

As others noted, it does happen and is called a human challenge trial. In fact, here's one for malaria that's currently accepting signups.

https://www.medschool.umaryland.edu/CVD/trials/MAM01/

There have been a half dozen challenge studies[1] of influenza in the last 50 years. They're interesting in that there are threshold effects and a dose response relationship. None of the small numbers of test subjects get sick or seroconverted at low doses. Medium doses produce seroconversion without illness. Higher doses produce illness.

Before covid I found a Thai study on the effect of masking nurses in healthcare clinics. Masks reduced infections with some respiratory viruses and not others.

Can't be stated strongly enough is you cannot use the behavior of one virus as a proxy for the behavior of an unrelated one.

[1] Lack of rigorous studies of respiratory infections in the last 70 years caught public health policy makers completely flat footed. Because they were working off out of date textbook knowledge that was low quality.

I think this is roughly what we've known for a few years—probably just more precise. I've definitely heard that early stage is when you shed the most.

People have been talking about this for at least two years. It's been a common topic in right-of-center circles, along with the (in)effectiveness of most masks.

"People coming out of a pool drip a lot of water early on. While that may seem obvious, did you know that the water is wet?"

Infected people shed viruses. Someone with the common cold can be contagious for up to two weeks.

Go figure..

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