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Masks

2020-08-01

Around the country, and world, there’s mask mandates. Forcing people to wear face coverings in response to covid-19.

I don’t wear a mask. They’re ineffective. Here’s why.

Conclusions

Conclusions are pretty uninteresting, when you get down to it. Everyone comes to different conclusions about things, and they fight over those conclusions repeatedly. But generally, people don’t come to those conclusions from an honest and good-faith examination of a problem. Conclusions are usually drawn before the person gains much knowledge about the problem. Then, they work backward to support the conclusion that sounds good to them. Folks get very excited about arguing for or against each other’s conclusions, to the point where just stating a fact makes them start to argue based on the conclusion they think you must have come to; because they’re mistaking data for "points" to be scored to bolster a conclusion.

So conclusions suck. Let’s try to forget that I had to lead this piece with my conclusion about masks, because otherwise nobody would read it. Let’s talk about how we can honestly solve problems.

Identifying the problem

note, this topic involves lots of nuanced and important points which need precise definition - but it screws with the flow of the piece to go too deeply into one or another. Look to footnotes for clarity if something pops out at you

COVID-19 is a virus. It infects people pretty quickly - its base r0 is just under 3, meaning that for every person that contracts it, they spread it to three more^[1]^. By contrast the seasonal flu, which is a collection of a few dozen different viruses, is determined by the ISIRV to have a base r-value of ~1.2. So COVID-19 spreads roughly twice as fast if left unattended.

It spreads through the air, just like the flu. Although there is some debate about whether it travels on "water particles" from breath, or freely in the air itself, we can safely say that it floats in the air for some time. It stays alive for about a week after leaving a host body, and given just how much ncov-19 is spread by carriers, it’s very likely that coming into contact with air that a host has exhaled will get you infected through some mucus membrane.

Finally, it mutates quickly. Once every ~12 generations of the virus it undergoes a genetic mutation. This is both a logarithmic problem that confounds antivirals and vaccines, but also a boon in that we can map gene lines of the virus to accurately understand how many people have contracted and spread it - making it so that we don’t need to exhaustively test the entire planet every few days to understand the spread.

We’ll worry about mortality curves, testing, and the current spread later - right now, let’s assume that our goal is to fight the virus. These are the facts on the ground.

Trying to solve the problem

Before we go deeply into specific solutions, let’s ask ourselves where we’re at. Can we eradicate it? Can we contain it? As of late-February, the scientific consensus has been that it’s too late to eradicate the virus. It would have been possible to eradicate if it were caught sooner at the point of origin, and draconian measures taken to contain it; but it’s too late for that now. We cannot eradicate it.

So containment becomes a question. Can we make it so that the virus is just in one part of the world? The way that malaria currently is? Well, no. It’s a worldwide pandemic now. The only places on Earth that it hasn’t been found are at the poles. In a humorous way, the best containment we can hope for is that it stays strictly on Earth, and doesn’t get into sattelites or space stations. We cannot contain it.

Given this, we must come to terms that we will all get it. There are absolutely no measures that can be taken to make that statement false. That’s not an opinion, that’s a conclusion based on the reality of what it is, where it is, and what we can do about it.

Therefore, the last option is reduction. Can we "slow the spread" such that it infects people at a slower rate? The twin goals of this being that if we slow the virus enough, perhaps we can eradicate it by keeping it slow for so long that it dies, and also that we reduce strain on the healthcare systems of the world by lessening how many people have the virus at once. Since this is a matter of "when", not "if", can we at least control the "when?" Well, after governors and governments began putting citizens out of work and closing their economies, there was a noticeable drop in the recorded spread of the virus ^[2]^. The answer, finally, is yes we can slow the spread.

If you think you already knew these things, then, good - but you are not representative of most people. Generally, people still talk about a time "after" covid, or think that we can "beat" it. This is still a conversation that people have not caught up to.

Can we eradicate in the future?

This is a bit of an aside. People who still believe this can be beaten tend to pin their faith on one of a few different ways to eradicate the virus. If you genuinely believe the virus might be eradicated, keep reading. If you’ve already progressed past that point in the conversation, skip this section.

Antivirals are effective against some viruses, but there’s no broad-spectrum antiviral in the way that there’s a broad-spectrum antibiotic. So far, nobody has an antiviral that effectively defeats COVID. There’s work being done, but nothing promising yet.

Vaccines are the primary way we’ve controlled viruses. This mutates too quickly, similar to the flu. We’ve got annual flu shots, but their efficacy is [pretty bad]((https://isirv.org/site/images/conferences/OptionsIX/Options_IX_Final_Programme.pdf) (page 182). There are vaccines on the way, but we can’t pretend that the virus will magically go away once we have it. Even if every single person on Earth were magically given the vaccine, the virus will still spread.

Quarantine is an obvious and time-tested way to protect a population from the infected. This might have worked when the number of infected was in the dozens or even hundreds, but at this point we’re talking about six or seven orders of magnitude more infections than that. Quarantine is not a realistic way to eradicate this.

Herd Immunity. That’s what we do with the flu. Doesn’t eradicate viruses that mutate too quickly. Even if it were something like measles, we still haven’t eradicated that with herd immunity, and it spreads much less quickly.

We will never eradicate it.

Do masks slow the spread?

Masks come in a variety of standards;

The virus, by contrast, is around 40nm in size. An order of magnitude smaller than the filters are rated for. A direct stream of air containing the virus would easily penetrate the mask. A stream of water containing the virus easily penetrates the mask.

You’ll probably notice that cloth masks aren’t rated. That’s because they have no measurable effect on preventing the spread of any disease.

And, importantly, these ratings are on the filters, not the devices. So a piece of cloth can be N95, but if it’s just hanging from your ears like a surgical mask, that rating isn’t going to mean what you think it does. We’ll come back to that in a moment.

Masks do what they are designed to do. Surgical masks are designed to prevent a forward flow of air coming out of the mouth to enter a patient’s open wounds or orifices. It’s a no brainer that you don’t want someone exhaling into a gash in your arm while they’re stitching it. Surgical masks are quite good at this.

When someone cites you studies about mask efficacy, they are overwhelmingly likely to be referring to studies that place an emitter and detector facing each other, put a mask in place, and then measure how much of the emitted air gets to the detector in a short time span. This is where you get those 99% reduction in "transmission" rates, it’s assuming that the two people only exist for a few minutes. In reality, our breath remains in a space for much longer.

If you were to stand in a room and breathe normally for a few minutes, then leave the room - your exhalation is still there. If you were transmitting ncov-19, we could say that the room’s ambient risk of transmission has gone up. Crucially, it doesn’t matter if you wore a mask or not. If your exhaust contains a virus, that virus is now in the air. It may be redirected up or back from your face, but that’s not important - the virus is in the air now.

If there is an unfiltered gas exchange between two vessels (such as your lungs and a room), a virus can spread. Period.

Masks that create a seal on your face (such as respirators) do prevent the virus from escaping out the sides of the mask, but they also typically have exhaust valve that just let it out. So if you have it, you’ll still spread it. But they will dramatically reduce your odds of getting it. Ironically, these are masks that are now discouraged because of that exhaust valve.

Isn’t it worth trying, at least?

The argument for masks generally boils down to this - "it may not actually help stop the virus, but it can’t hurt right?" This is known as Pascal’s Wager. While it initially sounds convincing, let me propose something else;

How would you feel about a requirement that you stop and pray for three seconds every time you enter or exit a building? Just three seconds! It’s not too much time out of your day, would that really hurt you to do? We don’t actually have reason to believe it will help stop the virus, but if it does stop the virus, then it’s a low price to pay, right?

You’d probably say "no, i wouldn’t support a mandate that I pray" - but why? If you know masks are ineffective, and prayer is ineffective, then the objection must not be about effectiveness.

So any solution we attempt must boil down to whether or not it’s likely to help. And if something isn’t likely to help, we mustn’t force people to do it.

Footnotes

Good lord this is a big topic.

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