Well, "other countries" also did the same. Spain, for example, seems to be the 3rd country with most infected and I got pneumonia about 2 weeks ago. Called the agencies here but they still didn't want to test me, even with pneumonia! Still got a cough since then and they still won't test me.
So, the US is not alone. And it does make a bit sense, I didn't require hospitalization, so makes sense they want to save the resources. But I feel like the article author could have done some better research.
I don't say that to diminish the importance of testing, my point is that the anecdotes aren't necessarily very informative.
From the actual descriptions of patients that have gone through it and been hospitalized, there are much worse symptoms, and maybe they should be addressed more immediately. The main one I've come across is the heavy chest pressure. I don't understand why, in the US at least, there isn't more specific messaging so that we can make sure people with more severe or COVID-19-related symptoms have the ability to get through. Not to mention the BS here of having to 'call your doctor' first before getting seen. There are a lot of people out there now without primary care doctors or that can't afford a visit. There have been no federal instructions on how we would get waivers for visits, testing, and possible hospitalization. If you've ever had to fight with medical billing in the US, it's frustrating and will be even more so after all this dies down.
On a side-note:
I was turned away from donating blood yesterday because I admitted to having a runny nose and a bit drainage that caused some coughing. I have seasonal allergies - it's March, it's been raining and plants are blooming, etc. I understand the caution but I had no fever (tested at 36.6 C / 97.8 F), which is about the same temp I've had for the past week (I've tested that and my blood pressure daily, just in case). I was a bit frustrated, because I really wanted to do something immediate to give back but so be it.
While walking home, it did make me wonder why they even bother taking 'healthy' people who could be asymptomatic if it's such a concern. They admitted to having no way to test the blood.
I think there's a lot that needs to be fixed and I hope that this crisis will provide a better future for us all. Epidemics aren't going to go away. We can learn and plan better.
If you don't have the tests, you don't have the tests. I get that.
But then just say, "Sorry guys, we can only test critical cases and emergency personnel right now because we don't have the tests."
What's concerning is that it's possible to reach a point where a person presenting with pneumonia, is not a critical case.
It's pretty much the same story with the masks, which is a political scandal in France at the moment.
More importantly, the U.S. could and should have provided global leadership as it did for the 2014 Ebola outbreak.
Yeah, we in the rest of the world is very aware of that and frankly a bit tired of it. But my grief about that is nowhere as big as South American or countries in the middle east.
> the U.S. could and should have provided global leadership
Realistically, I don't don't think the US would be able to provide global leadership. Your leaders were denying that this outbreak was even real and the person responsible for the containment is a person who believes prayers can actually solve things. So I don't think anyone is expecting the US to have any real play on the world scene today.
China has ramped their mask production to 200 million masks a day.
Had US government had the foresight and common sense to contract mask manufacturers to even produce half of what China is producing - let’s say 100 million masks, we could have had enough for everyone to have a mask in 3-4 days.
Universal masks for everyone (not only health care workers) together with hygiene protocol should be the way to “flatten the curve”. This would at the very least inhibit spread by those who have coronavirus but don’t know it yet (asymptomatic).
But instead, we’re having these mass shelter in place orders that are destroying our economy, killing businesses and destroying people’s livelihoods.
And I still haven’t heard of massive government contracts to mask manufacturers at the scale needed to provide masks for everyone.
COVID19 is worse than flu, but not as bad as it could have been. We could get hit with something worse in the future. Imagine a strain of Ebola that gestates asymptomatically longer, or another coronavirus with higher mortality rate. This outbreak is good preparation for that one.
Anytime you’re dealing with a harmful exponential growth process like an outbreak, the best way to handle it is to overreact early, quickly and briefly. Kill it hard while it’s still small and easy to kill, or it will get out of control fast.
Put everything on lockdown/shelter-in-place for a few weeks - [max(gestation period|time to develop and deploy test kits) + safety factor] - test extensively, isolate and treat the infected, stop the outbreak, and then return to normal. Outbreak stopped dead in its tracks, economic damage is minimized and mostly short-term.
This is basically what South Korea did and they got their first COVID19 diagnosis the same day as the US:
https://www.reuters.com/article/us-health-coronavirus-testin...
That needs to be become a social and political norm everywhere, not just the Asian countries that have faced a widespread outbreak before.
The experts are f* this up and it is going to have long term implications for already eroded public trust in institutions.
CDC: Our test is going to be so much better than the WHO's, we'll test for SARS-CoV-2 in two samples and also test for other simultaneous infections in this third part!
FDA: Approved
Hospitals: Hey, we can't get that third part to work!
CDC: That's ok, just use the first two parts, that's all you really need to diagnose COVID-19. Though I'm sad I won't get any data on simultaneous infections, apparently that was a problem in Northeast China and we want to figure that out for our guidelines.
FDA: Only running the first two tests is not what we approved! Verboten!
*
Laboratory: Let's develop our own SARS-CoV-2 test!
FDA: Sure, just make sure to fill out these forms, be sure to send them to us by mail rather than email, and oh, make sure to test against the original SARS to make sure your test doesn't give a false SARS-CoV-2 reading if they patient just has that.
Laboratory: Uh, sure. Hey, CDC, can I have a sample of SARS to test against?
CDC: NO WHAT ARE YOU CRAZY I'M NOT GIVING YOU THAT! THAT'S SUPER DEADLY!
They aren't staying home. Restaurants, bars, and events are still open. Trains are still packed at rush hour. Festivals are still happening. They're planning on starting school in April.
I can only see a few possibilities
(1) the numbers are false and Japan's death rate is going to accelerate
(2) the numbers are true but it's still coming
(3) Something about Japanese culture already limits the spread.
I don't believe this one. Japanese might wear masks but not all of them wear masks and they are not N95 masks. Japanese are also known to go to work sick, go to cafes sick, visit friends and family sick. Places are crowded. Open and over crowded offices everywhere.
(4) Something about Japanese genetics makes them less likely to have a strong reaction
I have no idea how to tell which of those it is except to see where they are in a few weeks. If the death rate rises it was (1) or (2). If not then it must be (3) or (4)?
Here's their latest graph. The 2 shallow lines at the bottom are Singapore (bottom) and Japan (2nd from bottom). The rest are Italy, Spain, Germany, France going left to right at the top.
https://rpr.c.yimg.jp/im_sigg.R1UwQuI2tgBhV1fzJ5o7A---x799-n...
Perfection is the enemy of the good. The amount of medical waste is shocking - as if tools went from 100% effective 100% safe to 0% effective 100% at midnight.
I suppose there is a strong cover-your-ass factor at play, that can only be overridden when they have some skin in the game (as in, risk being infected due to 0 mask)
“3M 1860; 3M 1870; 3M 8210; 3M 9010; 3M 8000; Gerson 1730; Medline/Alpha Protech NON27501; Moldex 1512; Moldex 2201.”
https://www.cdc.gov/coronavirus/2019-ncov/release-stockpiled...
tl;dr archive.is wants Cloudflare to implement ECS, Cloudflare refused due to privacy concerns, archive.is doesn’t allow queries from 1.1.1.1 to resolve correctly.
The devices to do this are getting cheaper faster than Moore’s law. Just takes the will to set up the programs
What do mechanisms for accountability here look like? Will they be used?
Edit: And more importantly how will we prevent theses same mistakes from happening again?
My sense is that a lot of the bad decisions don’t necessarily rise to the level of negligence, so civil/criminal penalties are unlikely.
They said they had no ability to get her tested, that we should not be concerned at all that it might actually be COVID-19, and she should visit a clinic. The clinic said it was probably just the flu, and told her to go ahead and fly back but to wear a mask.
This was absolutely criminal incompetence on the CDC's part.
This is very different from guidelines in general. Encouraging people to avoid large crowds, wash their hands and wipe surfaces, and possibly self-quarantine could have made a huge impact earlier on.
Instead, people kept going to bars, concerts, and traveling. A lot could have been done, and testing is only part of the story.
(Submitted title was "CDC Guidelines Hid the Coronavirus Epidemic")
(via https://news.ycombinator.com/item?id=22656060 but no comments there)
I was talking with some physicians and providers when I said that I think this will be the Chernobyl like moment of our era: where the truth is hidden from people to prevent a panic paradoxically exacerbating the current crisis. Shockingly, almost all agreed with me.
Call it hyperbole, but the Spanish Flu killed millions because the public was not told the truth soon enough. We were likewise told this was nothing to worry about for months, and now we have ~30%-50% of the US quarantined.
It disproportionately impacts the homeless. The problem appears to have started in San Diego and spread outward from there.
I'm aware of the issue because a reporter from San Diego contacted me and interviewed me via email in September 2017 because I run the San Diego Homeless Survival Guide.* Another reporter contacted me when it reached Los Angeles.
I received an email last September from something I'm subscribed to indicating it had reached Washington state, though my county was not listed.
On a per capita basis, the small town I live in has a worse homeless problem than the big cities that routinely make the news for it. If I had any real power, I would be trying to come up with the means to do a free hygiene event for the homeless and give away hand sanitizer and free haircuts and Hepatitis vaccines, something I had on my mind before covid19 became a thing.
I've seen relatively little in the press about it. I have seen at least one article about the resurgence of "Medieval diseases."
To my mind, our homeless policies are actively creating a health hazard for the entire nation. CDC policy looks to me like part of the problem. They seem to be sitting on the data about the spread of hepatitis and intentionally not making an effort to publicize it.
I imagine it will get swept under the rug entirely in the face of covid19. This seems to me like a good means to compound our problems.
I have no idea what do about it.
* https://sandiegohomelesssurvivalguide.blogspot.com/2017/09/f...
Italy is flattening and exponential growth becomes exponential decay.
Italy new cases did flatten to 3500-4000 per day for a few days this past week, but they have since resumed increasing on a daily basis. So I don't think they are out of the woods yet. It may not be exponential, but it is very much super-linear
Understandably the Chinese government would be unwilling to contract their strategic supply of manufacturing out when they need it for themselves.
We know from basic economic theory that there are manufacturers who would either ramp up production or go into production if the demand increased. With China seemingly out of the US mask business for who knows how long there are also fewer available suppliers — another motivator.
Domestic manufacturers should be happy to take our money — it’s simply a matter of timing. We knew of the mask shortage at least by January. I know this, because I was following the news around then, and went to the local stores and saw with my own eyes that they were out of stock. I could only get them at Home Depot. Not Walgreens, not Target, not Wal Mart. Had we been contracting manufacturers to produce masks starting then, we wouldn’t be experiencing as many shortages as we are today, assuming it doesn’t take 2 months for pre-existing manufacturers to ramp up production.
The botched timing in ramping up domestic production in response to a known shortage is the biggest issue, not the fact that China hasn’t been taking new orders for going on 3 months.
https://www.washingtonpost.com/business/2020/02/15/coronavir...
People were worried that overreacting (in particular if the outbreak fizzled out, in which case any reaction would have been an overreaction) would damage the economy. Personally, I viewed that as a positive - a decently resilient economy would absorb such short-term shocks without any long-term issues. Easiest way to force-create such an economy? Stress tests (c.f. Netflix’s Chaos Monkey). If governments overreacted 1-2 times every year, people (travellers) and companies (supply chains) would get used to occasional flight blockade, border closure, discontinuity and disruption. We’d build a much more anti-fragile world.
> Personally, I viewed that as a positive - a decently resilient economy would absorb such short-term shocks without any long-term issues.
That’s my sense of it too. The markets may fall in the short term, but as soon as the outbreak is stopped, roughly a month later, the markets will recover most or all of their losses.
Politicians so afraid of any stock market fall that they try to minimize the problem instead of treating the root of it are more likely to cause an even bigger market collapse.
People were already warning us years ago about a pontential pandemic and its impact (including Bill Gates), but we all ignored it.
A real pandemic seemed to be the only way to teach us. So I'm really happy for all of us that it's this moderate one, because it could have been a lot worse.
You can't manage what you can't measure.
To this date, I have seen no reliable data on how fast the disease spreads, or how dangerous it actually is. Testing only 'people with shortness of breath and high fever for more than 4 days' is so biased it's not even funny. There could be 10x or even 100x more people with milder symptoms that are never considered for testing. Reporting '10% of people tested die' is also very misleading, since we only tested people with severe symptoms in the first place.
We can poll 5 times a week for the chances of Biden or Sanders or Warren to become Trump's challenger in fall. Perhaps we could also perform randomized tests every week and get a better sense of the shape of the danger we're facing. Yes, testing for coronavirus is more expensive than calling a phone number, but shutting down the country indefinitely is orders of magnitude more expensive.
I’m sure there will be lessons here too. The difference in response of between countries is one obvious comparison. But I think another lesson will be how the virus spread globally. With this virus, we have much more information about how the virus was able to spread globally so quickly.
(1) Widespread testing is key. Testing symptomatic people is too little, too late. (2) You can't rely on people to self-quarantine. (3) Infected people need to be isolated from their households.
So now we have a massive, economy-strangling quarantine that is not even going to provide any relief, killing the economy and still not flattening the curve. All the pain with none of the benefit.
Anything I’ve read indicates China screwed up at almost every step only to have to do what the rest of the world is being forced to do now. Axios did a good timeline that leads me to believe the Chinese aren’t that special and if anything their government acted in such a way that doomed the rest of the world.
https://www.axios.com/timeline-the-early-days-of-chinas-coro...
Watch one of the now-daily press conferences and you'll see Dr. Fauci trying to gently (so he doesn't get fired) correct inaccurate information from the President, in real-time from the same room.
Take a look at this editorial written by John Ioannidis. Excerpt that is relevant, though the whole thing is a worthwhile read:
>If COVID-19 is not as grave as it is depicted, high evidence standards are equally relevant. Exaggeration and over-reaction may seriously damage the reputation of science, public health, media, and policy makers. It may foster disbelief that will jeopardize the prospects of an appropriately strong response if and when a more major pandemic strikes in the future. [0]
Quick BIO rip from wikipedia:
>Ioannidis studies scientific research itself, especially in clinical medicine and the social sciences. He is one of the most-cited scientists in literature. His 2005 paper "Why Most Published Research Findings Are False" is the most downloaded paper in the Public Library of Science, and has the highest number of Mendeley readers across all science."
>Ioannidis is a Professor of Medicine, of Health Research and Policy and of Biomedical Data Science, at Stanford University School of Medicine and a Professor of Statistics at Stanford University School of Humanities and Sciences. He is director of the Stanford Prevention Research Center, and co-director, along with Steven N. Goodman, of the Meta-Research Innovation Center at Stanford (METRICS). He is also the editor-in-chief of the European Journal of Clinical Investigation. He was chairman at the Department of Hygiene and Epidemiology, University of Ioannina School of Medicine as well as adjunct professor at Tufts University School of Medicine.
[0] https://onlinelibrary.wiley.com/doi/pdf/10.1111/eci.13222
It's worth reading [the rebuttal that followed][1] (as long as we're doing credentials: "Marc Lipsitch, D.Phil., is professor of epidemiology at the Harvard T.H. Chan School of Public Health and director of Harvard’s Center for Communicable Disease Dynamics."):
It agrees that the basic lack of good information is a failing and also certainly creates risk. But we have seen at least twice now the outcomes of doing nothing or almost nothing:
> First, the number of severe cases — the product of these two unknowns — becomes fearsome in country after country if the infection is allowed to spread.
> So acting before the crisis hits — as was done in some Chinese cities outside Wuhan, and in some of the small towns in Northern Italy — is essential to prevent a health system overload.
There are clearly no truly good choices available right now.
---
[0]:https://www.statnews.com/2020/03/17/a-fiasco-in-the-making-a...
[1]:https://www.statnews.com/2020/03/18/we-know-enough-now-to-ac...
Some of them still are. Bolsonaro went on TV to downplay the virus and is actively trying to reduce state agency because state governors aren't waiting on the federal government to protect their citizens.
Exactly why it matters that there was no one in the Whitehouse whose job it was to coordinate the Coronavirus response. Our current situation was predictable. This was written in 2018:
Around the same time that the administration proposed rescinding the funds, the National Security Council dissolved its biosecurity directorate, a small team focused exclusively on global health security threats and led by a director often referred to as the Ebola czar. Again, it’s worth remembering why that office came into existence — a hard lesson. Without a central office to coordinate federal efforts by many agencies, progress was slow the last time the world confronted Ebola. “It took months of wrangling to put things in place,” Mr. Konyndyk said. “If the only way to get resources is through long negotiations with committees, you are giving disease a head start.” It was based on that realization that the Obama administration established the biosecurity directorate and named the first Ebola coordinator.
https://www.nytimes.com/2018/05/22/opinion/ebola-outbreak-tr...
> Laboratory: Uh, sure. Hey, CDC, can I have a sample of SARS to test against?
I've been trying to stay on top of the testing saga, but it's been hard with all the daily changes.
Do you have news links that describe this hypothetical exchange taking place?
EDIT: in particular, the part around the FDA requiring testing against a sample of SARS.
>The officials at the FDA instructed him to test his test against the MERS and SARS viruses, which are also coronaviruses. It wasn’t a terrible idea, Greninger thought. Why not develop a test that catches all these deadly coronaviruses all at once? It did seem strange, however, that the FDA was asking for this in an emergency use application: by this point, COVID-19 cases had appeared in six states. (The FDA did not respond to a list of questions about the process.)
>Still, Greninger complied. He called the CDC to inquire about getting some genetic material from a sample of SARS. The CDC, Greninger says, politely turned him down: the genetic material of the extremely contagious and deadly SARS virus was highly restricted.
https://www.gq.com/story/inside-americas-coronavirus-testing...
Substandard masks are better than no masks, and many people wearing masks is better than few people wearing masks. These are not "all or nothing" matters.
https://www.againstcovid19.com/singapore/dashboard https://www.againstcovid19.com/taiwan/dashboard
This is vs the ~110 British cases and ~50 American cases the two countries have seen collectively.
Flight volume from Japan to both countries is normally quite substantial so this is evidence to suggest that Japan's case is not low solely due to undertesting.
This is a very western belief. Why do we continue to think that asians wearing masks are stupid?
Most importantly, say masks prevent 50% of transmission, and the majority of transmission is via the air (highly plausible), then that would mean drastically less transmission.
Even an N20 mask that reduces risk by 20% would make a huge difference to a population.
It is my prediction that masks are the single most effective means of dealing with the virus at present. Japan’s low infection rates are because they wear masks.
Wearing a bandanna over your mouth and nose just makes sense.
https://smartairfilters.com/en/blog/best-materials-make-diy-...
https://askul.c.yimg.jp/img/product/3L2/8475270_3L2.jpg
That is not a N20 mask.
Further they don't all wear them. < 50% wear them.
The majority of people wearing masks in Japan are for hay fever.
Surgical masks aren't about protecting the wearer from everyone else, they're about protecting everyone else from the wearer [1]. They may provide the wearer some protection, but that's not really the point.
The emphasis in the rhetoric about masks needs to change. It should not be about individualist self-protection, but about doing your part to protect the community. I think they should be recommended for that reason [2].
[1] Respirators are devices for protecting the wearer, and the N95 type has been much discussed. Everyone should learn the difference to de-confuse the general conversation in this topic:
https://www.youtube.com/watch?v=JR2uLfEVD2w
https://multimedia.3m.com/mws/media/956213O/differences-betw...
[2] If there's enough supply. It seems like surgical masks are getting drafted into the role of PPE for medical personnel (which they're poorly suited to) due to the N95 shortage. It's unfortunate that the US hasn't developed a culture where you wear a mask to protect others from your illnesses, so they're not widely available outside of healthcare settings.
Face protection must surely have the side-benefit as well that it signals to others to keep your distance and that this is a serious situation.
So yes once you've removed all non essential contact masks add another layer. But people are fairly stupid on average and need simple messages right now.
Most (if not all) distributors and manufacturers of masks has been prioritizing health care systems and governments over retailers since January. Just as they should do. Were there any that weren't? I didn't see any reports of that, but if so of course the proper thing is to report them and talk to them. Not to blame random joe for having a mask.
The fact was since January retail supplies were only existing stock, which as we know was quickly sold out with a lot being sent back to family overseas (no judgement there). And I haven't seen any masks being restocked at any hardware stores or pharmacies since. At no time did I hear about authorities going around every pharmacy or home depot to try to collect any masks. Why? Because they knew there were no supplies and what was there was so small it'd make no dent in the problem. So blaming the public is grossly irresponsible and even put people in danger. I have an immune compromised friend that was responsibly using masks but got harassed for wearing masks "that don't work". And there were plenty of similar reports of such behavior from others.
- The messaging (in Spain but looks similar everywhere) has been that you should wear one if you are sick or, more importantly here, if you are at risk. This is a clear indication that they do help protect against being infected. This should have prevented everyone from harassing anyone wearing one ("they must be a risk group"). The fact that people did that is indication that people are not acting responsibly.
I personally hate being told something that is patently false, but I totally understand that, collectively, we need to be lied to for our own protection, because collectively we become a bunch of idiots.
It appeared to be very common for citizens to wear masks in eastern Asia long before this pandemic. I'm not the least bit surprised they were more prepared to scale up production.
They still haven’t done this to date. Beyond frustrating.
If you look at almost all of their actions, they continually clamp down on things that might work because they have not been proven.
It seems to me that they are led by academics and theoreticians with very little operational capability at the top decision making channels.
"In the middle of the 20th century, a cadre of credentialed experts was created to replace citizens. This was a mistake. The selection mechanism for entry into this cadre selects against bravery and original thinking. Experts should be consulted, but what use is an expert unwilling to consult on a grand vision? The American system of the 2020s through the city, county, state, and up to the federal level has been staffed with people who know how to speak and make themselves appear blameless, but not how to act."
https://americanmind.org/features/the-coronacrisis-and-our-f...
The messaging around masks has been so aggravating to me that I got together with a couple of colleagues to write a detailed, scientific mini-review / commentary:
https://medium.com/@matthiassamwald/promoting-simple-do-it-y...
The benefit of widespread mask usage by the general population is source control [0]. This works even if the person wearing the masks makes mistakes such as touching their face more while wearing the mask.
Also, it should be obvious that there is no downside to wide-spread mask usage by the general population. The countries that have so far the most control over the virus' spread are the ones where wearing masks is normal and often done to protect others when sick.
Importantly, if the goal is source control, then all sorts of makeshift mask designs can work. People in Japan and other countries are already getting really creative [2,3].
Of course, the problem that medical personnel might face even more shortages if everybody starts wearing medical grade masks is real and must be taken seriously. But that's not the only option we have.
[0] One reference amongst many, this commentary in the Lancet: https://www.thelancet.com/journals/lancet/article/PIIS0140-6...
[1] Compare growth rates here: https://studylib.net/coronavirus-growth
[2] https://www.cottontimemagazine.com/page/10
[3] https://mobile.twitter.com/nekohnd/status/122368673365439692...
Have spare masks? We are trying to get them to the people who need them most: https://findthemasks.com/
We are presently listing hospitals accepting small-scale donations in 28 states, growing fast.
CDC’s continued insistence that face masks don’t work is disingenuous at best. Leading way to a global recession at worst.
Had they changed their guidelines to saying that face masks can help inhibit spread at the very least, especially from asymptomatic carriers who are wearing masks, US gov could have contracted mask manufacturers to with millions of dollars worth of mask orders. Spurring then to produce masks, eliminating this shortage of masks.
Instead, gov plan has no mask protocol, so the only other option is a global shutdown of “non-essential businesses”. Causing an essential shutdown of the economy. The cost of which they have obviously not calculated.
ISTM a moderately tightly woven or knit hydrophilic mask (e.g. cotton) could be quite effective. Knits could have the added benefit that droplets would need to take a twisty path to get through. And there is plenty of such material around.
This shouldn’t be that hard to study in a lab. Find a sick person, have them cough through different masks, and measure viral concentrations on nearby surfaces.
https://www.nytimes.com/2020/03/17/opinion/coronavirus-face-...
And some data back from SARS: "Always wearing a mask when going out was associated with a 70% reduction in risk compared with never wearing a mask. Wearing a mask intermittently was associated with a smaller yet significant reduction in risk."
https://wwwnc.cdc.gov/eid/article/10/2/03-0730_article
I saw a lot of people sanctimoniously talking about fit tests in normal healthcare settings as if an imperfect fit dropped effectiveness immediately down to 0% from 100%.
If we consider a place like South Korea, or Singapore, the executive actions contrast wildly with the executive actions that our city, state, and federal governments have taken.
If I'm not mistaken, in Singapore they even went so far as to distribute packs of masks to each and every family. I don't ask for that level of efficiency, but it does illustrate an example of effective executive action during times like these.
“Origami” tea cloth mask with rubber bands https://www.instagram.com/p/B96rcR8neYv/
In China, it's pretty much contained now, and everyone wears masks on the street -- The thing is, there are 1.3 billion people, of course there are a lot of people couldn't buy or afford surgical masks, let alone N95 masks.
It turns out people wear regular masks, or even they don't have any mask they sew their own mask.
Also, most surgical and N95 masks are disposable, in China, people cover their hand sewed mask outside, covering the disposable masks inside and try to reuse them, and disposes the hand-sews masks. This hack, of course, have potential risks, but it might help for people who are running out of masks.
Sorry to nitpick, but it's N95 respirators not masks. There's be a lot of terminology confusion on this topic, and I think it's making communication significantly more difficult on this topic.
https://www.youtube.com/watch?v=JR2uLfEVD2w
https://multimedia.3m.com/mws/media/956213O/differences-betw...
YES, we get it, but what about protecting others from your cough since most people don't even know they're contagious. Even a 20% decrease from a crappy solution is interesting when dealing with exponential curves.
Drives me mad.
If you are caught without a mask you get fined.
How else can people get the virus? Perhaps people shed the virus through their skin? Or touch their face and get it on their hands? So people can wash their hands before touching their face. Also people can get it in their private homes. But those groups don’t mix all the time.
So I am just wondering... N95 masks are for the person who doesn’t want to get the virus. But what about everyone else?
I understand that you could wear the mask crooked and there are problems with application. But mass producing N95 masks and giving them out and MANDATING everyone wearing them like women in Saudi Arabia seems like a better policy.
In countries where the epidemic is controlled, pretty much everybody wear masks, including handcrafted one in case of shortage. The goal is not to prevent from being infected, but to prevent infecting other, by limiting the amount of saliva you spread everywhere. Especially since tons of carriers are asymptomatic, or starting to be contagious before becoming symptomatic. And even a poor mask in front of your mouth is better than nothing, at least if everybody wears one, and if you don't become careless on other measures (distancing, washing the hands, etc.)
So there is an availability and potentially a cultural problem, but that can and should be fixed. Because this will be far less costly than infinite lockdowns.
As an alternative see Hong Kong, where they are encouraging the population to improvise masks: https://www.consumer.org.hk/ws_en/news/specials/2020/mask-di...
Cat meme because it was reposted to Chinese Quora. Obviously consider that Asian countries have no mask shortage due to existing cultural practices. Masks should be prioritized to prevent collapse of medical capacity when there is shortage - the policy suggestion most western countries are seeing. The TL;DR of the guide: the only scenario not to wear (normal surgical) mask is when you're alone. Surgical masks for almost every other situation, N95+ for high risk situations. On efficacy for public health, The microbiologist Yuen Kwok-yung, from HK who was a key figure in SARS and one of the expert teams on Covid response:
>Given this novel coronavirus is so "cunning", with probably many infected but asymptomatic people moving around in communities, how should ordinary citizens protect themselves?
>We can only rely on telling everyone to wear a mask, wash their hands frequently, use alcoholic sanitiser. I had called for everyone to wear a mask when I was in Beijing, but many people disagreed, saying that the World Health Organisation (WHO) said healthy people don't need to wear masks unless they go to crowded places. Nevertheless, if people wear masks only when they feel sick, then the eight infected people on the Diamond Princess would have transmitted it to others because they were not feeling uncomfortable. Wear a mask to protect not only yourself but also others, because if you are infected but asymptomatic, you could still stop the spread by wearing a mask.
>In our experiments previously, we found 100 million virus strands in just one milliliter of a patient's saliva. Therefore, scenarios with the potential for exchanging saliva are generally quite dangerous. The temporary success of virus control in Hong Kong this time is not only due to population controls, but also contributed by the early advocacy for mask-wearing, hand-washing, and social distancing. Otherwise, with such a dense population in Hong Kong, the epidemic would very likely have spread the same way as in Italy or Daegu in South Korea.
https://www.straitstimes.com/asia/east-asia/exclusive-qa-wit...
Google translate of guideline:
The general public
(1) Home and outdoor, no people gathered, well ventilated. It is not recommended to wear a mask.
(2) Being in a crowded place, such as office, shopping, restaurant, conference room, workshop, etc .; or taking a box elevator or public transportation. In low- and medium-risk areas, it is recommended that you wear spare masks (disposable medical masks or medical surgical masks) with you, and wear them when in close contact with other people (less than or equal to 1 meter). In high-risk areas, disposable medical masks are recommended.
(3) For those with cold symptoms such as coughing or sneezing. It is recommended to wear disposable medical or surgical masks.
(4) For those who live together with those who are separated from home and discharged from rehabilitation. It is recommended to wear disposable medical or surgical masks.
Personnel in specific places (1) It is located in densely populated hospitals, bus stations, railway stations, subway stations, airports, supermarkets, restaurants, public transportation, and community and unit import and export places. In medium and low risk areas, it is recommended that workers wear disposable medical masks or surgical surgical masks. In high-risk areas, it is recommended that workers wear medical surgical masks or protective masks that comply with KN95 / N95 and above.
(2) In prisons, nursing homes, welfare homes, mental health medical institutions, school classrooms, construction site dormitories and other densely populated places. In medium and low-risk areas, it is recommended that you always wear spare masks (disposable medical masks or surgical surgical masks) with you daily, and wear masks when people gather or come into close contact with one another (less than or equal to 1 meter). In high-risk areas, it is recommended that workers wear medical surgical masks or protective masks that comply with KN95 / N95 and above; other personnel wear disposable medical masks.
Key personnel
Suspected cases, confirmed cases, and asymptomatic infections of new coronavirus pneumonia; close contacts of new coronavirus pneumonia; immigrants (from entry to end of quarantine). It is recommended to wear medical surgical masks or protective masks without exhalation valve that conform to KN95 / N95 and above.
Occupational exposure
(1) Medical personnel such as general outpatient clinics and wards; emergency medical personnel in medical institutions in low-risk areas; administrative personnel, police, security, cleaning, etc. engaged in epidemic prevention and control. Medical surgical masks are recommended.
(2) Personnel working in the ward and ICU of patients diagnosed with a new type of coronavirus pneumonia, suspected case patients; medical staff at designated medical institutions for fever clinics; medical staff in emergency departments of medical institutions in middle and high risk areas; epidemiological investigations and experiments Room testing, environmental disinfection personnel; transfer of confirmed and suspected cases. Medical protective masks are recommended.
(3) Operators engaged in the collection of respiratory specimens; staff who perform tracheotomy, tracheal intubation, bronchoscopy, sputum suction, cardiopulmonary resuscitation, or lung transplantation, pathological anatomy in patients with new-type coronavirus pneumonia. Suggestion: hood-type (or full-type) powered air-supply filter respirator, or half-plane power-supply air-filter respirator with goggles or full screen; P100 anti-particulate filter should be used for both types of respiratory protection Elements and filter elements should not be reused. Use protective equipment after disinfection.
https://courses.lumenlearning.com/boundless-microbiology/cha...
The flu virus is typical: ...the flu virus is .17 microns in size.
https://www.envirosafetyproducts.com/resources/dust-masks-wh...
Masks work by trapping flu particles. The 95 in an N95 mask is shorthand for "this masks traps 95% of particles of size .3 microns.
There are also N99 and N100. N100 trap 99.7%. N100 when it is used in an air filter is called HEPA which I believe stands for High Efficiency Particle Attenuator or Arresting.
There is also a level above that found mostly in Europe called ULPA which pushes the decimal out further to 99.9997% . All of these aarea measure of the masks ability to trap particles of 0.3 except ULPA which is a measure of trapping particle 0.17
https://www.globalspec.com/learnmore/manufacturing_process_e...
Masks are matted fibers designed to trap particles on their fibers. They do this using 3 mechanisms which all masks share- diffusion, impaction and inertial impaction.
Diffusion happens when a particle is so small it is in Brownian (random) motion. These particles are trapped because they constantly change direction randomly as they pass through the mask and eventually run out of luck trying to dodge fibers. Such particles are less than 0.03 microns in size. (I should inject here that even though virus are smaller than this, there's more to the story as detailed below).
Inertial impaction happens when a particle is larger than .03 and owing to its size and momentum cannot change its direction of travel fast enough to stop itself running into a fiber.
Impaction happens when a particle comes within 1/2 of its radius of a fiber and touches it, becoming trapped. This is the most difficult size of particle to capture (as it happens) and that's why its the reference particle size for safety masks.
In the above I acted as though the particles were "trying" to avoid being trapped, but of course that's just a stub for the underlying physics off motion and magnetic attraction/repulsion which underlie these facts.
If you want to DIY some sort of mask to reduce your exposure, you have to consider that the weave of most cloth is far far wider than .03 and anyway not in layers (a cloth like yarn is the exception to the second property).
Just guessing but rags scarves etc lack the required fiber density to function as safety masks. It is possible that the virions would sail through them even under Brownian motion. But that is not really how virions are transmitted- they are transmitted mixed in with saliva particles which are hugely larger than the virions themselves. The size of a particle of saliva in a sneeze was examined here- tldr: a bimodal distribution of sneeze particle size all over 50 micrometers.
https://royalsocietypublishing.org/doi/full/10.1098/rsif.201...
Some other studies have put the size as small as .35 micrometer. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4676262/
What is really astonishing is how fast the particles travel- 200 MPH. https://www.livescience.com/3686-gross-science-cough-sneeze....
https://www.texairfilters.com/what-happens-to-the-particles-...
So all in all we can say this-any mask covering is better than no mask because it's an odds game with virus particles and saliva.
The less able you are to breath through it, the better it functions as a barrier.
Ordinary cloth is just not woven tightly enough to substitute for a p95 mask.
If you had to choose between multiple layers of x number of fibers and a tighter weave of the same fibers, it might be better to go for a tighter weave because even though individual virions would travel under Brownian motion, that's not how a spray of sneeze which is the transport mechanism of the virus is going to travel.
Some sneeze particles containing virions have a particle size of 5 microns and will stay aloft in a still room for a long, long, long time. If someone sneezes and three minutes later you walk through where they were, you could very well become the unknowing, unwilling next host of the virus.
That last - horrifying - fact is one of the the reasons why they're telling people to maintain social distancing and just stay home.
You cannot expect the general population to adhere to the standards of a TB hospital. It cannot be done, even if it was a good idea. For example, standard practice is that a mask is meant to be worn for only 8 hours and that is under the assumption that you have no reason to believe you were exposed. If the mask becomes wet, damp, or if you have any reason to believe you've been exposed you're supposed to immediately doff it carefully and dispose of it. Typically PPE is used only once per exposure, or is reused for exposure to one patient at a time.
There are so many variables at play here. From the efficacy of the masks themselves, the best allocation of resources, the different varieties of masks, the techniques for proper fitting, the decontamination processes, other PPE. Does this mean masks are not useful? No. And you won't find many experts making this claim. It's clear that masks help.
Think critically about this. It is not as simple as "masks good" or "surgeon general lied." There are manifold hysterics going around -- please don't contribute to it.
https://www.politifact.com/factchecks/2020/mar/17/instagram-...
https://www.politifact.com/factchecks/2020/mar/12/joy-behar/...
That said, calling the situation a hoax was beyond redemption.
Your link: https://www.politifact.com/factchecks/2020/mar/17/instagram-...
I just did a search for news articles from the end of January to the end of February, and only found articles like this one[1], where politicians are criticizing the Trump administration's communication, but aren't callng for stronger efforts or mass mobilization (and the article has a quote from Pelosi saying she has confidence in how the CDC is handling things). Congress wasn't passing legislation to fight the pandemic as things were heating up, and governors don't seem to have made effective plans. The media didn't consider it to be a major disaster until recently (it didn't get brought up in the presidential debates until a couple weeks ago, IIRC). Issues like our lack of emergency stores for things like masks and our lack of an ability to manufacture them here is an issue that goes back for years, as is the poor safety net that leaves Americans so vulnerable in times like this.
Hopefully this crisis will encourage people to look at the poor leadership America has had across the board. Simply getting rid of Trump and calling it a day is just rearranging deck chairs on the Titanic.
[1] https://www.washingtonpost.com/us-policy/2020/02/05/some-law...
Options -> Network Settings -> DoH provider
On top of both of these you're more than correct that lung function will likely decrease. This virus kills lung tissues and although we have cells that are there to heal lungs, SARS-CoV-2 tissue tropism is highest for these cells (ACE2 receptors on type II pneumocytes).
Dr. Facui is one of the most respected scientists in the medical field. He's either in the top ten or right around the top ten of the most referenced. He is the reason why HIV has killed only ~50 million people. I'm building his credibility because he has stated that he hopes we're over reacting to this [2-3].
1)https://pubmed.ncbi.nlm.nih.gov/32031570/
2) https://thehill.com/homenews/sunday-talk-shows/487639-fauci-...
3) https://www.axios.com/fauci-coronavirus-overreaction-decc88f...
If you're asking about hand washing practices in that era and if that would have prevented the spread, absolutely. Hand washing attenuated SARS spread during the 2002 epidemic by roughly ~50% [1]. I am not an expert in history so I cannot speak to hand hygeine practices during that era. What current research is suggesting is that H1N1 spread was exacerbated by a lack of knowledge to the public [2]. Time and time again public health is predicated on the right knowledge given as quickly as possible; this is the most important key to almost every single disease spread[3].
1)https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3323085/
because the public was not told the truth soon enough
Nobody knew the truth (as the "Spanish" moniker makes obvious). Germ theory itself was new, and viruses were unknown. In fact, a substantial effort to make a vaccine to combat the suspect bacteria resulted in actual deployment to thousands despite the fact that they had misidentified a bacterium as the culprit.I understand that the symptoms are pretty ordinary and there are a lot of pathogens which could cause it. And you're right, all I have are anecdotes.
My own cough is still going on for almost two weeks now. I'm pretty sure that I got it from a coughing man on my commuting train. Four days later I had a sore throat and on the fifth day I had this cough. If this person was tested, and was positive, there's no chance they could find me.
I wouldn't double down on an exact number, but it's clear enough that there are lots of negative tests happening in the US.
Here's speculation based on data:
I can't help but see the demographics of those who are dying and come to the conclusion that this is not a threat to the general population in the direct sense. No one aged 0-9 has died worldwide to date. No one in Italy under 30 has died. Of those that have died in Italy, 88% had one or more serious comorbidities; only 12% can be directly attributed to COVID-19. It seems that this is killing people who are already sick or in fragile health; it just so happens that the elderly of course dominate those categories. Consider this: nearly 3,000,000 people die every year in the USA. How many of those who will die this year from COVID-19 will overlap with that 3,000,000? In other words, could it be that the excess mortality rate of COVID-19 when amortized over the next two years isn't actually that high? Does it make any sense to throw ourselves into a depression because of this? Remember, the effects of eceonomic downturns affect every single aspect of peoples lives including their health. If we do this wrong even more people may die or have significant, long lasting, hardship because of an ill-considered and potentially unnecessary intervention.
I read a paper this morning that suggested some things that I believe need more attention:
> For example, we are learning that hospitals might be the main Covid-19 carriers, as they are rapidly populated by infected patients, facilitating transmission to uninfected patients. Patients are transported by our regional system,1 which also contributes to spreading the disease as its ambulances and personnel rapidly become vectors. Health workers are asymptomatic carriers or sick without surveillance; some might die, including young people, which increases the stress of those on the front line.
>This disaster could be averted only by massive deployment of outreach services. Pandemic solutionsare required for the entire population, not only for hospitals. Home care and mobile clinics avoid unnecessary movements and release pressure from hospitals.2 Early oxygen therapy, pulse oximeters, and nutrition can be delivered to the homes of mildly ill and convalescent patients, setting up a broad surveillance system with adequate isolation and leveraging innovative telemedicine instruments. This approach would limit hospitalization to a focused target of disease severity, thereby decreasing contagion, protecting patients and health care workers, and minimizing consumption of protective equipment. In hospitals, protection of medical personnel should be prioritized. No compromise should be made on protocols; equipment must be available. Measures to prevent infection must be implemented massively, in all locations and including vehicles. We need dedicated Covid-19 hospital pavilions and operators, separated from virus-free areas.[0]
> less than 50% wear them.
I looked a photo taken in Japan today - certainly looks like more than 50% to me - but hard to get facts on and I only looked at the first photo I could find.
> The majority of people wearing masks in Japan are for hay fever.
I.e. the mask is worn to reduce inhalation of small particles: surely you are contradicting yourself (you say they “seal nowhere” you are implying that they have no effect and that anyone using one for hayfever is mistaken).
Any other examples?
Now will we have another in the next 100 years? I don't think anyone knows what the base rate for 1918/coronavirus style viruses are, but there is no reason to think it will happen more frequently than the last 100.
I’m rather confused about this push back. Of course wearing a mask doesn’t guarantee you can’t get infected, but it’s better than not wearing one. There’s a bunch of evidence of this, in studies, and in China right now. What is there to worry about? If you’re really worried, then don’t go out.
Can you cite a study that supports your claim?
> Improvised masks commonly provide little protection, but obstruct breathing so people suck in more air with more force, increasing their risk of exposure.
The point of an improvised mask should not be to protect the wearer, but to protect the community from the wearer.
I'd be hesitant to use Economics 101 theories as a way to model the real world. While they are intuitive theories there is a reason they are 101 theories and even "expert" economists are often wrong. :)
These lines of thought are often similar to how people point to evolutionary reasoning because of how intuitively the "survival of the fittest" explanation comes into play (esp. wrt the capitalist society we live in).
But in any case, even tossing that basic fundamental economic theory aside, what about the rest of my comment? Is it not true that we would have more masks in production today if we started producing them in January?
If there was enough additional demand, you bet there would be more production. Let’s say someone in January is suddenly willing to write a 10 billion dollar check for 100,000 masks. Not one additional mask would be produced before March? Because people are scrambling to procure masks now. And additional masks are being produced and even donated.
Maybe they are effective - it remains to be seen in an internationally vetted way. And they also had an opportunity to disseminate globally that they had doctors reporting issues, but instead they maintained until at least the middle of January (this started in November) that human-to-human transmission wasn't documented.
Nothing they say inspires confidence given their history and current actions, especially when it's ostensibly at odds with the experiences of almost the entire rest of the world with higher living standards and more uniformly modern systems.
Increasingly as time goes on, I have a harder time believing this is anything other than another shooting the messenger, Chernobyl-style event from an oppressive, information-deprived regime.
Which country managed to get it under control it its own house since that date?
https://smartairfilters.com/en/blog/diy-homemade-mask-protec...
https://smartairfilters.com/en/blog/best-materials-make-diy-...
I dont disagree with your source obviously but several major fact checking websites are reporting the opposite.
Doing some more analysis it seem that the figures you posted include emergency funding the cdc received for things like zika. These are not part of the standard budget. For example in fy16, they include retained funds for swine flu which expired. If you remove these you as the trends reported in the news.
Most people aren't as fortunate as us computer programmers. I can get a job in a few days, even with the corona virus, not true of restaurant workers. And even some of us in the "programmer class" are struggling.
Some stress testing is good, but how to do it without killing the vulnerable.
Less stress, more often. I think regular random border closures or brief, targeted disruptions of small parts of supply chains would do wonders to curb over-JIT-ting of the economy, while not hurting too many people too much.
That said, I worry it's too little - it doesn't address head-on the incentives that create vulnerable supply chains.
Somehow that needs to be woven into a bigger fabric.
I wonder if there is a way to create simultaneous small pains randomly.
For instance, a hurricane and a cell phone outage would really suck.
This is the time to work together, not for one country to be the leader.
https://www.nytimes.com/2020/03/23/opinion/coronavirus-mcchr...
> This is the time to work together,
Agreed. Best of luck in Spain.
Well, why the crap not? Why is the west so unbelievably bad at handling this epidemic? Why aren't we able to produce our own masks? These things are essential and it was all off-shored to China. Now the west is screwed while life goes on in Asia.
We just didn't order up enough in the ramp up to prepare for the surge the way the government did in Singapore.
As to the question of competence, well, I guess maybe I should demand the eastern level of competence out of my leaders. But what good does it do to demand something that you know from the outset your leaders are not capable of? We have the leaders we have. I can't change that right now. The only thing we can do collectively is to try to get the best we can out of them, realizing that it's very likely their best ain't gonna be anywhere near asia level efficiency.
Maybe one of the good things to come out of this crisis will be a demand for higher quality stewards. Maybe we'll get much higher quality candidates at election time? But in all honesty, I kind of doubt it.
- The CDC (and the US Federal Government in particular) has been understaffed and underfunded for the entire duration of the Trump Administration; to expect the agency that's been gutted for 3 years to rise up to responding effectively to a pandemic seems a bit much. The CDC is not the Center for Pandemic Control; 99% of the time their goal is to optimize tests and 99% of diseases they work with are not pandemics.
- Understanding that the responses to the pandemic by federal agencies would be suboptimal, the pandemic response team was created for this very scenario to provide an "optimal" response to a pandemic. But that too was disbanded by the current administration.
Removing all the ways in which an agency is empowered to tackle a specific problem and then claiming its institutional decay doesn't sound reasonable to me. Federal agencies are hyper-specialized things and deliberately don't have the kind of "leadership" that you're looking for... that power is held by the President, as it should be. Literally any other competent president would have (re-)created the task force and empowered that to lead the response.
* CDC is the nation’s health protection agency, working 24/7 to protect America from health and safety threats, both foreign and domestic. CDC increases the health security of our nation.*
“Protection” is active, not passive. So yes, they are the center for pandemic control.
And if you don’t like my wording, then check out this page [0] which is the homepage for the Deputy Director for Infectious Diseases (DDID). On that page it states that “he directed CDC’s 2009 H1N1 Pandemic Vaccine Task Force”.
Finally, this funding story has been denied [1] by the CDC itself.
So yes, someone dropped the ball. I’m not mad about that (it’s a complicated environment, etc), as much as I am mad that nobody will own up to it. That lack of responsibility is why I hate politics and Washington crap in general.
[0] - https://www.cdc.gov/about/leadership/leaders/oid.html [1] - https://www.factcheck.org/2020/03/false-claim-about-cdcs-glo...
He downplayed the threat and called the alarm bells a political hoax. That is the same thing as calling the threat a hoax even if he never denied the existence of the virus. A week later it was a national emergency.
I think you're confusing the normal use for these masks with what they are actually capable of doing. Yes, in a surgical setting the masks are worn primarily to protect the patient from the surgeon, but the masks do work both ways. Here's a citation from an infectious disease specialist:
https://www.health.com/condition/cold-flu-sinus/surgical-mas...
>“Yes, a surgical mask can help prevent the flu,” Sherif Mossad, MD, an infectious disease specialist at the Cleveland Clinic, tells Health. “Flu is carried in air droplets, so a mask would mechanically prevent the flu virus from reaching other people.” It would work both ways, says Dr. Mossad, preventing transmission of the flu virus to others and for keeping a mask-wearer from picking up an infection.
> I think you're confusing the normal use for these masks with what they are actually capable of doing. Yes, in a surgical setting the masks are worn primarily to protect the patient from the surgeon, but the masks do work both ways. Here's a citation:
I wasn't confused. That's why I said they may provide the wearer some protection. The 3M YouTube video I linked even quantifies this, by measuring and comparing leakage between a surgical mask and an N95 respirator.
But that's not the point. Don't wear a mask to protect yourself, wear a mask to protect others.
Normal people using surgical masks in public are definitely also for protecting the wearer, and do offer protection.
"Any type of general mask use is likely to decrease viral exposure and infection risk on a population level, in spite of imperfect fit and imperfect adherence, personal respirators providing most protection."
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2440799/
Additionally, the number of asymptomatic carriers who may be able to spread the disease is possibly quite large.
For example, I don't trust the WHO much anymore because they lied and said that closing China's borders would not stop the spread of corona behind pressure from the Chinese government.
From https://www.factcheck.org/2020/03/dems-misconstrue-trump-bud...
> Morrison objected to claims that the office was “dissolved,” writing in the Post on March 16 that the administration “create[d] the counterproliferation and biodefense directorate, which was the result of consolidating three directorates into one, given the obvious overlap between arms control and nonproliferation, weapons of mass destruction terrorism, and global health and biodefense. It is this reorganization that critics have misconstrued or intentionally misrepresented.”
For medical professionals in close contact with patients and dealing with airborne-protocol pathogens (which is what a droplet-mediated pathogens like SARS2 becomes classed as once patients are coughing and being intubated) then a bad mask is quite probably worse then no mask (this has precedent: ineffective masks obstruct breathing, which makes you take deeper breaths and draw more particles in deeper in your lungs - it's a big problem when dealing with fine dusts in construction).
You’re saying you think anything less than an N95 has 0 effectiveness. Why do you believe this is likely? Are you aware of the data that says otherwise?
https://news.ycombinator.com/item?id=22655436
https://www.researchgate.net/publication/258525804_Testing_t...
https://jamanetwork.com/journals/jama/fullarticle/2749214
“As worn by health care personnel in this trial, use of N95 respirators, compared with medical masks, in the outpatient setting resulted in no significant difference in the rates of laboratory-confirmed influenza.”
To be clear, this trail was for outpatient care — not necessarily applicable to shoving tubes down throats, but probably applicable to people walking down the street.
> However, these masks would provide the wearers little protection from microorgan- isms from others persons who are infected with respiratory diseases. As a result, we would not recommend the use of homemade face masks as a method of reducing transmission of infection from aerosols.
https://www.cdc.gov/coronavirus/2019-ncov/hcp/ppe-strategy/f...
Unfortuately, the CDC really is giving out conflicting guidance here. For example, higher up in the section for lay-people is this: “You do not need to wear a facemask unless you are caring for someone who is sick (and they are not able to wear a facemask). Facemasks may be in short supply and they should be saved for caregivers.” https://www.cdc.gov/coronavirus/2019-ncov/prepare/prevention... (In “How to Prepare | Protect Yourself”)
If you are not exposed to high levels and are not required to put yourself at risk to care for patients, you are at low risk. You can protect yourself with milder measures like social distancing and face protection that is not as effective but not in such short supply
Current CDC guidance is “facemasks are an acceptable alternative when the supply chain of respirators cannot meet the demand”.¹
¹ https://www.cdc.gov/coronavirus/2019-ncov/infection-control/...
Now we have the separate issue of the fact that there is a critical supply shortage. In such a scenario I'm more than happy to oblige in managing systemic risk by allocating all the masks to healthcare workers, the critically vulnerable, etc. But don't lie to me along the way.
There's a lot of variation in influenza viruses, but most are spheroids or ellipsoids with a diameter from 80-120 mm.
For simple mechanical filtering, such as with a mask, they are going to behave pretty similar.
There is plenty of blame to go around but it concentrates at the top.
I have been preparing for this since early January, have you? If not, why not? If not, you fell into the trap almost everyone else did to fail to recognize the threat and the exponential nature of the threat. So stop throwing stones from within your glass house, and look forward. Critique the actions of leaders who are behind the curve today, not those who were behind it yesterday. The finger pointing backwards can happen later: for now, we should focus on course correction and survival.
Also, I did some more research, and it sounds like the tweet I was referencing above was in fact misinformation. So I stand corrected on that one! However, it was certainly the case that at the time flights were being called to be cancelled from China, there were accusations of xenophobia being through around.
Getting rid of Trump and replacing him with someone who would have handled this much better is great. Replacing Trump with someone who would have handled things about as well, keeping all the other political leaders who dropped the ball on this, and not changing the deep structural issues that have made things worse, will do little to help.
Asymptomatic carriers are showing as a large contributor of spread. We should have a mandate for masks for everyone (since we don’t know who is a carrier or not) and government should contract manufacturers to ramp production ASAP to meet the demand.
China and South Korea has ramped productions and is allocating 2 masks per week per resident.
US has 330 million people. 2 per person is 660 million face masks.
China is currently producing 200 millions masks a day. If we ramp production to even half of that, 100 million masks a day, we can have 2 masks for everyone in less than a week.
We already can see most countries working and flattening the infection curve, yet US is still growing exponentially. We are now #3 and looks like we will be #1 (surpassing China and Italy) before March ends.
Trump has invoked exactly the act you're referring to. I'm not interested in any debate, just wanted to let you know it has been done.
Absolutely, and this is true for all countries. Personal prophylaxis and distancing will have to become a natural part of our life if we want to get out of this before the eventual remedy happens. But the masks do not exist yet.
https://twitter.com/Surgeon_General/status/12337257852839321...
The government already misleads the public when it exaggerates things like the actual threat of terrorism to the average American, at least this time it is lying with some sort of societal good in mind.
Had to explain this to someone yesterday. They literally wouldn't believe me until I screenshotted an Excel spreadsheet of the daily doublings, despite a finance degree.
So, it makes sense for experts to put little value in trying to preserve it, when trying to balance the value of other courses of action. It sucks, but in their shoes I would do the same.
Yep, I understand this. I've also noticed recent emphasis on the danger of the virus to young people (like this somewhat misleading NYT article [1], although I just noticed that they recently updated it), I suspect because they want young people to stay home.
[1]: https://www.nytimes.com/2020/03/18/health/coronavirus-young-...
https://www.thesun.co.uk/news/11226440/three-junior-doctors-...
No sane medical person would connect three 30-years doctors to the breathing machines ("ventilators") unless they actually had to be connected to them:
https://www.telegraph.co.uk/health-fitness/body/ventilators-...
And the "invasive" ones (see the picture) are the last chance for people to survive, but it's best not to come that far:
https://www.thisismoney.co.uk/money/news/article-8131947/Eng...
That's why it's in the interest of everybody for the hospitals to remain functional and that the current speed of growth gets at least significantly reduced.
That's why "the curve" has to be "spread."
This is a tall order in the modern informational environment. There are enough honest people out there that the truth will filter out, first to people who think critically and then as a meme to be swallowed uncritically by the masses. Then you just end up further damaging the credibility of official sources at a time when their credibility is important.
"It's a great pleasure to be here, and to have a chance just to share with you some very simple ideas about the problems we're facing. Some of these problems are local, some are national, some are global.
They're all tied together. They're tied together by arithmetic, and the arithmetic isn't very difficult. What I hope to do is, I hope to be able to convince you that the greatest shortcoming of the human race is our inability to understand the exponential function."
Most people I try to explain the current problems are really not able to understand. I explain that the spread is exponential, and that the problem is that is grows so fast. I say look at the graph from China, look at the graph from Italy.
They answer "ah, the Chinese maybe hid some numbers."
I say, it just doesn't matter, only the shape of the curve matters, and it repeats in every land. Even if the Chinese hid half of the cases, that difference disappears in only three-four days in our locations, where it grows so fast, as it grew in China before they did their measures, much harder than ours.
They don't understand still. They think only "80000 in China is more than "50000 in Italy" and it stops there. That Italy will get from 50K to 100K in four days, that's what they don't understand until they'd see it happened, but it would still, sadly, not convince them in anything.
Whereas, not only it's just the shape of the curve that matters, we know exactly why the spread is exponential, and what has to be done to change the shape: manage to stop the people who have it to transmit the virus to the rest of the population. It's "just" people who spread it -- the virus is not a bacteria, it doesn't live or multiply by itself, it needs a host which will replicate it, and the only host spreading it among the humans is human. There's nothing else that we know to work than that.
The major danger is that 4 from 5 carriers of the virus won't feel so bad to think that they should really stay at home. Most of the carriers aren't aware what they do. They all have their lives where what they do at the moment is "urgent" and "must be done." As soon as the droplets they produce enter the lungs of other people, the virus is spread. The droplets are tiny enough to be normally invisible to us, of course.
It doesn't help at all that the most of the highest politicians, across many different countries, downplayed the seriousness of the situation for a long time. Even less that the scientific ignorance was promoted as a virtue for even longer times.
I mean I agree, of course, that they’re trying to maximize public health benefit, I just don’t think the guidance is at all clear to the public. The idea that anything less than N95 is useless is pervasive, you can see it right here on HN. My parents and co-workers believe it because it’s been reported in the mass media in the last weeks: “the CDC said masks don’t protect you!”.
For people who need to work or shop in public places, any kind of masks at all might well be statistically significant alternatives for people who are unable to practice social distancing. China seems to be doing it effectively right now; people are required to wear masks to go to work. They’re not telling the public to avoid masks because doctors need them, they’re telling the public not to leave the house and not to enter a work building without something over your face. It seems like the CDC is saying the opposite, you should not wear a mask unless you’re a doctor. If a bandana is even 50% or 30% or even 5% effective, and they want to maximize public health benefit, why aren’t they recommending people start with what they have at home for times when public exposure is necessary? Seems like that would both increase public health and deflect demand for surgical masks & N95 masks at the same time, no?
The recommendation here is assuming you have access to something better. If you have no access to something better, a homemade mask is better than no mask at all, until you can get something better. As others have pointed out here, it’s rather odd to suggest we should scoff at this imperfect solution, when there are no perfect solutions short of 100% full and complete quarantine, which is completely unrealistic.
These are not mutually exclusive in any way.
I think our government's decision to emphasize to the public that masks are not completely protective and that washing your hands is a more effective intervention is probably a good one, even if it neglects the fact that masks are more helpful than not.
Still, I think he should stay at home in other states. LA county seems to assume it is beyond containment and now only tests people if that would affect the treatment.
I think they know certain things need to be done, but they have to also manage expectations and make enough of the population/media/state govt be "demanding" these enforced lock downs before it is really feasible.
Lastly, I think most companies are doing the right thing. 3M is cranking out industrial N95 masks as fast as they can since the govt dropped liability protection (since they are not rated for medical use). GM and others have offered to make ventilators. The defense production act only needs to be invoked if factories/suppliers are not doing the right thing. The specifics of the invocation haven't been announced yet, but I suspect one or more companies started misbehaving, and that resulted in invoking the act.
or not having a strategic reserve of masks, gloves and suits in a giant warehouse somewhere. You could rotate the stock though the marketplace during safe times so it would cost little. Probably less than the CDCs $110 million dollar visitors center.
What kind of pandemic was the government preparing for? One that did not need n95 masks and disposable gloves? One that wouldn't see a shortage of PPE?
> The Department of Health and Human Services said last week that the stockpile has about 12 million N95 respirators and 30 million surgical masks —a scant 1 percent of the estimated 3.5 billion masks the nation would need in a severe pandemic. Another 5 million N95 masks in the stockpile are expired.
https://www.washingtonpost.com/investigations/face-masks-in-...
The article goes into a lot more detail, including what the stockpile includes, funding, and information about state stockpiles.
Some "bioterrorism" spectacle that would be localized to a small area, requiring only a small supply sold by a politically-connected middleman, who could mark up the price 30x while having no difficulty sourcing the modest quantity from a commercial supplier.
I have an N99 (actually FFP3, a pretty much equivalent European standard I gather) from some DIY work a year or so ago; I haven't been out in some time, but when I did I didn't wear it for the same reason.
It will be interesting to see what happens to production, and commercial & residential stockpiles when we do get back to something resembling normality. I suspect there'll be a marked increase in non-Asian* routine mask-wearers on public transport, for example.
(* it was a lot more common among that group anyway, so I'm not so sure in my speculation that it would increase so much.)
[0]:https://ohsonline.com/articles/2014/05/01/comparison-respira... [1]:https://www.amazon.com/gp/product/B008MCV1HY/ref=as_li_tl?ie...
https://www.wired.com/story/coronavirus-interview-larry-bril...
The thing is that even if it is bigger than virus it still stops part of it.
Especially if it is true that virus is is not airborne and spreads through droplets.
In that case even scarf might be better than nothing (you should wash it often though).
If both parties have a mask, even just made at home from a piece of cloth or even a scarf, the risk of one party infecting the other goes way down, even without sophisticated respirators being used.
[1] https://twitter.com/anndornfeld/status/1241372544764006400/p...
“Respirators with exhalation valves can be used in a healthcare setting when it is not important to maintain a sterile field (an example of an acceptable practice would be when taking the temperature or blood pressure of a patient). Respirators with exhalation valves should not be used in situations where a sterile field is required (e.g., during an invasive procedure in an operating or procedure room) because the exhalation valve allows unfiltered exhaled air to escape into the sterile field.”
https://www.cdc.gov/niosh/npptl/topics/respirators/disp_part...
Guessing the fix is to tape over the port?
lol https://en.wikipedia.org/wiki/Asset_forfeiture
https://en.wikipedia.org/wiki/United_States_v._$124,700_in_U...
While supportive of strict social distancing measures I do not think any governor or president can suddenly start tossing basic civil rights. The rise of authoritarian language from state leaders is very concerning
Buying implies right of refusal and no, I don't think that Target should be able to stockpile N95 masks in its warehouses.
For example: https://en.wikipedia.org/wiki/Defense_Production_Act_of_1950
That makes it extra scary.
https://en.wikipedia.org/wiki/Eminent_domain
I don't have time to look right now, but I suspect most states (and the feds) have the ability to repurpose private assets in emergencies, with some constraints.
Target is buying masks for resale.
The US government, given any sense, should be forbidding private sale of these masks until there's enough supply in hospitals and other critical spots. It shouldn't be hard for a mask distributor to find a hospital willing to buy right now.
They could, in fact, order that production. https://en.wikipedia.org/wiki/Defense_Production_Act_of_1950
Trump's been hemming and hawing on invoking it for several days now.
https://talkingpointsmemo.com/news/medical-orgs-urge-trump-t...
> Health care professionals from the American Hospital Association (AHA), the American Medical Association (AMA), and the American Nurses Association (ANA) sent a joint letter to President Donald Trump on Saturday pleading for more medical supplies amid the COVID-19 pandemic.
> In the letter, the three organizations implored Trump to utilize the Defense Production Act (DPA) to help with the “dwindling supplies” of respirators, surgical masks, and other necessary tools.
Furthermore, increasing long-term public demand for masks would reduce the severity of future respiratory pandemics, since a larger portion of the population would be prepared in the future.
Edit:
> "There are two issues you're mixing together. The government should stop lying [...]"
That's on-message for this entire discussion as far as I'm concerned. The topic for discussion is the CDC's lies. Discussing the distribution of masks without discussing authorities suppressing the demand for masks is myopic. These two issues are not distinct.
1. The government should stop lying that masks aren't effective.
2. The government should ensure healthcare workers get sufficient supplies first.
"Masks work, but we need to get them where they're needed right the fuck now" is the message that should be sent right now.