Some arguments against the masks and gloves approach:
1. Not enough masks. But meanwhile, you can tie a scarf around your mouth and nose. No, it doesn’t filter out everything. But it could filter out enough. Then go home and wash the scarf. The point is to reduce my ability to spread the virus to you, in case I have it without knowing it. At lower cost than shutting down lots of businesses.
2. You can still get the virus from doorknobs. Maybe this is true–we still have not done the experiment. If it is true, then we can try to mitigate it using handwashing, being careful how we touch things, and using disinfectant. No, that won’t be perfect, but again the goal is reduction of spread, not total elimination.
3. People might become overconfident, thinking that scarves confer immunity. Probably true for *some* people, but I would hope that if the approach is clearly communicated, most people would continue taking other precautions. But they would feel less nervous about going to stores or getting their hair cut.
Look, people, our current approach looks like stupidity layered on stupidity. Because we don’t have a clear picture of prevalence or how it spreads, we are advising people to stay away from one another. Because staying away from one another cripples business, the stock market has plunged, the Fed is taking over more of the financial market, and Congress is wrangling over a $1.5 trillion “stimulus,” i.e., trough for special interests to feed at. And we are witnessing President Trump get into a battle royale with his health advisers. Is this what you want?
Given all of the issues involved, the optimum spread rate for the virus from a policy perspective isn’t going to be zero. If we can just come up with an alternative that allows people to mingle in public while keeping the spread rate low enough to avoid another Italy or NYC, that is good enough, in my opinion. I am looking for ways to keep our hospitals from becoming overwhelmed that don’t involve so much economic dislocation.
Scarves now, masks when they’re ready. I would like to thank commenter Handle for the scarves suggestion.
True. Very, very, true.
False. Very, very, false. We have an almost perfect understanding of how it spreads, by respiratory droplets (coughs and sneezes). Anyone that doesn’t see that given the existing evidence is a Peacetime Bureaucrat that needs to be fired. Making good decisions based on the imperfect Facts on the Ground is the key trait of a Wartime General.
If you are correct, then scarves probably would work, although we still want to isolate people who are known to have the illness.
And perhaps somebody with a mild, occasional cough but otherwise not seeming to have the virus could go out in public with a scarf. Something to mull over.
A low priority question. Priority #1 is to make people aware that they need to Fully-Isolate for 10 days immediately on the first symptom of respiratory illness, be it sore throat, runny nose, cough, or fever.
Atul Guwande emphasized, in his book The Checklist Manifesto, that a good surgical list only includes the core items. It is meant as a memory aid. Scarves don’t belong on this list.
I am scratching my head as I watch everyone miss the key signals, like when New York City hospitals exceed capacity, the whole point of the Flatten the Curve message.
I’ve watched Canadians Plank the Curve but flatten the economy along with it. I’m watching Americans that are no closer to a strategy today than they were eight weeks ago. Canadian paternalism was partially effective. American know-how is missing in action; not a division of opinion but a complete absence of knowledge about the basic shape of the challenge ahead. At this rate, Italians are going to look like masters of execution in comparison.
The best benefit of the scarves or non-OSHA/ANSI masks is that it keeps the wearers droplets off of others. However, if one wears the same scarf all day, the scarf probably become loaded with whatever the wearer is sick with.
https://pbs.twimg.com/media/ET1ATC-XsAIkqbC?format=jpg&name=medium
Although the death rate for the young/middle aged is somewhat low (though who wants to take a 1/200 chance of dying) the rates of hospital admission and ICU admission are very high. This isn’t just something that kills sick old people. It kills the young, and when it doesn’t kill them it often means a very painful episode of illness that may cause permanent lung scaring.
What responsible person is going to go outside even if they are allowed if those are the consequences?
Consider a young/middle aged person that has a family to support. What level of risk would you allow that person to assume in the service of continuing to support their family before they crossed the threshold of irresponsibility? Is it 1/1,000,000, 1/1000, 1/100?
Can they support their family if they are sick or dying? If they transmit the disease to their family are they supporting them?
We can send people checks pretty easily. Nobody is going to starve if they stay home for awhile.
No, they cannot support their family if they are sick or dying. That is why it is a risk. Some risks are worth taking, some are not. Where do you draw the line?
How long is ‘awhile’?
COVID-19 has characteristics of both influenza and SARS/MERS. Like the flu, it can infect both the Upper Respiratory system and the Lower Respiratory system. When it infects the Lower system, bronchitis or pneumonia, it is life threatening just like SARS/MERS but “luckily” some people survive and face a life with only crippling lung damage.
Mutiny of health care workers is a real possibility. We are lucky that they are either selfless or bad at estimating their self interest.
Your insight is exactly right, asdf, but it is far more troubling when applied to health care workers.
Would I ride on a Boston subway or commuter rail train if I was wearing a mask? I think I would. And it wouldn’t have to be an N95. As it is, without a mask, I have probably averaged being in a store a day over the last few weeks. (For context, I am old but have no respiratory problems.)
Here’s the US Surgeon General
https://twitter.com/Surgeon_General/status/1233725785283932160
or look at his recent tweet history with “masks”
https://twitter.com/search?lang=en&q=masks%20(from%3ASurgeon_General)&src=typed_query
I find it honestly shocking to see the number of people who vehemently deny the idea that masks could work.
Common sense alone suggests that masks and reduced physical contact will decrease R0, and small changes in the rate of growth can have enormous repercussions down the road.
And the case for masks only gets stronger as you look at the data.
Japan was hit very early and has a population that is both dense and old, yet they haven’t gone into lock-down at all. Behavior has changed but work continues as normal. They are sometimes accused of lying to protect the Olympics, but there is absolutely no way to hide the horrific death toll that the west was anticipating in Japan.
It shouldn’t take a genius to look at Japan and Italy or Iran and ask what the difference was.
Stray thought. We know from data that most of the people who succumb to Covid 19 have co-morbidities, often caused by smoking. Often, multiple co-morbidities.
So should we give Covid 19 full credit for every death? Or should deaths be prorated in some way?
If a fellow dies of heart failure and Covid 19 and was a lifelong smoker….
The CDC reports a 0.1% death rate of those in the 20-44 year old age group… and that is of people who have been tested or admitted to hospitals. Really, it is looking like almost no one in the 22—44 year old age group dies from Covid-19. Which is why they want to hoot it up on beaches in Florida.
They do not sense danger as there is none.
This virus has been in play for a couple of months. This guessing is deadly, and has unimaginably large consequences. The only entities with the ability to do rapid, scaled controlled empirical experiments on how the virus spreads are nation states. We should have started these experiments back in January, and while we wouldn’t have perfect information yet, we would have vastly superior data starting to roll in. Yet there is nothing coming out except prior knowledge.
It seems unimaginable that we don’t have the resolve to do this, and that we are making decisions based on hunches instead of best available data, which should be getting more precise by the day.
Each day I look forward to Calculated Risk’s publication of US test numbers.
https://www.calculatedriskblog.com/
How is that number not a front page story every day?
As long as the number grows, I am optimistic. I know it’s not great data yet, but if the number grows and folks start paying attention maybe someone will think to randomize the tests somwhere.
For people who might object that they don’t want to ruin their cashmere scarves by constant washing, Japanese make serviceable disposable masks with paper towels, some string and paperclips, total cost well within 10 cents. https://www.youtube.com/watch?v=c7-oE_xBDSA Note that the video is 2 years old. Isegoria linked to a clinical study in Canadian hospitals showing that mask type (N95 vs surgical) makes negligible difference in the amount they reduce flu ward nurse infection rate (about 5x).
Taiwan has nearly 24 million people, urban and dense. It has been manufacturing masks at breakneck speed and flooding the zone with them. They are mostly not N95 respirators, just ordinary surgical mask types. But, as that study indicates, surgical masks work. And, as the study I cited indicates, fabric is about as good as surgical masks.
They have been having incredible success. Their “Central Epidemic Command Center” is a model for the world.
True, they did a lot of other important things, but among the things they didn’t do was close down the country. See this article. The are not socially isolating. They are not shutting down the economy. They don’t need to! Without those things, they are still doing far, far better than anywhere else. Because they went all-in on masks.
My emphasis, because wow.
But you know what’s even more wow? The incredibly low number of cases and deaths, especially given their proximity and relations to China.
Money quote:
Not “2 deaths per 100,000”. Two deaths. Not 37 indigenous cases announced today. 37 indigenous cases cumulatively, since the very beginning of the epidemic, fewer than one new case per day.
People, what more do you need? America could be open for business like Taiwan in no time is only we could do things like “make masks” anymore.
Journalists are clueless. Read the 2020 coronavirus pandemic in Taiwan Wikipedia article.
This is job #1 everywhere that the virus has been successfully contained. What American and Canadian press and politicians are missing is the distinction between Travel related cases and sustained Community transmission. Any international hotspot requires a 14-day “monitoring” period (the lack of consistent language is driving me bonkers).
If you apply these rules to the U.S. today, the only question is how wide a circle to draw around the hotspots of NY, CA, and WA with sustained Community transmission. The Ontario medical officer said today that the U.S. and Europe make up the majority of the incoming Travel cases, and the top sources are NY, CO, CA, and NV. I’d guess that Colorado is a quiet hotspot.
Masks are a critical aspect of the Personal Protective Equipment (PPE) used by health care workers. They are more signalling than protective for untrained citizens. The protection you gain from flying cough droplets is offset by the extra hand to face fidgeting that occurs while wearing a mask. Either way, it’s a rounding error in the overall impact compared to Monitoring, Testing, Isolation, and Tracing; the mainstays of epidemiology.
In hindsight, the Canadian 3 week shutdown(s) on FriThe13th (did anyone else notice that was the day things fell apart) probably made sense. The normal incoming Travel cases already stressed the Test and Trace capabilities of the system and the mass exodus for March break was set for the 14th, and all of these returning travellers plus the annual returning Canadian “snow birds” must have scared the heck out of the public health officials. The system bent but it didn’t break and the Canadian press still fails to see this and it is their responsibility to notice and report [near] government failures.
Social Distancing seems more like a national team building exercise that an important tactic.
It’s astounding to me how many people seem to think that only professionally manufactured and certified masks are any good. That’s nuts.
It’s just air filtration. Anything that lets enough air in to not make breathing too difficult, and keeps some particles from getting through – or even just prevents them from getting very far – is still going to make a lot of difference.
Filtration is a very basic concept. Whether on the macroscopic or molecular level, if you have a bunch of rods weaved into or overlapping each other, making something that like looks like a sieve, that will filter. (You can also have a packed but porous bed, for instance of a bunch of pebbles or sand, but that’s not relevant for this case.)
And potential air filters are everywhere! To include repurposing the material in actual air filters.
Most cough aerosol droplets are from 200-400 nanometers in diameter (only a few times larger than a typical virus), but ordinary air filter media is very good at capturing particles in that range.
If one if going to make one’s own mask, best to make it out of that kind of media, since cloth isn’t that good. Here is a study that is on point:
So expected, we were totally prepared for it and … oh, wait …
The bad news is that ordinary fabric isn’t nearly as good as N95 for small particles, and only provides very little protection.
The ambiguous news is that ordinary fabric is about the same as many surgical masks.
The good news is that this is still better than nothing.
However, check out Figure 6 – the “Walmart scarf”. Still not nearly as good as N95, but still, ok filtration in the right range.
Not as good *at air filtering*. But to judge by that Canadian clinical study, a basic level of filtering is enough and additional filtering appears to provide little benefit, at least in conditions similar enough to general public use (rather than dusty industrial environments). Perhaps the more important function of masks is just to prevent people from touching their mouth and nose. Who cares, really? We know they work. We can find out mechanisms later.
Agreed.
The study tried to test at the size and air flow associated with cough droplets, and found a lot of penetration for ordinary fabric and surgical masks.
But they still work really well, so the question is why, given those penetration numbers.
Like you said, we can worry about why later, but I have some hunches.
One is that penetration isn’t the whole story. Just getting to the other side of a barrier is one thing, but the barrier slows things down a lot, and so what gets through still can’t get very far, going into the general air currents and on a bunch of nearby surfaces.
Another is that masks and fabric tend to accumulate gunk and get a little clogged, which is probably not so great in terms of being sanitary after a while, but which may improve their performance at preventing transmission.
I think the best DIY material with which to make a facemask comes from home furnace filters.
I bought a MERV 16 rated filter of size 16x25x4. From that I stripped off the cardboard frame and the foil mesh and was able to make about 75 sheets of size 7″x4″ (same size as a surgical mask). MERV 16 is rated to stop 95% or better of particles between .3 and 3 microns of size. If you can’t find a MERV 16 rated filter, you can use lower rated filters like MERV 13 or 14 which should also help.
After I cut the filter into 7″ x 4″ strips, I reinforced the sides with a small square of tape and used a hole puncher to punch a hole on each side. Through each hole, I passed a thin elastic cord of about 9.5″ and tied it into a loop (for the ear loops).
At the top of the mask, I created a formable nose clip to block out air, since that is where most of the air leakage will come from. I took 20 gauge solid copper wire and cut 2 strips of about 3.5 inches long. I then taped those two wires horizontally to the top of the mask. The wire is malleable, but slightly stiff. I used 20 gauge because that is what I had at home, but a thicker gauge would work and would not require 2 wires for the proper stiffness. (Anything that is somewhat stiff but also formable would also work.)
I did one last thing. The upper corners of the mask were bothering my eyes so I cut a small diagonal strip off those corners. And there you have it. One thing to be aware of is that direction of the fabric does matter. When you first get the furnace filter there will be a wire mesh on one side. That is the side that should be touching your face.
When I put a bottle of vinegar to my face, I could still smell it with the mask on although the odor was much reduced. When I put an N95 mask on, I could barely smell the vinegar.
If you have any dust masks at home, an easier way to make a mask might be to take the furnace filter paper and use it to line the inside of the mask. I haven’t tried that yet.
Sorry to reply to my own message, but N95 filters are rated to block out at least 95% of particles greater than .3 microns, which is the same spec as the MERV 16 filter.
Common textile masks might be the only practical solution in my opinion because N95 masks make breathing difficult.
“Results obtained in the study show that common fabric materials may provide marginal protection against nanoparticles including those in the size ranges of virus-containing particles in exhaled breath.” That is from a study that says “40–90% instantaneous penetration”.
https://academic.oup.com/annweh/article/54/7/789/202744
The average is 65% penetration. If the person coughing is wearing such a mask and the person breathing is wearing such a mask that’s 65% times 65%. If the R nought is 2.5 then 2.5 times 0.65 times 0.65 is reduced to 1.06. If the convention is for everybody to wear a mask we are almost able to get R nought below 1.0.
There are problems. These masks may lack the nose clip and may have gaps around the sides. People touch contaminated masks and then touch “public” surfaces (fomites). Loosening the convention a little we might decide the mask is only necessary on public transit or busy city streets.
The commentary below by a respiratory disease expert on the science of transmission makes a lot of sense to me. I think the prolonged exposure in confined, poorly ventilated spaces is going to prove significant. The spittle with the shedding virus lingers in the air with activation lasting as long as 3 hours. Then someone breaths it in and out over a fairly long period of time to get the virus load that can take hold. Masks can thin the virus load intake. But improved ventilation can also do that.
Sadly, classrooms, sanctuaries, bars, dining rooms in restaurants have bad air change numbers. Not to mention elevators, and such. You can’t just move it around the building, it has to be replaced with fresh air. Negative pressure. This makes the energy efficiency nuts mad as outside air needs more conditioning.
http://www.cidrap.umn.edu/news-perspective/2020/03/commentary-covid-19-transmission-messages-should-hinge-science
It’s not the virus intake that you stop. It’s the virus outburst that a mask can contain. That’s what the strategy is about
On March 31, a week after Arnold’s post, the mainstream media is onboard: https://www.nytimes.com/2020/03/31/opinion/coronavirus-n95-mask.html