Masks

Now that the World Health Organization has finally endorsed a recommendation for wearing masks in public, it’s time for Australia to do the same.

The most important case is that of public transport including air travel. Urban public transport is vital, but until we take the necessary steps on masks, we will be stuck with recommendations to avoid peak hour travel, guaranteeing a return to private cars and congestions

The airlines have been the biggest transporters of the pandemic and have continued to behave irresponsibly, packing planes as full as possible without any requirement for masks. It’s time for government to step in and order them to require masks as a condition of travel.

Update: I checked and Rex is doing the right thing here, upsetting some passengers who want to be free to infect fellow passengers https://www.abc.net.au/news/2020-06-03/regional-express-passengers-upset-forced-wear-face-covid19/12312358

50 thoughts on “Masks

  1. Totally agree! Masks should be mandatory on public transport, and possibly also in any inside venue (like cinemas and theatres) where there is prolonged contact, and where air flows are more important than 1.5 metre proximity. Too bad if people can’t munch on their snacks while watching a film!

  2. WHO aren’t recommending masks in lieu of social distancing, I guess that there are more variables with masks.

  3. Masks aren’t required on planes? That’s nuts. And at minimum, they should be encouraged on public transport. For the next two weeks in Victoria people wearing masks shouldn’t have to pay for a ticket.

  4. I’m with J.Q. and the first 3 comments above (at least) on this one. I haven’t needed or worn a mask yet but then my lock-down is near total. I haven’t been off my 1.5 acres for 3 months except for us to take food to my locked-down father-in-law.

    My wife and I spent 12 weeks in the US late last year. (That makes me a hypocrite as I have come out heavily against global connectivity.) I’d say we sort of got out just in time. Indeed, I have wondered since whether a weird, horrible cold and sore throat we got at Lake Powell, Arizona/Utah was COVID-19 but at Sept. 2019 it was almost certainly much too early.

  5. I am surprised you waited for the discredited WHO to make this recommendation.

    The experience of many countries in virus control (e.g. China and the country of Taiwan), as well as much research, has suggested the value of masks for a long time. So much nonsense has been written about masks. For example: They are not 100% effective therefore 100% useless, people don’t wear them properly (again meaning they are useless), if people use them they will be careless about social distancing, they are useful for medical staff but quite useless for anyone else etc. etc.

    Yes, wear masks on transport and in any reasonably confined area – shopping center etc.

  6. The position of local medical authorities – that economics proves supply can’t rapidly meet demand, sociology proves safety devices like seatbelts actually make people less safe by creating a false sense of security and political science proves you can’t teach people to use new equipment rapidly in a crisis – prove medical officials should stop dabbling in economics, sociology and political science.

  7. Travelling on crowded public transport is Covid-dangerous and irresponsible. Wearing a mask reduces the danger by a only a small amount.

  8. If you have COVID-19 and you are wearing a mask it reduces the danger to others by a large amount.

  9. Masks aren’t magic. I agree wearing them on aeroplanes should be mandatory, and also I’d like to see it on public transport (good luck with enforcement though). But masks require the right conditions and technique to use, and this is the problem. Beards are out. You cannot have a beard and wear a mask effectively. Also, taking them on and off is a skill. You watch a person with medical training. They’ll never touch the front of it, and they’ll put it on and take it off by hooking thumbs through the ear looks (if it is that type) and stretching over the ears, or carefully tying around the back of the head if that type. You never, ever touch the front. And this is leaving aside the demonstrated issues with different mask materials efficacy at blocking 80 nanometre viral particles being ejected thought the fabric coughing or sneezing (some are vastly better than others, some are nearly useless).

  10. >You cannot have a beard and wear a mask effectively.

    Exactly. Ever seen a surgeon with a beard?

  11. COVID-19 is almost entirely spread by droplets from people’s mouths and noses ending up in other people’s mouths and noses. Please wear a goddamn mask over your goddamned beard to mostly prevent you from spreading droplets and potentially killing grandma.

  12. Ronald said …”and potentially killing grandma.”

    JQ “It’s time for government to step in and order them to require masks as a condition of”… tourist shopping.

    +R1? This weekend – for sure.

    Masks should be mandatory for crowded interiors particularly food & drink venues. And travellers. No mask, no shop – reviewed monthly.

    [ – JAMA Evolving epidemiology and transmission dynamics of coronavirus disease 2019 outside Hubei province, China: a descriptive and modelling study
    Closed environments facilitate secondary transmission of coronavirus disease 2019 (COVID-19)
    – COVID-19 Outbreak Associated with Air Conditioning in Restaurant, Guangzhou, China, 2020 Presymptomatic Transmission of SARS-CoV-2 — Singapore, January 23
    I’ll repeat – if you ever enter the return air duct in a large building, you would NEVER agree to work in that air. ]

    Don’t touch mask front to remove. Put instrucrions on the pack. Don’t treat humans in a 1 in 100 yr event as having zero capacity to learn. Quickly.

    I went to the shops Saturday – and promptly got back in car and left empty handed as… tourists. Absolute change in town. 10k to ? 20,000. From Sydney & Victoria by car plates. Busting out to freedom.

    Supermarkets – packed. 
    Gift shops on main street – milling queue feining distance. (must get present!)
    Juice shop – packed to the rafters.
    Most parking & venues packed. Almost zero physical distancing.

    Dirt bikes aplenty. All beds in ED occupied w broken bones I am reliably informed. 

    In my area it has gone locally from level ‘we don’t care’ to level ‘we are all coming and don’t care’. 

    3 aged care homes near me in central west nsw. 

    I have spotted 3 x mask wearing humans in six weeks from 12 shop visits.

    Level whatever. Where I live it is just cliff, meet base. Or is that base, meet cliff? 

    Masks. And I don’t care if we drop gdp by 0.00000001%. The life saved may be your close relation.

    https://www.maskssavelives.org/

    40+ papers here…
    https://docs.google.com/document/d/1HLrm0pqBN_5bdyysOeoOBX4pt4oFDBhsC_jpblXpNtQ/mobilebasic#

    Paper Summaries
    A review of masks Face Masks: Much More Than You Wanted To Know 
    Collection of Mask Research List of citations
    Can physical interventions help reduce the spread of respiratory viruses? – Burch, Jane – 2020 COVID-19:
    Why we should all wear masks — There is new scientific rationale 
    Curve Crushers: Killing Coronavirus Masks for All:  
    See next section for “summary of publications”

    Disease characteristics
    Aerosol and Surface Stability of SARS-CoV-2 as Compared with SARS-CoV-1 (7)
    Influenza Virus Aerosols in Human Exhaled Breath: Particle Size, Culturability, and Effect of Surgical Masks (6)
    Flight of the aerosol (15)
    SARS-CoV-2 Viral Load in Uppe r Respiratory Specimens of Infected Patients (31)
    Understanding of COVID‐19 based on current evidence (30)
    Do N95 Respirators Provide 95% Protection Level Against Airborne Viruses, and How Adequate Are Surgical Masks? 
    Performance of an N95 Filtering Facepiece Particulate Respirator and a Surgical Mask During Human Breathing: Two Pathways for Particle Penetration
    Editor’s Choice: Transocular Entry of Seasonal Influenza–Attenuated Virus Aerosols and the Efficacy of N95 Respirators, Surgical Masks, and Eye Protection in Humans
    Turbulent Gas Clouds and Respiratory Pathogen Emissions: Potential Implications for Reducing Transmission of COVID-19
    | Infectious Diseases | JAMA Evolving epidemiology and transmission dynamics of coronavirus disease 2019 outside Hubei province, China: a descriptive and modelling study
    Closed environments facilitate secondary transmission of coronavirus disease 2019 (COVID-19)
    COVID-19 Outbreak Associated with Air Conditioning in Restaurant, Guangzhou, China, 2020 Presymptomatic Transmission of SARS-CoV-2 — Singapore, January 23 … Virological assessment of hospitalized patients with COVID-2019 (Nature)
    Could SARS-CoV-2 be transmitted via speech droplets? (Anfinrud/Bax; medRxiv 2020)
    Epidemiology and impact assessment
    Modeling the Effectiveness of Respiratory Protective Devices in Reducing Influenza Outbreak (2)
    Final Country-wide Mortality from the Novel Coronavirus (COVID-19) Pandemic and Notes Regarding Mask Usage by the Public
    The Case for Universal Cloth Mask Adoption and Policies to Increase Supply of Medical Masks for Health Workers
    EfficacyThe bacterial and viral filtration performance of breathing system filters (16)
    Effectiveness of N95 respirators versus surgical masks against influenza: A systematic review and meta-analysis (12)
    Professional and Home-Made Face Masks Reduce Exposure to Respiratory Infections among the General Population (3)
    Testing the Efficacy of Homemade Masks: Would They Protect in an Influenza Pandemic?

    | Disaster Medicine and Public Health Preparedness (5)
    Effectiveness of Masks and Respirators Against Respiratory Infections in Healthcare Workers: A Systematic Review and Meta-Analysis (10)
    What is the efficacy of standard face masks compared to respirator masks in preventing COVID-type respiratory illnesses in primary care staff? (24)
    A quantitative assessment of the efficacy of surgical and N95 masks to filter influenza virus in patients with acute influenza infection (25)
    A cluster randomised trial of cloth masks compared with medical masks in healthcare workers (18)
    How effective are face masks in operation theatre?  A time frame analysis and recommendations (19)
    N95 Respirators vs Medical Masks for Preventing Influenza Among Health Care Personnel (20)
    Association between 2019-nCoV transmission and N95 respirator use (27)
    Protection by Face Masks against Influenza A(H1N1)pdm09 Virus on Trans-Pacific Passenger Aircraft, 2009 (32)
    Performance of N95 Respirators: Filtration Efficiency for Airborne Microbial and Inert Particles
    Respiratory virus shedding in exhaled breath and efficacy of face masks
    Can physical interventions help reduce the spread of respiratory viruses? (1)

    Impact on transmission
    The role of facemasks and hand hygiene in the prevention of influenza transmission in households: results from a cluster randomised trial; Berlin, Germany, 2009-2011 (21)
    Facemasks and hand hygiene to prevent influenza transmission in households: a cluster randomized trial. (22)
    Mask use, hand hygiene, and seasonal influenza-like illness among young adults: a randomized intervention trial.(23)
    Facemasks, Hand Hygiene, and Influenza among Young Adults: A Randomized Intervention Trial (33)
    SARS Transmission, Risk Factors, and Prevention in Hong Kong (34)
    Impact of Non-Pharmaceutical Interventions on URIs and Influenza in Crowded, Urban Households
    The First Randomized, Controlled Clinical Trial of Mask Use in Households to Prevent Respiratory Virus Transmission
    A familial cluster of pneumonia associated with the 2019 novel coronavirus indicating person-to-person transmission: a study of a family cluster 

    COMMENTARY: Masks-for-all for COVID-19 not based on sound data Policy and guidelines Addressing COVID-19 Face Mask Shortages: evaluating decontamination methods for N95 mask reuse. (8)
    Rational use of face masks in the COVID-19 pandemic (9)
    Physical interventions to interrupt or reduce the spread of respiratory viruses (11)
    Simple Respiratory Mask (13)
    What Hospitals Should Do to Prepare for an Influenza Pandemic (14)
    Sterilization of disposable face masks by means of dry and steam sterilization processes (17)
    Letter to editor: Role of masks/respirator protection against 2019-novel coronavirus (COVID-19) (26)
    Mass masking in the COVID-19 epidemic: people need guidance (28)
    Knowledge, attitudes, and practices towards COVID-19 among Chinese residents during the rapid rise period of the COVID-19 outbreak: a quick online cross-sectional survey (29)
    N95 Respirators and Surgical Masks
    Reuse Mask?
    DIY Mask? | Consumer Council

    Summary of Publications
    And on…

  13. It’s about time…. I don’t understand why this was not implemented I prepared for myself and my husband and ordered mask 😷 that I replace filters in and can wash. I make my husband use his when in public places for his safety. He was previously having bad seizures due to pain and low blood oxygen. I ordered mine right in eBay when everyone was saying there were shortages. The price didn’t matter to me because life is precious. The Who was terribly slow . The mask I ordered for my husband fits around his face and beard 🧔🏼 very well. I believe these are the best ones for men with beards. https://www.ebay.com.au/itm/184236391958

  14. Ronald, above, is probably mostly right but we should not discount contact spread and aerosol spread. Contact spread is a known vector for COVID-19 and aerosol spread (really small droplets which can drift at least further than about 2 meters) is feasible under certain conditions. Can air conditioning Spread COVID-19? That too is a valid question. Pragmatically, assume all are possible and take precautions accordingly; albeit the aircon risk could be vanishingly small in larger buildings but may be possible in confined places like aircraft passenger cabins. But then masks deal with aerosols and droplets to a considerable extent, with protection improving the more people wear them. So, wear masks in public. If you can buy them, meaning ones of a sufficient rating.

    Beards probably are a hazard. Why anyone with a salt and pepper or grey beard would wear one is beyond me. I certainly don’t but that’s just me. Some might consider that any covering on my face would be an improvement! 😉 Some beards you could fit a mask over but a ZZ Top beard is going to be a problem. I’d post a ZZ Top song video for fun but every one objectifies women in that dated bikinis, hot pants, daisy dukes manner so I had better not.

    https://blogs.scientificamerican.com/guest-blog/should-doctors-have-beards/

  15. It will be interesting to see if an outbreak can be traced to the Aust BLM rallies given that 95% wore masks ,it was outdoors and there was no touching, but distancing wasnt observed much. I reluctantly attended the Melb rally . I rode my bike in and stayed on the edge not coming within 2 meters of anyone ,only about 20 % of attendees seemed like they were trying to do that. Masks and sanitiser were being handed out. I like the statement that wearing a mask makes. I was too far away to hear the speakers ,but I am tired of being ranted at anyway, I am a whitey and like to think I am not part of the problem (implicit bias aside) .Surely they could have arranged distancing somehow -such as having everyone ring parliment house 2 meters apart, or get everyone standing on a field spelling out something for a drone photo. I went by a busy supermarket at Footscray on the way home (to Sunshine) and felt far less safe there. I am finding that the less white a suburb is the more masks and distancing you will see ,asians are good at this ,Indians OK ,but our African community is not so good . Affluent majority white suburbs are the worst from my experience.

    Off topic –> [ Its good to see talk turning to societal systemic problems as the root cause rather than just convicting a few cops and requiring the rest to do a PR course .Trumps Republican backers must be thinking how stupid is this guy – all he had to do was go through the motions like any normal president (Obama too) and it would be back to business as usual .The next crisis would be on someone else’s watch.]

  16. sunshine,

    I agree with pretty much everything you say there. Although I did not gain the impression from TV that mask use was as high as 95%. I must look more closely at the news and current affairs footage tonight. But if people mask up and don’t actually touch or get in each others’ faces they probably will be all right in most cases. But time and empirical results will tell.

    One American BLM group is writing and proposing legislation (State and Federal I guess) for the kind of equality and justice they want to see. This makes a nice change from corporations getting think tanks together and writing the USA’s laws for their legislators to sausage-machine through almost without amendment. Of course, only continued public and demonstration pressure will get this sort of legislation through if it makes any progress at all.

  17. Remember when you couldn’t enter a bank or public building with a mask because you could be a bandit or terrorist? Now you are expected to have a mask. People who wear hijabs and the like must now be laughing, with justification, at us. Just try to ban face coverings now! LOL.

  18. As a retired RN I wear a mask in public places because I’ve witnessed people dying with a respirator tube stuck down their airways and don’t fancy it myself as an end to days; a mask is some measure of protection even if less than complete and above all else has the added benefit of keeping others away from me when they assume my state to be infective.

    Hoorah for that as it is a vast improvement on being shouldered out of the way by younger persons in supermarket aisles and footpaths. I think I shall adopt it as a permanent measure.

    Didn’t go to the mass turnout in Sydney about Aboriginal DiC although I wanted to but fear of the bug kept me away. Never mind, sadly and doubtlessly there will be more deaths and further opportunities to show solidarity.

  19. Ned,

    Oh frabtious day, when to be treated as a social pariah is a boon to amenity and longevity! How, as a misanthrope, I have longed for this day. I must buy my masks immediately and live the dream.

    I’m not being entirely facetious. 🙂

  20. Next regime?

    Pooled testing for covid:
    by Zeph Landau

    “Zeph Landau, a noted quantum computing theorist at UC Berkeley … a guest post about pooled testing for covid—an old idea that, Zeph argues, could play a crucial role in letting universities safely reopen this fall. 

    “What seems clear is that right now—reopening committees and labs are perhaps aware of the idea of pooling but only as a theoretical idea of a technology that might be coming at some vague time in the future.  They are unaware that in the form of early detection surveillance, it is right in front of them ready to go.  They’d need a matter of weeks to convert a 1:1 lab into a lab that could handle both pooled screening and 1:1 testing (this lab did it, here is a brief outline of the steps).  In the same timeline, they could develop a system for handling the logistics of sampling large numbers of people.”
    https://www.scottaaronson.com/blog/?p=4834

    Large-scale implementation of pooled RNA-extraction and RT-PCR for SARS-CoV-2 detection
    https://www.medrxiv.org/content/10.1101/2020.04.17.20069062v2

    How to convert a 1:1 testing lab into a hybrid 1:1 lab and group screening lab.
    – The ability of labs to be able to perform a “group screen” would allow for early detection surveillance to be implemented in all sorts of settings.
    https://docs.google.com/document/d/1FVp55JAs2heqV5ktyGVVdoE-W_XTKmZgCWBy1SEoo-o/

  21. I don’t think masks work and I think they are a dangerous distraction. First of all that picture KT2 posted is wrong, most of the countries circled as “mask” countries don’t have any tradition of mask wearing, and they didn’t end their epidemics through masks. Vietnam, the most successful country in the world, and NZ, the second-most successful, didn’t have masks as any part of their response. Japan is the only country in the list with a strong mask-wearing tradition when the epidemic hit, and pretty much everyone was wearing masks in public when we were seeing 700 – 1000 new cases a day.

    Secondly, Peter Evans is right that most people don’t wear masks correctly, which can make them dangerously misleading. Even here in Japan where people have been wearing masks for years I see so much poor mask use – touching the outside, reusing them, storing them in pockets and bags, rolling them down to eat and talk, walking around with your nose above the mask, touching your face under the mask (where moisture gathers) and then touching other surfaces, taking your mask off on the train to pick your nose and wipe it on poles … if wearing masks encourages more people to leave the house while not being fully protective it will cause what we call risk compensation, really not a good idea. My kickboxing gym has reopened with the requirement that everyone wear a mask but really, when someone’s sweat is flying into your face it hardly matters that they’re wearing a mask! Even in hospital settings where masks are worn ubiquitously and everyone is trained in their use, hand hygiene is super important and is very strictly enforced. Hand-washing, proper social distancing and avoiding the three c’s is the key to prevention, but the reality is you cannot prevent a disease that is this infectious and also run your economy as normal. This is why Vietnam and NZ had the right strategy, following WHO recommendations, of elimination through aggressive non-pharmaceutical interventions.

    It is hilarious though to see people go from supporting laws banning facemasks because muslims do it, to demanding everyone wear facemasks because it might damage the economy not to. I wonder if it’s still illegal to wear a hijab in France, but illegal not to cover your face? Such larks!

  22. Now imagine how much masks could do if everyone would be wearing them properly :-). The German reality still is that many don´t wear them at all at places where it is mandatory.

  23. Wundering what the price of (good) ffp2/n95 masks could be with storage and/or excess capacities prepared for a crisis like this and wundering if everybody wearing those could be a sufficient solution instead of a lockdown (in combination with the other obvious things, like reacting faster, better contact tracing with aps etc.). Bougth some for 4 Euro each and hope i didnt outbid someone who needs them more at this point.

  24. If you are in Australia, Hix, and your situation isn’t special then, unfortunately, you probably did bid them away from someone who needs them more in another country. If it makes you feel better, there was actual bribery, or attempted bribery at least, going on with masks a month or two ago in Australia, with offers of masks from overseas in return for “favours” so at least you acquired yours “honestly”.

  25. Hix, also note that by bidding up the price you are encouraging mask makers to make more masks. Unfortunately, this takes time.

  26. faustusnotes says “First of all that picture KT2 posted is wrong”.

    Wrong, as in:
    1. I know it is wrong or
    2. I think it it wrong?

    If 1. I am sure you will provide us with some proof, study, citation faustusnotes. I am keen to hear any evidence either way. From you.

  27. Ronald my reading of that study is that it is 2.5 – 13%. There is another study being reported today but I haven’t bothered following it up because I’m tired and busy. We are seeing a resurgence in the USA now due to reopening. Policy trumps personal behavior with infectious diseases every time!

    KT2, my explanation of why I think it is wrong was in the comment immediately after the statement that it’s wrong. And no, I’m not going to find a citation for “Chinese people don’t wear masks” anymore than the dude who made the picture found a citiation for “Japanese people have strong social norms about obedience” or indeed for the arbitrary division of the world into masks and no masks.

  28. Faustusnotes, the paper’s conclusion states:

    “We believe that the reduction in the growth rates of infections by 40% to 60% is our best estimate of the effects of face masks.”

  29. Ronald, ah yes! I was reading the effect on cumulative infections not daily. I’m not convinced by the rest of that study (I think it has some problems) but I can’t be bothered trying to figure it out while I’m busy. The 40% – 60% reduction seems in line with the estimate I saw reported from another study today. But if these effects lead to risk compensation (so people gather together, go to big events, etc) then it will be pointless – the R of this virus is 3-5, so a 50% reduction in risk while engaging in normal social activities is not sufficient to stop its spread. We still need to focus on test, trace and case isolation!

    Also worth noting: masks don’t make much difference if cases self isolate, because when you “self isolate” you still infect your family. Test, trace and case isolation are key!

  30. Test, trace, isolate + masks.

    faustusnotes says at11:49 AM
    “I don’t think masks work..” – I understand what you think.

    faustusnotes, see list of peoole below plus 100 or so references. Feel free to amend your stance. I always aporeciate your passion yet a citation to back up assertions would be appreciated. Please ‘think’ with the people and institutes below. Let us know how it goes.

    “Widespread facemask use could shrink the ‘R’ number and prevent a second COVID-19 wave – study

    Even basic homemade masks significantly reduce transmission at a population level, according to latest modelling. Researchers call for information campaigns that encourage the making and wearing of facemasks.   

    We have little to lose from the widespread adoption of facemasks, but the gains could be significant
    Renata Retkute

    For the latest study, Cambridge researchers worked to link the dynamics of spread between individuals with population-level models, to assess different scenarios of facemask adoption combined with periods of lockdown.

    The modelling included stages of infection and transmission via surfaces as well as air. Researchers also considered negative aspects of mask use, such as increased face touching.

    The reproduction or ‘R’ number – the number of people an infected individual passes the virus onto – needs to stay below 1.0 for the pandemic to slow.

    The study found that if people wear masks whenever they are in public it is twice as effective at reducing ‘R’ than if masks are only worn after symptoms appear.

    In all modelling scenarios, routine facemask use by 50% or more of the population reduced COVID-19 spread to an R less than 1.0, flattening future disease waves and allowing less-stringent lockdowns.

    Viral spread reduced further as more people adopted masks when in public. 100% mask adoption combined with on/off lockdowns prevented any further disease resurgence for the 18 months required for a possible vaccine.   

    The models suggest that – while the sooner the better – a policy of total facemask adoption can still prevent a second wave even if it isn’t instigated until 120 days after an epidemic begins (defined as the first 100 cases).

    The team investigated the varying effectiveness of facemasks. Previous research shows that even homemade masks made from cotton t-shirts or dishcloths can prove 90% effective at preventing transmission.”…
    https://www.cam.ac.uk/research/news/widespread-facemask-use-could-shrink-the-r-number-and-prevent-a-second-covid-19-wave-study

    https://dx.doi.org/10.1098/rspa.2020.0376

    WHO nask uodate: (Note the date)
    CORRIGENDA
    Advice on the use of masks in the context of COVID-19: Interim guidance, 5 June 2020 (WHO/2019-nCov/IPC_Masks/2020.4)
    “This document was developed based on advice by the Strategic
    and Technical Advisory Group for
    Hazards (STAG-IH), and in consultation with the following members of:
    1) the WHO Health Emergencies Programme (WHE) Adhoc COVID-19 IPC Guidance Development Group (in alphabetical order):
    Jameela Alsalman, Ministry of Health, Bahrain; Anucha Apisarnthanarak, Thammsat University Hospital, Thailand; Baba Aye, Public Services International, France; Gregory Built, UNICEF, United States of America (USA); Roger Chou, Oregon Health Science University, USA; May Chu, Colorado School of Public Health, USA; John Conly, Alberta Health Services, Canada; Barry Cookson, University College London, United Kingdom; Nizam Damani, Southern Health & Social Care Trust, United Kingdom; Dale Fisher, Goarn, Singapore;
    Joost Hopman, Radboud University Medical
    Center, The Netherlands; Mushtuq Husain, Institute of Epidemiology, Disease Control & Research, Bangladesh; Kushlani Jayatilleke, Sri Jayewardenapura General Hospital, Sri Lanka; Seto Wing Jong, School of Public Health, Hong Kong SAR, China; Souha Kanj, American University of Beirut Medical Center, Lebanon; Daniele Lantagne, Tufts University, USA; Fernanda Lessa, Centers
    for Disease
    Control and Prevention, USA; Anna Levin, University of São Paulo, Brazil; Ling Moi Lin, Sing Health, Singapore; Caline Mattar, World Health Professions Alliance, USA; MaryLouise McLaws, University of New South Wales, Australia; Geeta Mehta, Journal of Patient Safety and Infection Control, India; Shaheen Mehtar, Infection Control Africa Network, South Africa; Ziad Memish, Ministry of Health, Saudi Arabia; Babacar Ndoye, Infection Control Africa Network, Senegal; Fernando Otaiza, Ministry of Health, Chile; Diamantis
    -15InfectiousPlachouras, European Centre for Disease Prevention and Control, Sweden; Maria Clara Padoveze, School of Nursing, University of São Paulo, Brazil; Mathias Pletz, Jena University, Germany; Marina Salvadori, Public Health Agency of Canada, Canada; Mitchell Schwaber, Ministry of Health, Israel; Nandini Shetty, Public Health England, United Kingdom; Mark Sobsey, University of North Carolina, USA; Paul Ananth Tambyah, National University Hospital, Singapore; Andreas Voss, Canisus-Wilhelmina Ziekenhuis, The Netherlands; Walter Zingg, University of Geneva Hospitals, Switzerland;

    2) the WHO Health Emergencies Programme (WHE) Adhoc Experts Advisory Panel for Infection Prevention and Control (IPC) Preparedness, Readiness and Response to COVID-19, and other international experts including (in alphabetical order):
    Mardjan Arvand, Robert Koch Institute Nordufer, Denmark; Elizabeth Bancroft, Centers
    for Disease Control and
    Prevention, USA; Gail Carson, ISARIC Global Support Centre, United Kingdom; Larry Chu, Stanford University School of Medicine, USA; Shan-Chwen Chang, National Taiwan University, Taiwan, Feng-Yee Chang, National Defense Medical Center, Taiwan, Steven Chu, Stanford University, USA; Yi Cui, Stanford University, USA; Jane Davies, Médecins
    Sans Frontières, The Netherlands;
    Katherine Defalco, Public Health Agency of Canada, Canada; Kathleen Dunn, Public Health Agency of Canada; Janine Goss, Public Health England, United Kingdom; Alison Holmes, Imperial College, United Kingdom; Paul Hunter, University of East Anglia, United Kingdom; Giuseppe Ippolito, Instituto Nazionale per le Malattie Infettive Lazzaro
    Spallanzani, Italy; Marimuthu Kalisvar, Tan Tock Seng Hospital, Singapore; Dan Lebowitz, Hopitaux Universitaires de Geneve, Switzerland; Outi Lyytikainen, Finland; Trish Perl, UT Southwestern, USA; F. Mauro Orsini, Ministry of Health, Santiago, Chile; Didier Pittet, University of Geneva Hospitals, and Faculty of Medicine, Geneva, Switzerland; Benjamin Park, Centers for Disease Control and Prevention, USA; Amy Price, Stanford University School of Medicine, USA; Supriya Sharma, Public Health Canada; Nalini Singh, The George Washington University, USA; Rachel Smith, Centers for Disease Control and Prevention, USA; Jorgen Stassinjns, Médecins Sans Frontières, The Netherlands; Sara Tomczyk, Robert Koch Institute, Germany.

    Good luck!

  31. “they get wet” “false sense of security”. Always amazes me we seem to have completely lost learning capacity re masks?!

    How Iceland Beat the Coronavirus
    The country didn’t just manage to flatten the curve; it virtually eliminated it.
    By Elizabeth Kolbert
    June 1, 2020

    “… asked Möller about masks. In Massachusetts, an executive order issued by the governor requires that masks be worn by anyone entering a store, taking a cab, or using public transit, and violators can be fined up to three hundred dollars. In Iceland, masks aren’t even part of the public conversation. Möller said that wearing one might be advisable for a person who is sick and coughing, but that person shouldn’t be walking around in public anyway. “We think they don’t add much and they can give a false sense of security,” she said. “Also, masks work for some time, and then they get wet, and they don’t work anymore”.
    https://www.newyorker.com/magazine/2020/06/08/how-iceland-beat-the-coronavirus

  32. KT2, how about I provide you references after you back up your assertion that Singapore and South Korea used masks? The section of that figure with a big circle on it saying “masks” could just as easily have a big circle saying “Case isolation”. Why do you think masks are the winner?

    As another example consider HIV. We have known since about 1985 that a personal choice of barrier method (condoms) is 90-100% effective against the transmission of HIV. And yet HIV exploded in the 10 years since, and only began to get under control after we introduced an effective treatment in the mid- to late-1990s, and only really after Bush funded it adequately in 2001. Why do you think that the barrier method didn’t work for 10 years, but testing, tracing and treatment did after it was adequately funded?

    Infectious diseases are controlled most effectively by policy, not by individual actions.

  33. The masks were from a discount store offer here in Germany, which pop up on a regular basis now. In a direct way, i´m rather optimistic the alternative buyer would have made worse use of them it´s more an abstract question of “had the discounter offer sold out later, would they be less willing to order more, which would avoid them outbidding some poor nations hospital etc…” We are definitly not in that ugly territory were rich countries hospitals lack ffp masks and Trump redicrects delivers to other nations with bribery anymore.

  34. Addition: There are sometimes (much) cheaper offers aswell, usually in the China shippment category. Don´t look like outright fraud either, still got my doubts those are functioning masks 3m Masks on the other hand still cost a fortune.

  35. Hix, I assumed you were in Australia. By keeping yourself safe you are improving the situation in Europe. In my state we’ve had 2 new cases of COVID-19 in 3 weeks so we’re at the point where we can start sending supplies to other countries.

  36. faustusnotes says 3:41 PM
    “Infectious diseases are controlled most effectively by policy, not by individual actions.”
    KT2 says? Physical distance the policies 1.5m and wash policy hands.

    faustusnotes also says 3:41 PM
    “KT2, how about I provide you references after you back up your assertion that Singapore and South Korea used masks? ”
    KT2 says “ok!”. (And links need space replaced w dot)

    Singapore:- 
    Masks in smart vending machines. Check stock before going out. How quaint are we?!
    “How to redeem the new reusable mask 😷
    Collection starts from 26 May 2020 at all CCs, RCs and special vending machines located at CCs
    Published on 22 May 2020
    http://www.gov sg/article/when-should-i-wear-a-mask

    Siingapore Mask Vending site:
    https://www.maskgowhere.gov.sg/

    Korea:
    “Comparison of mask use before/after the COVID-19 outbreak South Korea 2020
    Published by Won So, May 25, 2020
        According to a survey conducted in South Korea, around 70 percent of respondents stated that they started to wear face masks after coronavirus outbreak. About 19 percent were already wearing masks even before the outbreak and another 11 percent said they do not wear masks regardless of coronavirus. The most popular type of face masks among South Koreans was KF94 health masks.

    Comparison of face mask use before and after the coronavirus (COVID-19) outbreak in South Korea as of February 2020

    Share of respondents
    No before, Yes after 70%
    Yes both before and after 19%
    Neither before nor after 11%
    https://www.statista com/statistics/1103501/south-korea-mask-use-before-after-covid-19/

    “South Korea unveils new coronavirus rules, including bars registering all patrons
    MAY 25, 2020 / AP
        South Koreans will be required to wear masks when using public transportation and taxis nationwide starting Tuesday as health authorities look for more ways to slow the spread of the coronavirus as people increase their public activities.
    https://www.cbsnews com/news/coronavirus-south-korea-unveils-new-covid-rules-travel-face-masks-high-risk-businesses/

    Japan:
    The wearing of cloth or paper “sickness masks” while healthy and in public has become such a standard practice in Japan that in average years, the nation manufactures 4.3 billion face masks for personal use. The typical Japanese citizen goes through 43 masks per year.
    https://www.nationalreview com/2020/03/coronavirus-pandemic-japan-shows-masks-help-slow-spread-covid-19/

    Worldwide:
    “Which countries have made wearing face masks compulsory?
        More than 50 countries require people to cover their faces when they leave home.
    3 Jun 2020
    https://www.aljazeera com/news/2020/04/countries-wearing-face-masks-compulsory-200423094510867.html

  37. Nail.. no mask, meet Nassim Nicholas Taleb yes mask.
    “In fact masks (and faceshields) supplemented with constraints of superspreader events can save us trillions of dollars in future lockdowns (and lawsuits) and be potentially sufficient (under adequate compliance) to stem the pandemic. Bureaucrats do not like simple solutions”

    The Masks Masquerade

    Nassim Nicholas Taleb

    Jun 14 · 5 min read

    Incompetence and Errors in Reasoning Around Face Covering

    SIX ERRORS: 1) missing the compounding effects of masks, 2) missing the nonlinearity of the probability of infection to viral exposures, 3) missing absence of evidence (of benefits of mask wearing) for evidence of absence (of benefits of mask wearing), 4) missing the point that people do not need governments to produce facial covering: they can make their own, 5) missing the compounding effects of statistical signals, 6) ignoring the Non-Aggression Principle by pseudolibertarians (masks are also to protect others from you; it’s a multiplicative process: every person you infect will infect others).

    In fact masks (and faceshields) supplemented with constraints of superspreader events can save us trillions of dollars in future lockdowns (and lawsuits) and be potentially sufficient (under adequate compliance) to stem the pandemic. Bureaucrats do not like simple solutions.

    First error: missing the compounding effect

    People who are good at exams (and become bureaucrats, economists, or hacks), my experience has been, are not good at understanding nonlinearities and dynamics.

    The WHO, CDC and other bureaucracies initially failed to quickly realize that the benefits of masks compound, simply because two people are wearing them and you have to look at the interaction.

    Let us say (to simplify) that masks reduce both transmission and reception to p. What effect on the R0(that is, the rate of spreading of the infection)?

    Simply the naive approach (used by the CDC/WHO bureaucrats and other imbeciles) is to say if masks reduce the transmission probability to ¼, one would think it would then drop from, say R0= 5, to R0=1 ¼. Yuuge, but there is better.

    For one should count both sides. Under our simplification, with p=1/4 we get R0’= p² R0 . The drop in R becomes 93.75%! You divide R by 16! Even with masks working at 50% we get a 75% drop in R0.

    Second error: Missing the Nonlinearity of the Risk of Infection

    The error is to think that if I reduce the exposure to the virus by, say, ½, I would then reduce the risk, expressed as probability of infection, by ½ as well.
    Not quite….”
    … “Fourth Error: Misunderstanding the Market and People

    Paternalistic bureaucrats resisted inviting the general public to use masks on grounds that the supply was limited and would be needed by health professionals — hence they lied to us saying “masks are not effective”. “…

    View at Medium.com
    Via 3quarksdaily

    Anyone up for debating Taleb?

  38. KT2, that’s not evidence. I already said above: Japan was a known user of masks, and everyone was masked, when cases were growing to 700 a day. Now that Japan has reopened, shock! Cases are rising again despite everyone wearing masks.

    Your chart suggests that Korea, Singapore etc were wearing masks from the beginning of this epidemic. They weren’t. Their mask actions came after other policy actions. Now they’re using masks – catching up on a Japanese practice – but it’s too late to assess that now because the other policies were already in place.

    As another example, China is also now routinely wearing masks, and yet it has another outbreak in a market. Why?

    Or as another example: We have known for 40 years that condoms are 90-100% effective at preventing the spread of HIV, yet it remains a global pandemic. The only real gains made in preventing the epidemic occurred after 1995, when a treatment became available, and particularly since 2001 when widespread testing and treatment was supported globally by western donors.

    Can you see the lesson from this?

  39. Replying to KT2’s points here. For reference, the points were:
    1. Where is yours. Don’t bother replying without a citation.
    2. After emailing Taleb, please link to your reply from Taleb.
    3. EXACTLY what would YOU specify as evidence? 3a. When will evidence be available?
    4. Do you BELIEVE 1 condom has stopped 1 person after 1 sex act to NOT catch HIV from partner in sex act?

    4a. Is unprotected sex multiplicative?

    Here are the answers.
    1. I cited Japan government statistics on new cases. This is a citation of evidence: please see my note below about the difference between a citation and a link. Cases in Tokyo grew from 5 on the day the lockdown ended to about 40 yesterday, an 8-fold increase in 3 weeks despite everyone in Japan wearing masks. The trend is exactly the same as it was in early February when we started with similar numbers of cases. The difference between now and then is that everyone is wearing masks and social distancing. Ergo: no effect of masks.

    2. I don’t argue with Taleb, and I cannot contact him because he blocked me on Twitter after I sarcastically pointed out to him that he should read his own book on black swans during his Mary Beard meltdown. Taleb is a thin-skinned clown who confuses yelling and insults for debate. He doesn’t understand public health or infectious diseases, which is patently clear from his 6 points [if he understood these issues he would know his question 1 is an argument against masks]. I prefer to argue with people who understand the issue.

    3. Evidence of the effectiveness of masks can be obtained in two ways: directly, by studies of exposure risk in the laboratory, or indirectly through ecological evidence. The former [exposure studies] are unethical and cannot be performed. The latter are currently being performed in multiple countries, e.g. Japan, as they reopen with the additional requirement of mask wearing. As I pointed out in 1), we can see that the mask strategy does not work.

    4. I made clear in my comments that I believe condom use prevents HIV transmission: it is 90-100% effective, as I stated above. But the epidemiological evidence is that despite a) knowing this b) campaigns to increase this knowledge to others c) free distribution of condoms and d) extensive sex education, we have failed to eradicate or control a single STI or HIV. It is widely acknowledged that behavioral change strategies in sub-Saharan Africa have failed (see Kretchmar in the NEJM, sometime in I think 2010, for a summary); currently test and treat is the preferred strategy to control HIV in non-injecting populations because barrier methods are known to have failed.

    Incidentally, public health workers in HIV know this very clearly. Recently the director of 56 Dean St in London made a plea ot use the lockdown to end HIV, because reducing sexual contacts during lockdown is more effective than barrier methods. See here.

    The point you are misunderstanding here is that things that work on an individual basis do not necessarily work on a population basis. While it may be the case that mask-wearing offers some protection to an individual (or more likely, when a sick individual wears a mask) it does not work as a strategy. We have ample evidence that these individual barrier-wearing choices do not work from a) 40 years of HIV and b) experience in mask-wearing countries. As I said above, in March we were seeing 400 cases a day in Japan and everyone was wearing a mask, the govt had to declare a lockdown anyway. Now mask-wearing is 100% ubiquitous, and yet the epidemic is growing. This means that this strategy does not work. Just as individually-effective barrier methods work on individuals but fail in the population to prevent HIV, so too with masks.

    Clowns like Taleb want to believe that masks work because they want to believe a) that you can control an infectious disease through individual rather than group action and b) that by making a few small, relatively inconsequential personal behavioral changes like wearing a mask we can reopen the economy and control the virus. Obviously if b) were true this would be great but on a population level these individual choices do not work. Taleb is going to have to bite the bullet at some point and recognize that only public policy can prevent infectious diseases. If you want more evidence of this ask yourself why rates of STIs are so much higher in rural Aboriginal communities than they are in urban non-Aboriginal communities, even though condoms are widely available in both? The answer is that one community has access to immediate testing and treatment and one doesn’t.

    Or ask yourself why porn actors who don’t wear condoms don’t get HIV, and why outbreaks of HIV in porn actor communities are rare and quickly contained? It is because they practice rigorous strategies of testing and isolation.

    Finally, regarding citations: please be aware that a citation is not a link. When I cite Japan government statistics I am not obliged to provide you a link – I have given you the source. When you provide a link to Taleb’s video rant you aren’t providing me a citation, you’re just giving me more unsourced opinion. Do you understand? Also, when you paste material from other websites into your comments without distinguishing between your own and their material you are committing plagiarism. Please don’t lecture me about citations until you can learn how to blockquote and how to use inline links. It’s not difficult.

    Now, do you have any evidence for masks working, or any arguments as to why you think as a strategy they can work, given every country that relies on them is failing to control the epidemic?

  40. The point you are misunderstanding here is that things that work on an individual basis do not necessarily work on a population basis.

    For example: for an individual, abstinence works; but abstinence education campaigns are so futile and ridiculous as to be actively dangerous.

  41. Oh, the irony! – KT2 using faustusnotes to rebut faustusnotes.

    You faustusnotes, have said on YOUR OWN website re masks; 
    On the page “Why Was Japan’s COVID-19 Response Successful?” in a section titled “A note on masks” you state;
    “That is not to say one shouldn’t wear them, but one should not see them as a solution to the more basic responsibility of social distancing and isolation, and one definitely should not drop one’s hand hygiene just because one is wearing a mask:” 
    (plenty of caveats also)

    2nd major misrepresentation involes Ronald, and your reply to Ronald faustusnotes.

    Ronald posted a study ^1. stating he believed the paper showed a reduction of new infections of a third -33.333%.

    You replied faustusnotes ^2. “Ronald my reading of that study is that it is 2.5 – 13%.”

    What are we to believe of your ‘arguments’? Feel free to issue a Corrigendum.

    ^1. Ronald says: JUNE 10, 2020 AT 4:37 PM
    “In practice, mask use in Germany appears to reduce COVID-19 new infections by over one-third:
    https://www.iza.org/publications/dp/13319/face-masks-considerably-reduce-covid-19-cases-in-germany-a-synthetic-control-method-approach

    faustusnotes says:JUNE 11, 2020 AT 11:05 AM
    “Ronald my reading of that study is that it is 2.5 – 13%. There is another study being reported today but I haven’t bothered following it up because I’m tired and busy. We are seeing a resurgence in the USA now due to reopening. Policy trumps personal behavior with infectious diseases every time!”

    Is this plagiarism? 

    Have you issued a Corrigendum yet?
    n.
    An error to be corrected, especially a printer’s error.
    n.
    A list of errors in a book along with their corrections.
    n.
    Something, especially a word or phrase in print, that is to be corrected or altered.
    More at Wordnik 

    And finally faustusnotes, I have had all individual F1-11 plans, models and preparedness under my wing, and delivered briefings to the Office of Strategic Crime Assessment. No one, ever, in 30yrs of writing up OTHERS original insights, has anyone ever mentioned the p word. Pony up or issue a withdrawl of accusation.

    As you have levelled baseleas accusations at me fuastuanotes; “when you paste material from other websites into your comments without distinguishing between your own and their material you are committing plagiarism.”, which in this forum, I find laughable, I offer to correct the record on any and all instances of plagiarism by me. I’ve been accused of using too much formattig! You must either state proof or withdraw this trashy low blow, because you didn’t bother to parse text faustusnotes.

    In the same vien as accusing somebody without evidence, just a hand wavey dog whistle, I accuse you of major misrepresentation of your positions in your comments to me and others re masks. With your own statements as evidence!

    Feel free to correct me.

    And when I say reply in the sandpit next time faustusnotes, please comply. I will.

  42. What is the evidence around masks and COVID-19 transmission?

    11 June 2020.

    Our researchers identified 13 studies exploring whether mask-wearing in the community is likely to reduce COVID-19 transmission. Although the evidence overall was judged to be limited and of low certainty, 10 of the 13 studies indicated that wearing masks in the community was likely to reduce the spread of the disease. This finding applies to both early and later stages of the pandemic.

    Two modelling studies found a significant impact when masks were adopted early and worn by at least 80% of the population. Other studies suggested an effect on public transport or other public environments where social distancing is difficult. But the use of masks in recreational and mass gatherings was not found to be effective.

    Mask-wearing did not diminish adherence to other measures where the evidence is far more clear-cut, such as hand-washing and social distancing. Public health campaigns could further emphasise the importance of all these protections used together, the researchers suggested.

    But where there is any problem with the supply of masks or where universal use is not recommended, high-risk groups should be targeted, researchers say. These include the elderly, the vulnerable, people living in high-risk areas and those who are immunocompromised.

    The report was commissioned by the Australian Commission on Safety and Quality in Health Care (ACSQHC).
    https://www.saxinstitute.org.au/news/what-is-the-evidence-around-masks-and-covid-19-transmission/

    Download the full report here.

    Click to access Evidence-Snapshot_The-use-of-masks-by-asymptomatic-people-to-reduce-COVID-transmission.pdf

    Just in case any thinks this is my research, it is not ‘ “The report was commissioned by the Australian Commission on Safety and Quality in Health Care (ACSQHC).”. Ok?

  43. KT2, I did issue a corrigendum to my comment, immediately after my error was pointed out to me. The fact that you can’t seem to find it doesn’t mean it isn’t there. This kind of gotcha is weak. In fact my statement wasn’t wrong: the abstract of the study indicated a 2.5% – 13% reduction in cumulative infections while Ronald was referring to the finding on daily infections. I don’t think quoting the abstract is a mistake. Do you?

    I note that you haven’t responded to a single one of my points. You asked these four questions, I went to the trouble of answering them, but you choose to ignore my answers. Is this what you consider to be a debate?

  44. faustusnotes, I haven’t time to demolish your blindspots today [I will in time – in the sandpit ], so I will leave you this meta analysis.

    This is not my research.

    “Physical distancing, face masks, and eye protection to prevent person-to-person transmission of SARS-CoV-2 and COVID-19: a systematic review and meta-analysis

    June 01, 2020
    DOI:https://doi.org/10.1016/S0140-6736(20)31142-9

    We did a systematic review and meta-analysis to investigate the optimum distance for avoiding person-to-person virus transmission and to assess the use of face masks and eye protection to prevent transmission of viruses

    ….” Face mask use could result in a large reduction in risk of infection (n=2647; aOR 0·15, 95% CI 0·07 to 0·34, RD −14·3%, −15·9 to −10·7; low certainty), with stronger associations with N95 or similar respirators compared with disposable surgical masks or similar (eg, reusable 12–16-layer cotton masks;pinteraction=0·090; posterior probability >95%, low certainty). Eye protection also was associated with less infection …”
    https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)31142-9/fulltext

    For those with difficulty parsing plain text, the next para is me:
    As you are more knowledgeable than JQ, Taleb and the hundreds of researchers in my prior comments, we eagerly await you demolishing these researchers re masks, without using insults such as “. Taleb is a thin-skinned clown who confuses yelling and insults for debate”. Confirmation bias, compromise and conceit, and ego – tricky. You are up for it faustusnotes – the corner you have painted yourself into now needs you to intellectually demolish JQ & Taleb and all the actual researchers above to get out of the corner. Like I said – tricky.

    And no, no debating, just as close to evidence as we currently can get.

  45. Cloth masks — particularly those of decent quality — seem so effective at reducing the spread of COVID-19 I think Australia should *immediately* encourage their use in the Covid soaked hellhole states like Victoria. Particularly in choke points where it is difficult to maintain social distancing, such as public transport. If it turns out they are not as effective as they appear, they are still going to be effective enough to be worthwhile. The only fly in the ointment is supply. No matter how useful they are, they will save more lives in Arizona or Airy Bruno than anywhere in Australia. Of course, we have a lot of capacity to increase supply. There are plenty of grannies out there with sewing machines. Granpas too. Just not so many. We could also make them professionally.

  46. Supply should be non issue for that mask type. A) because indead everyone with a sewing machine can make one. B) The more professional production is already up and running. Demand for conventional textiles has colapced, not much else to do now for those armies of sewers in Malaysia. Most people here in Germany for example already have a couple of them, and there are no signs of major supply constraints in pricing anymore.We were a late introducer – the usual cultural bias towards rather doing something late than imperfect, which was utterly unecessary in this case. Right across the border in Czechia, they got a lot more trust into improviced measures, and that too worked out, a sufficient supply of self made masks didn´t even take a weak after an early instroduction.

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