Masks (repost from a month ago)

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: Obviously, the Victorian outbreak has increased the urgency of this. The Rail, Tram and Bus union has called for compulsory masks on public transport, but we will probably need to go to a general requirement for masks in all public places

15 thoughts on “Masks (repost from a month ago)

  1. Masks are a no brainer. I can’t understand the caution. There’s an article in the Lancet saying that they reduce the risk of contagion by 70 percent (and social distancing reduces the risk by 80 percent). I am sure there’s a lot more to the article than that (i.e., if mask is worn correctly, type of mask, how many other people are wearing them, etc). I bought one and I wear it. Yes it feels uncomfortable and yes it feels silly, but I see no alternative. We need to use every tool at our disposal: masks, lockdowns, social distancing.

  2. Healthy professionals are trained to have perfect mask technique. Anything less than perfect can evoke a strong emotional reaction because in a medical setting — given enough time — it will kill people. Unfortunately, rather than think about whether or not imperfect mask technique is a lot better than no mask at all, may health professionals went with their emotional reactions rather than actual thought. Dumb emotion trumping rational thought is, unfortunately, a sign of our modern times. And all other times. So we need to work more at preventing these kinds of mistakes.

  3. “It’s time for government to step in and order them to require masks as a condition of travel…” AND for the government to order airliners to carry only 1/3 or less of maximum passenger capacity.

    Actually, I think ALL domestic passenger aircraft in Australia should be grounded indefinitely until this pandemic is defeated. All non-essential international departures and arrivals should also be halted if they have not already been stopped.

  4. Masks on all public transport and in shopping centres and in crowded (inner city) public places yes. But masks in all public places is excessively restrictive in my opinion. For example, in my neighbourhood one can walk on most public roads for one hour and not meet anybody on some days. On other days and other times of the day, one may find 2 or 4 people or even 6 people on the same stretch of road. But the people are in the habit by now to avoid each other by moving from the footpath onto the road. On this relatively ‘high frequency’ road there is a nature strip of ca 2.5 m between the footpath and the edge of the road. There is a 3 m nature strip but no footpath on the other side of this stretch of road. Large areas of suburban Sydney have similar public place (road) conditions.

    It seems to me the compulsory aspect is quite important regarding surgical and fabric masks.

    The airlines promote the idea that the air conditioning system on aircraft provides sufficient safety. Prof Dr Dr Lauterbach, epidemiologist and medical practitioner, Social Democrat Member of the Federal Government in Germany, publicly stated that he would not fly with a fully occupied aircraft and no masks even short distances such as Germany to Majorca.

    My best guess is that the compulsory wearing of masks on public transport and in crowded public spaces is a reminder that the pandemic is still on and this signal may at least balance any concern of a false sense of security.

  5. For this to be an equitable mandate, masks would have to be affordably available to all. Based on signs I’ve seen in supermarkets and chemists, this might not be true currently; what can be done practically to overcome this? Provide or sell masks at point of entry?

  6. I agree that masks are obviously essential on public transport and while engaged in situations where you cannot socially distance. I have been wearing them myself, in these situations, for months.

    But I am surprised that you have waited for the WHO to endorse them before doing so yourself – there was abundant evidence on their useful role from Taiwan, South Korea, China and Hong Kong. Also, plenty of scientific studies endorsing the use of even quite crude masks.

    It would have been better for the WHO to endorse them and to provide education on their correct use, handling and disposal.

    The WHO track record on Covid -19 has not been good – not initially supporting restrictions on international travel (indeed siding with China when it criticized Australia’s restrictions on Chinese flights to Australia), not accepting for a long time the possibility of person-to-person transmission and, even now, not accepting that aerosol transmission is a possibility despite evidence from cruise ships and other enclosed spaces. Maybe it is finally changing its mind on this last point.

    If there are reasonable grounds for supposing a form of behavior is intensely damaging and it costs almost nothing to stop that behavior then a straightforward application of the precautionary principle suggests being risk-averse and avoiding that behaviour. The WHO has not performed well in sending out public messages on the pandemic and countries need to rely on national institutions for health advice.

  7. Here John is a counterpoint about why masks don’t work, what the evidence says and why we cannot expect to beat infectious diseases with personal choices. In response to James at comment 1, the Lancet does not say that masks reduce infection risk by 70%. It provides weak evidence of a 44% reduction in infection risk.

    Let’s take that as correct. Infectious diseases of this kind are usually modeled with a risk of infection that is linear in the number of contacts and the probability that a contact is infectious. If we reduce the probability that a contact is infectious by 44% that’s good, but if we say “well, now everyone’s wearing masks we can take more risks” and allow bars and indoor restaurants to reopen, so that we increase the number of contacts by more than 100%, we actually overall increase the spread of the virus. This is what is happening throughout the world.

    As a perfect example of this, Japan reopened on about 30 cases a day, and is now up to 200 a day, having gone from 5 a day in Tokyo to about 100 a day. Everyone here wears masks all the time. Just yesterday I was in a meeting with 25 or so people and 24 of them were wearing masks. We were also sharing a microphone. But we’re safe, right? Because we have masks. No, what happened is we went from meetings a month ago where 5 people were physically present and 20 were on zoom, to a meeting where 25 were physically present. We increased our contact risk 5-fold, in exchange for a 50% reduction in infection risk per contact.

    As another example, there was an outbreak recently in a Beijing market. Do you think the people working in that market were not wearing masks?

    Or, to look at it from another perspective: why doesn’t Trump get this virus, when so many people around him do and he never wears a mask, while Keisha Lance Bottoms, mayor of Atlanta and staunch mask advocate (and wearer) got it? Because he is running a strict testing regime, where everyone who has contact with him gets tested regularly and isolated when they’re found to be positive. No one positive is allowed near him. If everyone in the community enjoyed his level of testing this virus would already be gone. But instead we have to wear barriers so that we can do unsafe things, because the government isn’t willing or able to invest in the testing capacity we need.

    You also mention airlines. I don’t think there’s much evidence of transmission on planes, and if it does happen it is highly unlikely to be because of you spitting on the person next to you: much more likely it’s because of infectious people touching shared surfaces (particularly bathrooms), or due to aerosols in the air conditioning, which cannot be prevented by masks (if your spectacles steam up when you wear a mask, it’s not protecting you from aerosol particles). If you think airlines are a problem then you need to ban commercial travel, not require masks on planes.

    You mention urban public transport, but there is absolutely no way to make e.g. the Tokyo subways safe. It simply cannot be done. If you think crowded public transport is an infection risk you need to get people off public transport, not have them wear a mask. Me wearing a mask doesn’t protect me from contact infection from poles, hand rails and straps that I have to use while traveling; from escalator rails that I have to hold; or from the ticket machines and screens I have to touch. Ridership on the Toei line was down 80% while the lockdown was enforced, enough to reduce the basic reproduction number of this virus below 1. Getting that back to normal because “masks will protect you” means simply that the basic reproduction number will be 2 or 2.5, not 4 or 5. Sure that means the virus is doubling every 7 days instead of every 4 days, but it’s not going to save us.

    If you think a social environment is an infection risk you need to remove people from that social environment or reduce the number of people in it, not encourage them to return to that environment while wearing an imperfect barrier.

    The failure of barrier methods and “personal responsibility” is the entire story of the HIV response, and it’s deeply depressing that we haven’t learnt anything from 40 years of failures on this issue. You can’t eliminate infectious diseases with individual measures, you need policy, testing, treatment and where necessary forced isolation. Until people understand that we will not get rid of this virus.

  8. The author of this article, Mary-Louise McLaws, probably should be regarded as the most important person in Australia who we should be listening to most and taking advice from right now.

    In other forums, Mary-Louise McLaws, has argued for complete eradication of COVID-19 in Australia. This is the path we should be taking. Endless, rolling outbreaks will destroy our economy. One hard lock-down to (effective) eradication will set us up for a workable economy again. All those pressuring for the precipitate reopening of the economy, especially those in the pubs, clubs, restaurants, tourism and sports industries have done a major disservice to themselves and the rest of Australia.

    With the resurgence of COVID-19 in Melbourne and the “fleeing” of Victoria going on before the effective lock-down we face potentially an escalation to a UK or USA situation. Our predicament is now grave but not completely hopeless. Let us hope we learn the lesson from this outbreak and push hard lock-down again everywhere until eradication. Anything less is to be continually courting long-term disaster economically and in terms of public health.

    I do hope the “open too soon” lobby will finally get the message.

  9. Sounds a bit like kidnapping people ikonoclast. Will the kidnapped people get proper treatment in the new place they are taken too? If they cannot be confident of excellence in treatment, that will lead to the hiding of the problem.

  10. That’s a good article by McLaws, and the point about case isolation is very very important. It is case isolation that enabled China to control an epidemic that was spiralling out of control fast, and case isolation which ensured Vietnam and Japan had a slower growth and more rapid repression of the virus. Home isolation increases the required lockdown time because other people in the house get infected, and if these people are essential workers they continue to contribute to community spread. You can see the effect of this in the relative speed at which epidemics decline from their peak in e.g. NY (no case isolation) vs. Tokyo (case isolation).

    If JQ wants to talk about major changes that would really change the course of this epidemic, case isolation is what he should be pressing for.

    Also McLaws is right to argue for complete elimination of the virus. You simply cannot return to normal while even one case is floating around. Eliminate rapidly through lockdown and case isolation, then reopen, is the only strategy that works.

  11. It seems to me, one of the difficulties in formulating international advice on masks or other public health measures is the uneven development across countries, within countries and within cities regarding population size and distribution, housing, public infrastructure including health and age care facilities, production of goods (abattoirs vs highly automated metal), including masks and services (delivery vs dental), income distribution and other socio-economic factors such as languages and general education.

    If one were to look at the population density of Australia per square km, then one might conclude that no social distancing is required and the idea of wearing masks is farcical. But this aggregate statistic is of course useless for the purpose at hand.

    Social distances is much more difficult in high rise apartment buildings in the Sydney CBC than in large areas of suburbia even though the monetary value of each of these apartments exceeds that of most houses in the leafy suburbs.

    In early March I managed to get two surgical masks for $3 each. In April I managed to get 4 for $2 each and for quite some time I can buy any number I wish for $1 a piece at a local pharmacy. Supply rather than income constraint.

    It is difficult to order the wearing of masks in time when there is a severe supply constraint.

    Mr Macho from Brazil is now also wearing a mask – to protect others because he has tested positive. A cynic might say this is an extreme form of showing solidarity in local conditions!

  12. That’s a good point Ernestine. The evidence on mask use in non-healthcare settings in the Lancet paper is from studies that are more than 10 years old, conducted for SARS in China and Vietnam. It’s questionable whether those findings apply in very dense cities like Tokyo, or in the very different environments of Australia and the UK.

    At the gym this morning I saw a great morning news show presentation on Bolsonaro’s current difficulty, which called him “Brazil’s Trump” and managed to perfectly explain how reckless and stupid he has been without saying anything rude. They made a good point of observing that he took his mask off in front of journalists, and also that the point in time when he shared a meal with five diplomats was exactly the point when the transmission risk is estimated to be greatest. Yes he wore a mask, but he made sure to take it off and basically threaten journalists with contagion during the interview where he revealed his diagnosis.

    It’s hard to shake the idea that these people are a death cult.

  13. – I am still marveling at the inability of our corporate totalitarian society to handle even a short pause. How hopelessly inadequate can it be ?
    – No doubt the inquiry into the Vic quarantine security stuff up will just blame premier Dan for picking the wrong private security firm and not checking on the job they were doing .Will it question the wisdom of outsourcing and of shrinking government ?
    – mask supply shouldn’t be a problem as they can be reused.
    – My Melbourne residential disability care worker friend hasnt been given a mask to wear at work .They work 10 – 12 hr shifts in a house with one other worker and 3 or 4 residents ,they have always practiced good hand hygiene tho. They have no plan (that the workers are aware of) to deal with an outbreak . In Victoria this industry has recently been ‘privatised’ (ie; contracted out to the lowest bidder – like the quarantine security) .The virus would rip through that workplace.
    – It is possible to get across the border at Albury Wodonga by crossing the Murray river on foot ,at this time of year it is very low because water is being trapped in the Hume Weir about 10 km upstream .You would only have to get a bit wet and go on a moonlit night, apparently they are using drones to look for people trying that.

  14. A hard ask – certainly in America – 95% to wear masks for this outcome…

    “New IHME COVID-19 Model Projects Nearly 180,000 US Deaths
    June 24, 2020

    “The forecast shows 179,106 deaths (with a range of 159,497 to 213,715). Those numbers drop to 146,047 (with a range of 140,849 to 153,438), if at least 95 percent of people wear masks in public.

    “IHME’s new projections include the re-imposition of strong social distancing mandates when deaths per day reach a level of 8 per one million people, but currently only Texas and Florida reach this level of resurgence before October 1. Mask wearing at current reported rates is included in the model.   

    “These factors are vital in our projections and highlight how many lives can be saved,” Murray said.  

     The forecasts by state with and without 95% percent wearing masks are:: 
    Alabama: With mask use 1,334 (range of 1,118 to 1,644) / Without mask use 2,008 (range of 1,301 to 3,384)

    California: 8,745 (range of 7,709 to 10,489) / 11,631 (range of 9,093 to 17,007)
    [Also every state ]

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