I agree in principle. Then in real life example you will have real doctors and nurses giving conflicting advices and having wildly different viewpoints on the details.
The easy to point to example is how a lot of doctors viewed masks at the beginning of the pandemic. Or how trickle down economics is also endorsed by experts. Or experts opinions on mental health drugs. And so many other subjects where it won’t be hard to find an expert on the dumb side of the argument.
I think we should rely on experts, but we can’t dismiss people’s doubts or research just with a “I’ve seen a real doctor” slight of hand.
"how a lot of doctors viewed masks at the beginning of the pandemic"
Ok, so I've looked into the history of this a little, and most of the mask mythology seems misunderstood.
Prior to 2020, most medical professionals believed most viruses, and corona viruses particularly, could not be transported as aerosols. This was a subject of research where the data had not come in.
About late March, it began to appear that the virus could be an aerosol. Hard results did not come in until April and May, and many in the field discovered they had egg on their faces.
Conflicting advice is to be expected with new information.
My frustration is that, here in Canada at least, there is still an outdated way of talking about the virus as if it's a surface / hand sanitation issue, and much of the public policy (especially around school openings, etc.) still seems to be ignorant of the absolutely essential role that shared air has in transmission. Public authorities have failed to really drive home the reality of the virus, and instead we get sanitation theatre, a pantomime of virus control, and parents clambering to get schools reopened (while the numbers plummet since they've been closed after Christmas)
Example, a local wine shop in my small town where you are not allowed to touch the bottles, but I see the staff inside with their masks off when there's no customers in the store.
Frankly, I think people really just don't _want_ to believe it's aerosol transmitted. Because the consequences for public policy would be so drastic; no malls, no factories, no schools, etc. should really be open if you admit it.
It’s possible that it’s just been so long since we had a bad respiratory pandemic that medical advice assumes everything is food poisoning and norovirus, where cleaning surfaces actually does matter.
But it’s also possible they’d have to admit grandma-type adages about opening the windows actually work and office buildings don’t let you do this anymore.
If you go to ontario public health website and read their summaries on current covid papers, you'll note that the vast majority of papers come to the conclusion that schools have almost no impact on the spread of covid.
But no, keep applying youre second grade logic: spreads through air-> indoor places unsafe-> CLOSE EVERYTHING.
That's not to say some of it isn't security theater (ie my parents were washing cookie boxes with soap some a couple of months ago), but those measures aren't being driven by the public health, but rather the unrelenting fear mongering of the media.
I've also looked into it a little and come to the opposite conclusion. Here is one study from Singapore in 2014 that showed surgical and n95 have about a 68% and 95% efficacy respectively at preventing SARS transmission https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4293989/ Masks have also been shown to provide protection against the common cold (many strains of which are also coronaviruses) and seasonal flus https://www.livescience.com/7661-masks-protect-colds-flu.htm...
In the absence of more specific information about SARS-COV-2 early in the pandemic, surely it would have made sense to default to using the preventative measures that were known to be effective at controlling SARS and other known respiratory diseases? Especially when these measures come with no real risks.
It's true that they didn't know with 100% certainty, and China's misinformation about human to human spread in the beginning and not allowing the CDC team in early to investigate certainly didn't help either. Maybe these experts, including Dr Fauci, the CDC, and WHO, just made what turned out to be very bad judgement calls and they honestly thought that masks wouldn't prevent the spread of the disease. But by far the likeliest explanation in my mind is that these institutions knowingly lied to the public in an attempt to manipulate people into not buying masks, and I still find that to be absolutely unconscionable.
"In summary, despite the various mechanistic arguments about which organisms can be potentially airborne and therefore aerosol-transmissible, ultimately, the main deciding factor appears to be how many studies using various differing approaches: empirical (clinical, epidemiological), and/or experimental (e.g. using animal models), and/or mechanistic (using airflow tracers and air-sampling) methods, reach the same consensus opinion. Over time, the scientific community will eventually form an impression of the predominant transmission route for that specific agent, even if the conclusion is one of mixed transmission routes, with different routes predominating depending on the specific situations. This is the case for influenza viruses, and is likely the most realistic."
Honestly, I'm not sure what you're asking. Some kind of admission that the US health field ignored research because "eww, icky Asians?" Evidence that the US health experts knew of the research but are Snidely Whiplash-ish, mustache-twirling evil? As far as I can tell, they're just as confused as any other scientist trying to do their best, with the additional constraint that they have to provide an answer to a question and that any nuance in that answer will be ignored anyway.
The link I posted is to a 2019 paper discussing how and why some viruses are considered airborne transmissible such that masks would help. (Single papers don't usually settle complex questions, right?)
cactus2093's links are to a paper discussing the difficulty of getting people to use masks correctly and a science popularization article describing an unnamed study from the University of New South Wales and an unidentified CDC study. The first link does include references about the utility of masks, to articles titled "Risk of transmission of airborne infection during train commute based on mathematical model", "Knowledge about pandemic influenza and compliance with containment measures among Australians", "Physical interventions to interrupt or reduce the spread of respiratory viruses: systematic review", "Professional and home-made face masks reduce exposure to respiratory infections among the general population", and "A schlieren optical study of the human cough with and without wearing masks for aerosol infection control", but those don't seem to imply the issue is settled. The second link does go on to say, "While some governments are already stockpiling masks for use in emergencies, MacIntyre said these guidelines had been implemented without evidence to support them. "We now have provided that evidence," she said," but it's difficult to evaluate the last sentence.
> Prior to 2020, most medical professionals believed most viruses, and corona viruses particularly, could not be transported as aerosols. This was a subject of research where the data had not come in.
cactus2093 replied
> I've also looked into it a little and come to the opposite conclusion. Here is one study from Singapore in 2014 that showed surgical and n95 have about a 68% and 95% efficacy respectively at preventing SARS transmission https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4293989/ Masks have also been shown to provide protection against the common cold (many strains of which are also coronaviruses) and seasonal flus https://www.livescience.com/7661-masks-protect-colds-flu.htm...
There's two ways I can see you interpreting this.
1) You are being extremely narrow in your focus and saying that you are talking specifically about viruses being transmitted as aerosols (although the overarching topic here is about whether or not masks are effective). And thus, since there was no research specifically about this, then there's no reason to recommend masks. This doesn't address the point that there's research that shows masks are effective against similar kinds of viruses.
2) You actually are talking about effectiveness of masks and saying that viruses could not be transmitted via aerosol was to say that because they are not shown to be transmitted via aerosol, then there's no evidence that masks would work, in which case, again, we're back to the issue that there was research prior to 2020 that showed masks are effective against similar kinds of viruses.
So the question remains, are you wrong about your assertion that
> Prior to 2020, most medical professionals believed most viruses, and corona viruses particularly, could not be transported as aerosols. This was a subject of research where the data had not come in.
and if not, what are we missing about what you're trying to say?
> Some kind of admission that the US health field ignored research because "eww, icky Asians?"
There was certainly the perception that Asians wearing masks was ridiculous. Whether or not this perception extended to American experts and influenced their conclusions is unknown to me.
"There's two ways I can see you interpreting this.
"1) You are being extremely narrow in your focus and saying that you are talking specifically about viruses being transmitted as aerosols (although the overarching topic here is about whether or not masks are effective). And thus, since there was no research specifically about this, then there's no reason to recommend masks. This doesn't address the point that there's research that shows masks are effective against similar kinds of viruses.
"2) You actually are talking about effectiveness of masks and saying that viruses could not be transmitted via aerosol was to say that because they are not shown to be transmitted via aerosol, then there's no evidence that masks would work, in which case, again, we're back to the issue that there was research prior to 2020 that showed masks are effective against similar kinds of viruses."
Backing up a bit...
As far as I've seen, there are three primary routes for infection for respiratory diseases: 1) contaminated surfaces, 2) (large) droplets produced mostly by coughing or sneezing, and 3) (small) aerosol particles produced by normal activities like breathing and speaking.
The normal measures against 1) are avoiding touching possibly contaminated surfaces, washing your hands, and not touching your eyes, mouth, etc. And roughly speaking, that's about all you can do.
The normal measures against 2) are staying distant (i.e. 6ft) and keeping interactions short because the droplets do not remain airborne long, and covering your face when you cough or sneeze. Masks would certainly be helpful in the case of 2), but not especially so because a) the normal measures work fairly well, b) most people do not want to wear a mask[1], c) many people who do wear a mask do not do so correctly, and d) the supplies of medical grade masks were (are?) sketchy. (Both of the links provided are specifically aimed at b) and c), no?)[2] A study of 1000 students at an Australian university is interesting, but the advantage of a) don't necessarily overwhelm b), c), and d).
There are no normal measures against 3). The only useful measures are to avoid all contact with potential carriers, significantly improve indoor ventilation and air filtration (aerosols remain airborne for a very long time), and properly using medically-effective masks when interactions are required. Transmission by asymptomatic carriers is primary, hard epidemiological evidence of 3).
From your limited choices, my closest meaning is your 1). But,....
Now, put yourself in the place of someone making an official policy recommendation in, say, February or early March. You don't have hard evidence that masks are required, but you do understand that they will provide some marginal benefit. On the other hand, ensuring that masks are worn consistently and correctly is an uphill struggle (as we have seen over the last year). Further, the supply of medical grade masks where their use is required, hospitals for example, is not infinite. Oh, and you want to make the minimally invasive recommendation you can, because you actually aren't out to cause as much damage as possible by, say, killing the economy. Beyond that, you know that at some point you are going to be facing pandemic fatigue, where people stop taking the situation seriously and then things get very bad (as in last summer, last fall, and earlier this winter). What do you do?
As it turns out, they were wrong about some of their assumptions. Being wrong happens. It is not proof of an evil conspiracy or even of a conspiracy of stupidity. It's people who are pretty good at what they do, making what they think are the best choices, and being wrong.
https://news.ycombinator.com/item?id=25616014 (No, really, "The Plague Year" in the New Yorker is probably the best history of the pandemic so far, and explicitly touches on a lot of these issues---including medical professionals saying, "yeah, we were wrong.")
[1] I am talking about the US specifically, not Taiwan, Japan, or anywhere where mask wearing is more common socially.
[2] Everyone wearing pressurized, highly filtered contamination suits at all times would prevent essentially all cases of respiratory disease transmission. But no one is going to push that idea without a really, really good reason.
> But by far the likeliest explanation in my mind is that these institutions knowingly lied to the public in an attempt to manipulate people into not buying masks,
As I remember it, the advice wasn't "don't wear masks," the advice was "stay home." If they said "go buy masks," that would mean leaving your house to get a mask, which would directly contradict the more important advice of staying home. Also if they said wear a mask when you leave the house it would have been interpreted as "it's ok to go on with normal events as long as we have masks" which wasn't the message they were trying to send, either. The message was stay home, and at the time it was probably the right message, and not a lie.
Yeah, no. People could have worn masks they already had, ordered masks online if any were available, the market for home-made masks would have emerged like it ended up doing later. And even if people did go out to buy masks, people were already going out on essential trips like the grocery store, pharmacy, and continuing to go to work for many people. Making one trip to buy a mask and then wearing that mask on all other essential trips for the next few weeks would have been a big net win even if you did have to go into a store to buy that mask.
> As I remember it, the advice wasn't "don't wear masks," the advice was "stay home."
There was “stay home” but also “stop buying masks because you are stopping medical, first responder, etc. personnel from getting them and they aren't useful for the general public” during the initial PPE supply shortage and hoarding.
This wasn't a lie, AFAICT, but Aa statement that was completely correct public health statement in the context it was given that was widely interpreted as an individual health statement.
> was completely correct public health statement in the context it was given that was widely interpreted as an individual health statement.
There was no misunderstanding, the message was "don't wear a mask unless you're sick, masks don't help the wearer they only help keep a sick person from spreading it to others around them". That was just a lie at the time, we didn't know that for sure and we had every reason to suspect the opposite.
> There was no misunderstanding, the message was "don't wear a mask unless you're sick, masks don't help the wearer they only help
I've heard lots of people say that was the message, but it wasn't the one I heard and it's not the one I find in any of the documented statements from public health officials.
I definitely remember a lot of talk from experts saying non-surgical masks don't work and that surgical masks should be saved for medical professionals.
> Prior to 2020, most medical professionals believed most viruses, and corona viruses particularly, could not be transported as aerosols.
That’s most American medical professionals. And they mostly seemed to believe you would get yourself sick faster by touching your eyes after taking the mask off wrong, or that masks provided 0% protection unless you wore an N95 with a fit test, or that if they didn’t lie about them being useless people would steal them from hospitals. They certainly didn’t believe they were truly useless, since they were all wearing them for procedures.
Actually, wasn’t the excuse for suddenly being like “face masks are good actually” that they didn’t know COVID had asymptomatic spread before then? That’s even worse than not knowing it spread through aerosols.
> This was a subject of research where the data had not come in.
By using the technique of “not assuming all of Asia is primitive and superstitious”, it was easy to figure out what to do without an RCT. Note there isn’t evidence that surgical masks help during surgery either.
Yeah, I think what a lot of people going on TV failed to really express is that there was so much unknown about this new virus, that this is the best information we have to go on RIGHT NOW. And then when that changed, they didn't make it explicit enough that they were changing their advice based on NEW DATA. Partially this is just the soundbite driven media, where even if it was explained, that often doesn't make the 10 second clip replayed.
My company had a zoom conference with a very well respected British doctor, he won something more or less equivalent to a nobel prize in mediciine, and he told my company, on May 4th, that masks are not necessary. This was already a bit head scratching, but what I feel he probably meant, but certainly did not explicitly say- is that its not a priority for an individual to wear a mask when there are shortages for front line workers.
But mix a changing message with an inbred resistance to being told what to do and the inconvenience of a mask, and this comes out the end for many as "They don't know what they are talking about these "experts!", I don't need to listen to them, they can't get their story straight!" and here we are...
> My company had a zoom conference with a very well respected British doctor, he won something more or less equivalent to a nobel prize in mediciine, and he told my company, on May 4th, that masks are not necessary. This was already a bit head scratching, but what I feel he probably meant, but certainly did not explicitly say- is that its not a priority for an individual to wear a mask when there are shortages for front line workers.
This comes off as blatantly lying to us for our harm, not "they don't know what they're talking about". If someone lies to you and knowingly puts your life at risk through the lie, it's very rational not to believe anything they say in the future. This is not mere mixed messages.
If government and/or experts want to have non-negative credibility, they are going to have to start consistently telling the whole truth.
> Then in real life example you will have real doctors and nurses giving conflicting advices and having wildly different viewpoints on the details.
Exactly. Real life example - someone I know asked her doctor about getting the Moderna covid vaccine while pregnant. The doctor not only said it was ok, but also verbally recommended it and gave her a written paper to help her get the vaccine. She was able to get it a couple days ago. Then yesterday the World Health Organization announced that pregnant women should not be getting the Moderna vaccine because they were not included in the trials.
So who’s right here? It’s hard to trust a “real doctor” when something like this happens.
It also happens that, doctors in particular, barely see you for 5-15min, that is not enough time for them to fully understand what is going on with you and your whole history. It’s only enough time for them to make a quick judgement based on their pattern matching abilities from their own experience and then give, an educated, recommendation. But they are not really vested in you in particular, you are just one more, and if their recommendations don’t work for you, they usually don’t really care and won’t go down the rabbit whole with you, at the most they’ll just refer you to someone else.
But that ... that's not exactly incompatible. The WHO makes very simple blanket statements that are safe in general.
A doctor usually looks at an individual. (And we know a lot of pregnant women got infected with COVID. We know that hospitalization was higher for them, but also that mortality is the same - https://www.cdc.gov/mmwr/volumes/69/wr/mm6925a1.htm?s_cid=mm... , so the immune reaction should be the same too)
The real problem is that it's impossible for a non-expert to gauge the expertise of any of these entities (your full-sized real-life walking-talking doctor who you know for a deacade, the WHO and anyone in between). Even simply asking many questions is just the illusion of getting informed (not just because there's rarely any time for proper answers as you mentioned), but because the answers are biased, so this naturally biases the next question too. (Unless there's enough time and effort to go through years of science and try to falsify whatever theory is being communicated with very targeted questions, it's close to useless/futile effort.)
> But they are not really vested in you in particular, you are just one more,
Yep. Agreed. Also usually primary care physicians are better at "bedside manner" and pattern matching than at real medical science. (Because it's not really their job to have 20 doctorates in every subfield of biology.)
>Or how trickle down economics is also endorsed by experts.
Trickle-down economics is not explicitly endorsed by anyone, because it's a pejorative. That's like saying "totalitarianism is popular in some countries"; you might think those countries are totalitarian, but they don't.
Indeed. Even then, as a term, it refers to a specific regan-era tax policy.
What many on the left assume it means, is a sincere description of growth "raising the tide"; and how ridiculous an idea that is.
Of course the tide has risen to an unprecedented degree in human history both since the term "trickle down" was invented; and moreso, over the last 40 years.
Except the tide you're describing is global, and the policy in question was domestic, and wages and assets within the middle and lower economic classes have indeed stagnated in relation to almost every other economic indicator within the country, which is why "many on the left" consider this argument to be invalid.
The problem, to me, isn't peoples curiosity or attempting to broaden their horizons. I think the outcomes of this are largely good; it encourages discerning people to exercise caution and makes for good light conversation. Where things get off the rails is when people believe their tentative research or association with a domain makes them authoritative in some sense.
I read the same waffling about masks you did, the information I read (since it was inconsistent) led me to believe that I should wear masks more than directed. I did this out of an abundance of caution because at the time early research eerily concluded that not much is known about the longer term effects of this virus, there was stark contrast in the symptoms various people had, and that there were layers to exercising prevention. I acted in a similar manner when I limited my social circle.
The difference in the way, I think, these people used much of the same information that I did is that it became authoritative to them. After they'd read enough articles straight from the CDC it made them feel qualified to interpret them. I'm reminded of one guy who demanded I get another PCR test before he hung out with me, even after I hadn't experienced a fever for 10+ days. For some context, when I got sick I came back negative on both tests I was given. I was later told my viral load was not high enough on those days, ironically these also happened to be some of the worst days of the virus. It was only after I lost taste and smell that the doctors realized I had COVID. My friend cited all the reading he had done as evidence that I just wouldn't accept his "perspective". When I asked the doctor about getting both PCR and an antibody test she responded, "Do you have an actual reason? We already knew you were sick." In reality, the time which I would've been contagious had long passed, yet my friend couldn't get it out of his mind that transmission was a possibility.
Another example is a friend whose brother had gotten COVID a few months back. His symptoms were certainly worse than mine. Where I didn't experience much trouble breathing, he did among other things. I went on a walk one day because it was one of the days in between being sick that I had some energy and wasn't overcome with brain fog. I shared that I was exhausted after this short walk and that I'd probably stave off a walk for a few days to see where I was at. She chastised me for going on a walk, explaining that her brother had been told not to exercise for three to six months, and that it seemed as if I was taking COVID as a joke. What I realized after googling this specific treatment plan is that it's usually given to people with some form of cardiomyopathy and other conditions (none of which I have.) I am now about 3 weeks removed from having COVID and I'm back to riding my bike, which is consistent with what my doctor told me. My doctor told me recovery has a lot of variables and I'll need to go at the pace that I'm comfortable with and listen to my body. Regular checkups should help to that end as well.
The theme among these people is when I tried to explain what doctors had told me and why I was going to stick to what they were saying (more generalized as drawing boundaries) I was met with harsh rejection. The key here is that authoritative sources were no longer respected. The fact of the matter is that doctors do take a bit to arrive at consensus and that can be frustrating to a public opinion that is waiting on them for their own sanity, but just because you landed on the correct conclusion a couple times (or even a more conservative solution that kept you equally safe) does not make you an authoritative source. So, I'm not going to tell people to stay in their own lane but you can't just go lecture people based on your own understanding. That's when you forget that all of this information you gather outside of your own domain is good for exercising caution and light conversation.
The easy to point to example is how a lot of doctors viewed masks at the beginning of the pandemic. Or how trickle down economics is also endorsed by experts. Or experts opinions on mental health drugs. And so many other subjects where it won’t be hard to find an expert on the dumb side of the argument.
I think we should rely on experts, but we can’t dismiss people’s doubts or research just with a “I’ve seen a real doctor” slight of hand.