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PaperclipPerfector  4mo ago (text post)   2837 thread views

Small-Scale Question Sunday for December 31, 2023

Do you have a dumb question that you're kind of embarrassed to ask in the main thread? Is there something you're just not sure about?

This is your opportunity to ask questions. No question too simple or too silly.

Culture war topics are accepted, and proposals for a better intro post are appreciated.

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So... it's nearly 2024. Why are there still a noticeable amount of Americans wearing Covid masks everywhere they go? I traveled in Europe recently and I saw essentially ZERO masking. When I did see a mask it was obviously an Asian or American tourist. (And yes, Americans are easy to spot. North Face jackets are a dead giveaway).

Seriously, the rate of masking was below 0.1%. I'm not sure I saw a single French person wearing one.

Yet, here in Seattle, I still see Covid masks everywhere. On the plane, on the train, in a box, with a fox, at the movie theater, at the opera, at the grocery store, driving alone in a car (why?), riding a scooter on the fucking sidewalk, etc.. I'd estimate indoor masking rates are like 5% still. Are people in Seattle this mentally ill? Why is there such a difference between Europe and my corner of the US?

People here have no idea how empty the mind of the average 110 IQ midwit really is. I realize that sounds elitist but I mean seriously, it’s unbelievable, these are the people 100% responsible for the current political situation in the US, you could gather fifty in the room and there would be not a single interesting or original thought. Everything is pure bandwagon. Attempting some kind of genuine analysis would be fruitless and a waste of effort in any case, there is no process of rational enquiry going on.

Ever since hearing a seattlite talk about her humidifier and how it made the air tolerable, I’ve wondered if the masks get a boost from air quality. Your countryside isn’t particularly on fire, is it?

The humidity here is fine. We don't suffer from low humidity in the winter like they do in the Midwest.

On the other hand, Seattlites seem to have high rates of anxiety. Perhaps lack of adequate exposure to sunlight during the winter months?

Or one of the world’s most powerful selection biases. Honestly, I’ve never seen statistics on it, but that’s definitely the impression I get.

Maybe they have a cold/flu and don't want to infect others?

I seriously wish that habit from Japan would reach Europe.

I recognize people who consistently wear masks. Like cashiers or other strangers I see semiregularly. Also see people with a mask on outside on a bike or scooter. Or hiking near empty trails almost always many hundreds of feet from the nearest person. 0.00% possibility of COVID transmission but they got that mask on.

They wear masks to wear masks, not out of any sensible disease precaution.

I don't buy it. Everyone was wearing masks everywhere for two years and everyone still got Covid.

There's certainly no high-quality evidence that masks work, and that's remarkable considering just how hard they were being pushed.

But let's consider another possibility. What if large scale mask wearing actually increases disease burden? It's not just a binary of works/doesn't work. It's a trinary of works/doesn't work/is harmful.

Wearing masks is one of those things that only works some of the time and probably don't scale all that well. Different illnesses spread easier/harder to start with; COVID was so prolific, considering how naive everyone's immune system was, that masks hardly put a dent it in. Concerning scaling, preventing disease transmission takes a fair amount of effort, and simply throwing a mask on while continuing to do everything that you would have otherwise done is definitely not going to cut it at scale.

But of course masks can and do help reduce the spread of disease if used diligently and in conjunction with other efforts. My family got together, all in one house, for a couple weeks around Thanksgiving. My sister showed up sick (not COVID; she had bought the plane ticket months in advance), and my mom is immunocompromised. My sister mostly isolated herself in a bedroom (working from home) and wore a mask whenever she came out until she got over it. My mom also put on a mask when she was likely to be in the same room as my sister for a nontrivial amount of time. Thankfully, no one else caught whatever she had.

Is this actually why most of the people that you're seeing in public have masks? Almost certainly not. But it probably does explain some percentage. Would be difficult to find out what percentage that is.

But of course masks can and do help reduce the spread of disease if used diligently and in conjunction with other efforts

"masks" (or at least the ones everyone wears) do not stop or slow the spread of respiratory diseases; I wouldn't be surprised if something like a P100 respirator had some effect on respiratory illnesses, but as far as I know this isn't studied and certainly not at scale

if they "of course" did, it would be easy to find a strong statistically significant effect and yet when people try to do that they don't find it unless the "study" is helplessly compromised and manipulated

the best studies do not find this effect; the most they can do is find a weak effect which is washed out by any number of intentional or unintentional issues with the study themselves

Your "COVID is the only thing that matters" or "I only discovered this topic because of COVID" bias is showing. You do know that you can search Google Scholar for pre-2019 papers, right? Example

covid isn't the only respiratory disease and non-covid illnesses are included in this cochrane review of physical interventions to reduce the spread of respiratory viruses which includes quite a few papers from before 2019, e.g., the exact paper you're linking in your comment

I guess it's a good thing the selected group to conduct the review knows about google scholar

You know that you can search for pre-2019 papers, right? Citing a post-COVID review is likely shot through with motivation, one way or the other. In any event, that funnel plot looks pretty funnel-y, in the direction of a small benefit. Not surprising, given the wide array of different situations/interventions/adherence that they're having to muddle through in this type of meta-review. My position is vastly smaller in scope and cannot be dismissed by simply citing such a large agglomerating meta-review. Masks/quarantining/such can have a small effect of reducing risks in small, discrete settings. That is saying nothing about widespread use, which is rife with all sorts of weird interactions, adherence effects, etc. We don't have to say anything about that mess of a problem to be able to say, "If your sister is sick, do you think you're more likely to catch the disease from her if you both just stay at your respective houses all week, or if she comes over and sleeps in your bed with you all week?" We don't need to say anything about that big mess of a problem to say, "If your sick sister comes over for a few hours, does wearing a mask for the short period of time and washing hands help your probability a little bit over hugging and kissing?"

The Cochrane review is nice because it lists a large bulk of articles, even excluded ones, which are cited for easy reading if you're inclined.

I'm sure there is motivation, for e.g., the main author on the paper you linked has received grants and worked as as consultant for 3M corporation, the largest maker of masks in the United States at the time. Did you know that? Did that make you think the paper was "shot through with motivation"?

Lucky for us, the list has other papers with the listed outcomes for you to look at which are pre-2019 and you can read them past the abstract.

In any event, that funnel plot looks pretty funnel-y, in the direction of a small benefit.

this tends to happen when the passable positive studies find weak evidence of weak effects

when you're at the point when you're relying on a bundle of unseparated actions to make an "but of course ___" statement about any particular one let alone trying to pass off as a fair comparison masks vs kissing each other, you're at best just over your skis

in any case, thanks for the dialogue

More comments

What do you mean by "evidence that masks work"?

Surely there's no meaningful doubt that COVID-19 is caused by SARS-CoV-2 virus particles, primarily entering through the nose and mouth, and the chance of infection increases with the number of virus particles (likely saturating at some point). Nor that N95+ or equivalent masks block the vast majority of such particles. Similarly, we also are pretty sure at this point that telling a population "wear a mask" has minimal public health benefits, since I hope we can agree that masks have no effect when not worn. To me, the non-obvious parts seem to be:

  1. Exactly how many virus particles are needed to infect. i.e. in a situation where you're exposed to a billion virus particles, if the mask reduces this a factor of a thousand to a million virus particles, but ten thousand are enough for 90% chance of infection, then the mask isn't very useful. This doesn't seem to be the case, but to get direct evidence would require some creative experimental design to study as the obvious study would be a titrated human challenge, which, uh, isn't going to get past a medical ethics board.
  2. If it's actually feasible for an individual to wear a mask at nearly all times they are actually in the presence of virus particles. This is difficult to answer because it varies greatly on the environment (how many people in their community have the virus, how carefully the people they come in contact test, ...) and the individual's behavior. If you live alone and never leave home and get everything via no-contact delivery, you can probably be pretty sure you're never exposed... but also, masking isn't relevant either. But I do know people who are medically fragile and extremely careful with masking whenever they leave their home, but still go out and travel, so it is possible. But, of course, nearly everyone is going to have a lot more human contact than that, but exactly what that contact looks like (lots of packed indoor concerts where everyone is screaming or just going to small restaurants and retail stores with very tall ceilings?) is going to greatly change the risk of exposure.

My big problem is almost noone wears N95. They wear nearly useless paper masks.

Wracking my brain, I recall a worker at Home Depot who wears an N95 and it looks properly fitted, not that you can truly tell by looking. Pretty much every other masker isn't wearing an N95.

Interesting. That's definitely different from my observations. I rarely see paper masks outside of medical offices (some of which still give them away and require masking) where they are definitely the most common type of mask. But elsewhere, I think KN95s are, although N95s aren't far behind. The rest are ones I just can't identify, which may be useless cloth masks, or the occasional paper mask. I'm occasionally tempted to straight-up walk up to those people and ask them (while I'm wearing my N95) why they are wearing an uncomfortable ineffective mask when there's no mandate, but I've never done so. (I don't think I've ever seen an airgami or P100 in the wild, although I've seen friends use them.)

(Of course, the vast majority of people I encounter in public outside of masks-required situations aren't wearing any mask at all; I'm not trying to imply mask wearing is at all common.)

My local distribution:

  • Almost everyone: no mask.

  • Most maskers: paper or cloth.

    • Truly non-functional attempts at protection. A few of my coworkers are this way. Pulling up their non-functional cloth or paper mask when I approach them. As though sitting unmasked in an open office, but masking when talking to a particular person makes any sense.

  • The select few elite amongst the maskers: N95.

    • Strangely my techy coworkers aren't counted among them. But the fat rental desk worker at Home Depot is.

I admit that properly worn masks should work in a controlled situation. Like, if you really need to not get Covid right now, and you're on a bus full of infected, a properly worn N-95 should reduce your risk. Although I don't think this has really been studied, it seems fairly obvious that it should work.

Could masks make things worse for those who wear them? It certainly seems so.

What's the effect of trying to sterilize your environment to eliminate all exposure to antigens? For children, we know that this can be very negative. For adults, I believe it is likely negative as well. Other human systems thrive on adaptation to small amounts of stress. People who don't exercise are fragile. Is there a need to exercise your immune system as well? Probably.

Secondly, there could be a negative effect to mouth breathing your own stale air every day. The book Breath by James Nestor references a study where people's noses are blocked, forcing them to breath through their mouth. There are immediate and large negative health effects. Certainly no one would suggest wearing a mask 24/7. But even 8 hours a day seems likely to cause problems.

Do I have any evidence for this? No. I am pointing out that it's plausible that masks could do harm. It's not a case of good/nothing. It's a case of good/nothing/bad. We do have to consider the possibility that they cause harm. The evidence does suggest that they don't have any effect on a population level, which is why they were never recommended prior to Covid.

Is there a circumstance where I would I wear a mask? Actually, yes! If I thought I could entirely avoid a deadly disease I would do it. If, however, the disease were mild and inevitable, (as is Covid), wearing a mask would seem to do more harm than good. I am constantly in contact with Covid positive people, I go to crowded areas all the time, I never wear a mask, and I never get boosters. I got Covid just the one time in January 2022 and my immune system does the rest.

[...] Is there a need to exercise your immune system as well? Probably.

This is a complete misunderstanding of the hygiene hypothesis. I acknowledge that our understanding of the immune system remains pretty limited, but we are pretty certain that getting sick is bad for you.

I am constantly in contact with Covid positive people, I go to crowded areas all the time

And that seems like a reasonable trade-off to me. I have no interest in most activities that involve being around a lot of strangers where masking wouldn't work (e.g. bars/clubs/concerts), and I trust my friends I do spend time with unmasked to isolate when sick and be honest about exposures, so it doesn't cost me anything to wear a mask as I go about my normal daily life and it reduces my chance of infection to basically nothing. But I understand most people like gatherings with strangers, so the tiny marginal protection from, say, masking on the bus to/from such gatherings, is completely irrelevant to them. Just trying to explain why there's a minority for which masking is rational.

I acknowledge that our understanding of the immune system remains pretty limited, but we are pretty certain that getting sick is bad for you

My understanding is not so much that getting sick is bad for you but rather that sickness occurs when your innate and specific immune systems are unable to stop/manage the replication of a given microorganism within the body without broader measures (fever, inflammation, production of mucus).

In terms of whether that is long-term bad, some sicknesses are indeed debilitating, and if one could achieve the same net outcome with less severe symptoms then it would clearly be preferable to do so. This is what happens with live accentuated vaccines in particular- a very mild illness (possibly subclinical) occurs that trains the specific immune system to recognise a feature of the attenuated pathogen common to the actual disease, resulting in reduced or eliminated illness when the actual disease is encountered.

I think the point is that this process occurs on a much broader scale on a daily basis as one travels through life. You are constantly exposed to microbes, and you can think of the body using mild or non- illness generating microbes of the same type as the training set for its response to novel (i.e. new to the body) pathogens. More data and more similar data= better response to a new pathogen.

The risk of actively trying to reduce illness by avoiding social contact and wearing a mask is that you are successful and your immune system "drifts" out of sync with the rest of the population. This is due to a reduced training set meaning that more pathogens are novel to the body.

If this occurs, then novel pathogens that would not harm the broader population due to previous exposures to them or related microbes still harm you because you have missed that exposure. The resulting illness will consequently be more severe because you have no cross-immunity, and so your immune system is effectively starting from scratch in its response.

You might object that the whole point is to avoid any airborne pathogen through masking and thus no risk of illness actually arises. However, a) you still have some social contact and thus disease vector and b) the countermeasures are only risk reduction not elimination. As your immune system drifts, then the range of potential pathogens increases as you lose cross-immunity. You therefore have the a lower absolute risk of being exposed to a given microbe, but the relative risk in the event of exposure is greater.

At the most extreme, uncontacted tribes have immune systems highly adapted to their limited social circle and environment: and no immunity against common circulating pathogens that generally cause mild illness such as influenza. This is not due to intrinsic immune differences between them and the rest of humanity, but rather a consequence of limited exposure.

Hope that explains why one might not wish to "mask up". I've not got into whether masks result in lower initial pathogen counts (and if so whether this is practically advantageous) or the broader effectiveness or social desirability of masks.

I do not expect that masking or isolation, even taken to an extreme, will cause any notable negative health effects due to your immune system getting "out of sync".

That might apply if you were being raised in a clean-room since birth, but as far as I'm aware, in situations such as an immigrant from the Global South going to the West, you don't see them suddenly falling sick because of all the novel pathogens circulating in a country several continents away. International travel at that range is not so common that I expect everything to become homogeneous when it comes to the short-scale evolution of pathogenic microbes. Note I am not claiming the opposite, it is both true and a trope that Western visitors to the Global South often catch stomach bugs because of exposure to pathogens that the locals are inured to, but that's more a factor of said pathogens being more common, be it because they flourish in tropical regions, or because of lax standards in food safety or water treatment.

I do not expect wearing a mask in public for even years on end to change anything, our innate immunity does a lot of the heavy lifting, the adaptive component, while not negligible, is hardly sufficient, as anyone going through flu season can tell you. We are also vaccinated for the worst diseases, and I'd expect maskers to be even more fastidious about getting their shots.

Uncontacted tribes do have differences in innate immunity. You can literally trace historical population exposure to diseases like the Bubonic Plague, Smallpox or Malaria through genetic adaptations. But someone in civilized society fastidious about masking is never going to be as vulnerable as them, once again unless they were raised in a clean room from birth. If there is a negative effect, it's too trivial to worry about.

On your comment on the differences in innate immunity in different human lineages, you're absolutely right and I was being imprecise in my wording. Mea culpa.

On the broader point, I think that you are potentially neglecting the common phenomenon of traveller's flu for the South to North traveller. People do get ill due to e.g. diffetences in circulating influenza strains. Agree that illness in the North to South traveller is more likely and severe due to the broader range and exposure to excitingly virulent pathogens.

You are of course right to say that the innate does a lot of the work, but for potential pathogens that can evade the initial response, then as you know a major factor in the severity of the illness (I.e length and how debiliating it is) is the existence of relevant B- or T- memory cells. My argument is that fewer relevant memory cells (etc) exist if you have experienced fewer relevant infections due to reduced exposure. Vaccines can close some but not all of the gap simply due to sheer range of potential pathogens.

Perhaps a relevant example would be a person from 1910 time travelling to 1925, at which point the Spanish Flu is still circulating. They would have a higher risk of dying from Spanish Flu than the average 1925 person because they do not have previous exposure to the strain itself, or to the various similar strains circulating post-1917 and generating relevant cross-reactions.

I think the only way masks work out for reducing severe illness long-term is if there is indeed a dose effect that results in exposure to the same pathogens but milder illness. If masks are so effective that one only gets ill vanishingly irregularly, then the risk of that occasional illness being severe are increased due to lack of relevant previous exposure. If masks are not effective at all such that one has a similar immune profile to the general population, then there is little point in wearing them.

More comments

Yes, that's the "immune debt" hypothesis. It's a completely reasonable internally consistent hypothesis; it's not at all obvious that it's better to avoid infection entirely as opposed to hopefully getting minor infections that train the immune system while not being severe enough to do any lasting damage.

... but as far as I can tell, every vaguely reputable scientist with knowledge of the immune system or epidemiology thinks it is wrong and the odds don't work out that way.

To be clear, I'm merely claiming less exposure to pathogens is healthier. There are obviously costs to going out of your way to reduce your exposure to pathogens and the trade-off may not be worth it.

I'm not sure I share your views on whether immune debt is an unsupported position in the broader scientific community, but suspect that appealing to consensus may be unproductive.

Maybe the difference arises in the type of pathogen being discussed. A brief taxonomy could be the below:

  1. Rabies- no benefit to natural exposure as exposure is lethal. Vaccination/avoidance only means of reducing this.
  2. Cholera etc- natural exposure should be avoided due to high risk. Avoidance of causative agent possible.
  3. Influenza- high but limited number of strains. Some strains (e.g. Spanish Flu) lethal. Prognosis depends on strain, previous exposure, general immune strength.
  4. Colds etc- lots of disease causing agents. Prognosis typically mild or subclinical depending on prior exposure and general immune strength.

I agree that you avoid (1) and (2) if possible.

For (3), it depends on the costs and consequences. Through the veil of ignorance, I personally think we opt for as high an exposure as possible to the extent this is typically mild. This can be via vaccinations or general exposure: to the extent that lower cost options such as vaccines are available, they should be taken, and the equation may change as technology moves ( for example a universal flu vaccine would negate the benefits of natural exposure).

For (4) I think you just take the mild cost.

So in this view, avoiding some pathogens is healthier, but for others it increases the effects of related pathogens so it is not healthier on the net.

Among people I know or observe regularly, mostly in college towns and other liberal strongholds, I have definitely seen many adopting this habit of wearing facemasks when they are ill or when it is very cold outside (works better than a scarf in my experience), rather than masking indoors all the time out of some lingering covid paranoia.

It should be a given that people do the minimum to not make others sick. I don't care if the cold or the flu is not dangerous, being sick fucking sucks.

I don't know, but I notice the same thing in Canada. Most people kept wearing their masks after they lifted the mandate in March of 2022, but then they stopped over the following few months. But there are still a persistent few who wear them.

It became a tribal signifier here in a way it didn’t there. I also think our higher number of Asians made it more salient here.

But really, I think this is toxoplasmosis in action. It was controversial here, so people feel more strongly in both directions even years out.

Are people in Seattle this mentally ill?

Everyone I see with a mask in my red tribe area seems like a neurotic young woman or is an older lady from a Democratic constituency. It seems like a female thing around here. The men who do it are either Asian or seem just as neurotic as the women. My gut feeling is that really strong neuroses are an American thing more than a European thing.

Official advice from public health orgs is still “wear a mask if covid is going around!” and I’m guessing the older Democrats are taking it to heart. The young ones, I think, are just painfully shy and like that it covers their face. Plus it makes them feel like a Good Person (TM).

In the US masking became blue tribe signalling. Anyone who refused to mask was seen as a potential Trump supporter.

It was most likely not so politicized in Europe.

How do you explain Canada then, where the issue wasn't politicized at all and yet lots of people are still wearing masks?

It was totally politicized -- just that the covid skeptic side of the issue was overwhelmingly unrepresented in the halls of power.

Forever-maskers that I see in the wild these days do seem to trend neurotic -- but then again the political left trends pretty neurotic here anyways, including the need to constantly signal 'I am a Good Person, very different from those Bad People who are still standing around waving flags' -- so I'm not sure how you'd tease out the true cause.

The number one news network in Canada is CNN, not any of the domestic channels. The Canadian left is extremely focussed on the culture war in the US.

It can’t be explained because it’s not a blue tribe signal at all. The people who wear masks in the US are those who really don’t want to get a cold, flu, or COVID. I see it mostly with Asian-Americans (who masked at a much higher percent prior to COVID), but present day maskers come in all shapes and size.

Hard disagree, it's older neurotic urban hypochondriacs of either gender still wearing masks, and a few demented 20something women with goofy hair and pantsuitaloons. That's bluest of the blue.

...Assuming this is based on your own direct observation, maybe it's just different local populations? I have no problem believing that in a place with a relatively large asian population, most of the people one saw wearing masks would be asian-american.

The few remaining mask-wearers I see around here are mostly sickly-looking people or normie-looking seniors.

That'd be because Finland was much more sensible about the masking and "lockdowns" (*) than US / Canada ever were.

*: Why yes. I am still annoyed by too many Americans here implying that actual lockdowns were some universal western phenomenon.

I am still annoyed by too many Americans here implying that actual lockdowns were some universal western phenomenon.

Huh?

the issue wasn’t politicized at all

Quixotically LARPing the American Culture War is Canada’s national pastime.

Seeing this in the East Coast as well, there doesn't seem to be any pattern either. Latinos, Whites, Asians, Blacks, young, old, male, female.

There's definitely a pattern in how they are worn. Black people are more likely to wear a mask around the neck or with an uncovered nose.

Basically like this but for masks.

I think it might ironically be an example of American individualism. Some folks still call maskwearers sheep etc, but if you wear a mask at this point, you’re obviously bucking a great deal of indirect and sometimes direct societal pressure to just take it off and rawdog the air.

Lots of Euros wore a mask when the societal signal was to wear one and took it off when the society (I’d say the government, but there are still ‘formal’masking decals in public buses and so on, nobody just gives a shit) signaled that they should be taken off. A 2023-turning-2024 masker is resisting societal pressure - not to the same degree as 2021-turning-2022 antivaxxer, but still.

The Japanese soldiers who think the war is still going.

I think this explains most of it.

Americans really want to express themselves. The N-95 on the bus is the mirror image of the "Let's Go Brandon" t-shirt.

If I remember correctly, bumper stickers aren't really a thing in Europe either.

If I remember correctly, bumper stickers aren't really a thing in Europe either.

I see them on about 1 in 500, maybe 1 in 200 or 1 in 1000 cars in Poland.

Not sure is it making it a thing or not a thing.

Rate is much higher in the US. 1 in 10 maybe?

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