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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?

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

I seriously wish that habit from Japan would reach Europe.

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.

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.