> As the coronavirus epidemic spread around the globe, the Centers for Disease Control and Prevention provided restrictive guidance on who should be tested, archived pages on its website show. While agencies in other countries were advising and conducting widespread testing, the CDC, charged with setting the U.S. standard for who should be tested for the virus, kept its criteria limited
Well, "other countries" also did the same. Spain, for example, seems to be the 3rd country with most infected and I got pneumonia about 2 weeks ago. Called the agencies here but they still didn't want to test me, even with pneumonia! Still got a cough since then and they still won't test me.
So, the US is not alone. And it does make a bit sense, I didn't require hospitalization, so makes sense they want to save the resources. But I feel like the article author could have done some better research.
Germany does the same. I’m under the impression that there is a big selection bias because I know a lot of friends who have symptoms but can’t get testing because they don’t fit the criteria. And the criteria is having contact with a known corona patient or traveled to a risk area.
The U.S. likes to think of itself as the world leader. We should hold ourselves to that standard. "Other countries" such as South Korea, Singapore, and Taiwan were conducting widespread testing while the U.S. was and still is not.
More importantly, the U.S. could and should have provided global leadership as it did for the 2014 Ebola outbreak.
China has ramped their mask production to 200 million masks a day.
Had US government had the foresight and common sense to contract mask manufacturers to even produce half of what China is producing - let’s say 100 million masks, we could have had enough for everyone to have a mask in 3-4 days.
Universal masks for everyone (not only health care workers) together with hygiene protocol should be the way to “flatten the curve”. This would at the very least inhibit spread by those who have coronavirus but don’t know it yet (asymptomatic).
But instead, we’re having these mass shelter in place orders that are destroying our economy, killing businesses and destroying people’s livelihoods.
And I still haven’t heard of massive government contracts to mask manufacturers at the scale needed to provide masks for everyone.
"In an interview, Bowen said he could make 1 million masks a day if he ran his machines around the clock, a huge quantity for his firm but an amount that would barely make a dent in global demand. He’s hesitant, however, to ramp up production at the facility outside Fort Worth, scarred by the boom-bust mess that occurred after the swine flu pandemic in 2009."
I hope one thing that comes of this outbreak is that all nations develop the processes and capabilities to quickly stop the spread of outbreaks in general.
COVID19 is worse than flu, but not as bad as it could have been. We could get hit with something worse in the future. Imagine a strain of Ebola that gestates asymptomatically longer, or another coronavirus with higher mortality rate. This outbreak is good preparation for that one.
Anytime you’re dealing with a harmful exponential growth process like an outbreak, the best way to handle it is to overreact early, quickly and briefly. Kill it hard while it’s still small and easy to kill, or it will get out of control fast.
Put everything on lockdown/shelter-in-place for a few weeks - [max(gestation period|time to develop and deploy test kits) + safety factor] - test extensively, isolate and treat the infected, stop the outbreak, and then return to normal. Outbreak stopped dead in its tracks, economic damage is minimized and mostly short-term.
This is basically what South Korea did and they got their first COVID19 diagnosis the same day as the US:
People were worried that overreacting (in particular if the outbreak fizzled out, in which case any reaction would have been an overreaction) would damage the economy. Personally, I viewed that as a positive - a decently resilient economy would absorb such short-term shocks without any long-term issues. Easiest way to force-create such an economy? Stress tests (c.f. Netflix’s Chaos Monkey). If governments overreacted 1-2 times every year, people (travellers) and companies (supply chains) would get used to occasional flight blockade, border closure, discontinuity and disruption. We’d build a much more anti-fragile world.
I agree with you. A few days ago I made the statement that Covid19 is probably the best thing that could have happened to humanity.
People were already warning us years ago about a pontential pandemic and its impact (including Bill Gates), but we all ignored it.
A real pandemic seemed to be the only way to teach us. So I'm really happy for all of us that it's this moderate one, because it could have been a lot worse.
To this date, I have seen no reliable data on how fast the disease spreads, or how dangerous it actually is. Testing only 'people with shortness of breath and high fever for more than 4 days' is so biased it's not even funny. There could be 10x or even 100x more people with milder symptoms that are never considered for testing. Reporting '10% of people tested die' is also very misleading, since we only tested people with severe symptoms in the first place.
We can poll 5 times a week for the chances of Biden or Sanders or Warren to become Trump's challenger in fall. Perhaps we could also perform randomized tests every week and get a better sense of the shape of the danger we're facing. Yes, testing for coronavirus is more expensive than calling a phone number, but shutting down the country indefinitely is orders of magnitude more expensive.
Yeah maybe it'll be in place for next time. But this looks to be about a once in a century event. It happened in 1917 and happening now. I doubt we'll handle it better in 2115.
I think a lot of people in medicine, science, economics, policy and the media think what's happening right now is their shining moment, but if you talk to people on the ground -- this is a catastrophe and no one has any clue what's happening and people see that and they are internalizing it.
The experts are f* this up and it is going to have long term implications for already eroded public trust in institutions.
From the casual observer point of view, it appears only some Asian governments have been able to competently handle this crisis. It appears we're going to learn the hard way things that China, South Korea, etc. understood through intuition:
(1) Widespread testing is key. Testing symptomatic people is too little, too late.
(2) You can't rely on people to self-quarantine.
(3) Infected people need to be isolated from their households.
So now we have a massive, economy-strangling quarantine that is not even going to provide any relief, killing the economy and still not flattening the curve. All the pain with none of the benefit.
The experts are, in part, getting kneecapped by politics.
Watch one of the now-daily press conferences and you'll see Dr. Fauci trying to gently (so he doesn't get fired) correct inaccurate information from the President, in real-time from the same room.
Absolutely. One of the worst consequences that we may have to deal with at the end of this is that public trust will go down. In the beginning our leaders failed to act on the guidance of the scientific and medical communities -- almost two months wasted. And now, our leaders are flailing around implementing policy that is not based on reliable data or scientific evidence. They've both failed to react and then when they did react they are in many ways failing to act prudently.
Take a look at this editorial written by John Ioannidis. Excerpt that is relevant, though the whole thing is a worthwhile read:
>If COVID-19 is not as grave as it is depicted, high evidence standards are equally relevant. Exaggeration and over-reaction may seriously damage the reputation of science, public health, media, and policy makers. It may foster disbelief that will jeopardize the prospects of an appropriately strong response if and when a more major pandemic strikes in the future. [0]
Quick BIO rip from wikipedia:
>Ioannidis studies scientific research itself, especially in clinical medicine and the social sciences. He is one of the most-cited scientists in literature. His 2005 paper "Why Most Published Research Findings Are False" is the most downloaded paper in the Public Library of Science, and has the highest number of Mendeley readers across all science."
>Ioannidis is a Professor of Medicine, of Health Research and Policy and of Biomedical Data Science, at Stanford University School of Medicine and a Professor of Statistics at Stanford University School of Humanities and Sciences. He is director of the Stanford Prevention Research Center, and co-director, along with Steven N. Goodman, of the Meta-Research Innovation Center at Stanford (METRICS). He is also the editor-in-chief of the European Journal of Clinical Investigation. He was chairman at the Department of Hygiene and Epidemiology, University of Ioannina School of Medicine as well as adjunct professor at Tufts University School of Medicine.
Rather than just blaming the CDC, I think the real problem here has been the lack of coordination between the CDC and FDA?
CDC: Our test is going to be so much better than the WHO's, we'll test for SARS-CoV-2 in two samples and also test for other simultaneous infections in this third part!
FDA: Approved
Hospitals: Hey, we can't get that third part to work!
CDC: That's ok, just use the first two parts, that's all you really need to diagnose COVID-19. Though I'm sad I won't get any data on simultaneous infections, apparently that was a problem in Northeast China and we want to figure that out for our guidelines.
FDA: Only running the first two tests is not what we approved! Verboten!
*
Laboratory: Let's develop our own SARS-CoV-2 test!
FDA: Sure, just make sure to fill out these forms, be sure to send them to us by mail rather than email, and oh, make sure to test against the original SARS to make sure your test doesn't give a false SARS-CoV-2 reading if they patient just has that.
Laboratory: Uh, sure. Hey, CDC, can I have a sample of SARS to test against?
CDC: NO WHAT ARE YOU CRAZY I'M NOT GIVING YOU THAT! THAT'S SUPER DEADLY!
Exactly why it matters that there was no one in the Whitehouse whose job it was to coordinate the Coronavirus response. Our current situation was predictable. This was written in 2018:
Around the same time that the administration proposed rescinding the funds, the National Security Council dissolved its biosecurity directorate, a small team focused exclusively on global health security threats and led by a director often referred to as the Ebola czar. Again, it’s worth remembering why that office came into existence — a hard lesson. Without a central office to coordinate federal efforts by many agencies, progress was slow the last time the world confronted Ebola. “It took months of wrangling to put things in place,” Mr. Konyndyk said. “If the only way to get resources is through long negotiations with committees, you are giving disease a head start.” It was based on that realization that the Obama administration established the biosecurity directorate and named the first Ebola coordinator.
> FDA: Sure, just make sure to fill out these forms, be sure to send them to us by mail rather than email, and oh, make sure to test against the original SARS to make sure your test doesn't give a false SARS-CoV-19 reading if they patient just has that.
> Laboratory: Uh, sure. Hey, CDC, can I have a sample of SARS to test against?
I've been trying to stay on top of the testing saga, but it's been hard with all the daily changes.
Do you have news links that describe this hypothetical exchange taking place?
EDIT: in particular, the part around the FDA requiring testing against a sample of SARS.
I'm still trying to understand why Japan's numbers are so low. You can argue they aren't testing but if the infection rate is similar then the death rate should be similar was well regardless of testing or not.
They aren't staying home. Restaurants, bars, and events are still open. Trains are still packed at rush hour. Festivals are still happening. They're planning on starting school in April.
I can only see a few possibilities
(1) the numbers are false and Japan's death rate is going to accelerate
(2) the numbers are true but it's still coming
(3) Something about Japanese culture already limits the spread.
I don't believe this one. Japanese might wear masks but not all of them wear masks and they are not N95 masks. Japanese are also known to go to work sick, go to cafes sick, visit friends and family sick. Places are crowded. Open and over crowded offices everywhere.
(4) Something about Japanese genetics makes them less likely to have a strong reaction
I have no idea how to tell which of those it is except to see where they are in a few weeks. If the death rate rises it was (1) or (2). If not then it must be (3) or (4)?
Here's their latest graph. The 2 shallow lines at the bottom are Singapore (bottom) and Japan (2nd from bottom). The rest are Italy, Spain, Germany, France going left to right at the top.
> "I don't believe this one. Japanese might wear masks but not all of them wear masks and they are not N95 masks."
Substandard masks are better than no masks, and many people wearing masks is better than few people wearing masks. These are not "all or nothing" matters.
I think the numbers are real. Shanghai is already taking Japan off high alert list and you can be sure they are very cautious. Since they monitor and even quarantine travellers they should have the data.
I am also confused by Japan's situation. The one thing that I don't think Japan can fake is the death rate. As long as the death rate does not significantly rise, somehow Japan is keeping control of the virus without the significant changes to life that were necessary in other places.
One useful "sanity check" for countries under testing is to check the records of imported cases from countries doing rigorous contact tracing and publishing their data. So far, Singapore has 2 confirmed cases arising from Japanese travellers and Taiwan has 1:
This is vs the ~110 British cases and ~50 American cases the two countries have seen collectively.
Flight volume from Japan to both countries is normally quite substantial so this is evidence to suggest that Japan's case is not low solely due to undertesting.
> "I don't believe this one. Japanese might wear masks but not all of them wear masks and they are not N95 masks."
This is a very western belief. Why do we continue to think that asians wearing masks are stupid?
Most importantly, say masks prevent 50% of transmission, and the majority of transmission is via the air (highly plausible), then that would mean drastically less transmission.
Even an N20 mask that reduces risk by 20% would make a huge difference to a population.
It is my prediction that masks are the single most effective means of dealing with the virus at present. Japan’s low infection rates are because they wear masks.
Wearing a bandanna over your mouth and nose just makes sense.
I have a box of n95 masks I bought a few years back while living in Singapore (there is an annual smoke “haze” there from neighboring countries burning forest to clear land for palm oil production). I tried to give them to a nurse to distribute to other medical staff, but they couldn’t use them because they are a year or so beyond the expiration. News to me that masks even have an expiration date.
Pretty much everything has an expiry date because the manufacturer has guaranteed its still effective up to that date. Doing that requires time and money. This doesn't mean the masks doesn't work after the expiry date (although it might be less effective) simply that the performance isn't guaranteed and most likely hasn't been tested sufficiently.
“CDC/NIOSH believes the following products, despite being past their manufacturer-designated shelf life, should provide the expected level of protection…
The mask guidance is confusing as well. I get they are trying to preserve masks for medical staff. But, they also say it's mainly spread by coughing, sneezing, and resulting spray of bodily fluids. Surely even a scarf around your face would have some benefit? Yes, I get that the virus is small enough to pass through, but some deflection is better than none.
It's very irritating because people don't understand the concept of defense in depth. Are surgical masks going to give you total protection? Of course not, but as you say they provide SOME benefit. Saying "masks don't work because they don't fully stop the virus and users misuse them" is basically equivalent to saying "code review is a waste of time because it won't catch every bug and because devs don't do it correctly". The solution isn't stop doing code review, it's to teach people how to do it and to understand it's limitations.
The whole blaming people for hoarding masks and then the "masks don't work" things have been incredibly frustrating. It is almost like authorities didn't want anyone to start asking why the public couldn't get masks, as they can in say Taiwan.
Most (if not all) distributors and manufacturers of masks has been prioritizing health care systems and governments over retailers since January. Just as they should do. Were there any that weren't? I didn't see any reports of that, but if so of course the proper thing is to report them and talk to them. Not to blame random joe for having a mask.
The fact was since January retail supplies were only existing stock, which as we know was quickly sold out with a lot being sent back to family overseas (no judgement there). And I haven't seen any masks being restocked at any hardware stores or pharmacies since. At no time did I hear about authorities going around every pharmacy or home depot to try to collect any masks. Why? Because they knew there were no supplies and what was there was so small it'd make no dent in the problem. So blaming the public is grossly irresponsible and even put people in danger. I have an immune compromised friend that was responsibly using masks but got harassed for wearing masks "that don't work". And there were plenty of similar reports of such behavior from others.
I've posted this here before, so sorry about that, but in this case I think it's just so important that I belive it's justified:
The messaging around masks has been so aggravating to me that I got together with a couple of colleagues to write a detailed, scientific mini-review / commentary:
The benefit of widespread mask usage by the general population is source control [0]. This works even if the person wearing the masks makes mistakes such as touching their face more while wearing the mask.
Also, it should be obvious that there is no downside to wide-spread mask usage by the general population. The countries that have so far the most control over the virus' spread are the ones where wearing masks is normal and often done to protect others when sick.
Importantly, if the goal is source control, then all sorts of makeshift mask designs can work. People in Japan and other countries are already getting really creative [2,3].
Of course, the problem that medical personnel might face even more shortages if everybody starts wearing medical grade masks is real and must be taken seriously. But that's not the only option we have.
China has ramped their face mask production to 200 million a DAY. And
CDC’s continued insistence that face masks don’t work is disingenuous at best. Leading way to a global recession at worst.
Had they changed their guidelines to saying that face masks can help inhibit spread at the very least, especially from asymptomatic carriers who are wearing masks, US gov could have contracted mask manufacturers to with millions of dollars worth of mask orders. Spurring then to produce masks, eliminating this shortage of masks.
Instead, gov plan has no mask protocol, so the only other option is a global shutdown of “non-essential businesses”. Causing an essential shutdown of the economy. The cost of which they have obviously not calculated.
I haven’t seen any real results on whether bare virions in the air are infectious, but it certainly doesn’t sound like a major mechanism of COVID-19 infection. Certainly, when coughing, a good deal of the expelled material is visible and fairly large. And wet.
ISTM a moderately tightly woven or knit hydrophilic mask (e.g. cotton) could be quite effective. Knits could have the added benefit that droplets would need to take a twisty path to get through. And there is plenty of such material around.
This shouldn’t be that hard to study in a lab. Find a sick person, have them cough through different masks, and measure viral concentrations on nearby surfaces.
And some data back from SARS: "Always wearing a mask when going out was associated with a 70% reduction in risk compared with never wearing a mask. Wearing a mask intermittently was associated with a smaller yet significant reduction in risk."
I saw a lot of people sanctimoniously talking about fit tests in normal healthcare settings as if an imperfect fit dropped effectiveness immediately down to 0% from 100%.
Something does not add up about the advice. Specially given that Eastern authorities encourage the use of makes by the general public. Which part of the World is better handling this pandemic?
Masks work, masks are low impact on daily living, masks are used successfully overseas by countries that didn't lock down their society (tawain / Singapore etc) - huge empahsis on masks including govt run websites with live maps showing where to get them, masks in all post offices for distribution etc and BIG production increases.
I was wondering the same. I'm by no means professional but it seems to be better than nothing, especially for people who sneeze.
In China, it's pretty much contained now, and everyone wears masks on the street -- The thing is, there are 1.3 billion people, of course there are a lot of people couldn't buy or afford surgical masks, let alone N95 masks.
It turns out people wear regular masks, or even they don't have any mask they sew their own mask.
Also, most surgical and N95 masks are disposable, in China, people cover their hand sewed mask outside, covering the disposable masks inside and try to reuse them, and disposes the hand-sews masks. This hack, of course, have potential risks, but it might help for people who are running out of masks.
Agreed; I believe a scarf around your face will have some benefit. The CDC’s current guidance is about “respirators”, and maybe they’re not saying anything at all about plain masks or scarves, but studies posted here on HN in the last 2 days have shown some positive effectiveness for any kind of mask at all. I’ve heard first hand from a friend in Shenzhen China - where they are now back at work - that they are certain masks are effective, and the main vector is coughing and sneezing. If nothing else at all, wearing a mask can be a very helpful reminder to not touch your face.
My thought as well. The repeated consensus from gov & medical here in France seems to be that they are not effective at protecting you and that's pretty much all that they say.
YES, we get it, but what about protecting others from your cough since most people don't even know they're contagious. Even a 20% decrease from a crappy solution is interesting when dealing with exponential curves.
If the virus is mainly spread by coughing and sneezing, wouldn’t mandating absolutely everyone to wear a regular mask that covers their own cough be enough? Better than all these quarantine measures?
If you are caught without a mask you get fined.
How else can people get the virus? Perhaps people shed the virus through their skin? Or touch their face and get it on their hands? So people can wash their hands before touching their face. Also people can get it in their private homes. But those groups don’t mix all the time.
So I am just wondering... N95 masks are for the person who doesn’t want to get the virus. But what about everyone else?
I understand that you could wear the mask crooked and there are problems with application. But mass producing N95 masks and giving them out and MANDATING everyone wearing them like women in Saudi Arabia seems like a better policy.
The standard argument is that a mask may give you a false sense of safety which results in subtle behavioral changes that are a net-negative. Additionally if the mask inhibits breathing you might take deeper breaths which is also a net-negative.
Agreed. The US surgeon general lied to the population about the efficacy of masks to try to preserve them for healthcare workers. It would have been better to ask people to preserve N95 for healthcare workers and instead improvise their own. Any reduction in droplet transmission is going to drop the R0 of this and help flatten the curve.
For reference, this is the recently released guide on mask usage by Chinese National Health and Medical Commission: https://zhuanlan.zhihu.com/p/114129365
Cat meme because it was reposted to Chinese Quora. Obviously consider that Asian countries have no mask shortage due to existing cultural practices. Masks should be prioritized to prevent collapse of medical capacity when there is shortage - the policy suggestion most western countries are seeing. The TL;DR of the guide: the only scenario not to wear (normal surgical) mask is when you're alone. Surgical masks for almost every other situation, N95+ for high risk situations. On efficacy for public health, The microbiologist Yuen Kwok-yung, from HK who was a key figure in SARS and one of the expert teams on Covid response:
>Given this novel coronavirus is so "cunning", with probably many infected but asymptomatic people moving around in communities, how should ordinary citizens protect themselves?
>We can only rely on telling everyone to wear a mask, wash their hands frequently, use alcoholic sanitiser. I had called for everyone to wear a mask when I was in Beijing, but many people disagreed, saying that the World Health Organisation (WHO) said healthy people don't need to wear masks unless they go to crowded places. Nevertheless, if people wear masks only when they feel sick, then the eight infected people on the Diamond Princess would have transmitted it to others because they were not feeling uncomfortable. Wear a mask to protect not only yourself but also others, because if you are infected but asymptomatic, you could still stop the spread by wearing a mask.
>In our experiments previously, we found 100 million virus strands in just one milliliter of a patient's saliva. Therefore, scenarios with the potential for exchanging saliva are generally quite dangerous. The temporary success of virus control in Hong Kong this time is not only due to population controls, but also contributed by the early advocacy for mask-wearing, hand-washing, and social distancing. Otherwise, with such a dense population in Hong Kong, the epidemic would very likely have spread the same way as in Italy or Daegu in South Korea.
(1) Home and outdoor, no people gathered, well ventilated. It is not recommended to wear a mask.
(2) Being in a crowded place, such as office, shopping, restaurant, conference room, workshop, etc .; or taking a box elevator or public transportation. In low- and medium-risk areas, it is recommended that you wear spare masks (disposable medical masks or medical surgical masks) with you, and wear them when in close contact with other people (less than or equal to 1 meter). In high-risk areas, disposable medical masks are recommended.
(3) For those with cold symptoms such as coughing or sneezing. It is recommended to wear disposable medical or surgical masks.
(4) For those who live together with those who are separated from home and discharged from rehabilitation. It is recommended to wear disposable medical or surgical masks.
Personnel in specific places
(1) It is located in densely populated hospitals, bus stations, railway stations, subway stations, airports, supermarkets, restaurants, public transportation, and community and unit import and export places. In medium and low risk areas, it is recommended that workers wear disposable medical masks or surgical surgical masks. In high-risk areas, it is recommended that workers wear medical surgical masks or protective masks that comply with KN95 / N95 and above.
(2) In prisons, nursing homes, welfare homes, mental health medical institutions, school classrooms, construction site dormitories and other densely populated places. In medium and low-risk areas, it is recommended that you always wear spare masks (disposable medical masks or surgical surgical masks) with you daily, and wear masks when people gather or come into close contact with one another (less than or equal to 1 meter). In high-risk areas, it is recommended that workers wear medical surgical masks or protective masks that comply with KN95 / N95 and above; other personnel wear disposable medical masks.
Key personnel
Suspected cases, confirmed cases, and asymptomatic infections of new coronavirus pneumonia; close contacts of new coronavirus pneumonia; immigrants (from entry to end of quarantine). It is recommended to wear medical surgical masks or protective masks without exhalation valve that conform to KN95 / N95 and above.
Occupational exposure
(1) Medical personnel such as general outpatient clinics and wards; emergency medical personnel in medical institutions in low-risk areas; administrative personnel, police, security, cleaning, etc. engaged in epidemic prevention and control. Medical surgical masks are recommended.
(2) Personnel working in the ward and ICU of patients diagnosed with a new type of coronavirus pneumonia, suspected case patients; medical staff at designated medical institutions for fever clinics; medical staff in emergency departments of medical institutions in middle and high risk areas; epidemiological investigations and experiments Room testing, environmental disinfection personnel; transfer of confirmed and suspected cases. Medical protective masks are recommended.
(3) Operators engaged in the collection of respiratory specimens; staff who perform tracheotomy, tracheal intubation, bronchoscopy, sputum suction, cardiopulmonary resuscitation, or lung transplantation, pathological anatomy in patients with new-type coronavirus pneumonia. Suggestion: hood-type (or full-type) powered air-supply filter respirator, or half-plane power-supply air-filter respirator with goggles or full screen; P100 anti-particulate filter should be used for both types of respiratory protection Elements and filter elements should not be reused. Use protective equipment after disinfection.
Masks work by trapping flu particles.
The 95 in an N95 mask is shorthand for "this masks traps 95% of particles of size .3 microns.
There are also N99 and N100.
N100 trap 99.7%. N100 when it is used in an air filter is called HEPA which I believe stands for High Efficiency Particle Attenuator or Arresting.
There is also a level above that found mostly in Europe called ULPA which pushes the decimal out further to 99.9997% . All of these aarea measure of the masks ability to trap particles of 0.3 except ULPA which is a measure of trapping particle 0.17
Masks are matted fibers designed to trap particles on their fibers. They do this using 3 mechanisms which all masks share- diffusion, impaction and inertial impaction.
Diffusion happens when a particle is so small it is in Brownian (random) motion. These particles are trapped because they constantly change direction randomly as they pass through the mask and eventually run out of luck trying to dodge fibers. Such particles are less than 0.03 microns in size. (I should inject here that even though virus are smaller than this, there's more to the story as detailed below).
Inertial impaction happens when a particle is larger than .03 and owing to its size and momentum cannot change its direction of travel fast enough to stop itself running into a fiber.
Impaction happens when a particle comes within 1/2 of its radius of a fiber and touches it, becoming trapped. This is the most difficult size of particle to capture (as it happens) and that's why its the reference particle size for safety masks.
In the above I acted as though the particles were "trying" to avoid being trapped, but of course that's just a stub for the underlying physics off motion and magnetic attraction/repulsion which underlie these facts.
If you want to DIY some sort of mask to reduce your exposure, you have to consider that the weave of most cloth is far far wider than .03 and anyway not in layers (a cloth like yarn is the exception to the second property).
Just guessing but rags scarves etc lack the required fiber density to function as safety masks. It is possible that the virions would sail through them even under Brownian motion. But that is not really how virions are transmitted- they are transmitted mixed in with saliva particles which are hugely larger than the virions themselves. The size of a particle of saliva in a sneeze was examined here- tldr: a bimodal distribution of sneeze particle size all over 50 micrometers.
So all in all we can say this-any mask covering is better than no mask because it's an odds game with virus particles and saliva.
The less able you are to breath through it, the better it functions as a barrier.
Ordinary cloth is just not woven tightly enough to substitute for a p95 mask.
If you had to choose between multiple layers of x number of fibers and a tighter weave of the same fibers, it might be better to go for a tighter weave because even though individual virions would travel under Brownian motion, that's not how a spray of sneeze which is the transport mechanism of the virus is going to travel.
Some sneeze particles containing virions have a particle size of 5 microns and will stay aloft in a still room for a long, long, long time. If someone sneezes and three minutes later you walk through where they were, you could very well become the unknowing, unwilling next host of the virus.
That last - horrifying - fact is one of the the reasons why they're telling people to maintain social distancing and just stay home.
It's not all that confusing. The science is pretty clear. The best use of masks on people in public is on the sick themselves. You can't use the standards and practices in something like a TB hospital for medical personnel in public spaces. Not only is it an inefficient use of resources, but the efficacy is in question.
You cannot expect the general population to adhere to the standards of a TB hospital. It cannot be done, even if it was a good idea. For example, standard practice is that a mask is meant to be worn for only 8 hours and that is under the assumption that you have no reason to believe you were exposed. If the mask becomes wet, damp, or if you have any reason to believe you've been exposed you're supposed to immediately doff it carefully and dispose of it. Typically PPE is used only once per exposure, or is reused for exposure to one patient at a time.
There are so many variables at play here. From the efficacy of the masks themselves, the best allocation of resources, the different varieties of masks, the techniques for proper fitting, the decontamination processes, other PPE. Does this mean masks are not useful? No. And you won't find many experts making this claim. It's clear that masks help.
Think critically about this. It is not as simple as "masks good" or "surgeon general lied." There are manifold hysterics going around -- please don't contribute to it.
Metagenomics would solve these issues. Of course we have these problems when a new disease comes along if we have to invent new diagnostics for it. Metagenomics isn’t new, you just sequence the everything and look to see what DNA/RNA is in the environment. That’s orders of magnitude more data because it doesn’t require labels, you don’t need to know in advance what you’re looking for...
The devices to do this are getting cheaper faster than Moore’s law. Just takes the will to set up the programs
In late January my wife and daughter visited Disneyland, and there were a handful of COVID-19 cases reported in SoCal around the same time. On the Sunday they were due to fly back, my daughter came down with a very strong cough (she said it was even "hurting her throat") and a high fever of around 102F. We had been following the outbreak in China and my wife called the CDC to inquire about getting her tested for COVID-19.
They said they had no ability to get her tested, that we should not be concerned at all that it might actually be COVID-19, and she should visit a clinic. The clinic said it was probably just the flu, and told her to go ahead and fly back but to wear a mask.
This was absolutely criminal incompetence on the CDC's part.
The actual title is:
How the CDC’s Restrictive Testing Guidelines Hid the Coronavirus Epidemic
This is very different from guidelines in general. Encouraging people to avoid large crowds, wash their hands and wipe surfaces, and possibly self-quarantine could have made a huge impact earlier on.
Instead, people kept going to bars, concerts, and traveling. A lot could have been done, and testing is only part of the story.
My colleagues are out of PPE and now using scarves because we are so under supplied. CDC guidelines were just changed to allow staff to be exposed to COVID patients without properly protecting themselves.
I was talking with some physicians and providers when I said that I think this will be the Chernobyl like moment of our era: where the truth is hidden from people to prevent a panic paradoxically exacerbating the current crisis. Shockingly, almost all agreed with me.
This whole corona virus episode has definitely shown one thing. US, under the current govt can’t execute. Despite claims Like “world best”, “most powerful in the world” and whatever else our leaders proclaim it’s all baseless “marketing”. as they say past performance is not a indicator of future performance in the same way we did quite well from 40s/50s onwards for a certain time and build an image based on substance what we had at the time but is now just gone. It’s all a house of cards run on decrepit systems.
CDC has there shortcomings, no doubt but let’s not forget who’s truly to blame for the mess we’re in now. The trump administration’s disbandment of federal institutions created to combat this and the ongoing denial of a serious problem have led to a collapsing economy and isolation of millions. Good article here for sure but let’s not pass the blame to the CDC. We know who to blame...
Evidence? CDC has more funding than ever. And it's a myth trump got rid of the pandemic team at NSC. They just renamed it the bioterrorism team after people left.
This thought might comfort you, but if the only lesson we learn from this is “because Trump”, the next pandemic will be just as bad. Our regulatory agencies, our culture, our economic systems, all deserve consideration in the post mortem.
One of the problems with the hyperpartisanship in America is that it prevents people from acknowledging leadership problems that both parties share. Though I think that Trump has done an incredibly poor job of handling this crisis, there's little evidence that other leaders - in Congress, at the state level, in the media, etc. - have done any better. Of course all our leaders will want to blame other people right now - failure is an orphan, as the saying goes.
I just did a search for news articles from the end of January to the end of February, and only found articles like this one[1], where politicians are criticizing the Trump administration's communication, but aren't callng for stronger efforts or mass mobilization (and the article has a quote from Pelosi saying she has confidence in how the CDC is handling things). Congress wasn't passing legislation to fight the pandemic as things were heating up, and governors don't seem to have made effective plans. The media didn't consider it to be a major disaster until recently (it didn't get brought up in the presidential debates until a couple weeks ago, IIRC). Issues like our lack of emergency stores for things like masks and our lack of an ability to manufacture them here is an issue that goes back for years, as is the poor safety net that leaves Americans so vulnerable in times like this.
Hopefully this crisis will encourage people to look at the poor leadership America has had across the board. Simply getting rid of Trump and calling it a day is just rearranging deck chairs on the Titanic.
From what I gather, the CDC is also largely sweeping the Hepatitis issue under the rug (which is something of a quiet epidemic, but certainly nothing on the scale of covid19).
It disproportionately impacts the homeless. The problem appears to have started in San Diego and spread outward from there.
I'm aware of the issue because a reporter from San Diego contacted me and interviewed me via email in September 2017 because I run the San Diego Homeless Survival Guide.* Another reporter contacted me when it reached Los Angeles.
I received an email last September from something I'm subscribed to indicating it had reached Washington state, though my county was not listed.
On a per capita basis, the small town I live in has a worse homeless problem than the big cities that routinely make the news for it. If I had any real power, I would be trying to come up with the means to do a free hygiene event for the homeless and give away hand sanitizer and free haircuts and Hepatitis vaccines, something I had on my mind before covid19 became a thing.
I've seen relatively little in the press about it. I have seen at least one article about the resurgence of "Medieval diseases."
To my mind, our homeless policies are actively creating a health hazard for the entire nation. CDC policy looks to me like part of the problem. They seem to be sitting on the data about the spread of hepatitis and intentionally not making an effort to publicize it.
I imagine it will get swept under the rug entirely in the face of covid19. This seems to me like a good means to compound our problems.
Oh, data, that pesky thing. I go here, and observe rate of change (log) graphs. I ignore linear body counts, which all the headlines scream:
https://www.worldometers.info/coronavirus/
Italy is flattening and exponential growth becomes exponential decay.
Italy new cases did flatten to 3500-4000 per day for a few days this past week, but they have since resumed increasing on a daily basis. So I don't think they are out of the woods yet. It may not be exponential, but it is very much super-linear
capableweb|6 years ago
Well, "other countries" also did the same. Spain, for example, seems to be the 3rd country with most infected and I got pneumonia about 2 weeks ago. Called the agencies here but they still didn't want to test me, even with pneumonia! Still got a cough since then and they still won't test me.
So, the US is not alone. And it does make a bit sense, I didn't require hospitalization, so makes sense they want to save the resources. But I feel like the article author could have done some better research.
rmetzler|6 years ago
bilbo0s|6 years ago
If you don't have the tests, you don't have the tests. I get that.
But then just say, "Sorry guys, we can only test critical cases and emergency personnel right now because we don't have the tests."
What's concerning is that it's possible to reach a point where a person presenting with pneumonia, is not a critical case.
js2|6 years ago
More importantly, the U.S. could and should have provided global leadership as it did for the 2014 Ebola outbreak.
susanhi|6 years ago
China has ramped their mask production to 200 million masks a day.
Had US government had the foresight and common sense to contract mask manufacturers to even produce half of what China is producing - let’s say 100 million masks, we could have had enough for everyone to have a mask in 3-4 days.
Universal masks for everyone (not only health care workers) together with hygiene protocol should be the way to “flatten the curve”. This would at the very least inhibit spread by those who have coronavirus but don’t know it yet (asymptomatic).
But instead, we’re having these mass shelter in place orders that are destroying our economy, killing businesses and destroying people’s livelihoods.
And I still haven’t heard of massive government contracts to mask manufacturers at the scale needed to provide masks for everyone.
true_religion|6 years ago
Understandably the Chinese government would be unwilling to contract their strategic supply of manufacturing out when they need it for themselves.
shalmanese|6 years ago
https://www.washingtonpost.com/business/2020/02/15/coronavir...
SkyMarshal|6 years ago
COVID19 is worse than flu, but not as bad as it could have been. We could get hit with something worse in the future. Imagine a strain of Ebola that gestates asymptomatically longer, or another coronavirus with higher mortality rate. This outbreak is good preparation for that one.
Anytime you’re dealing with a harmful exponential growth process like an outbreak, the best way to handle it is to overreact early, quickly and briefly. Kill it hard while it’s still small and easy to kill, or it will get out of control fast.
Put everything on lockdown/shelter-in-place for a few weeks - [max(gestation period|time to develop and deploy test kits) + safety factor] - test extensively, isolate and treat the infected, stop the outbreak, and then return to normal. Outbreak stopped dead in its tracks, economic damage is minimized and mostly short-term.
This is basically what South Korea did and they got their first COVID19 diagnosis the same day as the US:
https://www.reuters.com/article/us-health-coronavirus-testin...
That needs to be become a social and political norm everywhere, not just the Asian countries that have faced a widespread outbreak before.
tomp|6 years ago
People were worried that overreacting (in particular if the outbreak fizzled out, in which case any reaction would have been an overreaction) would damage the economy. Personally, I viewed that as a positive - a decently resilient economy would absorb such short-term shocks without any long-term issues. Easiest way to force-create such an economy? Stress tests (c.f. Netflix’s Chaos Monkey). If governments overreacted 1-2 times every year, people (travellers) and companies (supply chains) would get used to occasional flight blockade, border closure, discontinuity and disruption. We’d build a much more anti-fragile world.
koonsolo|6 years ago
People were already warning us years ago about a pontential pandemic and its impact (including Bill Gates), but we all ignored it.
A real pandemic seemed to be the only way to teach us. So I'm really happy for all of us that it's this moderate one, because it could have been a lot worse.
pacala|6 years ago
You can't manage what you can't measure.
To this date, I have seen no reliable data on how fast the disease spreads, or how dangerous it actually is. Testing only 'people with shortness of breath and high fever for more than 4 days' is so biased it's not even funny. There could be 10x or even 100x more people with milder symptoms that are never considered for testing. Reporting '10% of people tested die' is also very misleading, since we only tested people with severe symptoms in the first place.
We can poll 5 times a week for the chances of Biden or Sanders or Warren to become Trump's challenger in fall. Perhaps we could also perform randomized tests every week and get a better sense of the shape of the danger we're facing. Yes, testing for coronavirus is more expensive than calling a phone number, but shutting down the country indefinitely is orders of magnitude more expensive.
JamesBarney|6 years ago
look_lookatme|6 years ago
The experts are f* this up and it is going to have long term implications for already eroded public trust in institutions.
tdfx|6 years ago
(1) Widespread testing is key. Testing symptomatic people is too little, too late. (2) You can't rely on people to self-quarantine. (3) Infected people need to be isolated from their households.
So now we have a massive, economy-strangling quarantine that is not even going to provide any relief, killing the economy and still not flattening the curve. All the pain with none of the benefit.
ceejayoz|6 years ago
Watch one of the now-daily press conferences and you'll see Dr. Fauci trying to gently (so he doesn't get fired) correct inaccurate information from the President, in real-time from the same room.
CriticalCathed|6 years ago
Take a look at this editorial written by John Ioannidis. Excerpt that is relevant, though the whole thing is a worthwhile read:
>If COVID-19 is not as grave as it is depicted, high evidence standards are equally relevant. Exaggeration and over-reaction may seriously damage the reputation of science, public health, media, and policy makers. It may foster disbelief that will jeopardize the prospects of an appropriately strong response if and when a more major pandemic strikes in the future. [0]
Quick BIO rip from wikipedia:
>Ioannidis studies scientific research itself, especially in clinical medicine and the social sciences. He is one of the most-cited scientists in literature. His 2005 paper "Why Most Published Research Findings Are False" is the most downloaded paper in the Public Library of Science, and has the highest number of Mendeley readers across all science."
>Ioannidis is a Professor of Medicine, of Health Research and Policy and of Biomedical Data Science, at Stanford University School of Medicine and a Professor of Statistics at Stanford University School of Humanities and Sciences. He is director of the Stanford Prevention Research Center, and co-director, along with Steven N. Goodman, of the Meta-Research Innovation Center at Stanford (METRICS). He is also the editor-in-chief of the European Journal of Clinical Investigation. He was chairman at the Department of Hygiene and Epidemiology, University of Ioannina School of Medicine as well as adjunct professor at Tufts University School of Medicine.
[0] https://onlinelibrary.wiley.com/doi/pdf/10.1111/eci.13222
Symmetry|6 years ago
CDC: Our test is going to be so much better than the WHO's, we'll test for SARS-CoV-2 in two samples and also test for other simultaneous infections in this third part!
FDA: Approved
Hospitals: Hey, we can't get that third part to work!
CDC: That's ok, just use the first two parts, that's all you really need to diagnose COVID-19. Though I'm sad I won't get any data on simultaneous infections, apparently that was a problem in Northeast China and we want to figure that out for our guidelines.
FDA: Only running the first two tests is not what we approved! Verboten!
*
Laboratory: Let's develop our own SARS-CoV-2 test!
FDA: Sure, just make sure to fill out these forms, be sure to send them to us by mail rather than email, and oh, make sure to test against the original SARS to make sure your test doesn't give a false SARS-CoV-2 reading if they patient just has that.
Laboratory: Uh, sure. Hey, CDC, can I have a sample of SARS to test against?
CDC: NO WHAT ARE YOU CRAZY I'M NOT GIVING YOU THAT! THAT'S SUPER DEADLY!
js2|6 years ago
Exactly why it matters that there was no one in the Whitehouse whose job it was to coordinate the Coronavirus response. Our current situation was predictable. This was written in 2018:
Around the same time that the administration proposed rescinding the funds, the National Security Council dissolved its biosecurity directorate, a small team focused exclusively on global health security threats and led by a director often referred to as the Ebola czar. Again, it’s worth remembering why that office came into existence — a hard lesson. Without a central office to coordinate federal efforts by many agencies, progress was slow the last time the world confronted Ebola. “It took months of wrangling to put things in place,” Mr. Konyndyk said. “If the only way to get resources is through long negotiations with committees, you are giving disease a head start.” It was based on that realization that the Obama administration established the biosecurity directorate and named the first Ebola coordinator.
https://www.nytimes.com/2018/05/22/opinion/ebola-outbreak-tr...
ejstronge|6 years ago
> Laboratory: Uh, sure. Hey, CDC, can I have a sample of SARS to test against?
I've been trying to stay on top of the testing saga, but it's been hard with all the daily changes.
Do you have news links that describe this hypothetical exchange taking place?
EDIT: in particular, the part around the FDA requiring testing against a sample of SARS.
Congeec|6 years ago
asiachick|6 years ago
They aren't staying home. Restaurants, bars, and events are still open. Trains are still packed at rush hour. Festivals are still happening. They're planning on starting school in April.
I can only see a few possibilities
(1) the numbers are false and Japan's death rate is going to accelerate
(2) the numbers are true but it's still coming
(3) Something about Japanese culture already limits the spread.
I don't believe this one. Japanese might wear masks but not all of them wear masks and they are not N95 masks. Japanese are also known to go to work sick, go to cafes sick, visit friends and family sick. Places are crowded. Open and over crowded offices everywhere.
(4) Something about Japanese genetics makes them less likely to have a strong reaction
I have no idea how to tell which of those it is except to see where they are in a few weeks. If the death rate rises it was (1) or (2). If not then it must be (3) or (4)?
Here's their latest graph. The 2 shallow lines at the bottom are Singapore (bottom) and Japan (2nd from bottom). The rest are Italy, Spain, Germany, France going left to right at the top.
https://rpr.c.yimg.jp/im_sigg.R1UwQuI2tgBhV1fzJ5o7A---x799-n...
catalogia|6 years ago
Substandard masks are better than no masks, and many people wearing masks is better than few people wearing masks. These are not "all or nothing" matters.
fspeech|6 years ago
gkanai|6 years ago
shalmanese|6 years ago
https://www.againstcovid19.com/singapore/dashboard https://www.againstcovid19.com/taiwan/dashboard
This is vs the ~110 British cases and ~50 American cases the two countries have seen collectively.
Flight volume from Japan to both countries is normally quite substantial so this is evidence to suggest that Japan's case is not low solely due to undertesting.
robocat|6 years ago
This is a very western belief. Why do we continue to think that asians wearing masks are stupid?
Most importantly, say masks prevent 50% of transmission, and the majority of transmission is via the air (highly plausible), then that would mean drastically less transmission.
Even an N20 mask that reduces risk by 20% would make a huge difference to a population.
It is my prediction that masks are the single most effective means of dealing with the virus at present. Japan’s low infection rates are because they wear masks.
Wearing a bandanna over your mouth and nose just makes sense.
austinnoone|6 years ago
jtms|6 years ago
s0rce|6 years ago
dempseye|6 years ago
kps|6 years ago
“3M 1860; 3M 1870; 3M 8210; 3M 9010; 3M 8000; Gerson 1730; Medline/Alpha Protech NON27501; Moldex 1512; Moldex 2201.”
https://www.cdc.gov/coronavirus/2019-ncov/release-stockpiled...
bookofjoe|6 years ago
sp332|6 years ago
tyingq|6 years ago
Thriptic|6 years ago
erentz|6 years ago
Most (if not all) distributors and manufacturers of masks has been prioritizing health care systems and governments over retailers since January. Just as they should do. Were there any that weren't? I didn't see any reports of that, but if so of course the proper thing is to report them and talk to them. Not to blame random joe for having a mask.
The fact was since January retail supplies were only existing stock, which as we know was quickly sold out with a lot being sent back to family overseas (no judgement there). And I haven't seen any masks being restocked at any hardware stores or pharmacies since. At no time did I hear about authorities going around every pharmacy or home depot to try to collect any masks. Why? Because they knew there were no supplies and what was there was so small it'd make no dent in the problem. So blaming the public is grossly irresponsible and even put people in danger. I have an immune compromised friend that was responsibly using masks but got harassed for wearing masks "that don't work". And there were plenty of similar reports of such behavior from others.
MR4D|6 years ago
If you look at almost all of their actions, they continually clamp down on things that might work because they have not been proven.
It seems to me that they are led by academics and theoreticians with very little operational capability at the top decision making channels.
svara|6 years ago
The messaging around masks has been so aggravating to me that I got together with a couple of colleagues to write a detailed, scientific mini-review / commentary:
https://medium.com/@matthiassamwald/promoting-simple-do-it-y...
The benefit of widespread mask usage by the general population is source control [0]. This works even if the person wearing the masks makes mistakes such as touching their face more while wearing the mask.
Also, it should be obvious that there is no downside to wide-spread mask usage by the general population. The countries that have so far the most control over the virus' spread are the ones where wearing masks is normal and often done to protect others when sick.
Importantly, if the goal is source control, then all sorts of makeshift mask designs can work. People in Japan and other countries are already getting really creative [2,3].
Of course, the problem that medical personnel might face even more shortages if everybody starts wearing medical grade masks is real and must be taken seriously. But that's not the only option we have.
[0] One reference amongst many, this commentary in the Lancet: https://www.thelancet.com/journals/lancet/article/PIIS0140-6...
[1] Compare growth rates here: https://studylib.net/coronavirus-growth
[2] https://www.cottontimemagazine.com/page/10
[3] https://mobile.twitter.com/nekohnd/status/122368673365439692...
MiguelVieira|6 years ago
susanhi|6 years ago
CDC’s continued insistence that face masks don’t work is disingenuous at best. Leading way to a global recession at worst.
Had they changed their guidelines to saying that face masks can help inhibit spread at the very least, especially from asymptomatic carriers who are wearing masks, US gov could have contracted mask manufacturers to with millions of dollars worth of mask orders. Spurring then to produce masks, eliminating this shortage of masks.
Instead, gov plan has no mask protocol, so the only other option is a global shutdown of “non-essential businesses”. Causing an essential shutdown of the economy. The cost of which they have obviously not calculated.
amluto|6 years ago
ISTM a moderately tightly woven or knit hydrophilic mask (e.g. cotton) could be quite effective. Knits could have the added benefit that droplets would need to take a twisty path to get through. And there is plenty of such material around.
This shouldn’t be that hard to study in a lab. Find a sick person, have them cough through different masks, and measure viral concentrations on nearby surfaces.
ceejayoz|6 years ago
https://www.nytimes.com/2020/03/17/opinion/coronavirus-face-...
And some data back from SARS: "Always wearing a mask when going out was associated with a 70% reduction in risk compared with never wearing a mask. Wearing a mask intermittently was associated with a smaller yet significant reduction in risk."
https://wwwnc.cdc.gov/eid/article/10/2/03-0730_article
I saw a lot of people sanctimoniously talking about fit tests in normal healthcare settings as if an imperfect fit dropped effectiveness immediately down to 0% from 100%.
sonicggg|6 years ago
skipwalker|6 years ago
“Origami” tea cloth mask with rubber bands https://www.instagram.com/p/B96rcR8neYv/
thoraway1010|6 years ago
namelosw|6 years ago
In China, it's pretty much contained now, and everyone wears masks on the street -- The thing is, there are 1.3 billion people, of course there are a lot of people couldn't buy or afford surgical masks, let alone N95 masks.
It turns out people wear regular masks, or even they don't have any mask they sew their own mask.
Also, most surgical and N95 masks are disposable, in China, people cover their hand sewed mask outside, covering the disposable masks inside and try to reuse them, and disposes the hand-sews masks. This hack, of course, have potential risks, but it might help for people who are running out of masks.
dahart|6 years ago
superzamp|6 years ago
YES, we get it, but what about protecting others from your cough since most people don't even know they're contagious. Even a 20% decrease from a crappy solution is interesting when dealing with exponential curves.
Drives me mad.
darrinm|6 years ago
EGreg|6 years ago
If you are caught without a mask you get fined.
How else can people get the virus? Perhaps people shed the virus through their skin? Or touch their face and get it on their hands? So people can wash their hands before touching their face. Also people can get it in their private homes. But those groups don’t mix all the time.
So I am just wondering... N95 masks are for the person who doesn’t want to get the virus. But what about everyone else?
I understand that you could wear the mask crooked and there are problems with application. But mass producing N95 masks and giving them out and MANDATING everyone wearing them like women in Saudi Arabia seems like a better policy.
kriro|6 years ago
unknown|6 years ago
[deleted]
flipflipper|6 years ago
unknown|6 years ago
[deleted]
en-us|6 years ago
As an alternative see Hong Kong, where they are encouraging the population to improvise masks: https://www.consumer.org.hk/ws_en/news/specials/2020/mask-di...
unknown|6 years ago
[deleted]
dirtyid|6 years ago
Cat meme because it was reposted to Chinese Quora. Obviously consider that Asian countries have no mask shortage due to existing cultural practices. Masks should be prioritized to prevent collapse of medical capacity when there is shortage - the policy suggestion most western countries are seeing. The TL;DR of the guide: the only scenario not to wear (normal surgical) mask is when you're alone. Surgical masks for almost every other situation, N95+ for high risk situations. On efficacy for public health, The microbiologist Yuen Kwok-yung, from HK who was a key figure in SARS and one of the expert teams on Covid response:
>Given this novel coronavirus is so "cunning", with probably many infected but asymptomatic people moving around in communities, how should ordinary citizens protect themselves?
>We can only rely on telling everyone to wear a mask, wash their hands frequently, use alcoholic sanitiser. I had called for everyone to wear a mask when I was in Beijing, but many people disagreed, saying that the World Health Organisation (WHO) said healthy people don't need to wear masks unless they go to crowded places. Nevertheless, if people wear masks only when they feel sick, then the eight infected people on the Diamond Princess would have transmitted it to others because they were not feeling uncomfortable. Wear a mask to protect not only yourself but also others, because if you are infected but asymptomatic, you could still stop the spread by wearing a mask.
>In our experiments previously, we found 100 million virus strands in just one milliliter of a patient's saliva. Therefore, scenarios with the potential for exchanging saliva are generally quite dangerous. The temporary success of virus control in Hong Kong this time is not only due to population controls, but also contributed by the early advocacy for mask-wearing, hand-washing, and social distancing. Otherwise, with such a dense population in Hong Kong, the epidemic would very likely have spread the same way as in Italy or Daegu in South Korea.
https://www.straitstimes.com/asia/east-asia/exclusive-qa-wit...
Google translate of guideline:
The general public
(1) Home and outdoor, no people gathered, well ventilated. It is not recommended to wear a mask.
(2) Being in a crowded place, such as office, shopping, restaurant, conference room, workshop, etc .; or taking a box elevator or public transportation. In low- and medium-risk areas, it is recommended that you wear spare masks (disposable medical masks or medical surgical masks) with you, and wear them when in close contact with other people (less than or equal to 1 meter). In high-risk areas, disposable medical masks are recommended.
(3) For those with cold symptoms such as coughing or sneezing. It is recommended to wear disposable medical or surgical masks.
(4) For those who live together with those who are separated from home and discharged from rehabilitation. It is recommended to wear disposable medical or surgical masks.
Personnel in specific places (1) It is located in densely populated hospitals, bus stations, railway stations, subway stations, airports, supermarkets, restaurants, public transportation, and community and unit import and export places. In medium and low risk areas, it is recommended that workers wear disposable medical masks or surgical surgical masks. In high-risk areas, it is recommended that workers wear medical surgical masks or protective masks that comply with KN95 / N95 and above.
(2) In prisons, nursing homes, welfare homes, mental health medical institutions, school classrooms, construction site dormitories and other densely populated places. In medium and low-risk areas, it is recommended that you always wear spare masks (disposable medical masks or surgical surgical masks) with you daily, and wear masks when people gather or come into close contact with one another (less than or equal to 1 meter). In high-risk areas, it is recommended that workers wear medical surgical masks or protective masks that comply with KN95 / N95 and above; other personnel wear disposable medical masks.
Key personnel
Suspected cases, confirmed cases, and asymptomatic infections of new coronavirus pneumonia; close contacts of new coronavirus pneumonia; immigrants (from entry to end of quarantine). It is recommended to wear medical surgical masks or protective masks without exhalation valve that conform to KN95 / N95 and above.
Occupational exposure
(1) Medical personnel such as general outpatient clinics and wards; emergency medical personnel in medical institutions in low-risk areas; administrative personnel, police, security, cleaning, etc. engaged in epidemic prevention and control. Medical surgical masks are recommended.
(2) Personnel working in the ward and ICU of patients diagnosed with a new type of coronavirus pneumonia, suspected case patients; medical staff at designated medical institutions for fever clinics; medical staff in emergency departments of medical institutions in middle and high risk areas; epidemiological investigations and experiments Room testing, environmental disinfection personnel; transfer of confirmed and suspected cases. Medical protective masks are recommended.
(3) Operators engaged in the collection of respiratory specimens; staff who perform tracheotomy, tracheal intubation, bronchoscopy, sputum suction, cardiopulmonary resuscitation, or lung transplantation, pathological anatomy in patients with new-type coronavirus pneumonia. Suggestion: hood-type (or full-type) powered air-supply filter respirator, or half-plane power-supply air-filter respirator with goggles or full screen; P100 anti-particulate filter should be used for both types of respiratory protection Elements and filter elements should not be reused. Use protective equipment after disinfection.
david_w|6 years ago
https://courses.lumenlearning.com/boundless-microbiology/cha...
The flu virus is typical: ...the flu virus is .17 microns in size.
https://www.envirosafetyproducts.com/resources/dust-masks-wh...
Masks work by trapping flu particles. The 95 in an N95 mask is shorthand for "this masks traps 95% of particles of size .3 microns.
There are also N99 and N100. N100 trap 99.7%. N100 when it is used in an air filter is called HEPA which I believe stands for High Efficiency Particle Attenuator or Arresting.
There is also a level above that found mostly in Europe called ULPA which pushes the decimal out further to 99.9997% . All of these aarea measure of the masks ability to trap particles of 0.3 except ULPA which is a measure of trapping particle 0.17
https://www.globalspec.com/learnmore/manufacturing_process_e...
Masks are matted fibers designed to trap particles on their fibers. They do this using 3 mechanisms which all masks share- diffusion, impaction and inertial impaction.
Diffusion happens when a particle is so small it is in Brownian (random) motion. These particles are trapped because they constantly change direction randomly as they pass through the mask and eventually run out of luck trying to dodge fibers. Such particles are less than 0.03 microns in size. (I should inject here that even though virus are smaller than this, there's more to the story as detailed below).
Inertial impaction happens when a particle is larger than .03 and owing to its size and momentum cannot change its direction of travel fast enough to stop itself running into a fiber.
Impaction happens when a particle comes within 1/2 of its radius of a fiber and touches it, becoming trapped. This is the most difficult size of particle to capture (as it happens) and that's why its the reference particle size for safety masks.
In the above I acted as though the particles were "trying" to avoid being trapped, but of course that's just a stub for the underlying physics off motion and magnetic attraction/repulsion which underlie these facts.
If you want to DIY some sort of mask to reduce your exposure, you have to consider that the weave of most cloth is far far wider than .03 and anyway not in layers (a cloth like yarn is the exception to the second property).
Just guessing but rags scarves etc lack the required fiber density to function as safety masks. It is possible that the virions would sail through them even under Brownian motion. But that is not really how virions are transmitted- they are transmitted mixed in with saliva particles which are hugely larger than the virions themselves. The size of a particle of saliva in a sneeze was examined here- tldr: a bimodal distribution of sneeze particle size all over 50 micrometers.
https://royalsocietypublishing.org/doi/full/10.1098/rsif.201...
Some other studies have put the size as small as .35 micrometer. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4676262/
What is really astonishing is how fast the particles travel- 200 MPH. https://www.livescience.com/3686-gross-science-cough-sneeze....
https://www.texairfilters.com/what-happens-to-the-particles-...
So all in all we can say this-any mask covering is better than no mask because it's an odds game with virus particles and saliva.
The less able you are to breath through it, the better it functions as a barrier.
Ordinary cloth is just not woven tightly enough to substitute for a p95 mask.
If you had to choose between multiple layers of x number of fibers and a tighter weave of the same fibers, it might be better to go for a tighter weave because even though individual virions would travel under Brownian motion, that's not how a spray of sneeze which is the transport mechanism of the virus is going to travel.
Some sneeze particles containing virions have a particle size of 5 microns and will stay aloft in a still room for a long, long, long time. If someone sneezes and three minutes later you walk through where they were, you could very well become the unknowing, unwilling next host of the virus.
That last - horrifying - fact is one of the the reasons why they're telling people to maintain social distancing and just stay home.
CriticalCathed|6 years ago
You cannot expect the general population to adhere to the standards of a TB hospital. It cannot be done, even if it was a good idea. For example, standard practice is that a mask is meant to be worn for only 8 hours and that is under the assumption that you have no reason to believe you were exposed. If the mask becomes wet, damp, or if you have any reason to believe you've been exposed you're supposed to immediately doff it carefully and dispose of it. Typically PPE is used only once per exposure, or is reused for exposure to one patient at a time.
There are so many variables at play here. From the efficacy of the masks themselves, the best allocation of resources, the different varieties of masks, the techniques for proper fitting, the decontamination processes, other PPE. Does this mean masks are not useful? No. And you won't find many experts making this claim. It's clear that masks help.
Think critically about this. It is not as simple as "masks good" or "surgeon general lied." There are manifold hysterics going around -- please don't contribute to it.
bionhoward|6 years ago
The devices to do this are getting cheaper faster than Moore’s law. Just takes the will to set up the programs
nikhizzle|6 years ago
What do mechanisms for accountability here look like? Will they be used?
Edit: And more importantly how will we prevent theses same mistakes from happening again?
rflrob|6 years ago
My sense is that a lot of the bad decisions don’t necessarily rise to the level of negligence, so civil/criminal penalties are unlikely.
unknown|6 years ago
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AndrewBissell|6 years ago
They said they had no ability to get her tested, that we should not be concerned at all that it might actually be COVID-19, and she should visit a clinic. The clinic said it was probably just the flu, and told her to go ahead and fly back but to wear a mask.
This was absolutely criminal incompetence on the CDC's part.
mrdrozdov|6 years ago
This is very different from guidelines in general. Encouraging people to avoid large crowds, wash their hands and wipe surfaces, and possibly self-quarantine could have made a huge impact earlier on.
Instead, people kept going to bars, concerts, and traveling. A lot could have been done, and testing is only part of the story.
dang|6 years ago
(Submitted title was "CDC Guidelines Hid the Coronavirus Epidemic")
dang|6 years ago
(via https://news.ycombinator.com/item?id=22656060 but no comments there)
neonate|6 years ago
Munky-Necan|6 years ago
I was talking with some physicians and providers when I said that I think this will be the Chernobyl like moment of our era: where the truth is hidden from people to prevent a panic paradoxically exacerbating the current crisis. Shockingly, almost all agreed with me.
CriticalCathed|6 years ago
unknown|6 years ago
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blhack|6 years ago
quietthrow|6 years ago
jmeister|6 years ago
davelacy|6 years ago
dang|6 years ago
https://news.ycombinator.com/newsguidelines.html
tathougies|6 years ago
https://www.politifact.com/factchecks/2020/mar/17/instagram-...
https://www.politifact.com/factchecks/2020/mar/12/joy-behar/...
gfodor|6 years ago
throwaway32120|6 years ago
I just did a search for news articles from the end of January to the end of February, and only found articles like this one[1], where politicians are criticizing the Trump administration's communication, but aren't callng for stronger efforts or mass mobilization (and the article has a quote from Pelosi saying she has confidence in how the CDC is handling things). Congress wasn't passing legislation to fight the pandemic as things were heating up, and governors don't seem to have made effective plans. The media didn't consider it to be a major disaster until recently (it didn't get brought up in the presidential debates until a couple weeks ago, IIRC). Issues like our lack of emergency stores for things like masks and our lack of an ability to manufacture them here is an issue that goes back for years, as is the poor safety net that leaves Americans so vulnerable in times like this.
Hopefully this crisis will encourage people to look at the poor leadership America has had across the board. Simply getting rid of Trump and calling it a day is just rearranging deck chairs on the Titanic.
[1] https://www.washingtonpost.com/us-policy/2020/02/05/some-law...
unknown|6 years ago
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_ea1k|6 years ago
DoreenMichele|6 years ago
It disproportionately impacts the homeless. The problem appears to have started in San Diego and spread outward from there.
I'm aware of the issue because a reporter from San Diego contacted me and interviewed me via email in September 2017 because I run the San Diego Homeless Survival Guide.* Another reporter contacted me when it reached Los Angeles.
I received an email last September from something I'm subscribed to indicating it had reached Washington state, though my county was not listed.
On a per capita basis, the small town I live in has a worse homeless problem than the big cities that routinely make the news for it. If I had any real power, I would be trying to come up with the means to do a free hygiene event for the homeless and give away hand sanitizer and free haircuts and Hepatitis vaccines, something I had on my mind before covid19 became a thing.
I've seen relatively little in the press about it. I have seen at least one article about the resurgence of "Medieval diseases."
To my mind, our homeless policies are actively creating a health hazard for the entire nation. CDC policy looks to me like part of the problem. They seem to be sitting on the data about the spread of hepatitis and intentionally not making an effort to publicize it.
I imagine it will get swept under the rug entirely in the face of covid19. This seems to me like a good means to compound our problems.
I have no idea what do about it.
* https://sandiegohomelesssurvivalguide.blogspot.com/2017/09/f...
magwa101|6 years ago
Italy is flattening and exponential growth becomes exponential decay.
RobAtticus|6 years ago
Italy new cases did flatten to 3500-4000 per day for a few days this past week, but they have since resumed increasing on a daily basis. So I don't think they are out of the woods yet. It may not be exponential, but it is very much super-linear