
Keeping the coronavirus from infecting healthcare workers - razin
https://www.newyorker.com/news/news-desk/keeping-the-coronavirus-from-infecting-health-care-workers
======
ZhuanXia
The shameful lies about masks not working for civilians will kill thousands.
Evidence based medicine (over the modern Bayesian Science-based medicine) has
paralyzed our health officials from making common sense calls off priors.
Homemade masks appear to be reasonably effective. The official response should
be to make some form of improvised mask required when out of home, and ration
regular mask for health care workers.

Even a scarf made of a t-shirt over the nose and mouth will likely reduce RO
when used at scale on the population. The best way to protect healthcare
workers is to reduce the R0 below 1. Nothing else will help. Widespread use of
homemade masks, though not tested in a double blind trial, is low risk enough
and seemingly effective enough to encourage.

Countries enforcing widespread mask use have lower ROs.

~~~
GordonS
I think if you're going to make a post like this, it's reasonable to expect
that you present some actual evidence, or is your whole argument that we
should ignore evidence?

"Homemade masks appear to be reasonably effective" is hardly a compelling
case.

~~~
JackeJR
I don't think the parent's point was that we ignore evidence but that in the
absence of evidence (as opposed to evidence suggesting the contrary), we
should use priors to guide what we do. In this case, while there are no double
blind randomised studies that suggest that widespread mask use reduces R0,
priors tell us that masks use protect against infection in other settings.

If we were to weigh the priors, the existing evidence would be leaving towards
mask use having a protective effect. The question that we should ask ourselves
is, what if the reality turns out to be different? There are 2 scenarios.
First, mask use is harmful and the second, mask use has no effect on
transmission. The first is very unlikely given what we know and the second
will mean that if mask use is encouraged, it will be wasted resources for no
gain. If these resources that were wasted were easily obtainable i.e. masks
made of old clothing etc, then the downsides aren't serious at all but could
have very good upsides if the priors were right.

So I agree, that we should encourage widespread home-made masks use and leave
the disposable ones to the healthcare workers.

~~~
ghostpepper
How can you rule out the possibility that mask use has a net negative effect
so easily?

~~~
traverseda
The hypothesis that face masks have a net negative effect is a very strong
claim, before considering it we'd need _some_ evidence that points in that
direction.

I guess if you believe that's actually true, you should be advocating for
doctors to stop wearing masks...

But that's not something we do, because we have enough priors that masks help
that we will continue to use them.

------
bamboozled
“Health-care facilities don’t remotely have the supplies that would allow
staff members to see every patient with all that gear on.“

As the article states, China had that ability.

If that statement is true, It’s amazing to me that this is something China can
do and not the U.S.A. The country that put man on the moon not even a century
ago! Incredible.

I feel like there are a lot of acquisitions lately that go on about how
“draconian” China’s behaviour is etc, but they protected their medical staff
by making sure they were adequately equipped. It read a bit like jealousy.

~~~
jtdev
U.S. leaders of industry along with our political establishment have
undermined American security by outsourcing the production of critical
resources to an authoritarian, communist nation (China). It’s high time we
wake up and hold these people accountable.

~~~
makomk
This. Something ridiculous like 95% of surgical masks and 75% of N95 masks are
normally imported from China, because theirs were slightly cheaper. Almost all
of them have been diverted to domestic use. Now the US, with almost no
manufacturing capabilities, has doctors and nurses who are forced to use
dubious improvised masks whilst China increases its international influence by
selling a small fraction of its output at inflated prices to desperate
countries in Europe. I've seen a load of dumb takes on social media blaming
this on a lack of "leadership and competent diplomacy", but having a leader
who grasps the diplomatic advantage of doing this is no good if your country
can't make the damn masks in the first place.

~~~
wbl
3M is in Minnesota. There was no effort to make more masks in the months we
had. This is entirely a failure of government at all levels.

~~~
makomk
3M and the various US surgical mask manufacturers have been ramping up
production since, if I remember rightly, January, but that's not enough to
cope with even the normal demand for them let alone the extra supplies needed
due to the coronavirus.

~~~
jtdev
There’s zero evidence that I can find showing that a single N95 mask is
actually currently manufactured in the U.S.

Quote from a Minneapolis/St. Paul Business Journal article related to the mask
manufacturing ramp up at 3M for COVID19: “‘We're seeing increased demand for
our respiratory protection products, and we're ramping up our production
worldwide, in China, around the world to meet that demand.’ (Mike Roman, 3M
CEO)” [0]

Nothing about that statement gives me any confidence that a single 3M N95 mask
is produced in the U.S. In fact, it sounds downright evasive to me.

[0]
[https://www.bizjournals.com/twincities/news/2020/01/29/3ms-c...](https://www.bizjournals.com/twincities/news/2020/01/29/3ms-
china-business-was-sluggish-coronavirus-could.html)

------
jtdev
Can we all agree that outsourcing the production of critical medical supplies
to China over recent decades was a bad idea?

I understand the “golden arches” theory, and the intent if globalism, but I
feel that COVID19 has revealed what a short sighted, deeply flawed view the
globalists have.

~~~
phreeza
I would argue the opposite is the case. The disease affects basically all
countries, so what matters is the global supply of these goods. So we are
better off if countries can specialize on their respective competitive
advantages. In the scenario you propose, every country would have their own
very inefficient mask industry which would now be just as or even more
overwhelmed.

~~~
nradov
We all understand Ricardo's law of comparative advantage. The problem is what
happens in a supply chain disruption. In that case it's better to have at
least _some_ inefficient local capacity instead of nothing.

As an extreme example, the US continues to manufacture it's own military
aircraft instead of buying from China. Even though China might be willing to
sell them cheaper than we can make them.

------
zaroth
There is a lot of conflicting data. China went full hazmat with the influx of
new healthcare workers they sent into Hubei, but Singapore and Honk Kong took
significantly more measured approaches which ultimately have also been
successful in limiting exposure.

The US policy of 14 day quarantine for healthcare workers who had even limited
exposure to a COVID patient was never sustainable and threatened to shut
entire ERs before the restrictions were loosened.

A broad array of moderate measures (stringent hand washing, surgical masks all
the time, 6 foot rule except during exams, etc.) combined with isolation of
only identified “close” contacts has worked in a few different places now.

The question of asymptomatic spread is still confounding experts. It seems
they can’t fully explain the spread in some places without it, but they can’t
explain lack of spread in some places with it.

When left in a situation where data is conflicting and unreliable, I think the
path forward has to always balance the conflicting interests. Just like you
can’t send the entire ER department home in the middle of an epidemic, you
also can’t exhaust your entire years supply of hazmat gear in a week, and you
similarly can’t crater your entire economy to put on a show of strong action.

Measured responses ultimately are what will save the most lives, because they
can be sustained for the reasonable expected duration of the outbreak rather
than shock and cripple the whole system in a matter of weeks.

~~~
bamboozled
You do realise it’s not eradicated in HK or Singapore ?

I’m not sure why people keep talking like this is all in the past for these
countries ?

~~~
wbl
They are not seeing the exponential growth others are. Eventually it will die
out there.

~~~
taeric
Exactly this. Evidence seems to be that, if you measure, you see exponential
growth of infections. Only a few places have seen the same curves on severe
cases.

------
hprotagonist
Atul Gawande is a voice i’m happy to listen to here, and this is a small ray
of hope.

He’s a practicing surgeon, public health researcher, educator, and he was one
of the early champions of wide use of checklists in hospitals to reduce
infection rates and complications.

He is not prone to blowing sunshine and rainbows, either.

------
js2
"Why Telling People They Don’t Need Masks Backfired. To help manage the
shortage, the authorities sent a message that made them untrustworthy."

[https://www.nytimes.com/2020/03/17/opinion/coronavirus-
face-...](https://www.nytimes.com/2020/03/17/opinion/coronavirus-face-
masks.html)

------
cryoshon
it's more or less unforgiveable that our american healthcare workers don't
have the PPE they need to protect themselves. attrition among our healthcare
workers is going to be very high, especially because unlike singapore, we use
the most inefficient quarantine guidelines when we suspect that they have been
exposed.

people are sewing masks to make up the difference between what is needed and
what we can supply. the federal government can't seem to supply the states
with much of anything. and purchasing domestically-produced masks is becoming
rapaciously expensive, with some manufacturers charging $7 per mask. allegedly
our domestic manufacturers are ramping up production. but let's face it, that
takes time. and we don't have time, because once one of our healthcare workers
gets sick, they're out of commission for weeks.

i will not abide by this disaster for our heathcare workers. i am working with
an established charity to raise money to purchase thousands of n95 respirator
masks from chinese manufacturers so that those masks can be shipped and
donated directly to hospitals in epicenters like new york.

i'm calling it the million mask campaign because i hope that we can eventually
donate at least a million masks to hospitals in need. in reality, we will need
many millions of masks if we want to protect our healthcare workers, but
everything we can bring to bear on their behalf will be beneficial.

please consider contributing to our campaign: [https://www.gofundme.com/f/the-
million-mask-campaign?utm_sou...](https://www.gofundme.com/f/the-million-mask-
campaign?utm_source=customer&utm_medium=copy_link-tip&utm_campaign=p_cp+share-
sheet)

------
christkv
A couple of weeks ago there was some news about salt treated masks
deactivating virus. I just found this site that claims to make them
[https://vkmask.com/](https://vkmask.com/) anyone know anything about them?
Are they real or a scam.

~~~
kevin_thibedeau
"fermented sea salt"

Might be effective in some way but there's a heavy dose of wackadoo there. US
patent 88,819,662 doesn't seem to exist either.

~~~
christkv
I think they are trying to pretend they are doing this
[https://www.nature.com/articles/srep39956](https://www.nature.com/articles/srep39956)

