Adding to the list of CDC failures was their utter failure to procure masks. You know, those things that would be absolutely vital for just about any epidemic or pandemic (never mind the respiratory variety that we knew would be the most likely). It’s not like preparing for an epidemic is the raisin d’etre for the CDC or anything. I’m normally not this snarky, but I too thought the CDC was the one functioning agency but it turns out that it’s closer to the opposite. And not only that, but their utter incompetence killed tens of thousands.
The agency was also gutted, and the group set up to respond to threats like this let go with the idea that they could be hired back whenever.
I really hope that the sterility issues the fda found in the cdc labs that held up testing[0] aren't indicative of the standards of the BSL 4 facilities handling smallpox, anthrax, etc ...
Even so, it sounds like the US pandemic response was put in a worse place by that change, and that’s the real point. I’m not saying it was excellent before; they never had a chance to prove themselves.
> It is true that the Trump administration has seen fit to shrink the NSC staff. But the bloat that occurred under the previous administration clearly needed a correction
This seems like a poor call. Shrinking staff and joining divisions together sounds like a easy way to get parts of your product that are unowned and unmaintained. When it comes to protecting against pandemics, I’m not sure the primary goal ought to be saving money.
I would be fascinated to learn more about what the officials in the organization did about COVID.
That's a John Bolton tweet quoted in the piece. Full context:
> On March 14, 2020, John Bolton described the changes made to the team as streamlining. He tweeted: “Claims that streamlining NSC structures impaired our nation's bio defense are false. Global health remained a top NSC priority, and its expert team was critical to effectively handling the 2018-19 Africa Ebola crisis. The angry Left just can't stop attacking, even in a crisis.”
It seems true to me. There was a team dedicated to pandemic response and now there isn’t. The fact that some of the members of the team were reassigned to a broader focus area that included pandemic response doesn’t make that false.
The CDC, US Surgeon General, and WHO have all claimed with a straight face that masks don't protect you from getting the virus. I guess that's why they didn't see any value in stockpiling them. /s
I too assume that surgeons wear those masks for funsies.
Of course the “masks don’t work” was pure, transparent, bullshit from the very beginning. It didn’t even pass the smell test. Now if the argument was “please save masks for healthcare workers first, they’re higher risk” that would be fine. But “they don’t work”? Fuck off.
Edit: I’m referring to the CDC here, not you personally, dear HN commenter.
It doesn’t look like anyone bought it, masks still sold out quickly and health care providers are still reusing N95 masks. And in exchange the CDC spent a large amount of their credibility; a real lose lose.
That's because the lies were so transparent. In the US we were told (by our wonderful Surgeon General) that citizens who wore masks were actually more apt to get covid than persons without masks.
I'm curious, was the official word always that even N95 masks didn't protect the wearer? Or just that "masks" in general (i.e., lesser masks) would not protect wearers?
Here he claims masks (general) do not protect you. But they do protect healthcare workers. It amazes me that he was willing to put two such contradictory claims in the same tweet. It was just such a transparent lie. Given the context and implication, I think it is referring to "medical" grade masks including N95, surgical masks, etc.
I’m genuinely not sure what makes me angrier: the lie, or how fucking lazy it was. The least he could do is come up with something that’s at least plausible.
N95 masks protect healthcare workers because HC workers know how to properly fit them; the general public does not have this training and thus N95 masks are wasted on the GP.
Another part of the confusion is that early on (six weeks ago) the assumption was that the virus spread like the flu, i.e. via droplets from coughing and sneezing. Masks alone (without face shields) are of little benefit for droplet-spread disease because they don't protect your eyes. Now we know the virus spreads via aerosols which are generated by talking or even breathing. Cloth masks do indeed help for aerosols by trapping virus particles electrostatically and by increasing humidity, both of which keep the virus out of your respiratory tract. Or so the latest thinking goes.
Hanlon's Razor applies, but this virus is also an insidious bastard that behaves very differently from what public health experts had expected.
First of all, there are very different rationales for healthcare workers and the general public to wear masks. Healthcare workers know they will be exposed, so the protocols must be damn near perfect. The general population does not know if they’ll be exposed, they’re trying to work in aggregate to put a drag on the viruses’ spread; even partially effective mask wearing slows that down. The general population can also practice social distancing, while healthcare workers must spend hours in close personal contact with positive patients by the nature of their jobs, vastly increasing their risk.
Second, this ignores the fact that mass mask usage prevents you from getting someone else sick. This is in fact exactly why surgeons wear surgical masks. Since we’ve known for months that this disease has asymptomatic transmission, the public health rationale for even cloth mask usage was obvious from the very beginning.
I used to think like what OP said. But after seeing the response in Asian countries with their much larger families and denser cities working against them and yet slowing the spread, masks might be playing an important role there. It also reminds everyone constantly. It does stop me from touching my face as well. So yeah, even if it's not perfect it's going to help quite a bit.
N95 masks are used as part of a package of PPE. That includes eye shields, gloves, and gowns. There's a complex protocol to put them on, and to take them off.
Without the rest of the kit, and without careful adherence to correct donning and doffing, there are at best marginal benefits to mask wearing.
There's some concern that those marginal benefits are eliminated if people wearing masks go on to engage in risky behaviours. These behaviours include increased touching of their face (often without immediate handwashing afterwards), reductions in distance between people, increase in frequency of leaving the home, etc etc.
PPE is designed to mitigate a completely different level and type of risk. PPE is designed for medical professionals who by the very nature of their job must spend hours in physical contact with known sick patients. The protocols must be strict because failure means guaranteed infection.
I on the other hand have no obligation to physically touch random strangers, thank god, and don’t have to go interact with known sick people. Instead I’m trying to provide some protection for myself, and trying to work in aggregate to reduce the risk that asymptomatic carriers spread the disease while doing essential activities. “Marginal benefits” in this context is also known as “reducing R0”, which is absolutely a public health goal.
Now all of that is a good argument for saving N95 masks for medical workers and relying on surgical or cloth masks for the general public, especially in the light of PPE shortages. But that is an entirely different argument from “masks don’t work”.
If you're wearing a mask to protect against droplets then maybe you'd get marginal benefits. But if your concern is virus carried in the water vapour that people exhale, then an N95 isn't nearly enough to protect you.
The 'marginal benefits' have been studied and are around 90% effective. Quit spreading negativity please. Its pointless, and gains you only imaginary internet points.
Something like 90% of people with a mask, any mask, not infected after sharing space for an hour or two with sick people. In an airplane. Pretty solid protection.
The problem is no one likes to look stupid, and this is one of the cases where anyone who can spell words together was able to see through the BS. Whether they are going to hoard it or not, the solution is not for an expert to lie to the public.
I don’t know if that’s true or not, but I’m certain that lying to the public about what they can do to stop the virus was a bad call and will have lasting harm.
We hear the same over the pond. The argument is that the masks may not be fit for purpose or be used incorrectly, thus might actually be more contagious as people will tend to touch their faces more often etc. The official stances are still that people need training in order to use masks correctly, and the masks must meet standards to protect the user. All masks may protect others to some degree though.
"Masks work, don't work" are not cogent arguments.
It's the same with plastic gloves. Their usage in ie. grocery stores etc. may not help as much as incorrect usage may work against the intention. Again the argument is that if you get your hands dirty, you know you need to wash your hands and might think twice before touching face. Even washing hands properly require some training.
We've since learned that less extreme measures may be good enough once you have control, testing and tracking.
No one knows why the CDC issued the guidelines that they did. There's also fairly little doubt that the CDC in previous decades would've been smarter and better organized.
A lot of the commentary about the matter is disingenuous. Of course they won't filter out all the infectious agents for all healthcare workers forever. It was a matter of risk mitigation, just as much as shelter-in-place is. Getting infected is a numbers game, as is the live-locking of available hospital capacity.
Surgeons wear masks to protect the patient from droplets from the surgeon's nose and mouth, which otherwise could easily fall right into the patient's open wound.
> Of course the “masks don’t work” was pure, transparent, bullshit from the very beginning. It didn’t even pass the smell test.
No, that's not true. Maybe the advice was wrong, but it wasn't "pure, transparent, bullshit." It was always clearly stated that N95s worked if worn properly, but there was a lot of debate if surgical masks would offer much protection or not (they're known to be inadequate for certain viruses). Especially early on, people didn't understand much about this virus, such as the particle sizes involved or if asymptomatic transmission was real or not. There were a lot of factors to weigh in the recommendation in an environment of uncertainty.
> Now if the argument was “please save masks for healthcare workers first, they’re higher risk” that would be fine.
> Most people don’t know how to use face masks correctly, and a rush to buy masks could prevent the people who need them most — health care providers — from getting them, said Dr. Amesh Adalja, a scholar at the Center for Health Security at the Johns Hopkins Bloomberg School of Public Health.
> In fact the U.S. surgeon general recently urged the public to “STOP BUYING MASKS!” “They are NOT effective in preventing general public from catching #Coronavirus, but if healthcare providers can’t get them to care for sick patients, it puts them and our communities at risk!,” wrote Surgeon General Jerome Adams on Twitter US:TWTR
> But “they don’t work”? Fuck off.
It's also pretty clear that they were right that tons of people in the general public don't know how to wear masks correctly. I don't go out much, but when I do there's always a bunch of fools wearing N95s improperly (not using both straps, bunching both straps together behind the head, not shaping the noise area to fit the face). I even see people wearing surgical masks improperly (e.g. not covering the nose, not shaping the nose area, not folding out the material to stretch from the nose to under the chin, etc.).
There's also the issue that the general public is unlikely to follow the kinds of rigorous protocols that make N95s effective in a healthcare setting.
1) Wearing masks is a trainable skill. None of us know how to use condoms initially either, yet literally millions of Americans use them effectively yearly.
2) Masks don’t have to be worn with perfect correctness to produce an effect in aggregate. If mask usage was even 30% effective, this would drop R0 by roughly as much, which is a big freaking deal.
The N95 vs surgical mask is a tricky balance to strike; of course N95 should be saved for those at the highest risk, and if you know your mask will be sprayed with virus droplets, extra precautions must be taken. But that’s much more relevant to medical workers, not those of us who want to reduce risk going to the grocery store.
> Wearing masks is a trainable skill. None of us know how to use condoms initially either, yet literally millions of Americans use them effectively yearly.
Not really. Do you have a qualitative fit test handy? Because you need to do a fit test with one to figure out if an N95 you chose actually works properly, even if you're wearing it properly. Healthcare workers are tested, and the kits cost $200 or more.
> [Surgical] Masks don’t have to be worn with perfect correctness to produce an effect in aggregate. If mask usage was even 30% effective, this would drop R0 by roughly as much, which is a big freaking deal.
I think that's why they ended up changing the recommendation.
And that’s a really good argument for surgical masks and not N95s; N95s could be used by the public, but given the shortages and the lack of fit tests any gains of N95 over surgical masks, if they exist, are not worth the increased cost and shortage of N95 masks for health care professionals.
The problem is that this isn’t the nuance that the Surgeon General or the CDC originally went with. His argument was literally “You can increase your risk of getting it by wearing a mask if you are not a health care provider”, and “STOP BUYING MASKS”, neither of which distinguishes between N95s, surgical masks, and cloth masks.
Most people don't wash their hands properly either, but we tell people to do it because even washing hands poorly is better than not. Even "fools" wearing masks wrong would help more than not having them at all.
The parent is right: was pure, transparent, bullshit. If they were intending to preserve masks for healthcare workers, then just say that. Telling people they don't work was not just stupid, it was dangerous and almost certainly made the situation worse. Don't lie to people about their health.
Actually surgeons wear the masks to protect the patient not themselves. That's very similar to what likely is the biggest benefit of widespread mask use, reducing the infectiosness of people.
It’s amazing how many people blindly repeat this as if it’s a good argument. It’s not a good counter argument at all.
Stopping other people from catching something you might have is a fantastic reason to ask everyone to wear a mask during a pandemic. It’s actually probably the main reason you’d want to do so, from a public health perspective, because it helps you prevent asymptomatic thread. The idea that the surgeon general would beg everyone to not wear a mask is utter madness.
I completely agree with you, they make perfect sense from a public health perspective and it was a major fck up by most of the health organisations World wide to say they wouldn't (if intentional or not doesn't really matter).
However I was replying to a comment that was implying surgeons are using them to protect themselves. That is just wrong. There are enough good arguments for masks, one does not need to make incorrect statements.
So was it a straight out lie or incompetence? I remember reading here in HN that a lot of the masks do not actually protect you from the infection. But rather what a mask does is that it stops YOU from spreading the infection if you are infected.
I know it's hard to believe that the CDC et. al. would just blatantly lie to you. But consider that they were simultaneously saying that masks WOULD protect healthcare workers. Here's an example tweet where the surgeon general claims that masks do not protect regular people, but they do protect healthcare workers. This is obviously nonsensical, those two things can't both be true.
Healthcare workers are in all-day contact with COVID patients that have late stage symptoms (fluid in lungs) and they perform operations where fluids spray around.
Of course do not / do protect are simplifications as the effects are not binary. This is needed for communicating with the public, the meaning was "don't help much" vs "make a significant difference".
If the health authorities always used the precise and caveat-ridden language of medical journal papers in order to ensure each sentence is logically correct when interpreted literally, they wouldn't get any messages through.
The guidance about public usage of masks has changed in a lot of countries because the guidance changed from "no evidence that it protects the public from infection enough to make difference in epidemic spread" to "let's take even the small benefit of reducing spray from the potentially infected mask wearers". It's a sensible change when the mask shortages let up.
No need to fan the flames of lightly assuming malice from health authorities, it's a bad time for that.
I agree with you that right now it's absolutely crucial that organizations like the CDC maintain credibility, which is what makes this such a huge problem. Me calling out the lie is not the problem. The lie is the problem.
I still don't see lies or malice. The guy correctly recounts that like other national health orgs, they changed their recommendation, and tells why they did so.
Don't be fooled by the way he dances around the key point we're all talking about. He is still claiming the mask does not protect the wearer. He claims masks only help stop you from spreading it if you are infected.
Isn't this still technically almost correct? The surgeon's masks don't entirely filter the virus out of the air. However, they work for a society because they prevent the virus from spreading into the air from those who are already infected.
The surgeon general disagrees with this claim. He claims that the masks do protect the healthcare workers. You can see the claim in this tweet, where he also claims that the masks don't protect you.
Because properly equipped healthcare workers are also wearing eye protection. SARS-CoV-2 will quite happily enter at the eyes; in fact, eyes are a bigger attack surface than nostrils.
With respect to protection from SARS coronaviruses, wearing just a mask and no eye protection is like a hockey goalie wearing a helmet but no mask.
> like a hockey goalie wearing a helmet but no mask.
An apt comparison -- a damage reduction by 66% using only a fabric mask is massively worse than a damage reduction by 95% using proper PPE and procedures. In fact, it leaves you 7 times more likely to get infected (get hurt by a puck). But if anyone tried to sell the NHL-watching public the line that "helmets don't help", they would be rightfully humiliated in public.
I initially started following the WHO, CDC, and a few other health related agency Facebook pages when this pandemic actually started to take off in North America (mid-March).
I had to stop following the WHO and CDC Facebook pages because the value of information they were posting was so poor, I was IMHO better of not having access to it.
> How Tea Party Budget Battles Left the National Emergency Medical Stockpile Unprepared for Coronavirus
> Dire shortages of vital medical equipment in the Strategic National Stockpile that are now hampering the coronavirus response trace back to the budget wars of the Obama years, when congressional Republicans elected on the Tea Party wave forced the White House to accept sweeping cuts to federal spending....
> The stockpile’s mission has steadily expanded as it confronts new public health emergencies. With limited resources, officials in charge of the stockpile tend to focus on buying lifesaving drugs from small biotechnology firms that would, in the absence of a government buyer, have no other market for their products, experts said. Masks and other protective equipment are in normal times widely available and thus may not have been prioritized for purchase, they said.
> “It just was never funded at the level that was needed to purchase new products, to replace expiring products and to invest in what we now know are the really necessary ancillary products,” said Dara Lieberman, director of government relations at the Trust for America’s Health, a nonpartisan public health advocacy and research group.
Similarly, the ventilator problem was recognized in the mid-2000s and a solution was nearly ready by 2013. However a corporate acquisition derailed the project because the new owners thought a low-cost ventilator wouldn't be profitable enough and would compete with their other product lines:
> The U.S. Tried to Build a New Fleet of Ventilators. The Mission Failed.
> Thirteen years ago, a group of U.S. public health officials came up with a plan to address what they regarded as one of the medical system’s crucial vulnerabilities: a shortage of ventilators....
> Money was budgeted. A federal contract was signed. Work got underway.
> And then things suddenly veered off course. A multibillion-dollar maker of medical devices bought the small California company that had been hired to design the new machines. The project ultimately produced zero ventilators.
> That failure delayed the development of an affordable ventilator by at least half a decade, depriving hospitals, states and the federal government of the ability to stock up. The federal government started over with another company in 2014, whose ventilator was approved only last year and whose products have not yet been delivered...
> Government officials and executives at rival ventilator companies said they suspected that Covidien had acquired Newport to prevent it from building a cheaper product that would undermine Covidien’s profits from its existing ventilator business....
> In 2014, with no ventilators having been delivered to the government, Covidien executives told officials at the biomedical research agency that they wanted to get out of the contract, according to three former federal officials. The executives complained that it was not sufficiently profitable for the company.
When the Obama administration was consuming the GOP-created PPE stockpile in 2009 and not replacing any of it, his party controlled both houses of Congress... including a filibuster-proof majority of 60 in their Senate caucus for much of the 111th Congress. It's disingenuous to blame this on any "tea party" effect.
I wouldn't call the undersuply of masks a failure. There is only so much supply and creating new production lines takes month. Without fighting wars, how should it be possible to procure enough masks when the entire world needs masks?
The mistake lies in not demanding that each and everybody covers their faces with whatever they have. There is no need to filter the air if the virus is not released.
The idea is that they should have been stockpiling them for decades. We’ve seen 3 major respiratory epidemics in the last few decades and we had a high degree of confidence that we were due for another. Masks were cheap for a very, very long time before the outbreak.
