For the @nytimes, I wrote about why health authorities telling people they didn't need masks, and, besides they wouldn't wear them right, misfired and maybe even fueled hoarding. There will be many painful truths, and we need to learn to talk about them.
One big reason we don't have enough masks is that not only did China stop exporting them completely after COVID-19, China went and "bought up much of the rest of the world's supply." We should have ramped up domestic production in January but we didn't.😢
Sadly all those (well-meaning) posts from healthcare experts on how masks won't work for ordinary people because they won't wear them correctly likely encouraged hoarding even more. That was never a message that would work. No wonder I'm constantly seeing online ads for masks!
This is so obvious that it's painful. I know my piece will upset some, but learning to deal with painful truths is one of the skills we really need to learn, especially as there are so many of them exposed now.
Not forgetting that the Chinese government unleashed this pandemic in the first place with initial lies and cover-up: not racist. Claiming that universal mask wearing in Hong Kong and Taiwan (where it is mostly under control) was just superstition? Yeah.
Authorities say don't wear a mask unless you're sick but DO wear a mask if you are. How are you supposed to know? Plus, see key paper: many have mild, undetected illnesses but are infecting others. Universal mask wearing *would* have helped. Painful truth is we don't have enough.
Hey, could someone from @Twitter please try to purge the mask-seller bots that are appearing in response to this? As the article points out, it really sucks but here we are and the health care workers desparately need these masks more. @safety @delbius
Also, everyone who wrote such articles, please rethink the harm of this message. The weird claim that people in Asian countries (where this pandemic is much more under control) with the deep experience of SARS wore masks out of superstition is part of the reason we are here.
New paper: Hong Kong has not only contained COVID-19 for the moment, they've drastically reduced flu rates with social distancing, hygiene and near universal mask wearing. (Note: their government is unpopular and wasn't on board. The people acted anyway.)
Taiwan also quickly ramped up domestic production of masks and had a sensible plan to curb hoarding while ensuring access. Along with other sensible and non-draconian measures, they also contained COVID-19 for the moment despite a lot of travel with China.
This is another important point. The "flatten-the-curve" urgency will eventually lead to "life must go on while we wait for vaccines/herd-immunity" and some form of mask-wearing may well be necessary for the transition.
Yep. That's why we can't just say "wear masks only if you're sick." Besides the fact that we're not testing enough so people can't know if they're sick, and that many can be infectious without any symptomps, it just creates a stigma around wearing a mask.
Please read this whole thread. We are eventually going to have to release people from lockdown, and universal mask wearing (not N95, but surgical masks) is one way to do it with less harm.
Folks don't @ me BUT do it: arrange locally to allow people to donate N95 masks to hospitals, maybe exchange with surgical masks. Hospitals are out of N95s; CDC is telling them to use surgical masks instead; people are sitting on N95s but hearing some willing to donate/exchange.
Washington Post published another masks are superstition oped, so I’ll just put this here instead.
The tragedy of this kind of top down misinformation is when we are done with the shortage how are they going to tell everybody to mask up? As they have to if we are to get through this? (Folks don’t hoard and donate N95s now).
I'm going to say it outright. It's crystal clear that we'll have to adopt universal mask wearing as soon as we're over the shortage for healthcare workers. People still saying masks don't help, people won't know how to wear them, they can be harmful etc. are doing real harm.
Not admitting the obvious fuels mistrust and hoarding more. People aren’t idiots. And once the shortage is over, it’s going to be tough to switch to universal mask wearing, which is obviously a requirement to get through the next year.
Local friends, UNC hospitals need donations of N95 masks and other supplies. It's a travesty we can't protect our healthcare workers despite months of warning. Also, if you needed proof any mask is better than none: they will accept homemade masks as well.
The sooner we stop misinforming people about the need and efficacy of universal mask wearing, the better. Not telling the truth now will make it harder to pivot after the mask shortage. Also people can see through the bullshit and mistrust fuels hoarding.
This top-down mask misinformation will cause another crisis: other critical workers (stores, pharmacies, delivery) will stop showing up because lack of masks means they are at high risk. Yes, hospitals first but then everyone at the front line and then all of us need to mask up.
Great overview of the evidence on masks. Notes that review of SARS studies (same family of virus as the one causing COVID-19) found that "face masks were the most consistently effective intervention" (though keep washing your hands). Read it yourself!
Indeed. This is false. After the shortage, we will need to expand to everyone. How will we convince them? Lol, a week ago you couldn't possibly wear a mask correctly, soooo complicated, and didn't need them but now you can and must wear them. Won't work.
This is terrible. Top-down misinformation has made life difficult for mask-wearers. I think the only way forward is honesty plus real apologies from people who misinformed us. It's a real pickle, but very difficult otherwise to get to where we need to be.
Some evidence from Hong Kong that paper towel outer layer and 3-ply soft tissue inner layer may be an acceptable *and* disposable replacement for surgical masks—perhaps with a plastic folder face shield. Can people with access to labs pleeease test this?🙏
The article is from February 5, but at this point, tweeting it out like this goes in the same folder as the WMD lies about Iraq. I don't know how else to put it. We have solid evidence of asymptomatic spread, thus obvious need for universal mask wearing.
“Television broadcasts, subway station announcements and smartphone alerts provide endless reminders to wear face masks”. The piece doesn’t mention it but the Korean government distributes masks to make sure everyone has them. Masks aren’t an afterthought. Https://
From an article that compiled interviews with top experts on what works to slow the spread of this coronavirus. Universal mask wearing!
Hong Kong is the densest city in the world. It has a tiny fraction of New York’s cases. Almost everyone wears masks though and they take the distancing seriously.
Future generations will be driven batty by the amount of concern over contamination from cardboard boxes—a tail risk: porous surface, exponential decay—compared with protecting the pathways to OUR RESPIRATORY SYSTEM WITH MASKS FOR A RESPIRATORY ILLNESS WITH ASYMPTOMATIC SPREAD.🤬
The Czech Republic converted, quickly, to universal mask wearing, including home-made masks as necessary about a week ago. There really are no arguments left against promoting universal mask wearing and yet media/guidelines still say no need.
Another misinformation I see floating widely: without eye-protection masks are useless. No. It's a respiratory disease. Goggles help lessen risk, sure, but key route is respiratory. Masks are key. Surface contamination from boxes is similarly a tail risk. (But wash your hands!)
When misinformation comes from the top (Saddam's Iraq has WMD!), as with masks, the job of journalists is to investigate, to speak with independent experts *and* find whistleblowers within these organizations and get the truth out there. Sooner the better.
Finally. Also need more on WHO—especially their China response/lack thereof—and more CDC. Most media still parrot CDC/WHO on everything without enough analysis. Both orgs *still* do much excellent work but are too important to act as if they are perfect.
We need to model whether distributing ~four surgical masks per person, to be sanitized via 160F oven for 30 min and reused, and worn universally for the next few weeks in hotspots like NYC might be a better way of preserving PPE for hospitals by reducing the pileup at their door.
People leaving NYC is no solution, as their necessary self quarantine in the next few weeks will inevitably require outings for food etc. Mask wearing must continue wherever people go. We can do this now maybe in the hotspots. Maybe NYC hospitals can lead this. Someone should.
They got together in March!They all washed their hands. They sat apart. Nobody had symptoms. They didn’t wear masks. It’s a respiratory disease with asymptomatic spread. Our denial here is increasingly at anti-vaxer level.
Not picking on Matt (Love @thenib!) and the reaction is understandable but yes, the internet rando with the touchscreen is correct and the WHO is wrong. It's as if the WHO is telling us Saddam has WMD. We need to stop fighting the last misinformation war.
Germany's medical association is on board with universal mask wearing. It is perhaps the easiest tool with most bang for the buck we could deploy right now, today, in the United States. And yet we are drowning in top-down misinformation. #maskeauf
Please look at the chart, folks.
I’m seeing people modeling length of lockdown time needed in the US using Wuhan parameters. What we’re doing isn’t anywhere near Wuhan did. Even the best we’re doing doesn’t resemble Wuhan. There are categories of action that were done in Wuhan that we haven’t even discussed.
I hope this is true!!! But please, start today. Make a homemade mask and wear it. Use a surgical mask—hopefully CDC can give us guidance on sanitization and reuse. Hospitals can distribute a few surgical masks per person—lessening the pileup at their door.
Yeah, please stop the hemming-and-hawing writing folks. The evidence is clear, the arguments are clear. Don't bury the findings. Universal mask wearing is one of the best ways to protect the whole community during a pandemic with asymptomatic transmission.
Also, based on a ridiculous and false misrepresentation of my piece on the widespread asystemic thinking that made things worse, @NateSilver538 told me I should “sit this out” and won’t correct his caricature of me. I *refuse* to “sit it out”—but putting it here for the record.
Another important op-ed on masks from @jeremyphoward in the Washington Post. We should especially pay attention to the Czech Republic: they, too, have a shortage. So they started with a massive campaign for homemade masks. Cultures can change and adapt.
One senator is on board!
The mask misinformation has gotten so bad that many people don't realize this is a RESPIRATORY ILLNESS. The main method of transmission is EXHALATION/INHALATION. People are bleaching cardboard boxes and then going shopping/to work without masks. (screenshot, not blaming person).
Another excellent article by a doctor on why we need to switch to masks for all, ASAP. Also sensible advice on managing the shortage while prioritizing medical workers. Slowing this epidemic with masks is how we will ultimately protect our medical workers!
Another European country is looking at switching to universal mask wearing. The evidence is clear. Still need to keep distancing and hand washing but it’s a potent tool in the arsenal.
🚨🚨‼️ Dr. Fauci on masks and asymptomatic spread: "There is some rationale we should use [masks] much more." YES. YES! They may shift! I'm begging everyone—especially editors—give them space to change guidance. Take your finger off the clickbait on this.
Another lengthy paper. Also I know that other doctors, virologists and epidemiologists are rushing with preprints and other compilations of evidence. The tough part will be switching messaging, but we have to do that.
I risked a lot to publish that mask oped weeks ago—against CDC and WHO guidance. Wished someone else would. Been called everything under the sun. But the scientific community is rallying around masks.💪But please, please, give the CDC/WHO space to shift.🙏
Many more countries are sensibly adopting masks for everyday use.
My mask plan is homemade cotton or paper towel/tissue or procedure masks UV-C sanitized for re-use. Plan for trimming my bangs isn’t so advanced, send help. #Masks4All
How is this happening? Is this true? Why aren’t masks rationed? “Roughly 280 million masks from warehouses around the U.S. had been purchased by foreign buyers and were earmarked to leave the country, according to the broker — and that was in one day.” Https://
This may be happening! YES! Finally! 🤞🧿🙏
More and more countries are accepting the overwhelming evidence and science that we clearly need universal mask wearing to combat a respiratory infection with asymptomatic spread. The sooner the better: first home-made, then ramped up domestic production.
Just adding this here. Also reminder that a peer-reviewed publication looking at what worked for SARS, same family as COVID, found that *masks* were the most effective intervention—better than hand-washing. Keep washing hands and distance though! Need all!
We should've ramped up national production in January, distributing N95s to hospitals and surgical masks to people like Taiwan did. Only three *total* deaths in Taiwan as of today, despite extensive travel to China before. But here we are. Let's start now.
Yes, I've been trying to make that point for weeks. Distributing some masks now: fewer intubations in three weeks. Each intubation has massive need for PPE compared to that mask. The trick is managing the transition without depriving medical workers now.
On the one hand, thank you. On the other hand, it was a hard piece to write, personally (a lot of risk). On the other other hand, the science was clear and media should challenge authorities when/if the science/facts warrant it. Otherwise what's the point?
In the digital age, neither journalists nor pundits need to spend too much time merely repeating what the authorities say, but rather also evaluating it in a credible and fact and science based manner. No science/facts=crank. No evaluation=irrelevant.
See this screenshot of Taiwan's action on masks (link has list of all its actions). Taiwan had extensive ties/travel with China but it has a total of five COVID-19 deaths and only a few hundred cases. Its schools have been open for more than a month.
Health care workers! Please consider signing this petition asking for CDC and the WHO to give clear, evidence-based guidance on masks. Every person who's not infected is one less patient you have to care for during this time. Folks, feel free to share.
These articles aren’t even attempting to be coherent anymore. There is no known evidence of harm. It’s a lot of weird speculation—all of which flies in the face of all the overwhelming scientific evidence we have.
But the world is moving. Time for WHO and the CDC to catch up to making evidence-based recommendation for face masks. People need guidance on sanitization/reuse for cloth, and we need rationed distribution once we have surgical mask production catch up.
Finally. Finally.
I had people tell me that my insistence on continuing to point out the overwhelming scientific evidence in favor of universal mask wearing was about my “anxiety”. In reality, I have the privilege of staying home. Many don’t. This was always about them.
Yep. Totally okay for ordinary people to think CDC/WHO got this right. They normally do! But if you needed to separate the good science journalist from the one that parrots official advice without analytic thinking/deep digging themselves... Litmus moment!
Yes! Finally! One thing left: CDC should issue guidelines for best practices for home-made masks and their re-use and sanitization, and consider distributing/rationing a few surgical masks per person in hotspots with instructions for sanitization/reuse.
The WHO is also, finally, finally, finally shifting. WHO, like the CDC, should quickly issue guidelines for best practices and sanitization. Time for them to step up and do what they are supposed to do, and can do.
I can't wait to put an end to this thread.
The WHO finally "encourages" the public to wear masks. What a tragic waste of time and a needless squandering of medical authority amidst a pandemic. By March, there was enough evidence of presymptomatic and asymptomatic transmission for me to write this.
Also not only is there no evidence for this claim, there is emerging evidence for the opposite, and there is decades of evidence from other safety devices that this concern is not warranted, and if this was a thing, it would also apply to hand-washing. 🙄
Here's a preprint of a paper (I'm a co-author) where we review the "false sense of security" claim and explain why it doesn't stand to evidence at all, and why, on the contrary, universal masks would be expected to lessen stigma and heighten solidarity.
If some past person had told me I'd spend most of my energy in the first months of a pandemic arguing against CDC and WHO guidelines, that they would drag their feet despite mounting evidence, and that we'd rely on grassroots movements instead, I'd have dismissed them as nuts.
I've been arguing for months that the most likely outcome of masks would be INCREASED adherence to distancing—because that's what social science suggests. That baseless "false sense of security" claim had no evidence for it. Now, experimental confirmation.
So Dr. Fauci has just said the public was told not to wear masks because they "were in very short supply." I just want to remind everyone what it was like in March—viral threads telling us not to wear masks. (Not picking on one person here—she was misled like everyone else).
How we got here: we were told that masks increased wearer's risk compared to no masks—and many experts and media parroted this uncritically despite absolute lack of evidence for this. And I could point to asymptomatic transmission in mid-March because there were already papers.
Don't focus on any one person! This was practically the entire ecology in March with authorities telling us masks were a risk and unnecessary—instead of the truth: shortage—and "experts"/media parroting them uncritically instead of looking at actual research or Asian expertise.
Of course! I wrote this, too, when people said "what about the shortages"? First, ramp up production then! Second, cloth masks are good for now. Third, each intubation requires tons of PPE! Every reduced case prevents deaths *and* helps the shortage.
Once again, Dr. Fauci says that they did not advise masks earlier because "there was a paucity of equipment that our healthcare workers required." But we were told masks were unnecessary, even harmful. They forgot "a pandemic is a communication emergency".
I don't live in the same universe as this CNN correspondent. Dr. Fauci admits they didn't recommend masks before—and even said they may harm, don't work—because of the shortage, and that's sign of a "best communicator? No, no, that's how you lose trust.
Could some *actual* reporters dig into that, and also this?
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