I have read with interest the back and forth discussion in recent days with regards to masks, the effectiveness of mask mandates, and should be continue to wear a mask after vaccination when knowingly coming in contact with a known positive case. I definitely have appreciated the back and forth and I think it has to the greatest extent possible, remained very civil. Interesting points have been made by both sides and I believe everyone is earnest in their beliefs. Thanks for keeping the thread as positive as possible with regards to a contentious issue.
I think a post by Civilized helped to really frame the whole mask mandate controversy and why people have strongly held beliefs. Masks have become a sign of government control and a large number of people have strongly held beliefs about the role of government and the amount of control it can exert over our lives. The pandemic and the associated health policies have tested all of us over the past year. Some of the policies make sense, so they are more easily adopted. Others, such as mask wearing mandates have been met with resistance, since they are a very visible sign of government's control.
Just the use of the word "mandates" designates a level of control. We all have to recognize that in the US, many people have a very deep-seated distrust of the collective government and as such, policies that do not appear sound (one day Fauci says don't wear a mask and later he says you must) are met with distrust. This is why messaging by the government and national leaders is so critical. You only have one chance to get it right and if you change your guidance or messaging, it generates distrust. Couple this with an already deep-seated distrust and you get reactions like you see today on this thread and all over the nation.
I am at a point in the pandemic (I actually reached is months ago) where I do not blame any one individual for the spread of cases. As I mentioned in earlier posts, I have encountered people on Twitter who use cases as evidence of "Trumpists" (her term, not mine) not wearing masks and she likes knowing how many cases we have, since it helps her to know how many "Trumpists" are not wearing masks. Obviously, she views what is happening through a political lens. I on the other hand recognize that even if we all wore masks, the virus would still exist and spread. This reminds me of the ridiculous thing the last CDC director said about masks being more powerful than vaccines (I am paraphrasing, but you remember what was said). It was absolutely reckless and further emphasizes my point no messaging. People think, if we all wear masks the virus will go away and this is just not going to happen.
Case in point (I have mentioned this in the past), I have two good friends who became infected while wearing masks. They both know who the infected person was while they were wearing masks and the person they came in contact with was also wearing a mask. They told me they were very surprised when they were diagnosed (got tested after learning the person they contacted was infected), since they had been wearing a mask ("correctly" in their words) at the time. Both of their cases were very mild and I think this could likely be due to the fact they were wearing masks - a reason I will get to shortly.
As I said, I have read most of the comments in this thread recently, including Mormad's question about visiting someone who is known to be infected with Covid-19, after you are vaccinated. It got me thinking about systems (after all, my education is Industrial Engineering and this is what we are taught to think about) and how a systematic view would apply to both vaccinations and mask wearing. As some of you know from my past posts, I am not a big believer in mask wearing after being vaccinated and this comes, in part, from viewing mask wearing and vaccination as an entire system.
Think of is this way, if you have been vaccinated, you have 85% to 100% protection against severe disease and in most cases, 100% protection against hospitalization and death (chart attached below). These are very good percentages. I then started looking for studies that would tell me how protective (from a quantitative point of view) wearing a mask would be. In this quest, I found a very interesting meta analysis (I will link it below) on the CDC's website. In the study, it pointed out the following:
"Increasing rates of asymptomatic and mild infection with COVID-19 have been seen over time during the pandemic in settings adopting population-level masking."My initial reaction was, Wow. How could this be? Wouldn't you expect mask wearing and in turn, mask mandates to be lowering infection levels in the population? I think the key here is the use of the word "asymptomatic." Remember what I said earlier about my friends. They were wearing masks, they became infected while wearing the mask, and were surprised when they tested positive. They were surprised, since they were asymptomatic. Some other studies were cited in the analysis, pointing to the following with regards to mask wearing and asymptomatic cases:
"A report from a pediatric hemodialysis unit in Indiana, where all patients and staff were masked, demonstrated that staff rapidly developed antibodies to SARS-CoV-2 after exposure to a single symptomatic patient with COVID-19. In the setting of masking, however, none of the new infections was symptomatic.""in a recent outbreak in a seafood processing plant in Oregon where all workers were issued masks each day at work, the rate of asymptomatic infection among the 124 infected was 95%.""An outbreak in a Tyson chicken plant in Arkansas with masking also showed a 95% asymptomatic rate of infection." So, what am I left to conclude? Here's my thinking:
1. Do mask mandates lower the spread of symptomatic cases of Covid-19? I believe the answer is yes, based on what I just posted.
2. Do mask mandates lower the spread of asymptomatic cases of Covid-19? Based on the studies cited and the comments in the analysis (and my own personal experience with my friends - yes I know it is anedotal), I would say the answer is yes, but not in 100% of cases. A couple of the studies I mentioned were congregate settings and I do believe in these types of settings, mask wearing is not 100% and in the cases cited, it was only 5% effective in reducing asymptomatic cases. If you assume many, due to the nature of the work (manual labor in difficult conditions) were not wearing masks properly, it is likely the protection is much greater.
3. Is the wearing a masks, after being vaccinated, additive protection? This is where my systematic approach comes in. If a vaccine gives you 85% to 100% protection against symptomatic infection, will a mask give you more protection. In this case, it depends. If you already have 95% to 100% protection from asymptomatic infection from a mask, it is not likely the mask will give you any more protection. In these cases, a vaccinated person wearing a mask would have redundant protection (ie., no added benefit). You can not have greater than 100% protection, just like you can not give more than 100% effort. If you assume the protection threshold at the 85% level, then it is possible wearing a mask will give you added protection (assuming it is additive), but this protection level would be an incremental ~10%.
4. Did people engage in less than safe practices while wearing masks, such as being in large, indoor crowds and still get infected? I believe the answer to this is yes. The masks likely gave people the sense that if I wear a mask, I can engage in behaviors that still put me at risk. In these cases, mask wearing did not prevent the spread and in some ways, it encouraged it. Remember, the CDC has advised (and Dr. Birx said many times) that you have to social distance while wearing a mask. I believe many people ignored this advice and assumed the masks would allow them to act in a more risky manner.
5. Was there a positive to the mask mandates and the wearing of masks? The analysis I cited would suggest there was, but it is not for the reason you would think. It was due to the fact that the masks prevented symptomatic and severe cases and in turn, allowed asymptomatic people to become infected and develop antibodies and T-Cells. In a backward kind of way, it was a positive. Here is the exact quote from the analysis:
"Although asymptomatic infection can be problematic in terms of increasing spread,4 it can also be beneficial.14 Higher rates of asymptomatic infection with SARS-CoV-2 lead to higher rates of exposure, as was seen with antibody testing campaigns in Japan48 or the surveillance study in the pediatric hemodialysis unit in Indiana.39"I had to read this a few times for it to sink in, but it is accurate. So, where does this all leave me on the topics discussed over the past few days? Here is where i land.
1. Would visit a known Covid infected person after being vaccinated without wearing a mask? Before answering, a brief story. When I was a kid (I've mentioned this before too), my mom sent my brother and I to play for an entire day with neighbors who were infected with the measles, in hopes we would become infected. This was before we had a measles vaccine and it was considered better to catch the measles as kids instead of in adulthood. Needless to say, it did not work. My brother and I never became infected and several years later, we got the vaccine after it was developed. Would I knowingly do this with something as deadly as Covid-19? No. Would I do it after being vaccinated? Likely not, but my fear level would be greatly reduced.
2. Do we need to continue wearing masks in public after vaccination? As I have stated before, I believe we should continue wearing them until them until 50% of the population has been vaccinated or three months after vaccines become so prevalent that anyone that wants one, can get one. When will this be? Likely in mid to late June.
3. Do I think people who are vaccinated can meet together and not wear a mask? Yes.
4. Do I think you need to wear a mask outdoors, even with other people around, after being fully vaccinated? No.
5. Will mask mandates remain longer than they need to be in effect? Unfortunately, I believe the answer is yes. Fear is a powerful thing and we have had a year of the media and national leaders spreading irrational fear. For this reason, mask mandates will likely remain in effect longer than required and the shaming of people not wearing masks will continue.
If you made it this far, thanks for taking the time to read my lengthy post. I am sorry it is so long, but I had a lot to say about the subject. If your opinion on the topic is different than mine, it is okay. You might not agree with some (or all) of what I said and that is okay. I like hearing different views and as I mentioned before, I appreciate honest and fair discussion.
Here is the link to the study I mentioned and the chart on vaccine efficacy (chart source: Dr. Monica Gandhi):
Masks Do More Than Protect Others During Covid-19Vaccine Efficacy:
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