Keeping the coronavirus from infecting healthcare workers(newyorker.com)
newyorker.com
Keeping the coronavirus from infecting healthcare workers
https://www.newyorker.com/news/news-desk/keeping-the-coronavirus-from-infecting-health-care-workers
135 comments
I recently co-authored a scientific commentary on this, ask me anything!
"Promoting simple do-it-yourself masks: an urgent intervention for COVID-19 mitigation" (Svara et al. 2020)
Pre-print available at https://link.medium.com/LY7RRNr2X4
Summary: "We demonstrate that widespread use of masks by the general population could be an effective strategy for slowing down the spread of COVID-19. Since surgical masks might not become available in sufficient numbers quickly enough for general use and sufficient compliance with wearing surgical masks might not be possible everywhere, we argue that simple do-it-yourself designs or commercially available cloth masks could reduce the spread of infection at minimal costs to society."
"Promoting simple do-it-yourself masks: an urgent intervention for COVID-19 mitigation" (Svara et al. 2020)
Pre-print available at https://link.medium.com/LY7RRNr2X4
Summary: "We demonstrate that widespread use of masks by the general population could be an effective strategy for slowing down the spread of COVID-19. Since surgical masks might not become available in sufficient numbers quickly enough for general use and sufficient compliance with wearing surgical masks might not be possible everywhere, we argue that simple do-it-yourself designs or commercially available cloth masks could reduce the spread of infection at minimal costs to society."
The biggest challenge is to overcome the mental block of decades of onetime use masks that have to be disposed in incinerators and be produced by ISO 9001 certified medical factories.
During world war 2 it was normal to use reusable cotton masks. They just need to be put into boiling water for a few minutes to kill sars-cov-2 at 100%.
You should try to get into touch with C. Drosten from Charité hospital Berlin. He recently stated in an interview that self-made masks could have a certain value, so he is not totally averse to this concept and Spahn [1] will listen to him.
China has been promoting it, now czech republic is doing it. If Germany also starts promoting it, that will help immensely.
The same goes for the hand sanitizer, any +70% alcohol/ethanol will do. No need to be from a factory with medical certifications.
I am in France, there is a total lock down here but police still wears no masks and so does nobody else. Super markets have no hand sanitizer at the entrance so the virus will continue to spread.
Masks cost nothing compared to the economic damage of the shut down.
[1] German minister of health
Edit: For those downvoting me, I'd sincerely be interested to hear your arguments.
During world war 2 it was normal to use reusable cotton masks. They just need to be put into boiling water for a few minutes to kill sars-cov-2 at 100%.
You should try to get into touch with C. Drosten from Charité hospital Berlin. He recently stated in an interview that self-made masks could have a certain value, so he is not totally averse to this concept and Spahn [1] will listen to him.
China has been promoting it, now czech republic is doing it. If Germany also starts promoting it, that will help immensely.
The same goes for the hand sanitizer, any +70% alcohol/ethanol will do. No need to be from a factory with medical certifications.
I am in France, there is a total lock down here but police still wears no masks and so does nobody else. Super markets have no hand sanitizer at the entrance so the virus will continue to spread.
Masks cost nothing compared to the economic damage of the shut down.
[1] German minister of health
Edit: For those downvoting me, I'd sincerely be interested to hear your arguments.
If the intended goal of wearing a mask is to protect others (since you have no way of knowing that you're not infected), then there's no practical reason that a mask can't be reused, whether sanitized or not.
> They just need to be put into boiling water for a few minutes to kill sars-cov-2 at 100%.
I was looking for information on (high) heat killing viruses such as sars-cov-2. Are you able to point to a reliable source on this?
I was looking for information on (high) heat killing viruses such as sars-cov-2. Are you able to point to a reliable source on this?
> I was looking for information on (high) killing viruses
They're not really alive, so they can't be killed. But you can destroy vital parts of them and make them unable to reproduce.
https://en.wikipedia.org/wiki/Denaturation_%28biochemistry%2...
They're not really alive, so they can't be killed. But you can destroy vital parts of them and make them unable to reproduce.
https://en.wikipedia.org/wiki/Denaturation_%28biochemistry%2...
Respectfully, I wish people would stop popping into discussions about coronavirus to say "Actually, ...".
Most educated people know that viruses aren't alive in the traditional sense. People who aren't as educated simply don't care, and I don't blame them. Using the more scientifically precise term helps nobody, except scientists, in this situation.
Should software engineers stop using the word "kill" in POSIX-land because CPU processes aren't really "alive"? Give me a break.
Most educated people know that viruses aren't alive in the traditional sense. People who aren't as educated simply don't care, and I don't blame them. Using the more scientifically precise term helps nobody, except scientists, in this situation.
Should software engineers stop using the word "kill" in POSIX-land because CPU processes aren't really "alive"? Give me a break.
I didn't bat an eye at this until you dropped in with a "Respectfully..." that sounded awfully insincere. Did your sentence really intend to convey respect? Because it came off as disingenuous.
You're searching for malice where there is none. I said nothing disrespectful.
> Respectfully, I wish people would stop popping into discussions about coronavirus to say "Actually, ...".
I answered his question while also correcting a minor mistake. Also I'm not sure what you're quoting there.
> Most educated people know that viruses aren't alive in the traditional sense. People who aren't as educated simply don't care, and I don't blame them.
Are you trying to insult your grandparent? Most people on HN aren't willfully ignorant and are quite open to new knowledge.
I answered his question while also correcting a minor mistake. Also I'm not sure what you're quoting there.
> Most educated people know that viruses aren't alive in the traditional sense. People who aren't as educated simply don't care, and I don't blame them.
Are you trying to insult your grandparent? Most people on HN aren't willfully ignorant and are quite open to new knowledge.
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It’s controversial. Some would characterize viruses as alive (because they replicate and evolve). So it’s fair to say that you can kill them (prevent from replicating). Debating the semantics of this is not helpful.
And in the non-controversial case - i.e. prions, people generally don't use the term "kill", they use the term "deactivate".
Debating the classification of life, while otherwise interesting, should not derail a conversation about practical steps to fight an ongoing pandemic.
Heat at 56°C kills the SARS coronavirus at around 10000 units per 15 min (quick reduction).
Hence I'd assume that boiling will be reasonably effective.
Source: WHO https://www.who.int/csr/sars/survival_2003_05_04/en/
Hence I'd assume that boiling will be reasonably effective.
Source: WHO https://www.who.int/csr/sars/survival_2003_05_04/en/
Are you aware of any viruses not killed by high heat?
According to an article on Quora, "At What Temperature Do Viruses Die?" ¹, for what it's worth:
> All [known] strains of virus can be inactivated at 70 °C.
For reference, an autoclave used for sterilization is around 121 °C.
> A minimum temperature range to inactivate most virus is 48°C to 60°C. Some virus still able to survive at temperature below 60°C e.g. adenoviruses(dsDNA naked virus) relatively thermostable, it able to withstand temperature at 56°C for 10min.
¹ https://www.quora.com/At-what-temperature-do-viruses-die-1
> All [known] strains of virus can be inactivated at 70 °C.
For reference, an autoclave used for sterilization is around 121 °C.
> A minimum temperature range to inactivate most virus is 48°C to 60°C. Some virus still able to survive at temperature below 60°C e.g. adenoviruses(dsDNA naked virus) relatively thermostable, it able to withstand temperature at 56°C for 10min.
¹ https://www.quora.com/At-what-temperature-do-viruses-die-1
Viruses exist where there is life, it's not a mound I'm willing to die on, but it's accurate here on Earth. There is life that lives in temperatures higher than 70 °C, therefore there are viruses that can survive in temperatures higher than 70 °C: http://www.rcn.montana.edu/Publications/Pdf/2005/4_18Young.p...
Thank you, I stand corrected! Please everyone disregard my previous comment and find a more reliable source of facts.
I imagine viruses from underwater volcanic plumes would be pretty heat tolerant. But I don't know if they are a danger to humans or if we are too cold to host them.
How hot is high heat? There are viruses that infect archaea that live in extreme conditions including near-boiling water.
Here's a mask pattern and some additional information from Forbes. It also links to the CDC's comment.
https://www.forbes.com/sites/tjmccue/2020/03/20/calling-all-...
> In settings where facemasks are not available, HCP might use homemade masks (e.g., bandana, scarf) for care of patients with COVID-19 as a last resort. However, homemade masks are not considered PPE, since their capability to protect HCP is unknown. Caution should be exercised when considering this option.
https://www.cdc.gov/coronavirus/2019-ncov/hcp/ppe-strategy/f...
This is because the medical industry needs proven methods, and they still suggest homemade masks as a last resort. Maybe we should all be wearing homemade masks in public.
https://www.forbes.com/sites/tjmccue/2020/03/20/calling-all-...
> In settings where facemasks are not available, HCP might use homemade masks (e.g., bandana, scarf) for care of patients with COVID-19 as a last resort. However, homemade masks are not considered PPE, since their capability to protect HCP is unknown. Caution should be exercised when considering this option.
https://www.cdc.gov/coronavirus/2019-ncov/hcp/ppe-strategy/f...
This is because the medical industry needs proven methods, and they still suggest homemade masks as a last resort. Maybe we should all be wearing homemade masks in public.
I've been promoting this idea as well.
https://www.facebook.com/edelsmurf/posts/10157054028823201
I've sent pleas to several local and national government agencies and health directors, but it's unlikely that such e-mails will be read, so information needs to be disseminated another way. The fact that the western world hasn't called for widespread use of even cloth masks is unconscionable. Presume you're already infected to protect others.
I've sent pleas to several local and national government agencies and health directors, but it's unlikely that such e-mails will be read, so information needs to be disseminated another way. The fact that the western world hasn't called for widespread use of even cloth masks is unconscionable. Presume you're already infected to protect others.
For reference, the government of Czech Republic made masks (of any type, including self made or even scarfes) mandatory while out of home. This has been in force for a few days & is actively enforced wit a couple people already getting hefty fines.
IMHO this is a really good idea, especially because people who are infected and dont know that yet are less likley to infect others. How good the mas is at protecting you is pretty much secondary concern at this point in time.
IMHO this is a really good idea, especially because people who are infected and dont know that yet are less likley to infect others. How good the mas is at protecting you is pretty much secondary concern at this point in time.
> the government of Czech Republic made masks (of any type, including self made or even scarfes) mandatory while out of home.
That is an amazingly forward-thinking position that we should applaud. The mask thing will be one of those “obvious” things that we’ll look back on in a couple of years and shake our heads at.
That is an amazingly forward-thinking position that we should applaud. The mask thing will be one of those “obvious” things that we’ll look back on in a couple of years and shake our heads at.
Unfortunatelly, this (mandatory masks) seems like one of the Czech Republic rules that has not yet been widely copied elsewhere.
BTW, its quite an interesting cognitive change - basically in a span of about two days everyone in public has a mask, even anchors and politicians in news coverage! Even the sign language interpetters!
Also I found out I feel rather uneasy now watching footage from affected areas, some of them in worse situation than us, with people not wearing any masks.
Such a simple way to protect otjers once you thing about it a bit, yet not universally adopted so far...
BTW, its quite an interesting cognitive change - basically in a span of about two days everyone in public has a mask, even anchors and politicians in news coverage! Even the sign language interpetters!
Also I found out I feel rather uneasy now watching footage from affected areas, some of them in worse situation than us, with people not wearing any masks.
Such a simple way to protect otjers once you thing about it a bit, yet not universally adopted so far...
The argument is usually that it has limited effect when it comes to protecting the wearer.
Simpler masks or home made masks can probably prevent transmission somewhat from the wearer by reducing the reach of droplets.
The argument against masks is based on 1) that people want them to protect themselves 2) that there aren’t nearly enough masks to do so.
So as I understand it, the authorities that say “don’t wear a mask” isn’t answering the question “would transmission be reduced if everyone wore a mask?”, but rather the question “Should I get a mask to protect myself”. Those are two very different questions.
The argument against masks is based on 1) that people want them to protect themselves 2) that there aren’t nearly enough masks to do so.
So as I understand it, the authorities that say “don’t wear a mask” isn’t answering the question “would transmission be reduced if everyone wore a mask?”, but rather the question “Should I get a mask to protect myself”. Those are two very different questions.
I haven't seen any evidence supporting the argument that they do not protect the wearer. The argument seems to be that they aren't 100% effective at that, and therefore shouldn't be used for those purposes, which doesn't make any sense. Even 20% reduction in the amount of incoming droplets is significant - both for protecting the wearer, and for reducing R0.
Part of the reasoning is that people who believe masks provide them full protection will take more risks than otherwise. Combine that with hoarding and other behaviors and it's possible that promoting widespread use of masks would cause new problems the west doesn't already have.
If we had successfully promoted "wear a mask when you're sick" as general US policy in advance we probably wouldn't have these supply chain issues and it would be safe to advise people just wear a mask at all times during the crisis. We didn't, so most people don't have any masks, which means they're going to look at this crisis + advisory and panic buy a big pile of them when supplies are already limited.
If we had successfully promoted "wear a mask when you're sick" as general US policy in advance we probably wouldn't have these supply chain issues and it would be safe to advise people just wear a mask at all times during the crisis. We didn't, so most people don't have any masks, which means they're going to look at this crisis + advisory and panic buy a big pile of them when supplies are already limited.
I agree that public health authorities have not lied, but that's not the point. "Would transmission be reduced if everyone wore a mask?" is exactly the kind of question public health authorities should be asking! The answer seems to be "yes" even for homemade masks. So, public health authorities should be promoting massive production, testing, and use of masks.
I use a home-made mask. It's made from two layers of fabric from a "fitness t-shirt" with a layer of filter paper from an air filter in between. I wash it in the washing machine and replace the filter between each use.
It completely covers my nose and mouth and chin and wraps around over my ears. I tie it in the back with 4 ties one on the top edge and one on the bottom edge.
I have friends tell me "that's dangerous! It may trap particles behind it and make you sicker!"
I'm willing to take my chances. I believe
- combined with my eyeglasses, it will keep me from touching my face and eyes when I'm out
- if someone a few feet away coughs, the large droplet that the virus is riding on will surely get trapped. The pores don't need to be virus-sized to do that.
I have a proper "Gas Mask" but I want to save that for a gas attack. That's why we all have one.
The NY Times ran an op-ed about this:
https://www.nytimes.com/2020/03/17/opinion/coronavirus-face-...
I've also seen people mis-wearing N-95 masks. I was behind a couple in the supermarket yesterday who were wearing them and every few minutes they were reaching up to readjust their noseclips. I got this on video, it was so perversely amusing to me. I hope they don't get sick.
It completely covers my nose and mouth and chin and wraps around over my ears. I tie it in the back with 4 ties one on the top edge and one on the bottom edge.
I have friends tell me "that's dangerous! It may trap particles behind it and make you sicker!"
I'm willing to take my chances. I believe
- combined with my eyeglasses, it will keep me from touching my face and eyes when I'm out
- if someone a few feet away coughs, the large droplet that the virus is riding on will surely get trapped. The pores don't need to be virus-sized to do that.
I have a proper "Gas Mask" but I want to save that for a gas attack. That's why we all have one.
The NY Times ran an op-ed about this:
https://www.nytimes.com/2020/03/17/opinion/coronavirus-face-...
I've also seen people mis-wearing N-95 masks. I was behind a couple in the supermarket yesterday who were wearing them and every few minutes they were reaching up to readjust their noseclips. I got this on video, it was so perversely amusing to me. I hope they don't get sick.
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.
"Homemade masks appear to be reasonably effective" is hardly a compelling case.
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.
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.
How can you rule out the possibility that mask use has a net negative effect so easily?
Wearing masks is common in several asian countries even before c19 was a thing and I'm not aware of anyone showing that it's causing harm at the population level. I consider that reasonable evidence that wearing them has no significant negative physiological effects.
I could see negative behavioral effects such as making people more careless because they're feeling safer. But again, effective containment in above-mentioned countries would also serve as evidence against that actually being an issue.
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.
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.
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Simple reasoning. We know that viruses can be transmitted through saliva. Covid-19 generally presents with a cough. Coughs aerosolize saliva. Wearing a mask or face covering catches most particles, and absorbs energy from all particles, so they dont travel as far. Less virus mass, and a smaller projection plume will result in less spread. Less spread results in a lower R0.
I realize that you are just enjoying being contrary here, but please try to think through your argument and ensure it isn't incorrect in itself before posting.
I realize that you are just enjoying being contrary here, but please try to think through your argument and ensure it isn't incorrect in itself before posting.
Ah! prefer inaction to potentially imperfect action argument, I see.
Also, how does "what we know" make this unlikely?
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Another study on homemade masks: https://www.researchgate.net/publication/258525804_Testing_t...
"Both masks significantly reduced the number of microorganisms expelled by volunteers, although the surgical mask was 3 times more effective in blocking transmission than the homemade mask. Our findings suggest that a homemade mask should only be considered as a last resort to prevent droplet transmission from infected individuals, but it would be better than no protection."
This is by no means a personal attack but this is approximately the thought pattern the parent comment is arguing against.
Absence of evidence does not prevent you from making decisions or otherwise coming to conclusions. The fact is, you can make decisions with no evidence at all. Your outcome may be no better than chance but also likely no worse.
Not making a decision can be worse than chance, especially in time critical or low information environments and if you always “wait for the evidence” you will end up being worse than a magic 8-ball at the most crucial moments.
Absence of evidence does not prevent you from making decisions or otherwise coming to conclusions. The fact is, you can make decisions with no evidence at all. Your outcome may be no better than chance but also likely no worse.
Not making a decision can be worse than chance, especially in time critical or low information environments and if you always “wait for the evidence” you will end up being worse than a magic 8-ball at the most crucial moments.
There is no "not making a decision". It's not that you can make decisions without evidence, you must make a decision even without evidence. Not wearing a mask is as much as a decision as wearing one.
Professional and Home-Made Face Masks Reduce
Exposure to Respiratory Infections among the General
Population. Marianne van der Sande. 2008. doi:10.1371/journal.pone.0002618
Here's a source that supports OP's claims: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3373043
I run freesewing.org, the website linked to in the Forbes article (1).
The university hospital here in Antwerp where I live is actively reaching out to the community asking them to make masks. (2)
I'm not a scientist, but here's something that I can do, so I'm trying to help. I trust the doctors, that's good enough for me.
(1) https://www.forbes.com/sites/tjmccue/2020/03/20/calling-all-... (2) https://www.uza.be/mondmaskers. (in Dutch)
(1) https://www.forbes.com/sites/tjmccue/2020/03/20/calling-all-... (2) https://www.uza.be/mondmaskers. (in Dutch)
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That is a misleading statement. The CDC has in fact changed its recommendations to recommend in a crises, even HCPs use home-made masks [0]
Health care providers, scientists and health officials are rapidly changing and adapting to the situation. It probably is a good idea for all people to wear homemade / improvised masks to reduce R0
But I'd still hope that civilians with large stores of N95 masks or other PPE would consider donating them to healthcare workers. The optimal scenario seems to be that non-HCPs stay home as much as possible, wash hands, sanitize and wear improvised masks when leaving home, and donate PPE to healthcare workers
9% of COVID-19 cases in italy are HCPs
[0] https://www.cdc.gov/coronavirus/2019-ncov/hcp/ppe-strategy/f...
Health care providers, scientists and health officials are rapidly changing and adapting to the situation. It probably is a good idea for all people to wear homemade / improvised masks to reduce R0
But I'd still hope that civilians with large stores of N95 masks or other PPE would consider donating them to healthcare workers. The optimal scenario seems to be that non-HCPs stay home as much as possible, wash hands, sanitize and wear improvised masks when leaving home, and donate PPE to healthcare workers
9% of COVID-19 cases in italy are HCPs
[0] https://www.cdc.gov/coronavirus/2019-ncov/hcp/ppe-strategy/f...
> But I'd still hope that civilians with large stores of N95 masks or other PPE would consider donating them to healthcare workers.
I was at Home Depot today and was surprised to see N95 masks available, though limited in number per customer.
I was at Home Depot today and was surprised to see N95 masks available, though limited in number per customer.
I believe wide-spread use of masks is an effective measure, but i disagree that evidence-based medicine vice Bayesian belief-updating is to blame here. If masks work well, the statistical evidence will come out, regardless of the statistical tribe you belong to.
It came directly from the Surgeon General himself. That’s the part that shocks me. It’s basically someone saying don’t use condoms because it’s not 100%.
I do find it ridiculous that we have ignored practical and common sense measures to protect the most at risk, and instead have decided fo trash our entire way of life and the economy along with it. In the future this will be looked back upon as one of the great blunders in history.
You're right, we should have done both.
You can’t reduce the basic reproduction number (R0) of a pathogen. You can reduce doubling time and similar metrics of the actual spread, but R0 is a fixed number. What you are referring to is the effective reproduction number, which is the rate of spread in a population at it’s current state.
https://en.wikipedia.org/wiki/Basic_reproduction_number
https://en.wikipedia.org/wiki/Basic_reproduction_number
Change in behavior can change basic reproduction number. That is what happened with SARS. Making basic reproduction number smaller is whole point of those curfew laws and of closing shops we now have. It is also the point of washing hands often and keeping distance.
It is defined as "expected number of cases directly generated by one case in a population where all individuals are susceptible to infection". And that is possible to influence by behavior. If no one even meets anybody, no sick person can generate next case. If people live in over-crowded houses, one person will infect many more.
It is defined as "expected number of cases directly generated by one case in a population where all individuals are susceptible to infection". And that is possible to influence by behavior. If no one even meets anybody, no sick person can generate next case. If people live in over-crowded houses, one person will infect many more.
Huh?
"R0 is not a biological constant for a pathogen as it is also affected by other factors such as environmental conditions and the behaviour of the infected population."
"R0 is not a biological constant for a pathogen as it is also affected by other factors such as environmental conditions and the behaviour of the infected population."
Pretty way of saying "Summer heat causes these things to go in remission" by lowering the R0 for a time.
Given that there are cases in hot, humid climates now, I wouldn’t expect summer to save us
From what I've read recently, I agree with this distinction. It's simply a matter of definition. R_0 is the infection rate without any measures taken. Sometimes, R is used for the net infection (e.g. with social distancing).
Read the first sentence of the second paragraph.
citation please
Added. It’s all in the first paragraph.
https://en.wikipedia.org/wiki/Basic_reproduction_number
https://en.wikipedia.org/wiki/Basic_reproduction_number
Maybe you should read a bit further than the first paragraph for your future citations?
"R0 is not a biological constant for a pathogen as it is also affected by other factors such as environmental conditions and the behaviour of the infected population."
"R0 is not a biological constant for a pathogen as it is also affected by other factors such as environmental conditions and the behaviour of the infected population."
“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.
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.
> 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!
My wife is an R.N. and is the clinical care coordinator on a cardiac critical care unit in northern NJ that has been converted to a negative pressure covid-19 unit. They currently have two positives and several suspected under treatment. They do not have enough PPE gear to see every suspected patient using full protection, i.e. gown, goggles, N95 mask, gloves, etc. This is a fact that bothered me much more than her. It's possible to prevent transmission to health care workers without full PPE on every case. See for reference this article currently linked on HN front page: https://www.newyorker.com/news/news-desk/keeping-the-coronav.... Naturally I still wish she was wrapped head to toe in antiviral something every time she goes near the place, but my fears are those of a layperson and I have to trust her professional judgement.
My wife is an R.N. and is the clinical care coordinator on a cardiac critical care unit in northern NJ that has been converted to a negative pressure covid-19 unit. They currently have two positives and several suspected under treatment. They do not have enough PPE gear to see every suspected patient using full protection, i.e. gown, goggles, N95 mask, gloves, etc. This is a fact that bothered me much more than her. It's possible to prevent transmission to health care workers without full PPE on every case. See for reference this article currently linked on HN front page: https://www.newyorker.com/news/news-desk/keeping-the-coronav.... Naturally I still wish she was wrapped head to toe in antiviral something every time she goes near the place, but my fears are those of a layperson and I have to trust her professional judgement.
> The country that put man on the moon not even a century ago!
Aren't those two massively different tasks/skills? And both in massively different situations?
Aren't those two massively different tasks/skills? And both in massively different situations?
It seems though that the US couldn’t actually go back to the moon or maybe even put people into space without the Soyuz, so now so it’s lost those capabilities amongst others, that is my point.
Even in a crisis, all that economic wealth and military dominance that the US claims to have can’t put masks and gowns on people that need them, so is there really much steam left in the tank ? I hope there is and I’m sure there is, it just needs to find the right channels. God Bless America!
Even in a crisis, all that economic wealth and military dominance that the US claims to have can’t put masks and gowns on people that need them, so is there really much steam left in the tank ? I hope there is and I’m sure there is, it just needs to find the right channels. God Bless America!
no country has the ability to go to the moon tomorrow. if there were a pressing reason to do so, the US and probably china or russia could do it eventually, but it takes time to organize that sort of effort. it's probably true that the time between deciding to go to the moon and actually doing it would probably be longer today, but a large part of that might be increased expectations for the crew's safety.
it's a similar story with the PPE. the US has moved a lot of manufacturing capacity overseas because it's economically efficient. the US is certainly wealthy enough to manufacture as much of this stuff as needed, but it isn't a switch that can be flipped overnight and the unit cost would be much higher due to regulatory burdens like worker protection.
it's a similar story with the PPE. the US has moved a lot of manufacturing capacity overseas because it's economically efficient. the US is certainly wealthy enough to manufacture as much of this stuff as needed, but it isn't a switch that can be flipped overnight and the unit cost would be much higher due to regulatory burdens like worker protection.
The ICU videos out of Wuhan have the doctors wearing triple PPE.
China has a lot of experience with SARs and other respiratory viruses. They are basically ground zero right.. so I would expect people to listen to China when they say you need masks.
China has a lot of experience with SARs and other respiratory viruses. They are basically ground zero right.. so I would expect people to listen to China when they say you need masks.
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.
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.
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.
Does 3M actually manufacture masks in Minnesota, or anywhere in the U.S. for that matter? Or do they simply buy masks from a white-labeler overseas?
From https://en.wikipedia.org/wiki/3M -:
3M's general offices, corporate research laboratories, and some division laboratories in the US are in St. Paul, Minnesota. In the United States, 3M operates 80 manufacturing facilities in 29 states, and 125 manufacturing and converting facilities in 37 countries outside the US (in 2017).[66]
I don’t believe 3M would buy white-label products, they employ several hundred research scientists and have invented countless original products / innovations.
3M's general offices, corporate research laboratories, and some division laboratories in the US are in St. Paul, Minnesota. In the United States, 3M operates 80 manufacturing facilities in 29 states, and 125 manufacturing and converting facilities in 37 countries outside the US (in 2017).[66]
I don’t believe 3M would buy white-label products, they employ several hundred research scientists and have invented countless original products / innovations.
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...
“‘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...
Yes, sorry, my previous respond didn’t answer your question.
I agree, you’d think if they were producing masks in the US they would make that clear.
I agree, you’d think if they were producing masks in the US they would make that clear.
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.
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...
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...
With the Feds helping and mandating setup of new lines and paying for them so much more could have happened.
China has ramped up production by 12 fold in February alone. Even exporting a small portion of it would exceed their normal export volume.
maybe it's time for you to realize that an authoritarian capitalist state is no better.
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.
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.
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.
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.
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.
The problem is that each individual country will (reasonably!) not allow critical medical supplies to be exported during a crisis. It worked out mostly okay this time, because the countries with large domestic mask production all got their crisis under control before the rest of the world got it. If the next pandemic happens in China and the US simultaneously, we're not going to have any masks at all.
And note that "mostly okay" here doesn't mean we have anywhere close to enough masks. Just that, with extreme rationing, we can ensure most but not all doctors have the absolute bare minimum of protective gear.
And note that "mostly okay" here doesn't mean we have anywhere close to enough masks. Just that, with extreme rationing, we can ensure most but not all doctors have the absolute bare minimum of protective gear.
Exactly! I too understand the theory of competitive advantage, but in light of this new information, current economic/business/free-market theory needs to be rebuilt from the ground up to take into account risks (global supply chain disruption, customer base vanishing, etc) seriously considered.
Or maybe shouldn't there be emergency plans that had all the steps to remodel current production lines in the country to adjust to production of medical supplies?
Like, in China, factories that made bedding products are re engineered to make masks, suits, etc.
These are exceptional conditions, so if you had the protocols in place (blue prints, machine configurations, assembly line structure, briefings for management, briefing and courses for factory workers), maybe it was doable.
And maybe it would be of low maintenance, just when new machines were introduced, you'd release a new document to configure that machine.
The main problem would be raw material, but again, maybe with planning and study new materials and combinations could be used (even if not perfect).
This would be only a problem for countries with little to no industry, but that's where organizations like the EU should come into play.
Like, in China, factories that made bedding products are re engineered to make masks, suits, etc.
These are exceptional conditions, so if you had the protocols in place (blue prints, machine configurations, assembly line structure, briefings for management, briefing and courses for factory workers), maybe it was doable.
And maybe it would be of low maintenance, just when new machines were introduced, you'd release a new document to configure that machine.
The main problem would be raw material, but again, maybe with planning and study new materials and combinations could be used (even if not perfect).
This would be only a problem for countries with little to no industry, but that's where organizations like the EU should come into play.
Not just that, global air travel has enabled the rapid spread of the virus in the first place.
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.
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.
> but Singapore and Honk Kong took significantly more measured approaches which ultimately have also been successful in limiting exposure.
I think Singapore and Hong Kong (and South Korea) were able to aggressively test (e.g. temperature readings at airports), contact trace (e.g. grab location data off phones), force mobile apps for tracking and checking in, etc. All of that gave them the option of a measured approach.
China had to go full in because they realized they had a uncontrolled pandemic brewing for a month before they took any significant action.
I think Singapore and Hong Kong (and South Korea) were able to aggressively test (e.g. temperature readings at airports), contact trace (e.g. grab location data off phones), force mobile apps for tracking and checking in, etc. All of that gave them the option of a measured approach.
China had to go full in because they realized they had a uncontrolled pandemic brewing for a month before they took any significant action.
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 ?
I’m not sure why people keep talking like this is all in the past for these countries ?
> 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.
They surely can. They just have to assume there are way more asymptomatic cases than they have been assuming, and a relatively small susceptible population.
They surely can. They just have to assume there are way more asymptomatic cases than they have been assuming, and a relatively small susceptible population.
Wrong in what way? Small susceptible to getting severe? Or getting it at all?
Well, you need both. If none would get it at all, it wouldn't spread, but if all got the virus it would show on exams.
Every model around assumes that everybody contracts the virus. If you have part of a population that is immune to it, the population behavior changes.
Every model around assumes that everybody contracts the virus. If you have part of a population that is immune to it, the population behavior changes.
But do you need both? What if severe cases to total cases is not a fixed rate, as assumed by most models I have seen?
Yes, if most of those people do not transmit the virus (or transmit very little), that could lead to a similar scenario if there is insufficient testing. South Korea would need to be a very exceptional point.
Anyway, whatever are the ratios, Japan and South Korea should be different because of mask usage too.
Anyway, whatever are the ratios, Japan and South Korea should be different because of mask usage too.
My point was you could have exponential growth with asymptomatic being the dominant number. All of the dire numbers assume that there is a fixed rate of low severity to high severity cases. What if asymptomatic is the norm? Could there be something about the places seeing high severe cases that makes them unique?
And it is not just Japan anymore. Germany and Norway both have low severity numbers. Most of the US is finding that the more they test, the more active cases they find today. We could really use testing that let us know the cases they missed a month ago.
And it is not just Japan anymore. Germany and Norway both have low severity numbers. Most of the US is finding that the more they test, the more active cases they find today. We could really use testing that let us know the cases they missed a month ago.
I think the idea that asymptomatic cases are the norm is well accepted and widespread already.
It still begs the question of why the severity varies so much.
It still begs the question of why the severity varies so much.
It is accepted that asymptomatic is common. It is also expected that a large number of asymptomatic cases demands a large number of severe cases.
What if there is an environmental agitator that causes the percentage of each to vary? High diesel fumes, as an example, could swing it so a larger portion are high severity.
What if there is an environmental agitator that causes the percentage of each to vary? High diesel fumes, as an example, could swing it so a larger portion are high severity.
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.
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.
"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-...
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...
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...
ZhuanXia(4)
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/ anyone know anything about them? Are they real or a scam.
"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.
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.
I think they are trying to pretend they are doing this https://www.nature.com/articles/srep39956
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.