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San Francisco, USA

 

Mask Primacy, Why?

Coronavirus is once again making waves in the US. Many people, once relieved by the wide availability of vaccines and low inflections rate, are on the edge once again. The necessity of wearing masks comes up in the headlines. Many governments are considering making it mandatory again.

I have a lot of doubts and questions about the strategy. This attitude, I name it mask primacy, believes the use of masks at population level is the primary mean to stop the spread of coronavirus. I challenge the validity of this belief. I think people overestimate the utility of masks and the governments are overinvested in masks.

First of all, I am not anti-mask. I started using a mask last year once I was convinced it could be helpful, before it was actually recommended by health authorities. Stay home when you are sick. Wash your hands and avoid rubbing your eyes. Maintain social distance. Stay six feet apart. I do them all. Then masks are added to the list. I too was exasperated at the resistance from the conservative population and the politicalization of a measure that was meant to protect public health.

The difference is I don’t see masks as a game changer. It is one of the many things to do that might help. I saw the virus sweep through the US in 2020. It hit the East coast states, it hit the central state, it hit West coast states. It hit the conservative states, and it hit the liberal states. There were some differences. But I don’t see any measures that clearly differentiate one region from another. Here in the Bay Area, we follow virus precautions quite diligently. Our inflection number in 2020 is about 40% of the US average. It is a good result, relatively speaking. But we were still hit by waves of inflection. The result was nevertheless bad by world standards.

I still think washing the hands helps, staying six feet apart helps, wearing masks helps. I still think we should take necessary precautions. But I see no evidence that they would produce a game changing outcome. I don’t want to mislead the public to think this way.

There is only one game changer - the vaccine. There is mountain of evidence showing its effectiveness, from decisively reducing death to suppressing virus infection and spread. It has reported that some vaccines are 90% effective, a number demonstrated experimentally. No other measure has comparable experimentally proven effectiveness.

So why is it that as soon as the inflection rises, some people and municipalities immediately call for a mask mandate? How do we explain this mask primacy? Why are people so confident that it can cause a change in the result?

The story goes like the delta variant is far more transmissible and puts all of us at risk. Even vaccines do not provide adequate protection. Therefore we must use masks.

Why do people not have similar doubts about masks? They could have said the same thing. The delta variant is so much more virulent, while the mask was helpful back in 2020, it is not as helpful against the delta variant. Therefore we should stop using surgical and cloth masks and switch to N-95. Or more sensibly, stop counting on masks to provide basic protection and make sure we all get vaccines.

In a stressful situation, people instinctively go back to masks. This is mask primacy.

People are quite sensitive about vaccine breakthroughs, people catching a virus despite being vaccinated. Any such story can make news headlines. Rationally speaking, comparing the much lower inflection rate and death rate between the vaccinated and unvaccinated should provide reassuring evidence that that vaccine is effective. Nevertheless, if only single vaccinated die, it would have deeply shaken the trust on vaccines’ protection.

The same people who are so concerned about the breakthrough inflection of vaccines would have thought nothing about breakthrough inflection of masked people. I have not seen any official numbers, but there are likely to be in the millions. How many people die despite diligently using a mask? Probably too numerous to count. Would this information have shaken the trust of the mask? Probably not. If you confront people, they would shrug their shoulders. “It is not perfect. But it has certainly helped”, they rationalize.

A breakthrough inflection to the vaccinated causes panic. A breakthrough inflection to the masked has no effect on the mask reliance. This phenomenon is another sign of mask primacy.

To think about it rationally, a breakthrough case causes a lot of concern because people expect much higher, perhap 100%, effectiveness on the vaccine. They accept certain breakthrough inflections that happen to masked people means that they have much lower expectations on masks. Inside, people understand that vaccines provide a different class of protection compared to masks. However, once people feel at risk, they still go to mask the first thing.

Even if a mask is not very effective, does it still help? The problem is we should focus on things that help the most, not things that help a little bit. When data show most new inflection comes from unvaccinated people, yet we react by asking the vaccinated people to wear masks. You can immediately see its futility.

If there is one important thing that should happen, I believe it is for the FDA to formally approve the vaccine with greatest urgency. Right now a lot of vaccine hesitant cite the emergency approval as the reason they are reluctant to take it. We should remove these excuses. Many institutions, from schools to the military, are also pending on FDA’s final approval before they can mandate it to their members. The formal approval has a lot of real life impact.

When hundreds of millions of people have already been vaccinated with clearly positive results, there is no question about its safety and effectiveness. The work on science and biology are painstaking. But the hard work has already been done. What is left is bureaucracy. Bureaucracy is an obstacle created by humans. It is within human’s power to overcome them.

2021.08.01 comments

 

 

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