Tag: hit&run

Fast reduction of the COVID-19 pandemic is necessary for public health, re-opening the American economy, restoration of rights and liberties, and prevention of large second or third waves. There is one very helpful step everyone can take to reclaim our country from the viral invasion: All Americans should wear masks in public. Masking is contrary to what the federal government has been telling the public for months. The government’s bad advice is one of the many ways that the U.S. government, like many European governments, has worsened the pandemic.

To be clear, I’m not telling you to swipe a N95 mask from a health care worker. Many types of masks, including those you can make at home, will be helpful.

The first part of this essay observes the differing rates of infection and death in nations that have pro-mask policies and those that do not. Part II describes different types of masks. Part III explains infection routes for SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2). Although the virus itself is smaller than the mesh openings in even the best masks, many types of masks can block infection via water droplets (e.g., from coughs or sneezes), because droplets are larger than mesh openings.

Part IV summarizes studies on the protective effects of hospital grade masks and of improvised masks, including tea towels, t-shirts, pillowcases, and others. While improvised masks are not as good as medical ones, they are still helpful. After the medical supply chain has been restored and health care workers have all the masks they need, high-volume production of medical masks should continue so that they are available to the entire public. Taiwan provides a good example for other nations.

Part V addresses three arguments against universal mask wearing. First, it is said that only symptomatic people should wear masks. This is among the worst public health advice ever given; people who are asymptomatic or presymptomatic are still contagious. Second, anti-mask rhetoric is intended to deter people from interfering with medical supply chains. However, homemade masks do not remove anything from medical supplies. Third, mask wearing may induce riskier behavior in some people. The last point is valid, but it is outweighed by the enormous benefits from mask wearing by people who do not take extra risks.

Finally, Part VI briefly provides some links for people to learn how to make and sterilize masks at home.

I. Observations from other nations

Although some people stigmatize mask wearers, the realistic view is that mask-wearing can be pro-social. East Asians have so understood for decades. What are the results there?

It is impossible to draw accurate conclusions from China, since there is no freedom of the press; inquiring American journalists have been expelled, and the Chinese Communist Party (CCP) dictatorship has lied about the pandemic from day one and continues to do so. Jim Geraghty, The Comprehensive Timeline of China’s COVID-19 Lies, National Review Online, Mar. 23, 2020.

Instead, consider some nearby nations in East Asia that have a free press (Taiwan and South Korea), or least more press freedom than communist China (Singapore). These nations have extensive economic relations with and travel to/from China. None have had to resort to the extreme measure of stay-at-home orders for the general population. People are going about their daily lives mostly as before. In Taiwan and South Korea, mask-wearing is a social necessity during pandemics, and is acceptable at all times, including for people who do not feel sick. Singapore has adopted pro-mask policies in response to the pandemic.

In February, Taiwan’s President Tsai Ing-wen ordered a national campaign for mask production and wearing. Mask exports were prohibited. A crash program to create many new mask factories was implemented. The program got up to speed ahead of schedule. Masks are distributed via pharmacies to the entire population; the rationing system is several masks per week per person, with children getting more. Increased production has increased the ration. Teng Pei-ju, Taiwan sets up 60 face mask production lines in a month: Daily production of face masks projected to reach 10 million by mid-March, Taiwan News, Mar. 6, 2020. Now, with massive production, Taiwan has just donated two million hospital masks to the United States.

No one claims that masks alone will defeat the pandemic, or that masks are the sole reason why non-communist East Asia is doing better than the United States. For example, a key to success in South Korea was prompt use of a just-invented test for COVID-19, at a time when the number of cases was low enough for rigorous contact tracing. In the United States, though, the test was prohibited by the sclerotic Food and Drug Administration. Paul Detrick, The Coronavirus Testing Debacle Stems From Decades of Bad FDA Policy: The agency’s emphasis on caution over speed led to needless suffering and loss of life long before the COVID-19 pandemic, Reason, Mar. 27, 2020.

In the West, mask wearers have been stigmatized–a problem aggravated by incorrect advice (discussed below) that people should only wear face masks if they are experiencing symptoms. Attitudes are changing rapidly, however.

For example, the Czech, Slovak, Austrian, and Bosnian governments have ordered citizens to wear masks outside the home, universally or under some circumstances. So have some German municipalities. More and more Italians are voluntarily doing the same. Drew Hinshaw & Catherine Luckey, U.S. Takes New Look At Advice on Use of Masks, Wall Street Journal, Apr. 1, 2020. The Mayor of Los Angeles recommends that residents to wear masks outside the home. Colorado Senator Michael Bennet uses a homemade mask and urges everyone to do the same.

The comparative international data suggest that widespread mask wearing has very large social benefits. A new policy paper by Yale professors rigorously examines the growth rates in COVID-19 (coronavirus disease 2019) in 42 nations, since the 100th confirmed positive test in each nation. The study compares nations with pre-existing pro-mask social norms (South Korea, Taiwan, Japan, China), countries that have recently adopted pro-mask policies (Singapore, Bulgaria, Thailand, Romania, Czech Republic, Switzerland, Italy), and countries without pro-mask policies. The study should not have included Chinese government data on COVID-19, which like CCP data on everything else, are notoriously falsified. Scott N. Romaniuk & Tobias Burgers, Can China’s COVID-19 Statistics Be Trusted? From GDP figures to coronavirus counts, China’s government has a long history of manipulating data for political gain, The Diplomat, Mar. 26, 2020.

Putting China aside, the international trends are still clear. In short, countries with pro-mask norms cut the growth rate of infection by 8-10%, depending on the model used. Countries with pro-mask norms had a growth rate in COVID-19 deaths of 11%, whereas countries without such norms had a death growth rate of 21%.

How much good a single individual can do by wearing a mask can be illustrated by economic impact. By contributing to reduction in mortality, each person who wears a mask confers on society a benefit of $3,000 to $6,000. On top of that are the unquantified but enormous advantage of allowing a speedier return of economic and social activity. Unemployment and social isolation are long-known to cause many types of health problems and social ills, so the sooner they are ended, the better for all of us. As the Yale authors point out, even if they overestimated mask benefits by ten-fold, the individual who wears a mask still confers a social benefit of at least $300. Jason Abaluck et al., The Case for Universal Cloth Mask Adoption & Policies to Increase the Supply of Medical Masks for Health Workers, Apr. 1, 2020.

II. Types of masks

Three types of masks are relevant here. First is the N95 mask, known as FFP in Europe. It blocks 95% of particles that are .3 microns are larger. A micron, also called a micrometer (μm), is one millionth of a meter; a human hair is 50 microns wide. One micron is equal to one thousand nanometers. A nanometer (nm) is one billionth of a meter.

Pre-pandemic, N95s were worn not only by medical personnel, but also by construction workers, DIYers, and anyone else who wanted to avoid inhaling particles. Under normal, non-shortage conditions, a N95 is discarded after a single use—a visit to a patient or a session of construction work.

The standard N95 is not protective against oily particles, such as the fumes from oil-based wood coatings; for these, workers wear a P95 mask. The P95 is much more cumbersome, and looks like a gas mask, which it is. It uses replaceable filters.

For the time being, N95 and P95 masks/filters are in short supply and are being appropriately rationed to hospitals and other health care workers.

However, some people may have leftover N95 masks from home construction projects and the like. Masks that have previously been worn, or that are no longer in their original wrapper (and therefore have been exposed to air), are not suitable for hospital donation. Even though not preferred by medical personnel, they can be effective for ordinary people to reduce viral transmission, in both directions.

Next best is the surgical mask. You’ve seen doctors wearing these in operating rooms, and you’ve also seen East Asians wearing them in airports. If you travel in East Asia, you know that in a large crowd of people, it’s never unusual to see several people sporting them. The best surgical masks are “high-density.” Some studies distinguish high-density masks from others, while others just examine surgical masks in general.

There are presently plenty of surgical masks available for sale on Amazon. However, these appear to mainly from manufacturers in China. Given the terrible quality of Chinese medical exports recently, there is no reason to believe these products to be well-made.

Finally, there are masks that almost anyone can make from materials at home, such as 100% cotton t-shirts. Nobody claims that they perform as well an N95 or a high density surgical mask. But according to medical research, detailed below, improvised masks do reduce inbound and outbound viral transmission. Any reduction is good, and the more reduction by the more people, the better.

III. Transmission modes

SARS-CoV-2 enters the body via the eyes, nose, or throat. The pathway can be direct (e.g., getting hit by a cough) or indirect—someone coughs on his hand and later touches a doorknob; someone else touches that doorknob and later touches her hand to her mouth.

After SARS-CoV-2 is established in the victim’s body and is reproducing, it exits the body through three main pathways. One is the southern land route. The other two are the mouth and nose. The viral shedding happens during normal breathing, and in greater quantity and distance for coughs and sneezes. (More on them below.)

The southern route is one reason you should do what your mother told you: wash your hands for at least 20 seconds after you go to the bathroom. You should also wash your hands anytime you touch a surface that could have the virus. SARS-CoV-2 can exist for up 4 hours on copper; 24 hours on cardboard; and 72 hours on plastic or stainless steel. Neeltje van Doremalen et al., Aerosol and Surface Stability of SARS-CoV-2 as Compared with SARS-CoV-1 (letter), New England Journal of Medicine, Mar. 17, 2020. A review of prior studies of other coronaviruses found persistence on metal, glass, or plastic up to 9 days. G. Kampf et al., Persistence of coronaviruses on inanimate surfaces and their inactivation with biocidal agents. 104 Journal of Hospital Infection 246 (2020).

Although this essay is about masks, it should be noted that wearing gloves in public is a good idea–especially when touching surfaces that are touched by many other people, such as gas station pumps, ATM machines, credit card readers, and so on. Medical grade disposable gloves are currently being rationed for health care providers, but there are plenty of alternatives, since you probably already own kitchen gloves, dress gloves, athletic gloves, and so on. Clean them after each use; soap and water should work fine, since SARS-CoV-2 is highly vulnerable to soapy water. In brief, soapy water dissolves the virus’s outer membrane, and the virus crumbles into nothing.

Instead of gloves, you can use a tissue, paper towel, or handkerchief as a touch barrier.

There are two air modes of travel for the virus. An aerosol is a small solid carried in a gas. An aerosol is smaller than 10 microns; it can float in the air and be carried by wind or ventilation. A droplet is a liquid that carries the virus. Speaking always produces droplets, even if you don’t talk like Daffy Duck.

Droplets are much bigger than aerosols, at least .1 millimeter or larger. With mere exhalation, droplets fall within 1.5 meters of the breather. Because of the greater velocity of a cough or sneeze, droplets travel further. A M.I.T. study found that cough droplets have a contamination range of up to 2.5 meters (8 feet). Lydia Bourouiba et al., Violent expiratory events: on coughing and sneezing, 745 Journal of Fluid Mechanics 537 (2014). Sneezes—which have initial velocities of 1,000 to 2,000 feet per second (similar to a gunshot)—would have even longer range.

The protective value of masks depends partly on the size of the openings in the mesh. The smaller the openings, the better. SARS-CoV-2 is about 100 nanometers in diameter. In other words, the virus is about a hundred-millionth of a meter. Marco Cascella et al., Features, Evaluation and Treatment Coronavirus (COVID-19), StatPearls.com, Mar. 20, 2020 (virus diameter is “approximately 60–140 nm”);  Jeong-Min Kim, Identification of Coronavirus Isolated from a Patient in Korea with COVID-19, 11 Osong Public Health Res. Perspect. 3 (Feb. 2020) (“Virus particle size ranged from 70–90 nm.”).

Thus, SARS-CoV-2 virus is smaller than the mesh openings in even an N95 mask. So masks of any type would not provide full protection against aerosolized SARS-CoV-2. A three-hour study of aerosolized SARS-CoV-2 found the virus persisting in the air for all three hours. van Doremalen et al., supra.

But masks would be protective against SARS-CoV-2 carried in droplets, which are far larger than aerosols. Notably, while everyone agrees that the virus is spread by droplets, whether or how much it is spread by aerosols is unclear. Ed Yong, Everyone Thinks They’re Right About Masks: How the coronavirus travels through the air has become one of the most divisive debates in this pandemic, The Atlantic, Apr. 1, 2020.

Although much is unknown, some evidence indicates that SARS-CoV-2, compared to some other coronaviruses, is particularly suited for spreading by an initial landing in the nose, via large droplets. Accordingly, masks capable of stopping droplets would offer important protection.

An editorial in Journal of the American Medical Association, JAMA, discussed how to overcome mask shortages in hospitals. As the editorial explained, the N95 stops 95% of .3 micron particles. A household anti-allergy air circulation filter with a MERV (minimum efficiency reporting value) of 14, will stop 75%. A filter with MERV of 13 will stop 50%. The N95 mask is equivalent to MERV 16.

Stopping some viruses is better than stopping none. So regarding household air filters and vacuum cleaner bags, JAMA wrote: “Although the SARS-CoV-2 particle is smaller than 0.2 μm [the mesh opening in a N95], the water droplets carrying it are larger and largely blocked by these filters.” Edward Livingston et al., Sourcing Personal Protective Equipment During the COVID-19 Pandemic (editorial), JAMA, Mar. 28, 2020.

III. Protective values of masks

The studies below examined masks’ role in reducing airborne transmission. The research shows important protective effects from all types of masks. However, the studies did not examine another potential mask benefit that is particularly relevant to SARS-CoV-2: as long as you’re wearing a mask, any type, you won’t be touching your mouth or nose. And wearing the mask might help remind you not to touch your eyes. Even if you fiddle with the mask to adjust it, touching your cheek is less dangerous than touching your nose or mouth.

SARS-CoV-2 is in the same family as the SARS (severe acute respiratory syndrome) coronavirus, which caused pandemics in some areas in 2003. Therefore, evidence about the effect of masks against original SARS may be informative. (As with SARS-CoV-2, the original SARS problem was massively worsened by the Chinese Communist Party’s lies, repression, and coverups. Yanzhong Huang, The SARS Epidemic and Its Aftermath in China: A Political Perspective, in Learning from SARS: Preparing for the Next Disease Outbreaks (Wash., D.C.: Institute of Medicine, National Academies Press, 2004).)

A metastudy of 138 papers on SARS 2003 found that handwashing at least 10 times a day reduced transmission by 55%. Wearing gloves reduced it 57%. A mask in general reduced transmission by 68%. Washing + gloves + masks (including surgical masks) reduced transmission by 91%. The N95 mask alone was 91% effective. Tom Jefferson et al., Physical interventions to interrupt or reduce the spread of respiratory viruses: systematic review, 336 British Medical Journal 77 (2008).

According to a study of influenza in Hong Kong households, hand hygiene plus facemasks were effective in reducing intrahousehold transmission, if the proactive measures began within 36 hours of a family member showing symptoms. Benjamin J. Cowling, Facemasks and Hand Hygiene to Prevent Influenza Transmission in Households: A Cluster Randomized Trial, Annals of Internal Medicine, Oct. 6, 2009.

Japanese scholars reported that 80% public compliance with wearing N95 or surgical masks is sufficient to stop an influenza outbreak. A compliance rate of 50% percent would cut the cumulative incidence rate by 20% and cut prevalence (percent of the population infected at a given time) by 50%. Jing Yan et al., Modeling the Effectiveness of Respiratory Protective Devices in Reducing Influenza Outbreak, 39 Risk Anal. 647 (2019).

The above studies did not specifically examine homemade masks. However, the U.S. Centers for Disease Control and Prevention (CDC), which has discouraged public masking, does recognize that homemade masks have protective value. CDC urged health care personnel to employ “homemade masks (e.g., bandana, scarf) for care of patients with COVID-19 as a last resort,” when hospital-grade masks are not available.

For many health care providers and for most the general public, hospital-grade masks are not presently available. The United States used to have a large Strategic National Stockpile of hospital grade masks. The reserve was used up in the 2009 H1N1 influenza epidemic, and then largely ignored. Face masks in national stockpile have not been substantially replenished since 2009, Washington Post, Mar. 10, 2020. The neglect to restock the reserve was the collective failure of seven years of Obama, three years of Trump, and a decade of Congresses with varying party control of each house. The failure to replenish is a good example of how the federal government has grown so gargantuan, and has involved itself in so many unnecessary matters, that it is incompetent at many basic and simple tasks that government should do. Similar dysfunction appears to be common in Europe.

How much protection do homemade masks provide? One study compared N95 masks, surgical masks, and tea towels. Tea towels (a/k/a kitchen towels) are made to be absorbent, and so are woven fairly densely, often with 24 threads per inch (thread count 48).

For inward protection (protecting the wearer from inbound spray droplets), the N95 mask stopped 99%, a surgical mask 75%, and a tea cloth 67%. For outward protection (blocking droplets expelled by the wearer breathing), the N95 stopped 70%, the surgical mask 50% and the tea cloth 10%. Based on the data, the authors concluded:

Although this [the tea cloth’s 67% inward performance] could imply that individual subjects may not always be optimally protected, from a public health point of view, any type of general face mask usage can still decrease viral transmission. Also, it is important not to focus on a single intervention in case of a pandemic, but to integrate all effective interventions for optimal protection.

. . . [O]verall these experiments show that significant protection against influenza transmission upon exposure can be conveyed also for lay people, including children, in spite of imperfect fit and imperfect adherence.

It is also clear that home-made masks such as teacloths may still confer a significant degree of protection, albeit less strong than surgical masks or FFP2 masks. Home made masks however would not suffer from limited supplies, and would not need additional resources to provide at large scale. Home made masks, and to a lesser degree surgical masks, are unlikely to confer much protection against transmission of small particles like droplet nuclei, but as the reproduction number of influenza may not be very high a small reduction in transmissibility of the virus may be sufficient for reducing the reproduction number to a value smaller than 1 and thus extinguishing the epidemic. Greater reduction in transmissibility may be achieved if transmission is predominantly carried by larger droplets. In a typical human cough half of the droplets may be small (<10 µm), but these comprise only a small fraction (2.5*10−6) of the expelled volume. Smaller droplets may however more easily penetrate the smaller bronchi and be more effective in transmission. . . .

[I]t can not be excluded that the amount of protection conferred by home made masks might sufficiently reduce viral exposure to impact on transmission during the early waves, while allowing people enough exposure to start mounting an efficient immune response.

Marianne van der Sande et al., Professional and Home-Made Face Masks Reduce Exposure to Respiratory Infections among the General Population, Plos One, July 9, 2009.

In other words, even though a tea towel won’t stop all incoming viruses, it will sharply reduce their number. Therefore, the body’s immune system may have sufficient time to produce enough antibodies to crush the viral invasion at an early stage, before the viruses can reproduce in sufficient quantity to harm the victim.

The same principle underlies the N95 mask. As the name indicates, it does not block 100% of the invaders. By blocking many of the invaders, the masks tilts the odds in favor of the victim’s immune system defeating the invasion on the beachhead.

What about other types of homemade masks? A study of ten different types of masks reported benefits from all of them. The study used two types of bacteria. The smaller one was the Bacteriophage MS2. Its size is about 23 nanometers. It is smaller than SARS-CoV-2, which is about 60-140 nanometers. Bacteriophage MS2 and SARS-CoV-2 are both much smaller than the mesh openings in a N95 or a homemade mask.

For the study, the bacteria were aerosolized. That is, they were floating in the air, in tiny particles. Some aerosols are larger than mesh openings and some are smaller. If the bacteria had been carried in droplets, which are larger than aerosols, they would have been easier for the masks to block.

Against aerosolized 23 nanometer bacteria, filtration efficiency was as follows: surgical mask 90%; vacuum cleaner bag 86%; tea towel 72%; cotton mix 70%; antimicrobial pillowcase 69%; linen 62%; pillowcase 57%; silk 54%; 100% cotton t-shirt 51%; and scarf 49%.

Notably, the test volunteers were given no instructions about how to fit their masks.

Although the vacuum cleaner bags and the tea towels performed well, they had high pressure drops, meaning that they could make breathing uncomfortable during long-term wearing. “The pillowcase and the 100% cotton t-shirt were found to be the most suitable household materials for an improvised face mask. The slightly stretchy quality of the t-shirt made it the more preferable choice for a face mask as it was considered likely to provide a better fit.”

The authors emphasized that “any mask, no matter how efficient at filtration or how good the seal, will have minimal effect if it is not used in conjunction with other preventative measures, such as isolation of infected cases, immunization, good respiratory etiquette, and regular hand hygiene.”

The authors cautioned that “homemade face masks” would not be effective “as a method of reducing transmission of infection from aerosols.” Accordingly, “An improvised face mask should be viewed as the last possible alternative if a supply of commercial face masks is not available, irrespective of the disease against which it may be required for protection.” Anna Davies et al., Testing the Efficacy of Homemade Masks: Would They Protect in an Influenza Pandemic?, 7 Disaster Medicine and Public Health Preparedness 413 (July 2013).

We are now at the point of the last possible alternative. It took a lot of bipartisan fecklessness to get us here.

Because the study filtration rates are based on aerosols, much higher filtration rates should be expected for droplets, which is a major (and perhaps the major) route for SARS-CoV-2 infection.

Even for aerosols, if masks stop just 48% or 70% of incoming viruses, reducing the infectious dose inflicted on a victim is likely beneficial. The lower the infectious dose, the greater the time for the immune system to mobilize and defeat the invaders before they spread.

Dr. Ellen Foxman, assistant professor of laboratory medicine and immunobiology at Yale School of Medicine explained that her own research indicates (although not with absolute certainty):

this virus infects the nose and throat, and if the local mechanisms to get rid of the virus are really effective and don’t let the viral load get too high, then that person is on the pathway to a more mild disease. Whereas if this virus is able to grow a whole bunch and really replicate to a high level in the nose and throat, you have a much higher chance of inhaling it into your lungs where the virus could set up shop.

James D. Walsh, Is ‘Viral Load’ Why Some People Get a Mild Case of COVID-19?, New York, Mar. 27, 2019 (interview with Foxman). Dr. Foxman pointed to a recent study of Hong Kong hospital patients, in which patients with higher viral loads tended to have worse symptoms. Kelvin Kai-Wang To et al., Temporal profiles of viral load in posterior oropharyngeal saliva samples and serum antibody responses during infection by SARS-CoV-2: an observational cohort study, The Lancet, Mar. 23, 2020.

Although the size of the infectious dose on SARS-CoV-2 is still unknown, research on SARS-CoV (the 2003 virus) showed that between 43 and 280 individual viruses were needed to enter the human body in order to start an infection. T. Watanabe et al., Development of a dose-response model for SARS coronavirus, 30 Risk Anal. 1129 (2010). If you get hit with 80 viruses from the dispersion of a cough, and your scarf blocks half of them, it might be your lucky day. Make sure to wash the scarf in soapy water each time you wear it.

In a Washington Post op-ed, Jeremy Howard, a Distinguished Research Scientist at the University of San Francisco, summarized the results of 34 studies: “basic masks can be effective in reducing virus transmission in public — and not a single paper . . . shows clear evidence that they cannot.”

Howard has started a social media campaign, #masks4all. The campaign’s website is https://masks4all.co/. It describes how to make homemade masks.

V. Arguments against masks

The public was told not to wear masks by Vice-President Pence, the Surgeon General, The Telegraph (London) (supporting government ban on advertising stating that masks are protective), the World Health Organization, the Centers for Disease Control, and many others. Supposedly, not wearing a mask properly could increase the possibility of the wearer being infected. And supposedly, masks provide no protection to a healthy person. The latter assertion is obviously false, since the same sources say that masks are necessary for health workers and others taking care of an infected person.

A. Argument that only infected people should wear them

According to the anti-mask sources, the only persons who should wear masks are persons who are showing symptoms of infection, since masks unquestionably do reduce the possibility that an infected person’s breath, cough, or sneeze could infect someone else. This advice is obviously wrong.

People carrying the SARS-CoV-2 virus can be asymptomatic for up to two weeks; therefore, they will not know that they have the virus and they may be spreading it.

Widespread population testing in Iceland found that about half of people with COVID-19 show no symptoms. A Singapore study detailed how presymptomatic people spread the virus to others. Wycliffe E. Wei et al., Presymptomatic Transmission of SARS-CoV-2 — Singapore, January 23–March 16, 2020, (CDC) Morbidity & Mortality Weekly Rep., Apr. 1,  2020. Research from China found that about 86% of persons with COVID-19 had no, mild, or limited symptoms, and they were responsible for 79% of transmissions. Riuyun Li et al.,  Substantial undocumented infection facilitates the rapid dissemination of novel coronavirus (SARS-CoV2), Science, Mar. 16, 2020. Classified data from the Chinese government, published in the South China Morning Post (Hong Kong) found that a third of coronavirus carriers had no symptoms. On the Diamond Princess cruise ship, half of carriers had no symptoms. Kenji Mizumoto et al., Estimating the asymptomatic proportion of coronavirus disease 2019 (COVID-19) cases on board the Diamond Princess cruise ship, Yokohama, Japan, 2020, 25 Eurosurveillance (Mar. 2020).

Persons with SARS-CoV-2 transmit the virus not only before they show symptoms, but also after the symptoms have ended. Roman Wölfel et al., Virological assessment of hospitalized patients with COVID-2019, Nature, Apr. 1, 2020.

Telling people to wear masks only if they have symptoms is, in the case of COVID-19, discouraging people with infectious disease from taking a step to reduce their spreading the infection.

B. Argument based on hospital needs

Another anti-mask argument is that if healthy people (or people who think they are healthy) are told that masks are beneficial, they will hoard masks, and thereby exacerbate the shortage of masks for health care workers.

The argument is mistaken for several reasons. First, some people may already own N95 or surgical masks that would not be suitable for hospital donation. For example, masks might previously have been worn for a home construction project. Or the masks might have been stored unwrapped, with long-term exposure to air. While these non-pristine masks would not be acceptable for a hospital, they would still provide useful protection to the wearer.

Second, as the Yale professors point out, encouraging industrial or homemade production of cloth masks will reduce the public’s perceived need to acquire or keep large reserves of N95 or surgical masks. Abaluck, supra, at 3.

C. Argument that masks promote dangerous behavior

The strongest anti-mask argument is made most prominently by the World Health Organisation (WHO). It’s true that the WHO is not necessarily a reliable source for health information—such as WHO’s January repetition of the Chinese Communist Party’s spurious claim to have evidence that SARS-CoV-2 cannot be spread from human to human. Because WHO is so submissive to the Chinese dictatorship, WHO excludes Taiwan from participation and information-sharing. WHO’s anti-Taiwan policy is particularly dangerous at present, since Taiwan has provided a global model for how to contain the CCP virus without shutting down the economy. Max Walden, WHO accused of suppressing information about Taiwan’s coronavirus prevention measures, ABC (Australia), Mar. 31, 2020.

However, WHO does make a partially valid point about masks and riskiness. Several decades of research indicate that some people have a particular risk tolerance; when their risks are decreased in one way, they compensate by increasing risks in other ways. For example, anti-lock brakes reduce the probability of auto accidents. Some drivers, after buying a car with anti-lock brakes, compensate for the brakes’ risk reduction by driving more aggressively—thus resulting in no net change in risk for the particular driver. William Ecenbarger, Buckle Up Your Seatbelt and Behave: Do we take more risks when we feel safe? Fifty years after we began using the three-point seatbelt, there’s a new answer, Smithsonian Magazine, Apr. 2009.

Accordingly, WHO worries that if people are told the truth (all masks provide some protection), then people will start wearing masks (reduced risk) and then compensate by increasing risk in other ways (e.g., being less careful about handwashing or staying several feet away from other people).

WHO’s concern is valid, but the organization’s anti-mask pronouncements are still harmful. To begin with, most people do not risk compensate in dangerous ways. Do you and your friends really drive more dangerously because you wear seat belts and have cars with accident prevention technology? When you are hiking, do you go into remote areas with insufficient maps and equipment because you know that backcountry rescue is available?

Because the majority of people behave sensibly, encouraging them to wear masks would reduce the risk that they get, and would reduce the risk that they make other people sick. It is destructive to tell the responsible majority not to protect themselves just because an irresponsible minority will misbehave. Even if the minority does risk compensate, then its net risks would remain the same as before, while the risks of the majority would decline.

VI. How to make and use masks

The authors of the Disaster Medicine article cited above have published a template and instructions for homemade masks. See Nir Eyal, Why we should all start making our own face masks during coronavirus—and an expert-approved guide on how, CNBC.com, Apr. 2, 2020. The websites of Masks4All and HKMask Manual also have instructions, along with details about how to clean reusable masks. Wash your hands well before putting the mask on, and after taking it off. Try to handle the mask only on the edges. More instructions are on the websites.

Masks won’t solve the COVID-19 by themselves, but they can help a great deal. They make the wearer and the community safer. Even if masks only protected the wearer, they would still help the community by reducing the possibility that the wearer will need to be hospitalized and thereby consume very finite health care resources.

The government of the United States of America was disastrously wrong to discourage improvised masks for the general public. After the government made things worse, the people of the United States must begin to make things better. Wearing masks is a simple and beneficial step that everyone can take. The more people who set a good example, the more will follow.

from Latest – Reason.com https://ift.tt/34dQDUg
via IFTTT

See these items from the Jerusalem Post, Portugal Resident, Columbia Cruise Services; from the Jerusalem Post:

A Venezuelan navy ship fired shots at a German-owned cruise ship on March 30 and rammed into the passenger vessel, leading to the sinking of the warship in the Caribbean.

… Venezuelan President Nicolás Maduro accused the captain of the RCGS RESOLUTE cruise ship of “terrorism and piracy” and sought to force the ship into a new direction on the high seas. The cruise ship, which had no passengers on board and was flying under a Portuguese flag, has a reinforced hull that enables it to sail through ice water.

And from the Portugal Resident:

The paper has learnt that the Resolute crew is entirely made up of Ukrainians [woo-hoo! -EV].

The boat, although registered in Madeira and flying a Portuguese flag, is the property of a German cruise company. It was being operated by a Canadian concern, One Ocean Expeditions, for commercial trips to the Antarctic but had been “idle in Panama for some months due to financial problems of One Ocean Expeditions.”

This of course reminds me of the old Soviet joke, mocking the Communist slogans of “Friendship of the Peoples”:

What is the Friendship of the Peoples? Friendship of the Peoples is when Armenians, Russians, Uzbeks, Ukrainians, and Latvians join hands and go together to beat up a Jew.

(See here for a version where they beat up a Georgian, perhaps because it’s framed as a Radio Yerevan joke.) Unsurprisingly, I don’t go for a real-world version of that as such, but when Ukrainians, Portuguese, Germans, and Canadians (sailing out of Panama) sink a Venezuelan military boat, especially one that seemed to be up to no good ….

Thanks to InstaPundit for the pointer.

from Latest – Reason.com https://ift.tt/3bGPCq6
via IFTTT

In the United Kingdom, Health Secretary Matt Hancock says that the government is looking into issuing “immunity certificates” to COVID-19 patients who have recovered from the illness. Such certificates, he told The Telegraph, would “enable people who have had the disease, have got the antibodies and therefore have immunity” to “get back as much as possible to normal life.”

Germany is also considering such a scheme, according to The Guardian. German researchers are preparing a mass study that aims to find out the extent of the pandemic by initially testing 100,000 volunteers for coronavirus antibodies. The testing would be extended to a growing sample of the population over time.

An immunity passport scheme could be piggybacked onto the testing campaign. “Those who are immune could be issued with a kind of vaccination pass that would for example allow them to exempted from restrictions on their activity,” Gerard Krause, head of epidemiology at the Helmholtz Centre for Infection Research, told The Guardian.

One downside of the scheme is that it might tempt some people to actively seek infection in order to obtain an immunity passport as way to get out of lockdown. That would foolish, since a good proportion of hospitalized COVID-19 patients are young or have no risk factors. Peter Openshaw, professor of experimental medicine at Imperial College London, warned the Guardian that this “would be putting your life at risk to try and catch it at the moment.” Better, he argued, “to adhere to social distancing and to wait for the vaccine.”

Nonetheless, this has at least some potential as a way to loosen the ties that have brought so much work and so many lives to a standstill. At the very least, it’s an idea our officials should explore.

 

from Latest – Reason.com https://ift.tt/3aEhIlD
via IFTTT

“In this time of global pandemic,” Harvard law professor and anti-liberal vanguardist Adrian Vermeule writes in the third paragraph of a much-discussed new Atlantic essay, “it has become clear that a just governing order must have ample power to cope with large-scale crises of public health and well-being—reading ‘health’ in many senses, not only literal and physical but also metaphorical and social.” This aggrandizement of executive power, Vermeule posited, should be constitutionally lubrciated by “an illiberal legalism that is not ‘conservative’ at all, insofar as standard conservatism is content to play defensively within the procedural rules of the liberal order.”

Italics—and direct warning—his.

As viral fate would have it, Vermeule’s philo-Falangist manifesto appeared just one day after the global poster-child for aspirationally illiberal conservatism, Hungarian Prime Minister Viktor Orbán, was gifted by a parliament he already dominates the power to rule by decree, suspend elections indefinitely, and imprison journalists for up to five years for publishing fake news about the coronavirus.

Vermeule’s vision of “ensur[ing] that the ruler has the power needed to rule well” was thus effectuated by the world leader who most embodies the new nationalism that’s gaining steam on the intellectual right, in the United States and elsewhere. “You are thinkers, but we are doers,” Orbán told a rapt audience two months ago at the National Conservatism Conference in Rome, where conservative intellectuals such as Rod Dreher and Yoram Hazony rubbed elbows with continental nationalists such as Marion Marechal. “Politics is about making decisions, gaining and keeping the trust of the nation, and getting the power and keeping the power.”

Orbán, like Vermeuele and other American integralists, is saying the loud part loud. “Liberal democracy…is over,” he proclaimed in Rome, while swatting around softball how-do-you-do-it questions from former American Enterprise Institute president and Reagan administration official Chris DeMuth. “We need something new. We can call it illiberal, we can call it post-liberal, you can call it Christian democratic, whatever, but we need something new, because on that [former] basis we cannot provide good governance for the people. So we developed a new theory and a new approach: that is Christian democracy. And instead of liberal freedom we use Christian liberty.”

The “liberalism” that this new right is fighting is not limited to woke progressivism, fond though they may be of detecting “cultural Marxists” in every bureaucracy, newspaper, and university. No, they mean very directly to smote “classical liberals” as well. Just as the rising left-populists of the Jeremy Corbyn or Sen. Bernie Sanders (I–Vt.) type despise “neoliberals,” their equally rising right-wing counterparts condemn the market-fundamentalist and hyper-individualist shibboleths that for too long (in their view) held sway in the democratic West.

“The Court’s jurisprudence on free speech, abortion, sexual liberties, and related matters will prove vulnerable under a regime of common-good constitutionalism,” muses Vermeule, before shifting to a more pronounced Bane-like tone. “The claim, from the notorious joint opinion in Planned Parenthood v. Casey, that each individual may ‘define one’s own concept of existence, of meaning, of the universe, and of the mystery of human life’ should be not only rejected but stamped as abominable, beyond the realm of the acceptable forever after. So too should the libertarian assumptions central to free-speech law and free-speech ideology—that government is forbidden to judge the quality and moral worth of public speech, that ‘one man’s vulgarity is another’s lyric,’ and so on—fall under the ax. Libertarian conceptions of property rights and economic rights will also have to go.”

At some point it becomes wise to take self-declared enemies of liberalism at their word. More still when real-life politicians start acting out those power fantasies.

Sure enough, there has been no shortage this week of western news organizations sounding the alarm bell at right-wing nationalists exercising heightened powers to combat COVID-19 worldwide: Orbán in Hungary, Benjamin Netanyahu in Israel, Aleksandar Vučić in Serbia, Rodrigo Duterte in the Philippines. Usually these pieces come with observation that many of these leaders maintain close relationships with President Donald Trump.

But this is where the conventional narrative about creeping global corona-fascism begins to founder. Because do you know who else gets the Friend of Trump treatment about COVID-19 policy? Politicians, at here and abroad, who take the opposite approach to coronavirus crackdowns.

“In Brazil, Jair Bolsonaro, Trump’s Close Ally, Dangerously Downplays the Coronavirus Risk,” goes the New Yorker headline this week. “How 2 Trump-loving governors are struggling amid the coronavirus crisis,” runs today’s offering at CNN. There are generally no such dot-connecting ideological/partisan exercises when the laissez-faire governmental responses come from populist lefties, as in Nicragua, Mexico, and (until recently) New York City.

Meanwhile, a whole commentary cottage industry has arisen over outraged non-conservatives urgently demanding that the president they despise wave the presidential wand to control the entire country’s behavior. “It is time for a national lockdown,” The New York Times editorialized last week. The longtime progressive website Common Dreams had a remarkable headline two days later: “As Trump Snubs Restrictions to Contain Coronavirus, New Poll Shows 3 in 4 Americans Back a National Lockdown.”

As ever, it takes libertarians to bring up rights in the midst of a national freakout. “The president doesn’t have constitutional authority to issue a national stay-at-home order, so please stop urging him to do so,” one of his fiercest critics, Rep. Justin Amash (I–Mich.) tweeted today. “He can recommend, but he doesn’t get to do whatever he wants, even in a crisis. That’s the law. That’s our Constitution. It exists to secure our rights.”

Rights, shmights, says Vermeule.

“Elaborating on the common-good principle that no constitutional right to refuse vaccination exists, constitutional law will define in broad terms the authority of the state to protect the public’s health and well-being, protecting the weak from pandemics and scourges of many kinds—biological, social, and economic—even when doing so requires overriding the selfish claims of individuals to private ‘rights,'” he wrote.

It was heartening to see so many commentators, including a few fellow-traveler nationalists on the right, flag Vermeuele’s manifesto as at the least wrongheaded and at the most frightening. But as the great libertarian legal advocate Timothy Sandefur and others have pointed out, utilitarian, will-to-power constitutionalism is a common feature in non-integrationalist legal academia as well.

And I am perhaps most alarmed by the critique that the anti-liberals get most right: that legal frameworks cannot long survive dislocating separations from the broader culture. Put more bluntly, in response to this deadly and terrifying virus, U.S. politicians are imposing, and Americans are accepting, a series of infringements on liberty more extensive and arbitrary than any I thought I’d see in my lifetime.

In order for liberalism’s enemies to be bested, there needs to be a robust liberalism left to defend. Right now, whether in politics or intellectual life or our ongoing overlapping lockdowns, there is little momentum on the side of Team Enlightenment. And we’re still nowhere close to the apex of dead bodies. As Keith E. Whittington concluded in his Volokh Conspiracy essay about Vermeuele, “Winter is coming.”

from Latest – Reason.com https://ift.tt/345KZ6j
via IFTTT

I’ve long much admired Prof. Bambauer’s work, and when I saw this forwarded to a lawprof discussion list I’m on, I asked her for permission to repost it:

The importance of testing and contact tracing to slow the spread of the novel coronavirus is now pretty well understood. The difference between the communities that do it and the ones that don’t is disturbingly grim (see, e.g., South Korea versus Italy). In a large population like the U.S., contact tracing and alerts will have to be done in an automated way with the help of mobile service providers’ geolocation data. The intensive use of location data in South Korea has led many commenters to claim that the strategy that’s been so effective there cannot be replicated in western countries with strong privacy laws.

Descriptively, it’s probably true that privacy law and instincts in the US and EU will hinder virus surveillance. The European Commission’s recent guidance on GDPR’s application to the COVID-19 crisis states that EU countries would have to introduce new legislation in order to use telecommunications data to do contact tracing, and that the legislation would be reviewable by the European Court of Human Rights. No member states have done this. Even Germany, which has announced the rollout of a cellphone tracking and alert app has decided to make the use of the app voluntary. This system will only be effective if enough people opt into it. (One study suggests the minimum participation rate would have to be “near universal,” so this does not bode well.)

And in the U.S., privacy advocacy groups like EPIC are already gearing up to challenge the collection of cellphone data by federal and state governments based on recent Fourth Amendment precedent finding that individuals have a reasonable expectation of privacy in cell phone location data. And nearly every opinion piece I read from public health experts promoting contact tracing ends with some obligatory handwringing about the privacy and ethical implications. Research universities and units of government that are comfortable advocating for draconian measures of social distancing and isolation find it necessary to stall and consult their IRBs and privacy officers before pursuing options that involve data surveillance.

While ethicists and privacy scholars certainly have something to teach regulators during a pandemic, the Coronavirus has something to teach us in return. It has thrown harsh light on the drawbacks and absurdities of rigid individual control over personal data.

Objections to surveillance lose their moral and logical bearings when the alternatives are out-of-control disease or mass lockdowns. Compared to those, mass surveillance is the most liberty-preserving option. Thus, instead of reflexively trotting out privacy and ethics arguments, we should take the opportunity to examine some of the assumptions that are baked into our privacy laws now that they are being tested.

At the highest level of abstraction, the pandemic should remind us that privacy is, ultimately, an instrumental right. It is meant to achieve certain social goals in fairness, safety, and autonomy. It is not an end in itself. When privacy is cloaked in the language of fundamental human rights, its instrumental function is lost.

Like other liberties in movement and commerce, conceiving of privacy as something that is under each individual’s control is a useful rule-of-thumb when it doesn’t conflict too much with other people’s interests. But the COVID-19 crisis shows that there are circumstances under which privacy as an individual right frustrates the very values in fairness, autonomy, and physical security that it is supposed to support.

I have argued in the past that privacy should be understood as a collective interest in risk management, like negligence law, rather than a property-style right. Even if that idea is unpalatable in normal times, I would hope lawmakers can see the need to take decisive action in support of data-sharing during crises like this one. At a minimum epidemiologists and cellphone service providers should be able to rely on implied consent to data-sharing, just as the tort system allows doctors to presume consent for emergency surgery when a patient’s wishes cannot be observed in time.

In fact we should go further than this. There is a moral imperative to ignore even express lack of consent when withholding important information puts others in danger. Just as many states affirmatively require doctors, therapists, teachers, and other fiduciaries to report certain risks even at the expense of their client’s and ward’s privacy (e.g. New York’s requirement that doctors notify their patient’s partners about a positive HIV test if their patient fails to do so), this same logic applies at scale to the collection and analysis of data during a pandemic.

Another reason consent is inappropriate is that it mars quantitative studies with selection bias. Medical reporting on the transmission and mortality of COVID-19 has had to rely much too heavily on data coming out of the Diamond Princess cruise ship because for a long time it was the only random sample—the only time that everybody was screened.

The United States has done a particularly poor job tracking the spread of the virus because faced with a shortage of tests, the CDC compounded our problems by denying those tests to anybody that didn’t meet specific criteria (a set of symptoms and either recent travel or known exposure to a confirmed case.) These criteria all but guaranteed that our data would suggest coughs and fevers are necessary conditions for coronavirus, and it delayed our recognition of community spread. If we are able to do antibody testing in the near future to understand who has had the virus in the past, that data would be most useful over swath of people who have not self-selected into a testing facility.

If consent is not an appropriate concept for privacy during a crisis, that suggests there is a defect in its theory even outside of crisis time. We can improve on the theoretical underpinnings of privacy law by embracing the fact that privacy is an instrumental concept. If we are trying to achieve certain goals through its use—goals in equity, fairness, and autonomy—we should increase our effort to understand what types of uses of data implicate those outcomes, and how they can be improved through moral and legal obligations.

Fortunately, that work is already advancing at a fast clip in debates about socially responsible AI. If our policies can ensure that machine learning applications are sufficiently “fair,” and if we can agree on what fairness entails, lawmakers can begin the fruitful and necessary work of shifting privacy law away from prohibitions on data collection and sharing and toward limits on its use.

Health care privacy isn’t my field, so I can’t speak independently about this, but if you can point to interesting articles on the other side, please pass them along.

from Latest – Reason.com https://ift.tt/3dOTuav
via IFTTT

How long can an economy that is legally about pretty much nothing but food production, distribution, and sales survive in this COVID-19 haunted world?

The United Nation’s Food and Agriculture Organization (FAO) isn’t feeling good about the near future, to judge from the statements posted on its website. “As of now, disruptions are minimal as food supply has been adequate and markets have been stable so far,” it says. But it detects threats looming from both “logistics bottlenecks (not being able to move food from point A to point B), and likely…less food of high-value commodities (i.e. fruits and vegetables) being produced.”

Over the next two months, the FAO anticipates “disruptions in the food supply chains,” thanks to “restrictions of movement, as well as basic aversion behaviour by workers…. Shortage of fertilizers, veterinary medicines and other input could affect agricultural production. Closures of restaurants and less frequent grocery shopping [will likely] diminish demand for fresh produce and fisheries products, affecting producers and suppliers.”

The agency is particularly concerned with “countries that rely heavily on food imports, such as Small Islands Developing States, and countries that depend on primary exports like oil. Vulnerable groups also include small-scale farmers, pastoralists, and fishers who might be hindered from working their land, caring for their livestock, or fishing. They will also face challenges accessing markets to sell their products or buy essential inputs, or struggle due to higher food prices and limited purchasing power.” The FAO also worries what will happen to the developing-world children—up to 85 million of them—who depend on school-supplied meals.

During the 2014–16 Ebola ourbreak in Sierra Leone, the group reports, quarantines “led to a spike in hunger and malnutrition. The suffering worsened as restrictions on movement led both to labour shortages at harvest time even as other farmers were unable to bring their produce to market.”

The FAO says is already sees “challenges in terms of the logistics involving the movement of food…and the pandemic’s impact on livestock sector due to reduced access to animal feed and slaughterhouses’ diminished capacity (due to logistical constraints and labour shortages) similar to what happened in China.” Transport route blockages from virus fears could especially harm the fresh food market, where products are highly perishable. The FAO thus anticipates price spikes in the meat and fish markets.

Some countries are already practicing isolated bits of food protectionism. Malaysia closed some palm oil planatations because of a virus outbreak. Reuters reports that Kazakhstan has “suspended exports of wheat flour, buckwheat, sugar, sunflower oil, and some vegetables until at least April 15 to ensure their steady supply during the coronavirus emergency.” Russia has stopped exporting processed grains, and Vietnam is stockpiling rice.

Here in America, the U.S. Department of Agriculture continues to order the destruction of tanker trucks of milk because processing dairies are full—a product of demand spiking and then, with the disappearance of school lunches, crashing. The U.S. also faces COVID-19-inspired immigration restrictions that will likely harm our food production.

The United Farm Workers union is warning that American food producers aren’t doing enough to prepare for the pandemic’s potential impact on the industry’s workers. “More than 400 commodities grown in California represent 13% of US agricultural value, totaling some $50 billion in business each year,” Quartz reports, and “just two California farms supply about 85% of US carrots. If the virus were to disrupt production at the largest of the state’s 77,500 farms, it would be felt globally” as “the state’s department of food and agriculture put its combined agricultural export value at $20.5 billion.”

Short-term stockpiling of things such as yeast can create apparent shortages that are really just supply-chain blockages. But as Ananth Iyer, a supply chain specialist with Purdue University, tells Quartz, labor-dependent items such as avocados, grapes, and tomatoes might face quicker actual shortages if agriculture workers start getting sick.

If U.S. farm worker safety is the world’s worry, then the world’s production and supply chain is the U.S.’s worry. As the food economist Shub Debgupta argued in The New York Times this week, “The United States relies on foreign suppliers for almost 20 percent of its food, including 80 percent of its seafood, with almost half of that coming from Asia….About half of our imported dairy products come from Europe, also hit hard by the virus. Almost 25 percent of America’s cheese comes from Italy…the nation with the world’s highest death toll from Covid-19.”

from Latest – Reason.com https://ift.tt/3dPbdP7
via IFTTT

The Food and Drug Administration (FDA) has relaxed another senseless regulation to help fight COVID-19: Gay and bisexual men will now be able to donate blood more easily.

U.S. medical centers have been facing a major blood shortage, as drives were canceled en masse amid the spread of the coronavirus, though the updated FDA guidelines are expected to remain in place after the COVID-19 emergency has been lifted.

The agency previously mandated that men who have sex with men abstain from that behavior from a full year before donating blood—even though every blood donation is screened for HIV. The FDA has now eased that period to a three-month deferral, which makes much more sense given current testing capabilities. When the U.K. instituted a similar three-month deferral, it saw no increase in HIV-infected blood. As I wrote Monday:

Paramount to this discussion is the safety of the blood supply—endangering that is certainly not worth sparing any one group’s hurt feelings. Calls to remove deferrals entirely for potentially risk-prone individuals make little sense. But current testing capabilities do support relaxing gay and bisexual men to a three-month deferral rate, which may even increase compliance among donors who would otherwise lie in the face of ridiculous waiting periods.

The new FDA guidance also recommends that those with new tattoos and piercings and those who have recently been to malaria-endemic areas be deferred for three months as opposed to a year.

Until 2015, the FDA enforced a lifetime ban on blood donations by men who have sex with men. That rule may have made sense in the 1980s, when it was instituted against the backdrop of the AIDS crisis. But blood testing capabilities have made leaps and bounds sense then. Every donation is tested for the full slate of blood-borne infectious diseases, including syphilis, hepatitis, human T-lymphotropic virus, and HIV.

Although those newly infected with HIV may initially test negative, current testing screens for the virus 9 to 11 days after transmission, rendering the yearlong deferral nonsensical. The regulation was particularly confusing in light of the fact the screening procedure does not discriminate against heterosexuals engaging in high-risk sexual practices. A man who has slept with several women in the span of a week would be able to donate blood without question; a gay male whose last sexual encounter was six months past would have been turned away.

from Latest – Reason.com https://ift.tt/2wcGhHE
via IFTTT

A couple of weeks ago, my oldest daughter, who is about to turn 27, developed symptoms consistent with COVID-19: a dry cough, a fever, and difficulty breathing. On March 23, she went to an urgent care clinic for a nasal swab test, which came back negative on Tuesday, eight days later. She was disappointed, in a sense, because she hoped she would at least come out of the experience with some immunity to the virus. Her doctor instructed her to remain isolated at home for three days after her symptoms subsided, just in case.

That is sound advice in light of evidence suggesting that negative COVID-19 tests may frequently be wrong. A study of 213 patients in China’s Guangdong province who had laboratory-confirmed COVID-19-related pneumonia found that in mild cases tested up to seven days after the onset of symptoms, the virus showed up in samples from nasal swabs 72 percent of the time; in severe cases tested within seven days, it was detected 73 percent of the time. For patients tested eight to 14 days after symptom onset, the nasal swab tests were positive 72 percent of the time in severe cases and just 56 percent of the time in mild cases.

“False-negative test results—tests that indicate you are not infected, when you are—seem to be uncomfortably common,” warns Harlan Krumholz, a professor of medicine at Yale, in a New York Times article published yesterday. “Some of my colleagues, experts in laboratory medicine, express concerns [that] the false-negative rate in this country could be even higher” than in China.

A substantial false-negative rate has several important implications. Most obviously, it means that people who have tested negative cannot safely assume they are not carrying the virus. The results of the China study, if confirmed (see caveats below), reinforce the case for general use of face masks in public and further undermine confidence in the official tallies of COVID-19 cases by the U.S. Centers for Disease Control and Prevention (CDC).

My daughter might have had COVID-19, but she does not count as a confirmed case. So in addition to all the people who carry the virus but do not seek treatment or testing because they have no symptoms or have mild symptoms they attribute to a cold or the flu, there may be a sizable group of people who have COVID-19 but are incorrectly told they do not. That makes calculating the true case fatality rate even more challenging.

“If you test negative for COVID-19,” the CDC says, “you probably were not infected at the time your specimen was collected. However, that does not mean you will not get sick. It is possible that you were very early in your infection at the time of your specimen collection and that you could test positive later, or you could be exposed later and then develop illness. In other words, a negative test result does not rule out getting sick later.”

Why might tests fail to confirm COVID-19 cases? “There are many reasons a test would be falsely negative under real-life conditions,” Krumholz writes. “Perhaps the sampling is inadequate. A common technique requires the collection of nasal secretions far back in the nose—and then rotating the swab several times. That is not an easy procedure to perform or for patients to tolerate. Other possible causes of false negative results are related to laboratory techniques and the substances used in the tests.”

The study of Chinese patients found that tests of sputum and bronchoalveolar lavage fluid (BALF) were more accurate than tests of nasal swabs. In 15 samples taken eight to 14 days after symptom onset, BALF tests detected the virus in all 12 severe cases, although they came up negative in the three patients who had mild pneumonia. The sputum tests were positive 74 percent to 89 percent of the time, depending on when the samples were taken and the severity of the illness. Throat swab tests, by contrast, detected the virus in 30 percent to 61 percent of the cases.

According to the CDC, a nasopharyngeal specimen, collected in the manner described by Krumholz, is “the preferred choice” for “initial diagnostic testing.” The CDC says anterior nares (nostril) swabs, nasal mid-turbinate swabs (collected from the middle of the nasal cavity), and oropharyngeal (throat) swabs are “acceptable alternatives.” All of those alternative procedures are easier to perform and more comfortable for the patient, since they do not involve the deep probing required by the nasopharyngeal test.

The China study does not specify which type of nasal swab was used. But overall, nasal swabs failed to detect the COVID-19 virus in 27 percent to 46 percent of previously confirmed cases, depending on sample timing and symptom severity. Throat swab tests were negative in 39 percent to 70 percent of cases. Sputum tests, by contrast, missed cases 11 percent to 26 percent of the time. The researchers conclude that “sputum is most accurate for laboratory diagnosis of [COVID-19], followed by nasal swabs.”

The BALF tests, which were performed only with samples collected eight to 14 days after symptom onset, were slightly more accurate than the sputum tests at that stage, missing 20 percent of cases (all mild), compared to 23 percent for sputum, 42 percent for nasal swabs, and 59 percent for throat swabs. But the researchers note that “collection of the lower respiratory samples” needed for BALF testing is “painful for the patients” and “requires both a suction device and a skilled operator,” so “BALF samples are not feasible for the routine laboratory diagnosis and monitoring” of COVID-19.

This study was limited to CDC-confirmed cases, which “may result in bias of sample selection,” the researchers note. In particular, the sample did not include people who carry the virus but have no symptoms, who may account for a quarter to half of all infections. The researchers also note that most of the specimens for the study “were collected after antiviral treatment, which may influence the viral shedding.” Another limitation is that the study sample was relatively small (especially for BALF testing, which included just 15 specimens). One other study, involving a sample of just nine COVID-19 patients, found no difference in virus detection between throat and nasal swabs.

The University of Oxford’s Center for Evidence-Based Medicine warns that “the only current COVID-19 specific data comparing [throat swabs] with [nasal swabs] comes from two low quality, non-peer-reviewed studies and should be viewed with caution.” It concludes that “it is not possible to accurately assess sensitivity from the existing data.”

from Latest – Reason.com https://ift.tt/2xL3Nvy
via IFTTT

Che Guevara was many things: a bloodthirsty executioner, a propagandist, an admirer of mass murderer Mao Zedong. But he was not a big fan of the Enlightenment philosopher John Locke, whose support for the rights to life, liberty, and property helped inspire the American Revolution.

Curiously, the curriculum company Flocabulary—best known for producing educational rap videos that teach history, vocabulary, and other subjects—thinks Guevara’s a great example of Locke’s influence and that students of all ages should know about it.

A parent of students enrolled in Alexandria City Public Schools in Alexandria, Virginia, has passed along a sample quiz question from one of Flocabulary’s units on the American Revolution. The unit, intended for grades 5–12, purports to teach kids about Locke and how his ideas inspired Thomas Jefferson and the American founding. Much of the content is fine, though the accompanying rap begins like this:

I’m the thinker with theories ’bout the government
Got the Enlightenment on lock because I’m running it
You wannabe Beyonces—change your clothes
I wrote down thoughts and I changed the globe.

The Locke rap also includes the lyric “I advocate revolution like Che.” And drawing a connection between Locke and Che turns out the be an idiosyncratic focus of the unit. Take a look at this bizarre reading section:

Where to begin? The reading implies that Locke’s thinking inspired Guevara’s revolutionary activities in South America and Africa, but there’s no evidence this is the case. Che’s revolution was based on Marxist-Leninism, and when he spoke about liberty he did not mean it in any Lockean sense.

Even setting Che aside, the question is a poor one. The correct answer must be A, but “the ability to blink” is not really “innate” in the same sense that rights are innate. Rights are abstract; the ability to blink is not.

Sadly, this sloppiness is characteristic of most—not all, but most—of the questions. Minor typos and awkward wording abound. Several items are duplicative. A few are so vastly superior to the others (an item about James Madison, for instance, is perfectly fine) that they must have been written by someone else.

I don’t intend to characterize the company’s entire curriculum based on one unit, but this unit was quite unimpressive. I realize that many lefties like Che Guevera: Frustratingly, his violent fanaticism is often overlooked by his T-shirt-wearing fans. But he’s hardly a compelling illustration of the ideas of John Locke.

A spokesperson for Flocabulary did not immediately respond to a request for comment.

from Latest – Reason.com https://ift.tt/2X2sFJX
via IFTTT

Last fall, the most-enlightened folks among us praised the move by some tech giants to police and even censor political ads. Sure, back in the day, Barack Obama had used Facebook and micro-targeting to good effect. Indeed, his campaign’s embrace of new ways of reaching young people (including using data from “unknowing users“) showed how liberals generally were so much more tech-savvy and forward-looking than old-school campaigns run by the likes of John McCain and Mitt Romney, who might as well have been wearing spats and sporting pocket watches. Then 2016 happened and it turned out that Donald Trump was a master of social media and Hillary Clinton was revealed as the hapless grandma who couldn’t even work her Jitterbug phone.  The super-retro real-estate mogul from Queens—who doesn’t even use email, fer chrissakes!—connected tremendously with all the mouth-breathers out there on Facebook, Twitter, Pornhub, whatever, and squeaked into the White House. Trump’s digital-media guy, Brad Parscale (Brad!) was the genius, while Clinton’s Robby Mook, once-always described as a guru, was the chump, a digital-era Joe Shlabotnik.

To the technoscenti, the obvious answer to such a turn of affairs was to ban or restrict political advertising online, often in the name of saving the Republic. Jack Dorsey of Twitter paused from taking meditation retreats in genocide-scarred Myanmar long enough to announce that he was banning political ads from his microblogging site, and people who only belatedly realized that non-liberals could be savvy at making memes breathed a sigh of relief. The same people lost their shit when Facebook’s CEO Mark Zuckerberg said he would continue to allow ads and he wasn’t even going to fact check them, either. Hadn’t this alien lifeform done enough damage to America already? When Google, the 800-lb. gorilla of online advertising, announced plans to restrict various forms of targeting and to police “false claims,” there was much rejoicing. As Kara Swisher, the founder of the great Recode platform who now writes for The New York Times, put it, Google’s decision to heavily restrict meant that Parscale “will now have one less weapon in his digital arsenal to wage his scorched-earth re-election campaign.”

But as Techdirt’s Mike Masnick writes, it turns out that censorship tends to work in mysterious ways, at least if you don’t understand that you won’t always be the censor. Here we are, in an election year during a full-blown pandemic whose severity many want to blame on Donald Trump’s inaction. Trump’s political opponents understandably want to flood the internet with messages about just how bad the “cheeto in chief” really is, but they’re running into the very restrictions they were applauding last fall. “Content moderation at scale is impossible to do well, writes Masnick,

and…things are especially tricky when it comes to content moderation and political advertising. Now, when you mix into that content moderation to try to stop disinformation during the COVID-19 pandemic and you run up against… politicians facing blocks in trying to advertise about Trump’s leadership failures in response to the pandemic.

He cites a report from Protocol that reads in part:

Staffers of several Democratic nonprofits and digital ad firms realized this week that they would not be able to use Google’s dominant ad tools to spread true information about President Trump’s handling of the outbreak on YouTube and other Google platforms. The company only allows PSA-style ads from government agencies like the Centers for Disease Control and trusted health bodies like the World Health Organization. Multiple Democratic and progressive strategists were rebuked when they tried to place Google ads criticizing the Trump administration’s response to coronavirus, officials within the firms told Protocol. (emphasis in original.)

Masnick notes that while political orgs face various forms of blocking and restriction, federal agencies do not and they are pumping out all sorts of public-service announcements and other ads geared around preventing the spread of coronavirus. Given that “this administration appears to view the entire apparatus of the federal government as solely part and parcel of the Trump re-election campaign, that basically means that Trump gets free reign over Google ads.” He stresses that he’s not criticizing Google but rather trying to underscore a point that always needs to be made when talking about online speech:

If you do content moderation, almost every “policy” you put in place will come back to bite you when you realize that, in practice, something will happen that seems insane even when you have a perfectly logical policy in place.

Masnick’s whole piece is here.

Let’s take this a step further: Yes, every individual platform has a right to ban or suspend whoever or whatever it wants (and thanks to much-beleaguered Section 230, every platform has the right to moderate some user-generated content without putting itself at legal risk, too). I’m sympathetic to the argument that some platforms want to limit viewpoint diversity or exclude certain types of speech and information as a way of creating or maintaining community.

But as you approach the size and scope of a Facebook, YouTube (owned by Google), and Twitter, the only real way forward is to trust your users to practice media literacy and to give them the tools they need to create the user experience they want. Masnick is right that content moderation, including picking what political ads are acceptable and which ones aren’t, is virtually impossible to do at scale. You either end up spending all of your time chasing down complaints or you create filters that simply block a ton of content in which your users are actually interested.

Just as it is in meatspace, the answer to bad, misleading, stupid, hateful speech is more and better speech. The power of online persuasion, including and possibly especially the role of Russian trolls in the 2016 election, has been wildly overstated. In an age of deepfakes, good-faith arguments, all sorts of data and versions of reality, and the growing participation of more types of people with all sorts of viewpoints, consensus will be harder to reach than ever. The beauty of online forums is that they give us more control over what we encounter even as they force us to check our premises. That all goes away if and when we cede control to gatekeepers who may not be any smarter or disinterested than we are.

from Latest – Reason.com https://ift.tt/3bM2gnI
via IFTTT