Here’s another reason I forgot to mention:
Expert anti-valve bias: most elastomerics have exhalation valves
And to be clear, I don’t think any of these reasons are enough (although, this somewhat depends on when in the pandemic these reasons were used) to justify not recommending the use of elastomerics.
It’s mostly too late for intervention #1. Now, everyone knows about these issues. However, it may do some good to replace a lot of old experts with much better ones like Zeynep Tufekci. Tufekci wasn’t perfect (never mentioned elastomerics), but she quickly got a lot of things right (even took lab leak seriously) and for the right reasons.
Intervention #2 has more merit, but I fear that the lack of urgency will take over and it will take too long to deploy elastomerics and/or PAPRs (which have certain advantages over elastomerics) at scale. This is starting to happen; I’ve seen a lot of talk about designing better respirators but nothing about deploying (or even recommending) the current generation of elastomerics to adults. The perfect is starting to become the enemy of the good.
If the current crop of experts can’t be reasoned with in a timely manner, one potential solution is to set-up an independent pandemic risk reduction organization. This org would make recommendations (e.g., elastomerics should replace other PPE, cheap PAPRs should be developed to replace elastomerics), take action (e.g., quick studies, cheap PAPR development and distribution), and be advised by experts like Tufekci. A possible source of funding might be the EA community.
The one you suggested seems even better.
It might be a better alternative to surgical masks for children, but it’s not necessarily better for adults. First, it’s not independently certified (by NIOSH, for instance). And second, it lacks an exhaust valve which could make it significantly less comfortable to use for extended periods of time due to increased humidity.
A better alternative for adults is the 3M 6000 series with the optional 3M 604 exhalation valve filter, if you care about filtering the valve’s exhaust.
N95 masks
KN95 masks
These aren’t elastomeric respirators.
I can think of many reasons why elastomeric respirators haven’t been widely used.
Slow expert opinion change: airborne transmission is not significant/only cause of infection
Bad assumptions: variants won’t become significantly more contagious
Unfamiliarity with elastomeric respirators: no/few studies, seem too uncomfortable, some advantages aren’t obvious (e.g., better face seal and comfort)
Naive empiricism: China’s lockdowns “worked,” and other Asian countries (like Hong Kong, South Korea, Taiwan, and Japan) controlled covid well without respirators
Hope: a combination of cloth/surgical masks and vaccines is good enough (see “Naive empiricism”)
Traditional expert training: contact tracing, vaccines, quarantine, social distancing
Low death rate: there’s less pressure to use the most effective means of dealing with the pandemic
Complacency: most people that would die of covid have already died
I suspect that the main reason was that most experts thought that a combination of traditional masks, contact tracing, vaccines, quarantine, and social distancing would be good enough. Old school epidemiology and naive empiricism strongly suggested this: China’s lockdowns “worked,” and other Asian countries (like Hong Kong, South Korea, Taiwan, and Japan) controlled covid well with masks, contact tracing, and border restrictions but without respirators, hard lockdowns, or even vaccines.
However, in the rest of the world, these solutions weren’t practical (due to the rise of more contagious variants) or available (vaccines).
#1 is a double-edged sword; it might help avoid #3 and #4 but might also avoid #2 (immortality). Although x-risk might be lower, billions will still suffer and die (assuming human-created medicine doesn’t progress fast enough) in a present and future similar to #3. OTOH, future humanity might run resurrection sims to “rescue” us for our current #3 situation. However, I don’t know if these sims are even possible for technical and philosophical reasons. From a self-preservation perspective, whether #1 is good or bad overall is not at all clear to me.
This is what happened:
Wrong expert opinion (no airborne transmission) → respirators not recommended → multiple lockdowns until vaccines became widely available → millions of dead people, massive economic and social disruption
This could have easily happened:
Fast expert opinion change (no airborne transmission → airborne transmission) → use first lockdown to manufacture respirators for everyone → use respirators until pandemic burns out or vaccines and therapeutics become widely available → thousands of dead people, only one lockdown, minimal economic and social disruption
The ideal scenario (everyone prepped with respirators for decades) could have also happened but expert opinion seemed to have been too stubborn to have considered airborne transmission as a real possibility before this pandemic, and even when sufficient evidence was acquired, this opinion was slow to change.
For similar pandemics (or future variants of the current virus that won’t respond to available vaccines or therapeutics) the solution is obvious: use respirators until the pandemic burns out or effective vaccines and therapeutics become widely available. Strangely, there still has been no big push to send respirators to areas of the world where vaccines and therapeutics like Paxlovid are less available.
Another thing that expert opinion continues to get wrong is its focus on the not-that-great disposable respirators rather than the better-in-almost-every-way reusable respirators (including PAPRs). If this doesn’t change and another pandemic (or nasty variant) develops, the disposables will run out again, a lot of them will fail (as they probably do today) to provide adequate protection (due to poor face seals), and the results will be similar to (or worse than) the current pandemic.
Just wear a respirator and be done with it.
Another factor to consider is how much outside air a ventilation system pulls in. This would help further dilute out the aerosols.
More worrisome are the 23.1% of people who wanted to take the flight while known to be positive. Thus, almost one in four people who follow a cautious doctor who writes frequently about Covid in the style above think that a known symptomatic Covid case should still go to a terminal and get on a flight. How many more of the general population must think the same way? That it’s fine to go around exposing people when you’re sick?
Well, maybe it’s not as clear cut as all that?
This is certainly a rather strong ‘planes are safe for Covid’ position, where it would be fine to put a known Covid-positive case on a plane (and more importantly, in the terminal to and from the plane) so long as everyone involved had masks, but without others wearing masks it turned into an unacceptable risk.
I notice my skepticism that things fit into these windows. A mask is a modest risk reduction. Even if we are super generous to both masks in general and mask use in practice and say 75% reduction between the two scenarios, a factor of four is actually rather unlikely to change the answer here. Which suggests that the masks are serving more of a symbolic ritual purpose, rather than anything else.
...
Bill Gates tests positive for Covid, properly treats it as an annoying need to isolate.
I don’t see why this is worrisome. If a covid-positive person is wearing a ventless N95 (or better) respirator, the chance of them infecting other maskless people is miniscule. This is due to the fact that even if a small amount of aerosols leaked from the respirator’s faceseal, it would be quickly diluted, especially in spaces (including terminals and flights) using any kind of ventilation system. Another thing to consider is that people that don’t use respirators already accept the risk of becoming infected at any time.
Technically, the best protection is a self-contained breathing apparatus (SCBA) which is a fancy way of referring to a respirator connected to an oxygen tank, but that thing too impractical and overkill for most people.
The amount of protection offered by a positive air pressure respirator (PAPR) depends on what kind of hood is being used and may offer about the same (or more) protection than a reusable elastomeric respirator. Assigned Protection Factor (APF) is a measure of the level of protection offered by types of respirators; PAPRs range from 25 to 1,000 APF, whereas reusable elastomeric respirators offer an APF of 10 (probably around 25 in reality) for half-facepiece respirators and 50 for full-facepiece respirators. Besides a potentially higher APF of 1,000, PAPRs also don’t require a fit test (which most people aren’t going to bother doing), so leaks are less likely, even though the APF might be similar or even less than a full-facepiece respirator. They’re also more comfortable than any other respirator. However, one hard-to-avoid disadvantage of a PAPR is that you’ll have to carry around an elastomeric respirator as a backup.
To mitigate the cost and bulk issues, it’s possible to DIY a PAPR (a plastic bag connected to filters, fans, and a battery). A DIY PAPR might be easier to repair and could also filter exhaust air, unlike commercial PAPRs. I haven’t bothered to DIY it yet, but others have definitely used these things successfully.
DIY PAPR intro info
https://viralhelmets.medium.com/15-viral-helmet-version-of-a-2000-hospital-mask-papr-4950905ae2cc
https://www.youtube.com/watch?v=zj_C4GrxfNM&t=102s
https://www.youtube.com/watch?v=xfaswOLIHoQ
DIY PAPR in-depth info
https://www.designnews.com/industry/beyond-n95-hackathon-produces-air-purifying-respirator
https://devpost.com/software/bunnypapr-for-jcrmrg-hackathon
https://bunnyscience.dozuki.com/Guide/Bunny+Science%E2%84%A2+PAPR/4
https://web.archive.org/web/20210202224805/https://bunnypapr.org
https://web.archive.org/web/20210825175428/https://www.viralhelmets.com
https://www.instructables.com/Viral-Helmets-9999-Hospital-Grade-Viral-Protection/
https://www.reddit.com/r/viralHelmets/
There are several elastomeric respirators that are ventless or that have add-on vent filters. I’ve heard that some of these respirators are not that comfortable to wear for long periods of time due to increased humidity, rather than pressure drop or C02 accumulation. I’ve tried a 3M 6000 series respirator with the 3M 604 exhalation valve filter, and I’ve noticed no significant increase in breathing difficulty, but I didn’t use it long enough to determine if humidity accumulation is a problem.
Ventless disposables can also have humidity issues, so you’re probably better off with an elastomeric anyway.
You’re right; I missed your end-of-post recommendation.
Yes, I’m saying that the newer variants can easily get past cloth and surgical masks but are highly unlikely (but not impossible due to faceseal leaks) to defeat elastomeric respirators equipped with P100 filters. This is due to the fact that P100 filters filter out nearly all particles, so the contagiousness of a virus doesn’t matter that much. Here’s another way to think about it: during a poison gas attack, what would you choose, a water-soaked handkerchief or a gas mask?
The whole thing (facepiece and filters) is a knockoff, and as far as I can tell, it’s not NIOSH-approved. Again, you can check for yourself.
This means that the reason to require masks at dances is to allow people to attend for which it would otherwise be too risky.
Or urge the people that think it’s too risky to attend to wear a respirator, instead of requiring everyone to wear one.
A group wearing surgical masks poses a risk to individuals (wearing the mask of their choice) that is roughly (per microcovid) 1⁄4 as risky as if the group were fully unmasked.
Microcovid is (still!) using outdated data (2020 and older) that doesn’t take into account the current covid variants that are far more contagious than the early-to-mid 2020 strains. It should be painfully obvious by now that surgical and cloth masks likely provide close to zero protection against these variants.
P100 is at ($16)
No one should buy that thing. It’s a (not NIOSH-approved) knockoff of the 3M 6000 series. Just buy a real 3M (or other NIOSH-approved model/brand) reusable, elastomeric respirator and filters from a reputable distributor.
Decreased social interaction can be a showstopper but sometimes it isn’t; so, I think a case-by-case policy would be more reasonable than a general stay-at-home-no-matter-what recommendation. In the party scenario, the choice is between attending and not attending (I’m assuming that there’s no remote party option like VR chat or something). For some parties (like birthday parties), attending might be better even if social interaction is reduced. For others (like indoor dinner parties), it might not be worth attending. In the job scenario, many jobs can’t be performed remotely, so physically attending would be better. You seem to have acknowledged this when you said:
if you’re at a job that benefits from in-person presence because of equipment or because your home is too disruptive, this doesn’t apply
Yeah, Paxlovid might not be as good of a cure as was initially thought due to the issue of relapse. How much of a problem this really is seems unclear.
symptomatic people (should) stay home
This is kind of OT, but I’m going to ask anyway: under what conditions do you think that symptomatic people should stay home? If a person’s symptoms are debilitating, staying home is the obviously correct choice. But if a person’s symptoms aren’t debilitating and wears a ventless respirator (and can tolerate it and it doesn’t interfere too much in what they’re doing), I don’t see why they should stay home.
Since respirators are widely available and have been for some time now, I don’t see any reason for mask mandates; a person wearing a respirator will be protected regardless of how many people around them wear masks. Plus, the masks most people wear (cloth and surgical) aren’t effective anyway.
Sure, I could have added the caveat “if you don’t die of anything else first (and most people won’t),” but I wanted to keep the caveats to a minimum. Perhaps a general caveat would be that these statements should be understood to apply to most people alive today. About two thirds of deaths are caused by aging (100k out of 150k per day) and in the developed world, it’s 90%.
If current covid policies (lockdowns and tracing) are relaxed, millions of Chinese could die. China’s CoronaVac vaccine doesn’t appear to be nearly as effective as the Western alternatives at two doses. Why a third dose hasn’t been more widely distributed yet is unclear. Respirators could also eliminate the need for current policies, but most experts still seem reluctant to recommend them for dumb reasons. There might also be “if it ain’t broke, don’t fix it” and “China is more effective and tougher than the rest of the world” attitudes floating around.