What precautions should fully-vaccinated people still be taking?

post by Sameerishere · 2021-06-27T19:10:24.312Z · LW · GW · 2 comments

This is a question post.

Contents

  Summary:
  Rationale:
  (confidence: medium-high)
  (confidence: low)
  (confidence: medium)
None
  Answers
    8 Dumbledore's Army
    5 ChristianKl
    2 Ericf
    -4 Florin
None
2 comments

(UPDATE 9/6/21: now that more is known about the Delta variant, I'm being more conservative than I articulated below, and managing to a weekly risk budget of 400 microcovids. The main difference beyond what I articulated below is that I'm no longer interacting freely with fully vaccinated people, but rather considering how risky various interactions are and moderating those accordingly or masking/distancing. I may relax that again based on my determination of how big an issue long covid is, which I'm exploring here: https://www.lesswrong.com/posts/jfHZR6Ykmc5DBSLCp/cliffs-notes-how-much-should-fully-vaccinated-people-care) [LW · GW]

ORIGINAL POST, FOR REFERENCE:

As someone who is now several months past my second dose of Pfizer, and who lives in San Francisco, which opened up completely earlier this month, I've been debating what events / spaces are still too risky to spend time in. Here are the rules of thumb I've been following and the thinking that informed them; would be interested in input!

I imagine I could make further progress with further thinking (and/or maybe I should just pick a risk budget and use the microCOVID calculator to stick to it), but figured that since I've done this amount of research and thinking, it might be helpful to some and low-cost for others to help fill in some gaps.

Summary:

Rationale:

(#1 and 2 drive my decision to take the precautions I am still taking. #3 drives my decision to relax precautions otherwise.)

(1) Current vaccines are less effective against the Delta variant (confidence: medium-high)

(2) There may be long-term adverse effects from COVID even if it doesn't require hospitalization, but the risk is low (confidence: low)

(3) Prior to the Delta variant being a major concern, prevailing guidance was that it was fine for fully-vaccinated people to interact in close quarters indoors without masks. My understanding is that this hasn't changed for fully-vaccinated people since then. (confidence: medium)

Answers

answer by Dumbledore's Army · 2021-06-28T13:05:33.557Z · LW(p) · GW(p)

You omit to give your age, which is highly relevant. Take the risks from the below paper* and then deduct another 95%+ to account for being fully vaccinated. Unless you’re either very elderly or seriously unwell (on the order of having leukaemia not just being mildly asthmatic) I suggest that the risk level is now low enough that it should not be driving your decisions, in the same way that you’re not dedicating this much effort to avoiding flu. (No, Covid isn’t flu, but when you are fully vaccinated then the risk level becomes comparable.)

It sounds like you’ve been overthinking this a lot. It’s time to live your life, see friends, enjoy yourself, and live again. There are more important thigs in life than squeezing out every last micromort of risk at the expense of all joy and of everything that makes life worth living.
 

*Our analysis finds a exponential relationship between age and IFR for COVID-19. The estimated age-specific IFR is very low for children and younger adults (e.g., 0.002% at age 10 and 0.01% at age 25) but increases progressively to 0.4% at age 55, 1.4% at age 65, 4.6% at age 75, and 15% at age 85. Moreover, our results indicate that about 90% of the variation in population IFR across geographical locations reflects differences in the age composition of the population and the extent to which relatively vulnerable age groups were exposed to the virus
 

https://www.medrxiv.org/content/10.1101/2020.07.23.20160895v7

comment by ChristianKl · 2021-06-28T14:22:41.987Z · LW(p) · GW(p)

IFR is not the only thing that matters. Avoiding long term heart and brain damage is also important. 

Replies from: Dumbledore's Army, matthew-barnett
comment by Dumbledore's Army · 2021-06-28T16:28:40.023Z · LW(p) · GW(p)

Point stands, I think. Once you’re fully vaccinated the risk - including risk of post-viral fatigue - is in the range we normally consider tolerable.

More generally, you need to balance risk reduction against actually enjoying your life. I would rather live a rich life than extend a grey and joyless existence, even if it means tolerating a small risk that said life will end early. That calculus shifts in the presence of large risks, but we aren’t talking about large risks now. I would encourage the OP, and everyone else who is vaccinated and still panicking worrying excessively about now-small risks, to look at the big picture and ask if they need a sense of perspective.

Replies from: Sameerishere, ChristianKl, neel-nanda-1
comment by Sameerishere · 2021-06-29T00:36:20.057Z · LW(p) · GW(p)

I'd find it helpful if folks had evidence to share about the level of risks other than death. (E.g. the risk of post-viral fatigue.) I agree that you need to balance risk reduction against actually enjoying your life, but I've been able to do that to my satisfaction and am interested in assessing the marginal risk of the items I noted in my post. I didn't go much into the benefit side in the post, because that varies by individual, and I feel pretty capable of assessing the marginal benefit for myself. (I can assure you that my life is quite rich, and nothing close to grey and joyless, even though I haven't leapt into indoor activities with unvaccinated people). 

comment by ChristianKl · 2021-06-28T18:00:24.446Z · LW(p) · GW(p)

Panicking isn't useful. Having discussions about how to effectively deal with risk isn't panicking, talking about panicking is strawmanning. 

Replies from: Dumbledore's Army
comment by Dumbledore's Army · 2021-06-29T06:59:49.213Z · LW(p) · GW(p)

Ok, reworded to something else.

comment by Neel Nanda (neel-nanda-1) · 2021-06-28T21:31:12.449Z · LW(p) · GW(p)
Once you’re fully vaccinated the risk - including risk of post-viral fatigue - is in the range we normally consider tolerable.

Do you have a source for this? I've seen good data about hospitalization and risk of death, but nothing about long COVID. They probably correlate, but I've seen suggestive data that they correlate less than I'd intuitively expect.

It definitely doesn't feel like there's enough data to be confident in saying 'this is now a silly thing to care about or spend mental energy on'. Though I'd mostly agree if you live in an area with very low case counts.

Replies from: Dumbledore's Army
comment by Dumbledore's Army · 2021-06-30T16:35:12.220Z · LW(p) · GW(p)

Sorry, no source - but given the vaccines massively (>90%) reduce risk of other harms ie death & hospitalisation, I think the null hypothesis has to be that vaccines also massively reduce risk of long COVID. 

I also start with a prior that a lot of discussion about long-COVID is low quality and I think it's an example of post-viral fatigue rather than some brand-new thing. It gets lots of media hype, like anything vaguely scary and covid-related, but hard data seems to be hard to come by and often very low quality. 

Replies from: neel-nanda-1
comment by Neel Nanda (neel-nanda-1) · 2021-06-30T17:22:23.237Z · LW(p) · GW(p)

The [best source I've found] (https://institute.global/policy/hidden-pandemic-long-covid) finds a 30% reduction in P(Long COVID | infection after 2 vaccine doses). Infection reduction is about 85%, so total risk reduction is about 90%, MUCH less than the risk reduction for hospitalisation.

The study is based on 3,000 infected patients, all over 60, unclear how it generalises to younger people.

In general, there is SOME good quality research on long COVID, and it seems obvious to me that it is a legitimate thing and respects a good fraction of the harm of the pandemic. Even if overall research is much less high quality than I want.

Replies from: Dumbledore's Army
comment by Dumbledore's Army · 2021-07-01T08:47:20.468Z · LW(p) · GW(p)

Thanks for the source, I hadn’t seen it before. 90% risk reduction is still an order of magnitude, seems like a big deal to me. 

One point to be aware of: I notice they don’t distinguish between the different vaccines, they just give a population-wide figure. The UK has used a combination of Pfizer and AstraZeneca, and on other metrics eg efficacy against symptomatic infection or hospitalisation, AZ is slightly to moderately worse than Pfizer. Assuming the same pattern holds for long covid, I would assume a >90% risk reduction for Pfizer (and Moderna with similar mRNA technology), which is the read-across relevant to American readers.

comment by Matthew Barnett (matthew-barnett) · 2021-06-28T20:02:44.373Z · LW(p) · GW(p)

They said "No, Covid isn’t flu, but when you are fully vaccinated then the risk level becomes comparable." So, what's the evidence that long term heart and brain damage of COVID-19 is worse than the flu (or the cold for that matter) after you're already vaccinated?

Replies from: ChristianKl
comment by ChristianKl · 2021-06-28T20:14:36.077Z · LW(p) · GW(p)

The general way to deal with drugs is to put the of burden of evidence on the drug that it helps with certain conditions (it's called the precautionary principle in medicine). Nobody gathered evidence that any of the vaccines help against long COVID.

The vaccines do seem to help against outcomes like hospitalization but if we look at an issue like brain damage there's no statistical significant difference between whether or not the person was hospitalized. It's been a while since I read up on heart damage and from what I remember that also didn't need hospitalization to occur. 

Replies from: TAG, skot523, None
comment by TAG · 2021-06-28T20:55:22.100Z · LW(p) · GW(p)

Nobody gathered evidence that any of the vaccines help against long COVID.

Nobody could have within the time frame. Have you noticed how there's always one bunch of people complaining that everything has been slowed down by bureaucracy, and another saying that nothing has been tested thoroughly enough?

Replies from: ChristianKl
comment by ChristianKl · 2021-06-28T22:05:22.143Z · LW(p) · GW(p)

The sentence said nothing about requiring testing. We could just say: "You get 5$ extra per vaccine dose if you show it helps reduces long COVID by 90%".

Replies from: TAG
comment by TAG · 2021-06-28T22:40:18.175Z · LW(p) · GW(p)

How do they show something wthout testing it?

Replies from: ChristianKl
comment by ChristianKl · 2021-06-28T22:50:35.990Z · LW(p) · GW(p)

They are not required to show it to get their vaccine to market. Generally, the idea is to make it easier to bring vaccines to market and then pay extra for proof that the vaccine does desirable things.

Replies from: TAG
comment by TAG · 2021-06-29T00:15:14.504Z · LW(p) · GW(p)

Specifically, you are paying them extra money to show it.

Replies from: ChristianKl
comment by ChristianKl · 2021-06-29T13:08:40.335Z · LW(p) · GW(p)

Yes, you are paying money for important information. That's different then slowing down response via bureaucracy. 

Replies from: TAG
comment by TAG · 2021-06-29T16:02:11.910Z · LW(p) · GW(p)

Yes, you are paying money for important information

You are not, because money can't buy time in the required sense. If the purchasers of the drug can't afford to wait to study the long term impact, it is no good paying the providers extra, because there is no way they can accelerate time.

That’s different then slowing down response via bureaucracy.

You are assuming the very lesswrongian assumption that all bureaucracy is unnecessary. It's more complicated than that. If you remove the checks and balances, you don't get the same results faster , you get worse results faster.

Replies from: ChristianKl
comment by ChristianKl · 2021-06-29T17:22:45.258Z · LW(p) · GW(p)

You are not, because money can't buy time in the required sense. If the purchasers of the drug can't afford to wait to study the long term impact, it is no good paying the providers extra, because there is no way they can accelerate time.

That's just wrong. You can run multiple studies. Moderna/Pfizer didn't have information about whether the vaccine reduces transmission in the first trial that lead to bringing the vaccine to market. It's information they gathered in later trials and there's no reason why the couldn't have run tests for long COVID on patients of those trials. 

Recruiting more patients for clinical trials accelerates the trial and costs money. Recruiting the amount of patients that allowed Moderna and Pfizer to get their vaccines approved when they did cost hundreds of millions of dollars. 

You are assuming the very lesswrongian assumption that all bureaucracy is unnecessary.

I'm not sure why you want to strawman. I never said that I reject all bureaucracy. I'm just for less of it and smarter regulation. I'd love to see a law that criminalizes intentionally witholding information about biosafety breaches from the public.

As Pakinson described, he British foreign service managed to get by with orders of magnitude less bureaucrats when they had an actual empire to manage then they have employed afterwards. Bureaucracy grows like cancer and is hard to reduce. 

Hydra manages to have bureaucracy that does independent quality testing. The FDA doesn't manage to do any independend quality testing and thus fails to remove fraudulent products like those of Ranbaxy from the market within reasonable trimeframes and manages to approve drugs where their scientific advisory panel says they don't work. 

The FDA combines a lot of resistence to bringing drugs to the market with little action to provide actual safety.

If you remove the checks and balances, you don't get the same results faster , you get worse results faster.

In this case we got vaccines with extremely high side effects compared to the vaccines that we usually use as a result of the regulation. While they might not cause lasting harm, being ill for a day isn't nothing. 

Without regulation we would have used well understood and easy to scale up vaccine technology earlier in 2020. The regulation we have only allowed for vaccines with patent protected technology to be effectively brought to market and unfortunately that came with a lot of disadvantages. 

Replies from: TAG
comment by TAG · 2021-06-30T12:25:25.088Z · LW(p) · GW(p)

You can run multiple studies

I'm aware that parallelism is how you usually speeds things up. I am saying that it doesnt work in cases where you are studing a long term phenomenon.

As Pakinson described, he British foreign service managed to get by with orders of magnitude less bureaucrats when they had an actual empire to manage then they have employed afterwards

They also didn't mind millions starving. You can see increased bureaucracy and regulation as being a reflection of putting an increased value on individual wellbeing. I don't know if that's right , but you could consider it.

In this case we got vaccines with extremely high side effects compared to the vaccines that we usually use as a result of the regulation

That's hindsight fallacy.

Replies from: ChristianKl
comment by ChristianKl · 2021-06-30T13:21:44.434Z · LW(p) · GW(p)

I'm aware that parallelism is how you usually speeds things up. I am saying that it doesnt work in cases where you are studing a long term phenomenon.

You can't study effects of COVID a few years out. At the same time we could now have information about what 6-month after infection effects the vaccines prevent.

You can see increased bureaucracy and regulation as being a reflection of putting an increased value on individual wellbeing. I don't know if that's right , but you could consider it.

I can also consider that increased bureaucracy and regulation is due to God making it happen. There are a lot of bad explanations that I can consider. 

If the increased bureaucracy is due to increased value of individual wellbeing, we would only see it in situations where the point of the regulation is increased wellbeing. Few people think about tax law as being primarily about wellbeing, yet the complexity of it grows constantly. 

Just like cancer grows naturally bureaucracy does as well. Pakinson did good work on describing how it works. 

That's hindsight fallacy.

Hindsight fallacy would be saying that it would have been predictable when the pandemic started that the process leads to vaccines with higher side-effects. What I said was just that it did lead to vaccines with higher side-effects. That's an observation that does come from hindsight and it would have been possible for regulation to produce no net damage in this case. At the same time I have written about how regulation increases side-effects of drugs before, so it's not completely a thesis that comes out of hindsight. 

If we look at vaccines, vaccines that get developed in a way where the inventor of the vaccine vaccinates himself early are more likely to be safe then ones that get validated through clinical trials where increasing the chance of the trials finding a clinical effect is more important then reducing side effects. 

You could write a regulation that the first human in which a new vaccine gets tested as to be the CEO of the vaccine company to create skin-in-the-game. Such regulation wouldn't slow down vaccine development but would help with safety.

Replies from: TAG, TAG
comment by TAG · 2021-06-30T19:32:18.305Z · LW(p) · GW(p)
comment by TAG · 2021-06-30T19:32:18.304Z · LW(p) · GW(p)

You can’t study effects of COVID a few years out.

No,not even for five extra dollars a dose.

You can see increased bureaucracy and regulation as being a reflection of putting an increased value on individual wellbeing. I don’t know if that’s right , but you could consider it

You could also consider that the truth lies somewhere between.

If the increased bureaucracy is due to increased value of individual wellbeing, we would only see it in situations where the point of the regulation is increased wellbeing

Which is to say : "if the increased bureaucracy is entirely due to increased value of individual wellbeing..."

If we look at vaccines, vaccines that get developed in a way where the inventor of the vaccine vaccinates himself early are more likely to be safe then ones that get validated through clinical trials where increasing the chance of the trials finding a clinical effect is more important then reducing side effects.

I am finding that hard to parse. How are you defining "safe", how are you checking that they actually took their miracle cure, and why are you placing so much confidence on a single (at best) data point?

It's easy to justify having some non-zero level of regulation by looking at the quackery prevalant in the nineteenth early twentieth century. And claiming to have benefited from a cure you had never personally taken is quackery 101.

comment by skot523 · 2021-06-29T23:23:49.009Z · LW(p) · GW(p)

I completely lost my sense and smell and it did return over the next few months, for the record. Therefore, I wouldn’t consider that damage final in all cases.

comment by [deleted] · 2021-06-30T05:08:49.445Z · LW(p) · GW(p)

I am super skeptical of that whole brain damage thing.  Brains change, from all kinds of things.  I can't help but notice that everywhere they see statistically significant differences is downstream of smell and taste, and actually closely resembles previously described brain changes in people with chronic rhinitis that blocks the sense of smell through ordinary means.

comment by Sameerishere · 2021-06-29T00:31:14.970Z · LW(p) · GW(p)

I'm in my mid-30s, and I'd say, moderately asthmatic, which probably falls into the same risk category you had in mind. I'm not sure what led you to believe that I've been avoiding seeing friends or enjoying myself, and squeezing out risks at the expense of everything that makes life worth living -- refraining from indoor events with people who're unvaccinated hasn't had much of an impact on my quality of life, but it will have a bigger impact on my quality of life now that events are loosening restrictions. Hence my post.

I think it's clear that IFR is low among people of my risk level, but as the other folks who replied to your comment noted, I think it's worth considering effects other than death. I'd be interested to know if anyone has evidence on that.

answer by ChristianKl · 2021-06-28T10:37:37.634Z · LW(p) · GW(p)

Your interventions seem to be based on the idea aerosols accumulation doesn't matter much. My current assumptions is that aerosols accumulation matters a lot for COVID-19. This means that when indoors ventilation and running air filters is important and plausibly more important then masks/distance. 

More dakka with airfilters is an option if you are worried about transmission when hosting a party. 

When it comes to masks it's worth noting that different masks provide different protection. The study in military recruits suggests that while cloth masks might reduce your chances to spread the disease they don't reduce your change of getting infected.

comment by Sameerishere · 2021-06-29T00:24:49.375Z · LW(p) · GW(p)

Thanks. I'd say that my interventions are based on the assumption that I can't personally do much to impact aerosol accumulation in the indoor events I want to attend. I think that I may be underestimating the extent to which I can influence / screen for that (and perhaps overestimating the efficacy of masks and distancing indoors), so thanks for raising this. 

Replies from: ChristianKl
comment by ChristianKl · 2021-06-29T14:04:09.630Z · LW(p) · GW(p)

When taking an Uber, it's quite easy to say "Hey, I want to have the windows open". 

You likely won't get a quantity of air filters that makes an indoors event like an outdoor event outside of a meeting between rationalists, but you can still voice the preference to open windows at many events. 

answer by Ericf · 2021-06-29T02:35:34.816Z · LW(p) · GW(p)

Don't French kiss people who are symptomatic and known to be infected.

Or, more reasonably, if you know someone is infected OR symptomatic avoid "Sharing their air."

Once you account for the lack of community cases (if 1 in 10,000 people are infected, as is currently approximately the case in the vaccinated parts of the world) then having a close interaction with 100 people at a gathering of any size has less than .1% chance of even including an infected individual.

answer by Florin · 2021-06-27T21:03:13.843Z · LW(p) · GW(p)

If you want zero risk, wear an elastomeric respirator or DIY PAPR. Masks probably don't work against the variants (masks wiped out the flu but not the massive fall/winter covid wave).

There's no good evidence that outdoor transmission is even a thing, and mechanistic reasons (aerosols can't accumulate outdoors) also cast doubt on the idea of outdoor transmission. In places where lots of people are vaccinated or have immunity by having been infected, the risk is miniscule even in outdoor crowds. If you're extremely risk-averse, wear a respirator or PAPR or avoid crowds altogether.

comment by Neel Nanda (neel-nanda-1) · 2021-06-28T11:47:02.809Z · LW(p) · GW(p)
Masks probably don't work against the variants (masks wiped out the flu but not the massive fall/winter covid wave).

This seems like the wrong inference. The R0 of flu is something like 1.2, the R0 of Alpha was about 4 (at pre-COVID levels of social distancing). 'Masks work' looks like masks reducing R0 by some factor. If this reduces R0 to below 1, it wipes out the disease, if it remains above 1 you will still get a massive wave. Because the R0 of flu is so much lower, 'flu was wiped out but COVID wasn't' is approximately 0 evidence about the effectiveness of masks.

For example, this paper found a 25% reduction in R0 from universal mask wearing. That would reduce flu to 0.9 and wipe it out, but reduce Alpha to 3, which is still very virulent. Yet, it is still obviously correct to wear a mask

Replies from: florin-clapa
comment by Florin (florin-clapa) · 2021-06-28T21:41:57.643Z · LW(p) · GW(p)

It is obviously correct to wear a mask only if you do not have access to a respirator or PAPR.

Better protection could have wiped out covid just like masks wiped out the flu. While masks may have offered some better-than-nothing protection, it was grossly inadequate protection.

Replies from: neel-nanda-1
comment by Neel Nanda (neel-nanda-1) · 2021-06-28T22:12:52.169Z · LW(p) · GW(p)
It is obviously correct to wear a mask only if you do not have access to a respirator or PAPR.

Sure, I'd agree with this. Things like N95s and P100s are much better than cloth or surgical masks.

comment by gjm · 2021-06-27T22:18:51.593Z · LW(p) · GW(p)

"Don't work" seems like the wrong phrase. Unless the newer variants have evolved teleportation, masks will be about as effective as they ever were at reducing the extent to which respiratory droplets carry the virus from one person to another. I bet they produce about the same reduction in R as they used to.

Against newer more transmissible variants, widespread mask-wearing may not be enough to stop exponential growth among the unvaccinated. But "aren't enough" and "don't work" are two very different things.

Replies from: florin-clapa
comment by Florin (florin-clapa) · 2021-06-28T00:07:47.976Z · LW(p) · GW(p)

"Don't work" in the sense of "masks wiped out the flu but not the massive fall/winter covid wave." One can argue that the last covid wave could have been worse without masks, but that's pure speculation.

The newer variants might have defeated masks by producing more virus particles, for instance; no teleportation required. Whatever the mechanism, it seems clear that above a certain threshold of infectivity (compared to the original covid variants and last season's flu variants), masks don't work, or if you're picky about it, masks don't work that well.

Replies from: gjm
comment by gjm · 2021-06-28T10:49:32.767Z · LW(p) · GW(p)

Again, I don't think it's clear that "don't work" is at all a good way to say it.

Consider the following scenario, which I expect has something like the right shape although all the concrete numbers are made up and probably wrong (and of course the numbers aren't as deterministic as this makes it sound): the effect of wearing masks is that the number of virus particles you get hit with from being near someone infected is 3x lower; the likelihood of an infection taking hold is greater when the number of virus particles is larger; newer variants make infected people produce 2x more virus particles; maskless, the infection rate is high enough for exponential growth when the number of virus particles is >= half the number passed on (maskless) by the original variant.

Then (1) the original variant could be effectively stopped just by masks (you get N/3 virus particles, which is smaller than N/2); (2) the new variant can't be (you get 2N/3 virus particles, which is larger than N/2); (3) the masks are still reducing virus transmission by the same factor as ever.

In this scenario the new variant needs something more than masks to stop it (e.g., more distancing, vaccination, testing-and-tracing). But that isn't because masks don't work any more, it's because the new variant is worse and you need to do more to stop it.

It might turn out that if you pick any single intervention it "doesn't work" with a newer more infective variant, if all you mean by that is that that intervention on its own isn't enough to solve the problem. "Masks don't work", "distancing doesn't work", "contact tracing doesn't work", "vaccination doesn't work", and so on. Might as well give up, then: no point doing lots of things that don't work. Except that they do work, but you need to do more than one of them at a time, and if you don't use masks because "masks don't work" then you need to do more of the other things instead.

It seems rather far from "pure speculation" to suggest that the last wave would have been worse without masks, given that it's pretty well documented what masks do and how, and any increase in transmission makes things worse. (I mean, it could be that people would have reacted by being stricted about other safety measures like never leaving their homes, and that the net effect would have been to leave the number of cases about the same. But "number of cases about the same, because everyone inconvenienced themselves more" is one variety of "worse".)

"Masks don't work" would apply to a disease that spreads mostly by direct physical contact, or surface contamination. Masks don't work against syphilis or tetanus. It's incorrect, and irresponsible, to say that "masks don't work" against a disease for which they do reduce transmission. If you think it's plausible that they don't in fact reduce transmission with newer strains of COVID-19, then present your evidence. ("People wore masks and there was still a wave of the disease" is not evidence[1].) Otherwise, I don't think I'm the one who's engaging in pure speculation.

[1] Of course strictly speaking it is evidence, in the same way that every time something happens that someone has prayed for it's evidence for the existence of the god they prayed to, or every time someone rolls well in a game of backgammon it's evidence that they have telekinetic powers. But like those things it's weak evidence, because there are highly plausible scenarios in which those things happen even though the thing they're meant to be evidence of isn't so. You can get lucky when rolling dice. A disease can be infectious enough to spread even though masks help a lot in reducing transmission.

Replies from: florin-clapa
comment by Florin (florin-clapa) · 2021-06-28T21:55:16.991Z · LW(p) · GW(p)

If the choice is between wearing a mask and nothing, wearing a mask would probably be better than nothing.

If the choice is between wearing a mask and a respirator or PAPR, choosing to wear a mask significantly increases risk, because we already know that masks offer poor protection. We know this because masks failed to stop the last covid wave.

In the wider context of covid waves: if everyone wore a respirator or PAPR starting before the last covid wave, covid would have been wiped out.

Replies from: gjm
comment by gjm · 2021-06-28T22:26:31.870Z · LW(p) · GW(p)

OK, sure: other more elaborate barriers between your face and the outside world are more effective than surgical masks, bits of cloth, etc. No question. But, again, the situation isn't that masks don't work. It's that other things work even better.

(I would bet fairly heavily that surgical masks + full vaccination[1] are "enough", given a modest level of general caution otherwise, even for the latest and most infectious strains. Surgical masks are much less hassle than respirators or PAPRs. I do not think I would recommend that fully vaccinated people who aren't extra-vulnerable or extra-anxious should go out and get N95 respirators and the like rather than making do with masks.)

[1] With, say, Pfizer or Moderna or (less good but still probably enough) AstraZeneca. The same may be true for others but my ignorance about them is greater.

You need a model of the world that's less black-and-white than "X works" versus "X doesn'tt work". Any given intervention reduces transmission by a certain amount. Depending on how transmissible the currently-relevant strain of the virus is, different combinations of interventions will be sufficient or not. Collapsing all that to "works" versus "doesn't work" is a bad idea; it makes it harder to think clearly.

Replies from: florin-clapa
comment by Florin (florin-clapa) · 2021-06-29T07:01:58.861Z · LW(p) · GW(p)

At this point in the pandemic, the level of protection offered by masks is so uncertain (10% 1%? 0.1%?) and likely to be so small that masks are little more than a Hail Mary for those that don't have access to vaccines, respirators, or PAPRs. While a Hail Mary doesn't technically mean that it "doesn't work," it's pretty close, and making a big deal about these distinctions is becoming a little pedantic.

For the vaccinated, recommending masks (which may or may not offer a tiny extra bit of protection) over vastly more effective respirators due to a small-to-none hassle factor seems a bit silly. It's much more reasonable to recommend respirators or nothing.

Replies from: gjm
comment by gjm · 2021-06-29T12:40:52.395Z · LW(p) · GW(p)

You said something about "pure speculation" earlier, but I think that's what you're engaging in here.

What makes you think that masks offer "10%? 1%? 0.1%?" protection? Indeed, what do you mean by those numbers? What actual model of transmission leads you to think this?

[EDITED to add:] Actually, maybe I misunderstood you; is the "10%? 1%? 0.1%?" meant to be an amount of protection (in which case, why also say "and likely to be so small that ..." -- aren't you saying the same thing twice?) or a probability of any protection at all (in which case, what are you smoking?)? Again, what actual model of transmission is this based on?

What masks do is to reduce the fraction (viruses breathed in) / (viruses breathed out), by blocking the passage of droplets or changing the pattern of air flow. Unless the later strains have evolved teleportation or something, it seems unlikely that the factor by which this fraction has reduced in any given situation is much different now from before. I've had trouble finding really convincing figures, but it seems like the typical factor for a surgical mask is somewhere on the order of a 3x-10x reduction in the "outward" direction, larger when speaking or coughing than when just breathing normally (which is good, because speaking and coughing make you emit a lot more viruses if infected). "Inward" protection seems to be somewhat less -- maybe 2x? Home-made cloth masks appear to be substantially inferior to (ordinary, cheap) surgical masks.

This would mean e.g. that the amount of time you need to spend near an infected person in order to get infected yourself is 3-10x greater if they're masked, 6-20x greater if you both are.

If you think that somehow none of this works any more because of the newer more infectious strains, or that it's all nonsense and actually masks never had any substantial effect at all, then you should either give credible evidence that it doesn't or explain a plausible way in which it would have stopped working (or would never have worked). "There was a wave of infections and masks didn't stop it" is not credible evidence; that just means that the virus was infectious enough that whatever masks did wasn't enough, which is perfectly consistent with masks doing a lot.

Replies from: florin-clapa
comment by Florin (florin-clapa) · 2021-06-29T21:19:46.312Z · LW(p) · GW(p)

We know that masks have poor performance, because while masks seem to have eliminated the flu and to have stopped or significantly slowed down the spread of the original variants, especially in Asia, masks failed to have the same effect on the newer variants which caused the fall/winter wave. And since Delta is even more contagious than those variants, masks will be even less effective than they were during the last wave. How you can claim that this is not evidence is beyond me.

I also doubt that it's useful or even possible to accurately calculate the efficacy of masks for the latest variants without doing lab work. How would you quantify the decrease in efficacy caused by increased infectivity due to better binding of the variants to human cells? How much more virus particles do these variants produce, if any, and how does that relate to mask efficacy? Is mask efficacy a spectrum or are there thresholds that suddenly render masks 0% effective in most or many situations? But since we already know that masks offer poor performance anyway, quantify exactly how poor the performance is (10%, 1%, 0.1%, or whatever) doesn't seem to be all that important.

Masks have become a dangerous distraction from far more effective interventions.

Replies from: gjm
comment by gjm · 2021-06-30T01:36:13.776Z · LW(p) · GW(p)

You still seem to be assuming that "poor performance" = "not on their own sufficient to stop the latest variants growing exponentially", and that is just unambiguously wrong.

Do you, or do you not, have any information that isn't broadly consistent with the following crude model? 1. An infected person emits virus particles at some (somewhat random) rate, more when speaking or coughing than when breathing normally. 2. If you breathe in virus particles, there is some probability that you get infected; the probability is higher when the number of virus particles is higher. 3. If the infected person is wearing a mask, then the rate at which they emit virus particles is reduced by a constant factor somewhere in the vicinity of 5x. 4. If the not-yet-infected person is wearing a mask, then the number of virus particles reaching them is reduced by a constant factor somewhere in the vicinity of 2x. 5. Newer variants are more infectious, meaning some combination of (a) infected people emit more virus particles, or (b) the probability of infection for a given intake of virus particles is higher.

If this model is somewhere near the truth, then the only way for masks to be near-useless ("10%, 1%, 0.1%", as you put it -- but I asked you to explain what these numbers are supposed to mean and you didn't, and I would still like you to) is if the newer variants cause such a colossal increase in the number of virus particles put out by an infected person, or in how effectively infectious they are, that being near them even briefly basically guarantees getting infected. Because otherwise, if you and they both wear masks then that means something like a 10x increase in how much exposure you can have before getting infected, and if the unmasked figure would be (say) 2 minutes' conversation at a 2m distance, then that would turn into 20 minutes, and I at least have plenty of conversations that are longer than 2 minutes but shorter than 20 minutes.

Do you have good reason to believe that that model is far from the truth?

If not, do you have good reason to believe that the new variants are basically infinitely infectious?

If not, is there some other reason why the argument above fails?

Or have you just determined to keep saying "masks are useless" over and over, without ever making your claims precise enough to be evaluated, and without any actual model of how infection happens by which to justify your claim?

Once again, I appreciate that you are arguing for using something more effective than masks. I agree that things more effective than masks are more effective than masks. But it seems to me that you are either making almost certainly false claims about the effectiveness of masks (if you are saying that they aren't what-I-call-effective, that they don't substantially extend the range of what one can do without substantial risk of infection) or else using very misleading language to make the claims you are (if you are only saying that they are not sufficient on their own to stop a wave of Delta-variant COVID-19 -- which I agree is almost certainly the case), and I wish you wouldn't do either of those things.

Replies from: florin-clapa
comment by Florin (florin-clapa) · 2021-06-30T21:45:42.641Z · LW(p) · GW(p)

Given the fact that we already know that masks have poor performance based on the what I've already mentioned, models are pointless for most situations.

If you're referring to modelling a strategy of maximizing personal (rather than public) protection with a poor performing tool, models could help you do that, but in the case of masks, it will turn out that most strategies are impractical because 1) there will be too many variables to keep track of, 2) some variables will be impossible or hard to obtain, and 3) some variables will be hard to control even with perfect knowledge. With or without a mask, if the distance between people is far enough, infection will be avoided regardless of infectivity due to dilution. If the distance is between two people, you may be able to calculate a minimum safe distance if you know all of the variables. Some of these variables are room size, ventilation, infectivity, mask type, rates of breathing and vocalization, and vaccination status. You'd also need to know if the room was previously occupied and by whom. Some of these these variables will be known but some will not be. You'll also need to recompute these variables once they change. If you're dealing with a simple model with two people in which nothing changes, this strategy might work. But real world cases are almost nothing like this. What if you go to another room or another person walks in? Is the ventilation the same? Is the person vaccinated? What kind of mask are they wearing? How many people were in the room before you walked in (aerosols can become suspended for hours even if the people that generated them are no longer around)? Modeling this stuff quickly becomes impractical, and if you can avoid that by wearing a respirator, why bother?

"10%, 1%, 0.1%" was meant to poke fun at the attempt of precisely quantifying the poor performance of masks and is not based on any data.

Replies from: gjm
comment by gjm · 2021-06-30T22:49:28.332Z · LW(p) · GW(p)

I don't think further discussion in this thread is likely to prove fruitful.

comment by Sameerishere · 2021-06-27T21:30:53.742Z · LW(p) · GW(p)

Thanks! I'm not particularly worried about outdoor things (though your comments on crowds help fill in a gap where I had some uncertainty). More curious whether to attend indoor events without a vaccination restriction.

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comment by Dustin · 2021-06-27T20:11:34.876Z · LW(p) · GW(p)

WSJ reported that about half of adults infected in an outbreak of the delta variant in Israel were fully vaccinated with Pfizer,

Isn't that what we'd expect with their high vaccination rates, even if the vaccine was still really effective but not 100% effective?

Replies from: Sameerishere
comment by Sameerishere · 2021-06-27T20:32:27.326Z · LW(p) · GW(p)

That's a good point, so I guess the more important statistic is the lower effectiveness of the vaccines against the Delta variant. But would need to crunch some numbers to figure out how much that decrease in effectiveness matters in practical terms.