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You might want to consider adding additional protection measures (like a respirator), as the effectiveness of some vaccines can be moderate to non-existent. The effectiveness of the flu vaccine in years when its well-matched to the circulating strains is between 40% and 60%, and when the vaccine is not well-matched, it's protection against illness plummets, although it may still offer some protection against complications such as pneumonia. Vaccines don't exist for bad colds and the stomach flu.
Reusable respirators will work well against any fast-spreading pandemic (assuming no ridiculously-long, asymptomatic incubation periods).
There seems to have been plenty of papers on airborne aerosol transmission of the flu and experiments with human subjects strongly suggested that the common cold is transmitted via aerosols. So, this makes it even more surprising that the experts got transmission so wrong and took forever to correct their mistake.
Yes, but your post seemed to focus on the individual, and that's why I didn't mention future humanity.
For humanity, it did go from no doom to maybe doom which is worse. And perhaps it's worse for the individual in the long run too, but that's a lot more speculative.
In any case, there's still some hope left that our luck will last long enough to avoid doom, even if it will be by the skin of our teeth.
Until very recently, it was doom for every individual. Maybe-doom is a vast improvement.
And whatever happens, we'll have the privilege of knowing how human history will have turned out.
The virus most likely leaked from the gain-of-function experiments that they were doing under BSL-2 and not from the BSL-3 or BSL-4 labs.
Third scenario: bat-to-researcher transmission during field work at bat caves or from the bat repository/colony or unaltered bat viruses at the labs in Wuhan.
https://www.nytimes.com/2021/06/25/opinion/coronavirus-lab.html
It's a tricky situation. As soon as Hong Kong relaxed its pandemic strategy, excess deaths exploded. Since China followed a similar (and even stricter) pandemic strategy, it seemed inevitable that the same thing would happen (all things being equal) and millions would die with many more millions becoming hospitalized. But all things might not be equal; the circulating strains of covid in China might be less lethal than when Hong Kong relaxed its own pandemic strategy. So, it could go either way.
The real problem here is that China is playing Russian roulette; rather than using more effective vaccines and respirators, its using less effective vaccines and poorly-performing masks instead. The expert consensus seems to correctly identity the vaccine problem but still mostly ignores the mask/respirator issue, as they've done throughout the pandemic.
I was referring to how docs do brain surgery (e.g., infection prevention procedures, what instruments are used, where incisions are made, etcetera) rather than error rates or second opinions. I highly doubt that many non-experts (even a very motivated brain cancer patient) could successfully determine the appropriateness of specific surgical techniques for brain surgery. And since brain cancer is rare, it's low stakes from a societal or even a personal survival point of view (although, it will become high stakes if you'll live a lot longer than the current lifespan).
Nah, bridges (see other reply) and rockets aren't high stakes enough to be worth worrying about.
What kind of demise are you referring to?
Bridge building is nowhere near as important as cryonics (or more appropriately, "brain preservation" technology which may not involved cryonics at all), because brain preservation tech has the potential to save hundreds of millions and possibly billions of people from certain death. Even if you disagree, it is still potentially important for personal survival way more than bridge building.
My general heuristic is that the higher the stakes (especially for personal and societal survival), the more you need to check the expert consensus (especially for softer sciences such as medicine, sociology, and economics). Examples where expert opinion should be checked (and is or was probably wrong or misguided): cryonics, certain pandemic mitigation strategies, aging research, geoengineering. Examples where expert opinion probably shouldn't be checked very often by non-experts: brain surgery, bridge building, rocket engineering, archeological excavation.
In most situations (with some exceptions like going to the dentist) and for nearly everyone (with some exceptions like people living in a nursing home), the level of risk remaining after taking reasonable efforts to protect oneself seems miniscule.
I suspect we mostly agree about this, and the apparent disagreement was caused by a misunderstanding.
So, let me clarify: what I tried to say is that as long as individuals can protect themselves, there is no compelling reason for society to force others to protect individuals or for others to voluntarily protect individuals in those situations in which individuals can protect themselves (I probably should have been more explicit about this to avoid any confusion). For instance, if you need a root canal, you obviously can't protect yourself by wearing a respirator (and assuming that vaccines weren't effective), and dental staff should wear respirators and perhaps also increase ventilation. In the case of flying, individuals can protect themselves by using a respirator, and there would be no point in having anyone else mask up. Earlier in the pandemic, having everyone mask in most situations was a good policy at the societal and individual level, but now it's not for the reasons I've already mentioned.
You seemed to be talking about mask mandates versus individual responsibility, and that's what I replied about. If you think my reply didn't address your comment, can you rephrase it or point out why you think my comment wasn't responsive?
If there were no reasonable ways (e.g., lack of respirators and/or vaccines) for an individual to protect themselves against covid, society could force everyone to protect individuals. The only reason why mask mandates (and associated NPIs) were ever a thing was that there were no other reasonable ways of protecting against covid. Now, there are other reasonable ways of protecting against covid, and that's why mask mandates aren't a thing anymore.
The CDC also says:
Most of these products have an ear loop design. NIOSH-approved N95s typically have head bands. Furthermore, limited assessment of ear loop designs, indicate difficulty achieving a proper fit. While filter efficiency shows how well the filter media performs, users must ensure a proper fit is achieved.
https://www.cdc.gov/niosh/npptl/respirators/testing/NonNIOSHresults.html
Anything that has earloops (this includes most of the KN95s that I've seen and all KF94s) can't be a respirator, because it's nearly impossible to form a seal between the filter material and the face with the low amount of tension that earloops provide. There will be massive air leakage and the filtration efficiency will be much less than 95% (the minimum standard for most respirators), regardless of the filtration efficiency of the filter material itself.
For kids, options exist that are likely to be lot better than anything with earloops. Some KN95s do have head straps like N95s (but I've heard that a good seal is not easy to get around the nose due to the lack of a piece of foam which N95s often have). Kid-sized elastomeric respirator-like facepieces (like the Flo Mask and Aria 19) exist and some have been "tested to" N95 or higher standards (but not officially approved by any standards body, AFAIK). A PAPR that can fit anyone can be DIYed. Although it isn't officially approved by any standards body either AFAIK, the seals and filtering material can be verified by the person that's DIYing it.
The masks in your photo don't look like respirators.
Also, KN95s aren't respirators.
If respirators are widely available (even in the absence of vaccines), the responsibility for protection (especially for voluntary activities) falls on the person that doesn't want to get infected.
If someone wants to protect others, they should wear ventless (or vented-but-filtered) respirators. Non-respirator masks provide little to no protection.
Also, this is a good time to practice using respirators to mitigate against much worse future pandemics which may kill or disable the young at similar rates to the old.
An elastomeric respirator or PAPR paired with N100-equivalent filters should provide the best available protection and should significantly reduce risk.
Here's the reasoning:
- You can't get anything that can filter out more stuff short of using an oxygen tank.
- There's some empirical evidence suggesting that elastomeric respirators have provided adequate protection for health care workers in a TB ward, whereas disposable N95s might not provide adequate protection in similar circumstances.
- There's more recent quick-and-dirty evidence for covid and disposable N95s here. There might be even more such evidence, but I haven't looked for it.
- Elastomerics and PAPRs can provide more protection than disposable N95s.
- Even if some tiny amount of virus aerosols penetrate the respirator, it would still be extremely difficult for them to actually produce an infection due to the different hoops they'd have to jump through (i.e., they would be extremely diluted, have avoid sticking to the walls of the respirators, and then have to reach the right cells and avoid getting stuck in mucus).
You could use a respirator until you get access to a better vaccine or other effective therapeutics.
Even if you're not concerned for your own safety but you live with older people, you still might want to wear an elastomeric respirator or DIY PAPR when going out in order to protect them and encourage them to do the same.
For me, the bottomline of this masking study is that if you wear a respirator only for a relatively small amount of time in a hospital setting, you might as well go maskless, because you'll just get infected when you're not wearing a respirator (because non-respirator masks don't work well at preventing covid due to poor face seals, inferior filter media, etcetera).
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.
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.
Other lists:
https://c19early.com
https://www.consumerlab.com/answers/do-natural-remedies-or-supplements-prevent-coronavirus/natural-remedies-coronavirus/
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%.
The probability of dying of aging is 100%.
The probability of dying of AGI is less than 100%.
The probability of the development of anti-aging tech via non-AGI means is close to 100% (e.g., senolytics).
The probability of the development of anti-aging tech via AGI is not close to 100%.
Therefore, some of us prefer to focus more on aging than AGI.
There's fairly decent, real-world evidence that covid spreads almost exclusively by aerosols. There doesn't seem to be much outdoor transmission, and that rules out direct droplet transmission. There's nearly zero evidence for fomite transmission. Also, indoor transmission seems to be required for transmission. All of that (and more) points to aerosols.
They upgraded to N95s because that's what the media and public health experts have talked about. You've started to right this wrong, but you could go a little further.
Wearing a respirator such as an N95 is mostly about risk reduction rather than convenience. While there's no reason not to mention convenience, any recommendations should be ordered mostly by risk reduction.
I'm not sure about the level of counterfeiting, but there does seem to be at least some of it going on.
https://www.youtube.com/watch?v=aQinLD3sXzQ
https://www.youtube.com/watch?v=BPhdshC6Yew
Zoro.com (owned by Grainger) is a reliable and reputable vendor.
I see almost no significant reason for anyone (with a few exceptions such as people with speech issues) to use disposable N95s instead of elastomeric respirators. As I pointed out in the comment I linked to, N95s generally provide a poor seal. Another problem is that the straps N95s use are more difficult to put on and take off. The straps also lack adjustability and a head harness. Compared to elastomerics, differences in weight and bulkiness (while wearing) aren't that significant. Muffled speech is noticeable with elastomerics but can be compensated for by speaking louder or using an electronic voice amplifier.
Here are some technical notes about elastomerics: 1) Elastomerics should not be referred to as "P100s," because that just refers to a filter standard and most elastomerics can use different types of filters including N95. 2) The 3M 2291 filter is better than the 3M 2091 due to its lower pressure drop (that means it takes less effort to inhale). 3) Another alternative (for people with breathing difficulties, for instance) is to use an N95 filter which probably has an even lower pressure drop. 4) The N95 cartridge filters (3M 603 adapter, 3M 501 retainer, and 3M 5N11/5N71 filter pads) don't weigh significantly more than the P100 pancakes. 5) I've seen some anecdotal reports that the 7500 series is more comfortable than the 6500 series due to the (supposedly) slightly more pliable silicone. 6) You reported on counterfeiting on Amazon, yet still linked to Amazon without offering verified vendors for the filters.
I'd say that unhealthy-for-their-age young and middle-aged people and otherwise healthy-but-middle-aged people might want to be more cautious. Healthy-for-their-age young people probably don't need to worry.
The counterargument would apply to "It wouldn't be relevant to non-elderly people...."