Tuesday, July 21, 2020

My Take on COVID19 Mask Messaging

Hi Faithful Friends,

I'd like to take some time to talk to you about my personal view of the mask messaging debacle, from the beginning of the #COVID19 pandemic until now. I have been thinking a lot about this lately, in no small part thanks to my friend @mi55br00ke, who reminded me of some important issues we’re all being faced with during this unprecedented time of uncertainty. These are my thoughts on my messaging on Twitter, and mine alone.

3-Ply Blue Surgical Mask (10 Pack) - CPAP Store USAWhen this all began I was one of the virologists advocating against masks and here’s why: People wanted to wear masks that protected themselves and I knew that A) in general, people wouldn’t have access to N95s designed to protect from biological aerosols, and B) if they had access to them, they wouldn’t have the tools needed at home to fit test them properly. I tried to make it clear that my logic was that in light of those things, I worried people would buy any old N95 and then think they were more protected than they were. That is not flawed thinking, but I realize now how incomplete the message was.

My perspective is really informed from extensive experience in high-containment BSL4 labs. That training really gives me a very strict view of protocol adherence. If a mask isn’t going to protect you as much as you think it will, then you shouldn’t wear it. Period. It’s dangerous. And when it turned out we couldn’t get N95s and there was a shortage for health care workers, but we needed something because spread was taking off, then we started hearing about surgical masks to protect *from the wearer* and this I agreed with. I still tried to make it clear that the surgical mask would not protect the wearer, but that seemed to be lost in the fray and then everyone thought we should have been advocating for surgical masks from the beginning.

Maybe we should have, but I still think the message that surgical masks do not protect the wearer as much as they think it will, is an important thing to make clear. And I would not change that messaging were I to go back in time. But I think I made a serious mistake with my messaging in that it was not complete. It’s not something I can change, but I can tell you I am sorry for it and hope that in the future this mistake can be avoided in an effort to more effectively guide people on this issue.

What should the messaging have been, in my opinion? I wish I would have said what I needed to say on surgical masks not being as protective as one might think, but I would add next time:

  • We don’t know what infectious dose is required for SARS2, but the reality is that wearing a surgical mask will reduce that dose if someone coughs on you while you’re wearing it. It will not keep you from being exposed to their virus, but reducing the amount you're exposed to is likely to make a difference in how fast the virus disseminates throughout your body and/or in how sick you get. 

That's a big omission and it is my regret in all of this. I was being pedantic, as I usually am, and in so doing I neglected to point this out. It kills me because I know this messaging affected decisions people made including those made by the people caring for my mother. Had they implemented having residents of her nursing home wear surgical masks early, would she still be alive? Maybe. Honestly, I think probably. Was I responsible for the messaging the staff in her facility heard? I really don't think so. I spoke to them and tried to get them to take the virus seriously quite early on and they didn’t hear me. But I could be wrong. I know that. I live with it. Did my messaging directly impact anyone on Twitter? I don't know, my voice doesn't reach very far, but it very well could have. And that alone is enough for me to recognize how big this mistake was.

My goal here is to help you understand my thought processes along this journey and hope you can understand my logic and how it led to that mistake. A mistake I deeply regret. Was it intentional? No. Does that matter? Not really. Especially when I have been defending my initial position strongly since then. I defended it and still defend it as an effort to help people by communicating that they wouldn’t be as protected as they might think they are with N95s or surgical masks. But I should not have stopped there. I should have been less pedantic and more aware of the need for the information that I recognize now would have been more helpful.

I also recognize that this post won’t undo the damage. It’s not intended to do that. Nothing can undo the damage. I know that. It’s simply me coming to you in honesty and saying, I hear you. I feel your anger and frustration and I know I played a part in that. I am expressing my genuine regret. Regret for the inadequacies of my messaging. And to let you know, I will do better in the future. I hope you allow me that opportunity.




  1. As an avid reader of yours but also a layperson, I have a few thoughts on this, and they add up to a sense that you're being too hard on yourself here. Losing a parent can lead to all kinds of reactions to the grief, including questioning whether you "did everything you could". I think virtually everyone who loses a parent they love goes through some version of that. (I could tell you some stories...)

    The first is the obvious cliche that "hindsight is 20-20", but it goes much deeper than that. If you erred, then so did a star-studded array of highly renowned public health experts including the WHO, CDC and Anthony Fauci. And the reason for that was (a) it was a highly fluid situation and (b) one with so many countervailing and essentially unquantifiable factors at work.

    Among the constellation of unknowns you and those respected parties were operating in were: transmission mechanisms and parameters that weren't entirely nailed down by Feb/March, a relative scarcity of masks that were and still are more crucial for HC workers than average citizens, questions of how well or poorly the average Joe would do at deploying a mask even given good faith motivations, and also the degree to which people would succumb to false security and adopt risky behaviors because of that.

    The point here is that if one had tried in Feb/March to build a biophysical model with all those factors to predict whether universal mask wearing would increase or decrease expected total deaths, the best stab at parameters they'd have put in that model would have pretty sizable uncertainty bars on them. First, the model would need to include some projected curve representing the ramp-up in manufacturing both kinds of masks so that HC workers were covered, which itself wasn't clear back then as one didn't know who was going to jump in to fill the supply void, and how fast ICUs would fill up, etc. Then behaviorally... as a modeler *I* would have probably assumed that everyone out there would wear the masks reasonably sensibly - I mean, it's not *that* complicated to get it reasonably right for someone not working in a lab. And I'd have been dead wrong in that assumption, as we watch all these people walk around wearing them like feed bags/bibs (some of that is rebellious misuse, but you get my point I hope). And then the issue of how lax people would get under presumed protection by not hand-washing, clustering indoors too much with people outside their normal living "pod", etc., is still a fuzzy parameter. This quickly becomes like trying to model a complex world economy (with 7 billion autonomous agents), something economists have never gotten right to date.

    We now know empirically from large-scale data that the public wearing even cloth masks religiously has helped several countries tame the virus. But I think in March that was still a mass-scale experiment that hadn't been run yet.

    So I guess that's all a long-winded way of saying "hindsight's 20-20", but also I hope the point that so many of these forcing factors that worked against one another weren't well-quantified back then isn't lost. And maybe, when all of this is over in a year or so, go and have a drink with some of those big names mentioned above to rehash the whole thing, and then ask yourself how much recrimination you owe yourself. :)

  2. I genuinely appreciate your comment and I agree with you. I do think all of those you mentioned also made the same mistake but I can't speak to that. And even with all those factors, I believe my message was too narrow, when it could have been more effective. More accurately, my message did not evolve as it should have to provide the information I never provided until today. No one's message did, but that does not mean I shouldn't own up to my own mistake. I sincerely appreciate all of your points and am grateful for your friendship and readership. I also want you, and all my readers, to be confident that you can keep trusting me with these things.

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