Mask Mandates

|The Volokh Conspiracy |

Writers in the Washington Post and the New York Times now agree with many other sources that masks may be useful in combatting COVID-19, perhaps because masks reduce the probability that the wearer will infect others or, at least by discouraging touching of the face, the probability that someone else will infect the wearer.

Meanwhile, writers in the Washington Post and the New York Times are beginning to describe how the economy might restart in the not-so-distant future. Neither mentions the word "mask."

At this point, we don't know for sure how well masks work, and there is a danger that masks could provide a false sense of security. If masks in fact greatly reduce transmission, however, then mask mandates will likely be part of the solution. A mask mandate is a much lesser intrusion on liberty than stay-at-home orders.

Surgical masks are not yet widely available, but apparently even DIY masks have some utility, allegedly helping to explain why the Czech Republic has modestly flattened the curve. The CDC could help at this point by encouraging everyone who must be in public or at work to wear at least a DIY mask, while still warning that the measure is not a replacement for social distancing. That might help people get used to the idea. More broadly, the government could help by focusing on mask production. For example, the federal government could promise to buy billions of surgical masks in the event manufacturers are unable to find buyers; the worst case scenario is that the national stockpile is replenished for the next pandemic.

In the longer term, more analysis would be helpful. Perhaps we'll learn more as some countries, states, and municipalities adopt mask mandates, or as masks become more popular in some areas than other. Some form of random experimentation would be especially helpful. For example, once health care providers have enough surgical masks for themselves, the government could distribute masks in randomly selected municipalities and compare growth of COVID-19 infection rates.

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  1. “once health care providers have enough surgical masks for themselves, the government could distribute masks in randomly selected municipalities and compare growth of COVID-19 infection rates.”

    There is both an ethical and political issue involved in doing this — what do you say to the municipalities that don’t get masks, both now and if masks are shown to be effective? Trump’s already being accused of playing favorites, this would be incendiary.

    1. One thing you could say is that statistically, every mask in a high hazard setting prevents more transmissions, and saves more lives, than the same mask in a low hazard setting. The lowered transmissions, especially, are of great use to everyone, no matter whether their locale gets masks or not, or, more realistically, has to wait a bit.

      Or, you could note the obvious, which is that wearing a mask is an inconvenience which people who don’t think they are at risk will wish to avoid. But if they do think they are at risk, many will want masks. At some high level of risk, almost everyone will be desperate for masks.

      1. What I was trying to say is that no (democratic) government could resist the demands to release the masks in the highest hazard areas — for the exact reason you state — and hence would never conduct the experiment suggested.

        I argue that it would be unethical — that it is more important to save as many lives as possible than to get good statistics on mask effectiveness.

        1. I argue that it would be unethical — that it is more important to save as many lives as possible than to get good statistics on mask effectiveness.

          I agree.

        2. “I argue that it would be unethical”

          IIUC, the proposal isn’t that we have 100 masks and 100 people, and withhold masks from 50 people as a test. It is that we have 100 masks, and two towns of 100 people each. You could distribute the masks two ways:

          1)Send 50 to each town, and have the town flip coins to see which 50 residents get masks
          2)Flip the coin and send all the masks to one town or the other.

          Either way all 100 masks are on randomly selected people, so to me they seem ethically equivalent, but in the second case you get a little more information about how well universal mask wearing affects things.

          (I suppose you could estimate it for case 1 by comparing infection rates between people with/without masks, but case 2 measures the spread rates directly)

          1. Reality 101 is that we already have people (including a few here) openly accusing Donald Trump of sending resources to Governors who are friendly to him and “punishing” unfriendly Governors by denying those states resources.

            One Boston publication openly stated that “[Governor Baker] and the president are — at least nominally — members of the same political party. And, like all governors, he’s aware that the president is watching them extra closely, testing for symptoms of disloyalty to him and threatening to mete out coronavirus resources accordingly. Our hospitals’ access to extra ventilators could be at stake.”

            Now what do you think the people in the city that did not get the masks would say — when this is being said when things are being distributed on the basis of greatest need. Look at what Rhode Island is doing…

            No, people are not going to quietly be the control group in an experiment. Not in a situation like this — and then you will have variance, people in the no-mask city acquiring them from the other city. If you’ve ever seen undergrads getting around the 21-year-old drinking age, you’ll understand that there are all kinds of ways to obtain something that you want….

            1. Dr. Ed,

              If Trump doesn’t want people to think he is showing favoritism to governors who are obsequious to him, he shouldn’t talk about how important that is to him.

              The accusations are based on his own statements, and the fact that Florida is being fully supplied with equipment, while other states aren’t. Maybe there’s a good reason for that, but his statements and action sound a lot like, “I would like you to do us a favor, though.”

              1. It’s not like Florida has the 5th highest median age in the US along with a metric fuckton of large retirement communities in densely populated areas or anything. Oh wait…

                1. More to it than that, ravenshrike:

                  Anecdotally, there are wide differences, and they do not appear to follow discernible political or geographic lines. Democratic-leaning Massachusetts, which has had a serious outbreak in Boston, has received 17 percent of the protective gear it requested, according to state leaders. Maine requested a half-million N95 specialized protective masks and received 25,558 — about 5 percent of what it sought. The shipment delivered to Colorado — 49,000 N95 masks, 115,000 surgical masks and other supplies — would be “enough for only one full day of statewide operations,” Rep. Scott R. Tipton (R-Colo.) told the White House in a letter several days ago.

                  The Federal Emergency Management Agency inherited control of the stockpile barely a week ago from HHS. Lizzie Litzow, a FEMA spokeswoman, acknowledged the agency maintains a spreadsheet tracking each state’s request and shipments. Litzow declined repeated requests to release the details, saying the numbers are in flux.

                  Florida has been an exception in its dealings with the stockpile: The state submitted a request on March 11 for 430,000 surgical masks, 180,000 N95 respirators, 82,000 face shields and 238,000 gloves, among other supplies — and received a shipment with everything three days later, according to figures from the state’s Division of Emergency Management. It received an identical shipment on March 23, according to the division, and is awaiting a third.

                  So FL gets it all, and others get zilch. The large number of retirees isn’t near enough to account for the discrepancy. There are old people everywhere. And note that, as usual, the administration is refusing to release the data.

                  And, like it or not, that fucking asshole Trump did effectively threaten governors who were not “appreciative.”

          2. The problem with this approach is that some who are not allocated masks will get them elsewhere, or already have them, which will confound the results.

            No one is going to refrain from wearing a mask they have available to help with this experiment.

            1. Sure, and some people won’t wear the mask you give them, etc. Presumably, though the experiment only makes sense when masks are pretty scarce.

              As to Mr. Ed’s concern, those of us of a certain age remember setting in front of the TV watching the draft lottery. It was carefully run so that no one could complain it wasn’t fair (people didn’t like ‘winning’ and getting drafted for Vietnam, but the complaint wasn’t that the lottery wasn’t fair).

              In any event, my concern, and comment, wasn’t really addressing whether such a study makes sense or is practical, I was merely disagreeing with it being characterized as unethical.

              1. Wasn’t the draft lottery a replacement for something else that was perceived as being quite unfair?

  2. I have read several pieces in the media over the past few weeks, parroting official advice that masks don’t work for the general public, but they’re always riddled with obvious non sequituurs and contradictions.

    In prime position is the argument that the general public wearing masks reduces the supply of masks to the medical profession, where they’re really needed. Perhaps so, but this is not an argument that masks don’t work to prevent, to some extent, the virus travelling from person to person in the general public. It’s totally irrelevant to the question that these articles purport to be addressing – whether masks are effective or not when used by members of the public.

    The fact that column inches are wasted on these non sequituurs indicates that the real argument that is being pushed by those who are really writing the articles – the officials briefing the journalists – is that the officials would like masks to be retained for use by the medical profession, not that they don’t work for the general public.

    In second position is the false sense of security argument. It is of course perfectly true that there may be secondary behavioral effects which outweigh the primary effect. But assuming that the current balance of advantage must therefore be that those hypothetical seconary effects do balance out the primary effect, is nuts.

    And in third position is the relentless refusal to acknowledge the obvious. If someone sneezes or coughs and they’re wearing a mask, some of what they sneeze or cough will hit the mask, and so the amount released into the air will be reduced. Likewise if someone sneezes three feet from your face, and you are wearing spectacles, some of what they sneeze will hit the spectacles rather than your eyes. And ditto mask. Or scarf. Or Magritte’s apple.

    So it has not been difficult to see that articles pushing the official view that masks are useless for the general public, are themselves useless (or worse.) If they had any validity they’d not be full of such obvious tosh.

    1. “the question that these articles purport to be addressing – whether masks are effective or not when used by members of the public. “

      It’s more a question of how effective — and we don’t know that.

      First, we don’t know what the dose necessary to cause infection is. Take Anthrax (about which we know quite a bit more) — you can breathe in an Anthrax spore without it hurting you and if you live where cattle were once kept, probably have at some point in your life. There is a critical mass — a certain number of spores — that you have to breathe in to become infected.

      We have no idea what the infectious dose is for the Wuhan Virus.

      Second, a N-95 mask only filters 95% of the particles that are ten times the size (diameter) of a virus. The medical ones are designed to stop blood (a liquid) so as to protect from AIDS. A virus can fit through the filter — that’s why you go to outside air for people working in containment labs.

      Third, most infections are vectored by the person’s own hands. You touch something and then touch your mouth/nose/eyes, or touch food that you eat, and that’s how the virus gets inside you. This is why hand washing is so important — and we’ve known this for a long time, all the way back to learning that childbirth fever was being spread by doctors not washing their hands between deliveries.

      Now the average reporter is both stupid & lazy — and hence isn’t going to comprehend any of the above — but I believe that the advice was based on the above. My take was that it wasn’t needed, and the government was (responsibly) attempting to prevent hysterical paranoia.

      We still neither know what percentage of the population has the Wuhan Flu, nor what percentage has already recovered from it. (We also aren’t *sure* that the latter group have immunity from it.)

      1. I don’t disagree with anything you say. Except…..

        My take was that it wasn’t needed, and the government was (responsibly) attempting to prevent hysterical paranoia.

        My take was that seeding stupid and lazy journalists with obvious nonsense, to try to prevent a mad scramble for masks was foolish. They blew their credibility with poor quality propaganda. If you’re determined to blow your credibility, you may as well produce good quality propaganda, and get the benefit of fooling people at least once.

        1. I’m not sure it was propaganda — they weren’t wearing masks.

    2. Simply put: Experts and officials have engaged in a deliberate campaign of lies as a scarcity management strategy, and dullard journalists have been happy to play along.

  3. Seems about right.

    Regardless of what anyone does, we’ll be told it was the wrong thing, or it was too late (even though the complainers didn’t have a plan to do it sooner) or too early, or done with the wrong mechanism, or the messaging was wrong, or any other random complaint you can think of.

    As if anyone could always get everything perfect during normal times when people are hyping dangers that never happen and also during extreme outlier events where the danger actually turns out to be real — though still not as dire as the hype.

    If people spent 1/10th the time and effort helping each other out as they do complaining and making trouble life would be a lot better in the US. And if we didn’t have to deal with the 95% of made up, hyped up problems, we’d have a lot more resources left over for the 5% of problems that turn out to be real. We set up lots of boobytraps to defend against the bogeyman and now that we need to take action against a real threat they’re in our way.

    1. This is so true, especially now = If people spent 1/10th the time and effort helping each other out as they do complaining and making trouble life would be a lot better in the US

      To me, fuck the politics. Every American is in this one together, like it or not.

  4. My wife is a retired public health nurse of 25 years. Some diseases like tuberculosis are mainly airborne. Others, like the flu, are transmitted mainly through physical contact.
    Imagine a sick person rubbing his nose, then opening the door. You come along later, open the door yourself and get infected snot on your hand. If you touch your mouth, eye, or nose as Harvard Medical say you probably do every six minutes then you will directly introduce the virus into your body.This is by far a more effective way to transmit this disease than any other.
    If you use a mask then you are prevented from touching your nose or mouth. If you wear glasses, then you will not touch your eyes. The touching is habit, something about being a human. You can also try to keep your hands in your pockets or wipe everything down before touching it, or use hand sanitizer every few minutes.
    The mask is simpler.

    1. And the Wuhan Virus can live for up to 3 days (72 hours) on plastic surfaces.

      So someone could have sneezed on that ATM pad two days ago…

    2. If you wear glasses, then you will not touch your eyes.

      Not sure that’s entirely true. You get used to glasses, so you can rub the corner of your eye without noticing. The mask you’re not used to, and is in any case a better blocker of nose and mouth than glasses are of eyes.

      But I agree with your general point.

      Mrs Moore has taken to wearing goggles, which really do stop you touching your eyes.

  5. Your experiment assumes we do enough testing that we actually know something about infection rate. Testing only people with severe symptoms is not effective at establishing that.

    1. Agreed. We would need widespread testing for a randomized experiment to work. The trajectory on testing is good but we’re not nearly close enough.

    1. Don’t let these guys watch “Escape from New York”, otherwise there will be landmines on every bridge and tunnel in and out of New York City.

      1. I’m waiting for when some drug dealer doesn’t stop at the (illegal) checkpoint, gets chased and has a shootout with the cops, killing one.
        Then the question will be probable cause to stop him in the first place — and I could see a good attorney getting him off.

        1. The other thing this is going to do is bring to a head the issue of the rights of non-resident property owners. This is a full gutting of the “full faith & credit” clause, and that’s on top of the fact that in a lot of these summer communities the majority of the property owners, who own the most expensive properties, are unable to vote in local elections.

          This is more of a political than legal issue, and I don’t know how it will play out, but I have no doubt there will bring this long-simmering issue to a head.

  6. I have three of these masks in my toolbox leftover from when I was a millwright. I’m saving them for just in case my missus or I get sick.

    I had 4+ boxes of them when I was retired out on disability, but I gave them to the rest of the crew as I left with my tools.

  7. “the federal government could promise to buy billions of surgical masks in the event manufacturers are unable to find buyers”

    Is there a scenario where private manufacturers make lots of masks but find no buyers in the general public?

    What’s the deal with mask shortage anyway? Are there health specification which masks have to meet, and only a few manufacturers who can comply?

    I’m sure there are obvious answers, and the Internet is the place I go for obvious answers.

    1. Masks do expire — as I understand it, the biggest problem is that the elastic band breaks down, although I don’t understand why you can’t staple a new elastic to them. I also understand that litigation and fears of product liability litigation (yes, lawyers) led a lot of the smaller manufacturers to stop making them.

      There’s also the special fabric that they are made out of, half of that is made in China and China wants to keep the masks it produces for its own use.

      But the big thing, I believe, is return on investment. If you make the capital investment in new mask producing equipment, you want a return on that investment and that means a guaranteed price per mask when this is all over because otherwise you are stuck paying off expensive equipment and unable to recover your costs (because the price of masks has dropped).

      Hence it becomes like government cheese — the government promises to buy masks at a set price to guarantee companies the ability to sell them at the price they are planning their equipment purchases on.

      1. There was supposed to be a government stockpile of masks and other personal protection equipment, but a good part of it got used up during the H1N1 pandemic of 2009, and somehow never got replaced.

        1. That was intended for terrorist attack, possibly one using a nuke or CBW, it was never intended to be a national supply for all the hospitals in all 51 states (i.e. including DC). And the other thing is that while stockpile stuff comes for free, hospitals have to pay for it if they buy it themselves — and a lot of vendors want cash.

          I believe that ventilator machines go for about $5000 each — that’s real money when you are talking a lot of them, and even the price of the masks isn’t insignificant in the numbers that the states want.

          Hence at least part of this likely is a fight over who pays for it, the hospitals, the states, or the Feds. And this is in the backdrop of the shell game that is Medicaid, and cost shifting, and the hospitals hurting because the elective surgeries (where they shift the costs to) have been canceled.

          Yes, a good portion of what we had got used up and wasn’t replaced — but it never was intended to supply *every* hospital in a situation like this. And instead of building new fancy lobbies in their buildings, you gotta wonder why some of the people running hospitals didn’t think of buying some of this stuff themselves. Just in case they might need it…

          1. To be fair, these lobbies can double as emergency rooms now.

          2. “I believe that ventilator machines go for about $5000 each”

            I’ve read it’s more like $25,000 each.

      2. Hence it becomes like government cheese — the government promises to buy masks at a set price to guarantee companies the ability to sell them at the price they are planning their equipment purchases on.

        Hey, that’s what Glorious War Powers are for!

        And price supports for this until long after your grandkids are dead.

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